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This work aims to provide a comprehensive overview of the use of front‐of‐package nutritional labeling (FOPL), identify and characterize the major existing FOPL systems, examine the impact of FOPL systems on consumer behavior, and discuss future perspectives. The searched databases were PubMed, Scopus, and Web of Science, and papers in English, Portuguese, Spanish, and French were considered. The integrative review method was used, comprising 68 papers. The FOPL system from more than 47 countries from North America, South America, Africa, Europe, Australia, and Asia was included in this study. The two main ways to characterize FOPL are the level of interpretation and the type of information provided. Interpretive schemes (such as warning labels, multiple traffic lights, and Nutri‐Score) appear to lead to better consumer understanding and support healthier food purchases. However, due to the differences among the results and the specificity of the contexts in which they are used, it is impossible to define one FOPL interpretation scheme superior to the others. Some potential factors that influence the effectiveness of FOPL on consumer attitudes have been identified, such as food taste, as a major intrinsic factor. Extrinsic factors, such as price, food category, cultural diversity, politics, and economics, were also relevant. The lack of availability of similar alternatives, lack of understanding of the importance of FOPL, and lower levels of income and education were also some cognitive and social aspects impairing FOPL effectiveness. Prospects for the United States, Europe, Brazil, Colombia, and Argentina were discussed. [ABSTRACT FROM AUTHOR]

The aim of the investigation was to review experimental articles and patents referring to corn-based nutritional products for sportspeople published in the period 1970-2019. Publications were searched in the ISI Web of Science and Scopus databases, as well as the Google Scholar and Google Patents internet search engines. Factorial combinations of the keywords ("Zea mays" or "maize" or "corn") and ("athlete" or "sport") were applied. Most papers and patents were published in the period 2010-2019 by researchers affiliated to the USA and China - the two largest global producers of corn. Altogether, 65 patents and 16 articles were recorded. Inventors patented food supplements based on corn-derived saccharides and proteins. Empirical articles were devoted to the impact of corn-based food products on health of sportspeople, evaluation of the impact of length of consumption on the metabolism and performance of athletes, as well the frequency of use and acceptance of nutritional products based on corn by sportspeople. [ABSTRACT FROM AUTHOR]

Keywords: Ragweed; Health; Aerobiology EN Ragweed Health Aerobiology 45 48 4 04/08/20 20200301 NES 200301 This paper is a synthesis dedicated to the "ragweed story", starting from the plant to the patient's health, with a focus on the particular situation determined by the I Ophraella communa i LeSage ( I 0. communa i ) spreading. 2012; 27: 27-32 4 Bonini M, Sikoparija B, Prentovi'c M, Cislaghi G, Colombo P, Testoni C, Grewling L, Lommen STE, Müller-Schärer H, Smith M. Is the recent decrease in airborne Ambrosia pollen in the Milan area due to the accidental introduction of the ragweed leaf beetle Ophraella communa? 10.1007/s10453-015-9380-8 5 Bonini M, Sikoparija B, Prentovi'c M, Cislaghi G, Colombo P, Testoni C, Grewling L, Lommen STE, Müller-Schärer H, Smith M. A follow-up study examining airborne Ambrosia pollen in the Milan area in 2014 in relation to the accidental introduction of the ragweed leaf beetle Ophraella communa. 10.1007/s10530-010-9880-y 14 Grewling L, Jenerowicz D, Bogawski P, Smith M, Nowak M, Fratczak A, Czarnecka-Operacz M. Cross-sensitization to Artemisia and Ambrosia pollen allergens in an area located outside of the current distribution range of Ambrosia. [Extracted from the article]

Previous research has agreed that meaning-making is a key element in the promotion of patients' well-being during and after a traumatic event such as cancer. In this paper, we focus on an underestimated key element related to the crisis/rupture of this meaning-making process with respect to the time perspective. We consider 40 narratives of breast cancer patients at different times of treatment, undergoing chemotherapy and biological therapy. We collected data through writing technique. We performed an interpretative thematic analysis of the data and highlighted specific ways to signify time during the different treatment phases. Our central aspect "the time of illness, the illness of time" demonstrates that the time consumed by illness has the risk of becoming an illness of time, which transcends the end of the illness and absorbs a patient's past, present, and future, thus saturating all space for thought and meaning. The study suggests that narrative can become a therapeutic and preventive tool for women with breast cancer in a crisis of temporality, and enable the promotion of new semiotic connections and a specific functional resynchronization with the continuity/discontinuity of life. This is useful during the illness and medical treatment and also after the treatment. [ABSTRACT FROM AUTHOR]

Objectives: Analytical difficulties and lack of a biological exposure index and reference values have prevented using unmetabolized urinary benzene (UB) excretion as a biomarker of low-level environmental exposure. To explore what environmental factors beyond active smoking may contribute to environmental exposure to benzene, we monitored UB excretion in a non-smoking, non-occupationally exposed sample of the general population. Methods: Two spot urine samples were obtained from 86 non-smoking, non-occupationally exposed subjects, selected among a random sample of the general population of the metropolitan area of Cagliari (Sardinia, Italy), at 8:00 a.m. (UBm) and 8:00 p.m. (UBe). UB was measured by headspace solid-phase microextraction (HS-SPME) followed by gas chromatography-mass spectrometry analysis. Questionnaire information on personal and environmental exposures during the sampling day was gathered with personal interviews. Multivariate analysis of variance and multiple regression model were applied to investigate the role of such variables on the level of UB. Results: The ninety-fifth percentile of UBe in this population was 311.5 ng/L, which is tentatively proposed as the UB guidance value for unexposed populations. UBm and urban residence were the only predictors of a significant increase in UBe excretion. Self-reported residential vehicular traffic will not account for the excess median value among urban residents; commuting time among urban residents showed a suggestive nonsignificant linear correlation with UBe, but the small sample size prevented reliable inference to be drawn. Age, environmental tobacco smoking, employment status and body mass index did not affect UB excretion. Conclusions: Our findings support the use of unmetabolized UB as a specific and sensitive biomarker of low-level environmental exposure to benzene. [ABSTRACT FROM AUTHOR]

BACKGROUND: Asthma is a serious problem for low-income preteens living in disadvantaged communities. Among the chronic diseases of childhood and adolescence, asthma has the highest prevalence and related health care use. School-based asthma interventions have proven successful for older and younger students, but results have not been demonstrated for those in middle school. METHODS: This randomized controlled study screened students 10–13 years of age in 19 middle schools in low-income communities in Detroit, Michigan. Of the 6872 students who were screened, 1292 students were identified with asthma. Schools were matched and randomly assigned to Program 1 or 2 or control. Baseline, 12, and 24 months data were collected by telephone (parents), at school (students) and from school system records. Measures were the students' asthma symptoms, quality of life, academic performance, self-regulation, and asthma management practices. Data were analyzed using multiple imputation with sequential regression analysis. Mixed models and Poisson regressions were used to develop final models. RESULTS: Neither program produced significant change in asthma symptoms or quality of life. One produced improved school grades (p = .02). The other enhanced self-regulation (p = .01) at 24 months. Both slowed the decline in self-regulation in undiagnosed preteens at 12 months and increased self-regulation at 24 months (p = .04; p = .003). CONCLUSION: Programs had effects on academic performance and self-regulation capacities of students. More developmentally focused interventions may be needed for students at this transitional stage. Disruptive factors in the schools may have reduced both program impact and the potential for outcome assessment. [ABSTRACT FROM AUTHOR]

Urban minority children have higher rates of asthma morbidity due to multiple factors. Many school-based programs have been funded to improve asthma management, especially for these “high-risk” inner-city children with asthma. Here we report the outcomes of the Children’s Hospital of Orange County Breathmobile program, which is a school-based asthma program that combines the use of a mobile clinic and a pediatric asthma specialist. Baseline evaluations included a detailed history and physical, skin prick test to common allergens, spirometry measurements, and asthma severity classification based on the current National Asthma Education and Prevention Program guidelines. From April 2002 to September 2005, a total of 1321 children were evaluated for asthma. Analysis of the 1112 (84%) children diagnosed with asthma showed a population mean age of 7.8 years, 81% Latino ethnicity, and 73% with persistent disease. At baseline, only 24% of children with persistent asthma were on daily anti-inflammatory medications, which increased to 78% by the first follow-up visit. In the year prior to entry into the program, 64% had school absenteeism related to asthma (38% >10 days), 45% had emergency room (ER) visits (28% >1), and 19% had hospitalizations (9% >1). There was a significant reduction (p < .001) in the annual rates of ER visits, hospitalizations, and school absenteeism when comparing pre- and postentry into the program. These data suggest that a mobile asthma van clinic at the school site with an asthma specialist could be an effective model in reducing morbidity in the underserved child with asthma. Further studies are necessary to determine whether this model is applicable to other inner-city settings. (J Sch Health. 2006;76(6):313-319) [ABSTRACT FROM AUTHOR]

The number of definite and probable human chemical carcinogens identified by IARC approaches between 1987 and June 2004 is reported to be 50 agents. However, overall, given the rapid expansion in the number of chemicals in use, the throughput of the current approach to identifying potential environmental carcinogens is low. The long-term rodent bioassay, a key part of the current approach, identifies many chemicals which eventually turn out to be irrelevant for human health with regard to cancer. A new approach is suggested which focuses on identifying the potency of environmental mixtures for induction of toxicological changes relevant to carcinogenesis (e.g., cell proliferation, chronic inflammation, inhibition of apoptosis, mutagenicity). Details regarding a suggested strategy for prioritization of mixtures are provided with more detailed information regarding mutagenicity as an end point. The long-term rodent bioassay is not included in the proposal (although it is acknowledged that it will continue to be important in premarketing regulatory schemes) for hazard identification. The Multiple Chemicals and Actions Model (MCAM) is developed. In this model the chemical mixtures in the environment act via a number of mechanisms as 'effectors' or 'inhibitors' of a multistage carcinogenic process. Identifying effectors and inhibitors of the rate-limiting step would be important for preventive strategies. Genetic polymorphisms act as modulators of effector and inhibitor mixtures. It is suggested that the MCAM model could be used in public education programmes to help inform on public health issues regarding cancer and to help avoid future scares which tend to focus on single chemicals. It is acknowledged that there would need to be basic research undertaken to generate appropriate data to support the application of the proposal before it could be used in cancer prevention strategies. [ABSTRACT FROM AUTHOR]

Background: Environmental pollution such as exposure to pro-carcinogens including benzo-α-pyrene is becoming a major problem globally. Moreover, the effects of benzo-α-pyrene (BaP) on drug pharmacokinetics, pharmacodynamics, and drug resistance warrant further investigation, especially in cancer outpatient chemotherapy where exposure to environmental pollutants might occur. Method: We report here on the effects of benzo-α-pyrene on esophageal cancer cells in vitro, alone, or in combination with chemotherapeutic drugs cisplatin, 5-flurouracil, or paclitaxel. As the study endpoints, we employed expression of proteins involved in cell proliferation, drug metabolism, apoptosis, cell cycle analysis, colony formation, migration, and signaling cascades in the WHCO1 esophageal cancer cell line after 24 h of treatment. Results: Benzo-α-pyrene had no significant effect on WHCO1 cancer cell proliferation but reversed the effect of chemotherapeutic drugs by reducing drug-induced cell death and apoptosis by 30–40% compared to drug-treated cells. The three drugs significantly reduced WHCO1 cell migration by 40–50% compared to control and BaP-treated cells. Combined exposure to drugs was associated with significantly increased apoptosis and reduced colony formation. Evaluation of survival signaling cascades showed that although the MEK-ERK and Akt pathways were activated in the presence of drugs, BaP was a stronger activator of the MEK-ERK and Akt pathways than the drugs. Conclusion: The present study suggest that BaP can reverse the effects of drugs on cancer cells via the activation of survival signaling pathways and upregulation of anti-apoptotic proteins such as Bcl-2 and Bcl-xL. Our data show that BaP contribute to the development of chemoresistant cancer cells. [ABSTRACT FROM AUTHOR]

The genus Phlebovirus (order Bunyavirales, family Phenuiviridae) consists of 66 species according to the International Committee on Taxonomy of Viruses (1). Phleboviruses are globally distributed and can be transmitted by [...]

: Introduction: Simplified hepatitis C virus (HCV) diagnostic strategies have the potential to improve HCV diagnoses and treatment. We aimed to investigate the impact of simplified HCV diagnostic strategies on HCV incidence and its effect on HCV diagnosis and treatment among men who have sex with men (MSM) regardless of HIV status and use of HIV pre‐exposure prophylaxis (PrEP) in Taiwan. Methods: A compartmental deterministic model was developed to describe the natural history of HCV disease progression, the HCV care cascade and the HIV status and PrEP using among MSM. The model was calibrated to available data for HCV and HIV epidemiology and population demographics in Taiwan. We simulated the epidemic from 2004 and projected the impact of simplified testing strategies on the HCV epidemic among MSM over 2022–2030. Results: Under the current testing approach in Taiwan, total HCV incidence would increase to 12.6 per 1000 person‐years among MSM by 2030. Single‐visit point‐of‐care RNA testing had the largest impact on reducing the number of new HCV infections over 2022–2030, with a 31.1% reduction (interquartile range: 24.9%−32.8%). By 2030, single‐visit point‐of‐care HCV testing improved HCV diagnosis to 90.9%, HCV treatment to 87.7% and HCV cure to 81.5% among MSM living with HCV. Compared to status quo, prioritized simplified HCV testing for PrEP users and MSM living with diagnosed HIV had considerable impact on the broader HCV epidemic among MSM. A sensitivity analysis suggests that reinfection risk would have a large impact on the effectiveness of each point‐of‐care testing scenario. Conclusions: Simplified HCV diagnostic strategies could control the ongoing HCV epidemic and improve HCV testing and treatment among Taiwanese MSM. Single‐visit point‐of‐care RNA testing would result in large reductions in HCV incidence and prevalence among MSM. Efficient risk‐reduction strategies will need to be implemented alongside point‐of‐care testing to achieve HCV elimination among MSM in Taiwan., INTRODUCTION Among men who have sex with men (MSM), hepatitis C virus (HCV) is transmitted via sexual contact and sharing of unsterile injecting equipment and disproportionately affects MSM living with [...]

Byline: Aditya. Sharma, Aditi. Sharma, Ayman. Soubani OBJECTIVE: The aim of this study was to estimate the predictors, associations, and outcomes of COVID-19-associated pulmonary disease (CAPA) in the United States. [...]

: Introduction: Eastern Europe is facing major HIV and hepatitis C (HCV) epidemics, with many people living with HIV (PLHIV) and HIV/HCV coinfection living in Ukraine. Despite the previous progress towards care quality improvement, the ongoing war in Ukraine is disrupting HIV and HCV care. Methods: We described an HIV cascade of care (CoC) in PLHIV from two clinical sites and an HCV CoC for anti‐HCV‐positive PLHIV from six sites in Ukraine, enrolled in the CARE cohort between 1 January 2019 and 1 June 2020. The cross‐sectional HIV CoC and HCV CoC are described at study enrolment. Results: Of 1028 PLHIV, 1014 (98.6%, 95% confidence interval [CI] 97.7–99.3) were on antiretroviral therapy (ART), and 876 (86.4% of those on ART, 95% CI 84.1–88.4) were virologically suppressed. Of 894 participants on ART >6 months, 90.8% (95% CI 88.7–92.6) were virologically suppressed (HIV‐RNA Conclusions: Over 98% of PLHIV in care in both CARE sites in Ukraine were receiving ART, and the target of 90% virally suppressed was achieved in persons >6 months on ART. Only one of six HIV/HCV study sites tested over 50% anti‐HCV‐positive PLHIV for HCV‐RNA and treated over 25% of eligible persons. While free HCV‐RNA testing and DAA treatment are paramount to achieving HCV elimination targets, they remained a challenge in Ukraine in 2019–2020. The extent of the HIV and HCV care disruption during the war will be further assessed in the CARE cohort and compared with the pre‐war findings., INTRODUCTION Ukraine, a country with the second‐largest HIV epidemic in Eastern Europe, was home to an estimated 260,000 people living with HIV (PLHIV) in 2021 [1], of whom, 150,005 were [...]

Cases of pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were first described in Wuhan, China, at the end of December 2019 (1). The infection rapidly spread, causing [...]

Infection is an uncommon but potentially devastating complication of cardiac implantable electronic device (CIED) implantation (1). Staphylococcal species cause most of these infections, followed by other pyogenic bacteria (1). CIED [...]

Background The management of steroid-sensitive nephrotic syndrome (SSNS) requires treatment with high-dose glucocorticoids (GCs), but GC usage causes the most frequent form of drug-induced osteoporosis. The aim of our study was to evaluate the impact of GCs on bone mineralization in patients with SSNS using two diagnostic tools, dual-energy X-ray densitometry (DXA) and quantitative ultrasound (QUS), and to compare the diagnostic efficacy of these two imaging tools. Methods A total of 30 children with SSNS (age 5.20 ± 2.20 years) were evaluated at the start (T0) and after 1 (T1), 2.44 ± 0.75 (T2, 18 patients) and 5.96 ± 2.33 years (T4, 12 patients) of GC treatment. Patients who stopped at T2 were also evaluated at the 1-year timepoint after ceasing GC treatment (T3). Results Of the patients assessed at T2, 11 had bone mineralization at the lower limit of normal versus those at T0 and T1, with bone mineralization rescue at the 1-year timepoint after GC discontinuation. At T4, 6/12 patients had densitometric parameters at the lower limit of normal values, and 3/12 patients showed reduced bone mineralization. The parameters derived from measurements of DXA and QUS were significantly related to each timepoint. Conclusions Patients with SSNS receiving GC therapy undergo bone status alteration related to the dosage and duration of the therapy. In terms of diagnostic efficacy, DXA and QUS were comparable, indicating that QUS is a reliable tool to evaluate bone health in children with SSNS. Keywords Steroid-sensitive nephrotic syndrome * Bone status * Quantitative ultrasonometry * Dual energy X-ray absorptiometry * Glucocorticoids, Introduction Childhood steroid-sensitive nephrotic syndrome (SSNS) is a kidney disease which promptly responds to high-dose glucocorticoid (GC) therapy, with the patient going into complete remission within 30 days. Unfortunately, the [...]

CONTEXT: Delaying sexual debut is an important HIV prevention strategy, yet few studies have examined associations between both community- and individual-level characteristics and sexual debut among youth in Sub-Saharan Africa. METHODS: Cross-sectional survey data collected from 8,183 youth aged 11-17 in 160 schools in Nyanza, Kenya, were used to examine the relationships between individual and community measures and the timing of sexual debut. Multilevel discrete-time hazard models were used to identify bivariate and multivariate associations. RESULTS: At the individual level, youth were more likely to have initiated sex (or had done so at an earlier age) if they had felt pressure to engage in sex from a greater number of sources (odds ratios, 1.3-1.8); perceived that they had a small or (among females) moderate chance, rather than no chance, of contracting HIV (1.2-1.3); or endorsed a greater number of HIV transmission myths (1.1 for both sexes). In addition, males with higher abstinence self-efficacy had a reduced risk of sexual debut (0.95). At the community level, males and females had a reduced risk of sexual debut if they lived in a community where AIDS deaths were publicly acknowledged (0.6-0.8) or the Primary School Action for Better Health program had been implemented (0.8-0.95); risk was also reduced among young men who lived in communities where HIV was discussed at a greater number of parent-teacher association meetings (0.9) or where abstinence was the primary AIDS prevention message conveyed to youth (0.9). CONCLUSION: Community-level variables are frequently associated with sexual debut and should be included in future research. Contexto: Retrasar el debut sexual es una estrategia importante de prevention del VIH; sin embargo, son pocos los estudios que han examinado las asociaciones entre las caracteristicas tanto a nivel de la comunidad como a nivel individual y el debut sexual de jovenes en Africa subsahariana. Metodos: Mediante una encuesta transversal, se recolectaron datos de 8,183 jovenes en edades de 11 a 17 anos de 160 escuelas en Nyanza, Kenia. Estos datos se utilizaron para examinar las relaciones entre algunas medidas individuales y comunitarias con el momento del debut sexual. Se utilizaron modelos multinivel de analisis de riesgo en tiempo discreto para identificar las asociaciones bivariadas y multivariadas. Resultados: A nivel individual, los jovenes tuvieron mas probabilidad de haber iniciado su actividad sexual (o lo haMan hecho a una edad mas temprana) si haMan sentido presion para tener relaciones sexuales a partir de un mayor numero de fuentes (cocientes de probabilidad, 1.3-1,8); si haMan percibido que tenxan un riesgo pequeno o moderado (entre las mujeres) de contraer el VIH en lugar de ningun riesgo (1.2-13); o si estaban de acuerdo con un mayor numero de mitos sobre la transmision del VIH (1.1 para ambos sexos). Ademas, los hombres con un nivel mas alto de autoeficacia en la abstinencia tuvieron un riesgo reducido de debut sexual (0.95). A nivel de la comunidad, tanto hombres como mujeres tuvieron un riesgo reducido de debut sexual si vman en una comunidad en donde las muertes por SIDA eran reconocidas publicamente (0.6-0.8) o si el programa 'Action en la escuela primaria para una mejor salud' [Primary School Action for Better Health] haba sido implementado (0.8-0.95); el riesgo tambien se redujo en el caso de los hombres jovenes que vman en comunidades en donde el VIH era tema de conversacion en un mayor numero de reuniones de la asociacion de padres y maestros (0.9), o donde la abstinencia era el primer mensaje de prevention del SIDA transmitido a los jovenes (0.9). Conclusion: Las variables a nivel de la comunidad se asocian frecuentemente con el debut sexual y debenan incluirse en investigaciones futuras. Contexte: Differer les premiers rapports sexuels constitue une importante strategie de prevention du VIH. Peu d'etudes ont cependant examine les associations entre les caracteristiques de niveau communautaire et individuel et le debut de l'activite sexuelle parmi les jeunes d'Afrique subsaharienne. Methodes: Les donnees d'enquetes transversales collectees aupr'es de 8.183 jeunes ages de 11 a 17 ans dans 160 ecoles de Nyanza (Kenya) ont servi a l'examen des liens entre les mesures individuelles et communautaires et le moment des premiers rapports sexuels. Des modeles de risque a temps discret multiniveaux ont permis d'identifier les associations bi- et multivariees. Resultats: Au niveau individuel, les jeunes etaient plus susceptibles d'avoir deja eu des rapports sexuels (dans cette tranche ou avant) s'ils en avaient ressenti la pression d'un plus grand nombre de sources (RC, 1,3-1,8), s'ils percevaient courir un risque faible ou (cote feminin) moyen, plutot que nul, de contracter le VIH (1,2-1,3), ou s'ils souscrivaient a un plus grand nombre de mythes concernant la transmission du VIH (1,1 pour les deux sexes). De plus, les garqons ayant une auto-efficacite d'abstinence superieure presentaient un moindre risque d'avoir deja eu des rapports sexuels (0,95). Au niveau communautaire, les garqons et les filles presentaient un moindre risque de premiers rapports consommes s'ils vivaient dans une communaute ou les deces imputables au sida etaient reconnus publiquement (0,6-0,8) ou dans laquelle le programme Primary School Action for Better Health avait ete mis en xuvre dans les ecoles (0,8-0,95). Le risque etait egalement moindre parmi les jeunes hommes vivant dans les communautes ou le VIH etait discute a un plus grand nombre de reunions de l'association parents-enseignants (0,9) ou dans lesquelles l'abstinence etait le principal message de prevention du sida communique aux jeunes (0,9). Conclusion: Les variables de niveau communautaire sont souvent associees au debut de l'activite sexuelle et doivent etre incluses dans la recherche a venir. International Perspectives on Sexual and Reproductive Health, 2014,40(2):68-78, doi:10.1363/4006814, Although the global prevalence of HIV and AIDS has declined substantially, Sub-Saharan Africa continues to have the largest share of the global HIV burden. (1) In Kenya, the prevalence of [...]

Background Hyponatremia is the most common electrolyte abnormality in clinical practice, but little is known about the association between febrile urinary tract infection (UTI) and hyponatremia or its significance to clinical outcomes. Methods Data from 140 children with febrile UTI between 2000 and 2010 were retrospectively analyzed. Laboratory examinations [white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and serum sodium concentration], renal ultrasonography, [sup.99m]Technetium-dimercaptosuccinic acid (DMSA) scintigraphy, and voiding cystourethrogram were performed. Culture growing >50,000 colonies of one single bacterial species on a urine sample obtained by catheter or >100,000 colonies on two clean-catch samples was required to establish diagnosis of UTI. Results In children with renal cortical defects diagnosed after DMSA scintigraphy (group 1), duration of fever was significantly longer (P=0.038) and WBC (P=0.047) and CRP (P Conclusions Our study indicates that hyponatremia may be a substantial inflammatory marker and is significantly and independently associated with the degree of inflammation in children with febrile UTI. Keywords Urinary tract infection * Hyponatremia * Inflammation * [sup.99m]Tc-dimercaptosuccinic acid scintigraphy, Introduction Acute urinary tract infection (UTI) is a common bacterial infection that can cause an inflammatory response and may lead to serious morbidity and mortality in children [1]. Clinical symptoms [...]

Glucocorticoid-induced hypertension is a common clinical problem that is poorly understood, thus rendering treatment strategies sub-optimal. This form of hypertension has been commonly thought to be mediated by excess sodium and water reabsorption by the renal mineralocorticoid receptor. However, experimental and clinical data in both humans and animal models suggest important roles for the glucocorticoid receptor as well, in both the pathogenesis and maintenance of this hypertension. The glucocorticoid receptor is widely expressed in a number of organ systems relevant to blood pressure regulation, including the kidney, the brain and the vasculature. In vitro studies in isolated kidney tissues as well as in vascular smooth muscle and vascular endothelial cells have attempted to elucidate the molecular physiology of glucocorticoid-induced hypertension, but have generally been limited by the inability to study signaling pathways in an intact organism. More recently, the power of mouse genetics has been employed to examine the tissue-specific contributions of vascular and extra-vascular tissues to this form of hypertension. Here we review recent developments in our understanding of the pathogenesis of glucocorticoid-induced hypertension. Keywords Hypertension * Glucocorticoid receptor * Mouse model * Vascular smooth muscle * Endothelium * Nitric oxide, Introduction Excess glucocorticoid, whether endogenous, as in Cushing's syndrome, or exogenous, via pharmacological administration of glucocorticoids, induces hypertension. Approximately 80% of patients with Cushing's syndrome have hypertension, while 20% of [...]

Hyponatremia is the most common electrolyte abnormality encountered in children. In the past decade, new advances have been made in understanding the pathogenesis of hyponatremic encephalopathy and in its prevention and treatment. Recent data have determined that hyponatremia is a more serious condition than previously believed. It is a major comorbidity factor for a variety of illnesses, and subtle neurological findings are common. It has now become apparent that the majority of hospital-acquired hyponatremia in children is iatrogenic and due in large part to the administration of hypotonic fluids to patients with elevated arginine vasopressin levels. Recent prospective studies have demonstrated that administration of 0.9% sodium chloride in maintenance fluids can prevent the development of hyponatremia. Risk factors, such as hypoxia and central nervous system (CNS) involvement, have been identified for the development of hyponatremic encephalopathy, which can lead to neurologic injury at mildly hyponatremic values. It has also become apparent that both children and adult patients are dying from symptomatic hyponatremia due to inadequate therapy. We have proposed the use of intermittent intravenous bolus therapy with 3% sodium chloride, 2 cc/kg with a maximum of 100 cc, to rapidly reverse CNS symptoms and at the same time avoid the possibility of overcorrection of hyponatremia. In this review, we discuss how to recognize patients at risk for inadvertent overcorrection of hyponatremia and what measures should taken to prevent this, including the judicious use of 1-desamino-8d-arginine vasopressin (dDAVP). Keywords Hyponatremia * Encephalopathy * Cerebral edema * Pulmonary edema * Fluid therapy * Saline * Sodium chloride * Myelinolysis * Arginine vasopressin, Introduction Hyponatremia is one of the most common electrolyte abnormalities encountered in children, with mild hyponatremia, serum sodium (SNa) Why does hyponatremia develop? Under normal circumstances, the human body can [...]

BACKGROUND: In urban communities with high prevalence of childhood asthma, school-based educational programs may be the most appropriate approach to deliver interventions to improve asthma morbidity and asthma-related outcomes. The purpose of this study was to evaluate the implementation of Kickin' Asthma, a school-based asthma curriculum designed by health educators and local students, which teaches asthma physiology and asthma self-management techniques to middle and high school students in Oakland, CA. METHODS: Eligible students were identified through an in-class asthma case identification survey. Approximately 10-15 students identified as asthmatic were recruited for each series of the Kickin' Asthma intervention. The curriculum was delivered by an asthma nurse in a series of four 50-minute sessions. Students completed a baseline and a 3-month follow-up survey that compared symptom frequency, health care utilization, activity limitations, and medication use. RESULTS: Of the 8488 students surveyed during the first 3 years of the intervention (2003-2006), 15.4% (n = 1309) were identified as asthmatic; approximately 76% of eligible students (n = 990) from 15 middle schools and 3 high schools participated in the program. Comparison of baseline to follow-up data indicated that students experienced significantly fewer days with activity limitations and significantly fewer nights of sleep disturbance after participation in the intervention. For health care utilization, students reported significantly less frequent emergency department visits or hospitalizations between the baseline and follow-up surveys. CONCLUSIONS: A school-based asthma curriculum designed specifically for urban students has been shown to reduce symptoms, activity limitations, and health care utilization for intervention participants. Keywords: child and adolescent health; chronic diseases; evaluation., Asthma is the most common chronic disease of childhood. 1,2 In the United States, approximately 12% of children younger than 18 years have been diagnosed with asthma. (3) Asthma is [...]

BACKGROUND: Children with asthma experience more absenteeism from school compared with their nonasthma peers. Excessive absenteeism is related to lower student grades, psychological, social, and educational adjustment. Less is known about the relationship between the presence of asthma and the academic achievement in school-aged children. Since students with asthma miss more days from school, this may negatively impact their academic achievement. The goal of this study was to investigate the relationships between absenteeism, presence of asthma, and asthma severity level with standardized test level performance in a predominantly African American urban school district. METHODS: A cross-sectional analysis was conducted of 3812 students (aged 8-17 years) who took the Missouri Assessment Program (MAP) standardized test during the 2002-2003 academic year. RESULTS: After adjustment for covariates, a significant inverse relationship was found between absenteeism and test level performance on the MAP standardized test in all children (F = 203.9, p < .001). There was no overall difference in test level achievement between those with and without asthma (p = .12). Though not statistically different, those with persistent asthma showed a modestly increased likelihood of scoring below Nearing Proficient compared with those with mild intermittent asthma (adjusted odds ratio = 1.93, 95% confidence intervals = 0.93-4.01, p = .08). CONCLUSIONS: A negative impact of absenteeism on standardized test level achievement was demonstrated in children from an urban African American school district. Children with asthma perform the same academically as their nonasthma peers. However, those with persistent asthma show a trend of performing worse on MAP standardized test scores and have more absence days compared with other students. More research is warranted on the effects of persistent asthma on academic achievement. Keywords: asthma; severity; academic; test level performance; school., Increased absenteeism, minority status, gender, and low socioeconomic status (SES) are all measures associated with poor academic performance among the school-going child. (1-10) Studies demonstrate that children with asthma are [...]

BACKGROUND: Few evaluations of school health programs measure academic outcomes. K-12 education needs evidence for academic achievement to implement school programs. This article presents a systematic review of the literature to examine evidence that school health programs aligned with the Coordinated School Health Program (CSHP) model improve academic success. METHODS: A multidisciplinary panel of health researchers searched the literature related to academic achievement and elements of the CSHP model (health services, counseling/social services, nutrition services, health promotion for staff, parent/ family/community involvement, healthy school environment, physical education, and health education) to identify scientifically rigorous studies of interventions. Study designs were classified according to the analytic framework provided in the Guide developed by the Community Preventive Services Task Force. RESULTS: The strongest evidence from scientifically rigorous evaluations exists for a positive effect on some academic outcomes from school health programs for asthmatic children that incorporate health education and parental involvement. Strong evidence also exists for a lack of negative effects of physical education programs on academic outcomes. Limited evidence from scientifically rigorous evaluations support the effect of nutrition services, health services, and mental health programs, but no such evidence is found in the literature to support the effect of staff health promotion programs or school environment interventions on academic outcomes. CONCLUSIONS: Scientifically rigorous evaluation of school health programs is challenging to conduct due to issues related to sample size, recruitment, random assignment to condition, implementation fidelity, costs, and adequate follow-up time. However, school health programs hold promise for improving academic outcomes for children. Keywords: academic achievement; coordinated school health; asthma management; physical education. Citation: Murray NG, Low BJ, Hollis C, Cross AW, Davis SM. Coordinated school health programs and academic achievement: A systematic review of the literature., Over the past decade, public education has been increasingly held accountable through measures of academic achievement such as standardized testing. Pressure to improve test scores has resulted in greater emphasis [...]

School-based asthma interventions delivered by nonschool staff have been successful but are limited in their reach because of the cost and effort of bringing in outside educators and their inability to establish improved communication about asthma between schools, families, and primary care providers (PCPs). To address these problems, Columbia University and the New York City Department of Education and the New York City Department of Health and Mental Hygiene undertook a randomized controlled trial to test the efficacy of a comprehensive school-based asthma program. In this intervention, school nurses were trained to facilitate the establishment of a preventive network of care for children with asthma by coordinating communications and fostering relationships between families, PCPs, and school personnel PCPs also received training regarding asthma management. There was limited support for this model While case detection helped nurses identify additional students with asthma and nurses increased the amount of time spent on asthma-related tasks, PCPs did not change their medical management of asthma. Few improvements in health outcomes were achieved. Relative to controls, 12-months posttest intervention students had a reduction in activity limitations due to asthma (- 35% vs -9%, p < .05) and days with symptoms (26% vs 39%, p = .06). The intervention had no impact on the use of urgent health care services, school attendance, or caregiver's quality of life. There were also no improvements at 24-months postintervention. We faced many challenges related to case detection, training, and implementing preventive care activities, which may have hindered our success. We present these challenges, describe how we coped with them, and discuss the lessons we learned (J Sch Health. 2006;76(6):307-312), INTRODUCTION Given the large number of children with asthma and the significant time they spend at school, it is important that school personnel are trained to facilitate asthma management. Asthma [...]

This article describes the evaluation of a comprehensive school-based asthma management program in an inner-city, largely African-American school system. All 54 elementary schools (combined enrollment 13,247 students)from a single urban school system participated in this study. Schools were randomly divided between immediate and delayed intervention programs. The intervention consisted of 3 separate educational programs (for school faculty/staff students with asthma, and peers without asthma) and medical management for the children with asthma (including an Individual Asthma Action Plan, medications, and peakflow meters). Children with asthma were identified using a case detection program and 736 were enrolled into the intervention study. No significant differences were observed in school absences, grade point average, emergency room visits, or hospitalizations between the immediate and delayed intervention groups. Significant increases in knowledge were observed in the immediate intervention group. This study of a school-based asthma management education and medical intervention program did not show any differences between the intervention and control groups on morbidity outcomes. Our experience leads us to believe that such measures are difficult to impact and are not always reliable. Future researchers should be aware of the problems associated with using such measures. In addition, connecting children with a regular source of health care in this population was difficult. More intensive methods of medical management, such as school-based health centers or supervised asthma therapy, might prove more effective in inner-city schools., INTRODUCTION African-American children have the highest rates of asthma prevalence, morbidity, and mortality (1-12) among racial ethnic groups in the United States. In addition, the highest rates of asthma-related disability [...]

The 'Partners in School Asthma Management' program for inner-city elementary school children comprises (1) case finding; (2) linkage of school nurses, parents, and clinicians; (3) a computer-based tailored educational program; and (4) school environmental assessment and intervention. Case finding identified 1730 children in 60 elementary schools with probable asthma; 835 (96% Hispanic or African American)joined the study. Baseline, posttest, and follow-up measures of asthma knowledge, self-efficacy, and self-management behavior were obtained from the children, and data on symptoms, emergency department visits, and hospitalizations were obtained from their parents. The schools provided data on grades and absences. Each school had a baseline and follow-up environmental assessment. The children in the intervention group showed greater increases in knowledge, self-efficacy, and some aspects of self-management. No differences between groups were found in health status variables, school performance, attendance, or levels of environmental allergens in schools. In 15 schools, an enhanced intervention allowed children and their parents to meet with a project physician, develop an asthma action plan, and receive a 1-month supply of medication; the project physician then followed up with the child's community physician. Children participating in this enhanced intervention had better school performance and fewer absences than the comparison group. Overall, the program was effective in improving children's asthma self-management but not in improving their health status. While the case-finding, computer-based self-management training program and linkage system were successfully implemented, the program failed in creating needed changes in the medical (action plans by community physicians) and physical environments (reduced school allergen levels) of the children., INTRODUCTION Asthma is a common chronic disease in childhood, and efforts to improve care and control (because of its high rates of morbidity, mortality, and health care expenditures) are a [...]