Association between atopic dermatitis and obesity in adulthood.

BACKGROUND: Obesity in early childhood is associated with increased risk for and severity of atopic dermatitis (AD). Objective To determine whether obesity in adulthood is associated with risk of AD. METHODS: This was a retrospective case-control study of 2090 adults using questionnaire, height and weight, and skin-prick testing between January 1994 and December 2003. RESULTS: Obesity in adults was associated with increased AD [multinomial logistic regression: adjusted odds ratio (aOR) 1·43, 95% confidence interval (CI) 1·08-1·89; P=0·01], but not nonatopic dermatitis (aOR 0·59, 95% CI 0·21-1·68; P=0·32). Obesity was also associated with increased atopic asthma (aOR 1·98, 95% CI 1·47-2·66, P<0·0001), but not associated with nonatopic asthma (P=0·20), atopic or nonatopic rhinoconjunctivitis (P=0·08 and 0·31, respectively), food allergies (P=0·67 and 0·35, respectively) or atopy (P=0·40). The association between obesity and AD remained significant even when controlling for history of asthma, rhinoconjunctivitis and food allergies (aOR 1·40, 95% CI 1·05-1·86; P=0·02) or in subset analyses of subjects with AD alone (aOR 1·96, 95% CI 1·02-3·75; P=0·04) and with comorbid asthma, rhinoconjunctivitis and/or food allergies (aOR 1·40, 95% CI 1·03-1·91; P=0·03). CONCLUSION: Obesity in adulthood is associated with AD. Further studies are warranted to determine if weight loss may prevent or mitigate AD in adults.

Results of a programme to improve house staff use of metered dose inhalers and spacers.

PURPOSE: Metered dose inhalers (MDIs) and spacers are used widely in the treatment of asthma. Medical personnel who are responsible for training patients must themselves be proficient with the devices. The proficiency of a group of new medical interns with use of MDI and spacer devices was determined, and improvement in their use of these devices was sought. SUBJECTS: Fifty six medical interns tested at the start of their first house staff training year. METHODS: The ability of medical interns to use MDIs and spacers was assessed using a visual scoring system before and after a large group lecture emphasising proper device use and once again after an intensive one-on-one training session with an attending physician. RESULTS: Initially, only 5% used an MDI perfectly. This improved to 13% after a lecture and demonstration, and 73% after an intensive one-on-one session. Almost no new interns could use a collapsible or tube spacer properly initially. This improved to 15% and 29% respectively after a lecture. After one-on-one training, correct technique was increased to 69% for collapsible spacer and 95% for the tube spacer. Analysis of individual steps of MDI use showed that interns had particular difficulty in coordinating actuation with inhalation. The tube spacer appeared easiest to learn. CONCLUSIONS: Incoming medical house staff have limited ability to use MDI with and without spacers. A large group lecture is relatively ineffective when compared with a one-on-one training session in training with these devices.

Physicians' metered dose inhaler technique after a single teaching session.

BACKGROUND: It is known that many housestaff physicians are unable to demonstrate perfect metered dose inhaler (MDI) technique. OBJECTIVE: This study assessed whether a single teaching session for house staff physicians would significantly improve their MDI technique. METHODS: Thirty-eight pediatric house staff physicians were asked to demonstrate MDI technique with a placebo MDI. The physicians were evaluated on the following seven steps: (1) shaking the MDI and removing the cap, (2) exhaling prior to MDI use, (3) holding the MDI upright, (4) proper timing of actuation, (5) a slow inspiratory effort, (6) one MDI actuation per breath, and (7) holding the breath > or = 5 seconds. A 20-minute teaching session and demonstration of proper MDI technique was then given. At the end of this session all residents were eventually able to demonstrate proper technique. Two months following this educational session the same house staff physicians were re-evaluated on their MDI technique. RESULTS: Initially, ten participants (26%) demonstrated perfect technique. Two months postinstruction the same number of physicians (ten) demonstrated perfect technique. Only six physicians demonstrated perfect technique at both evaluations. Three of the seven steps showed enough change from the first evaluation to the second to permit statistical analysis. Step 4 (timing of actuation) had 11 Physicians' performances improve while three worsened (P=.03). Step 5 (a slow inspiratory effort) had nine physicians' performances improve while three worsened (P=.073). For step 7 (holding the breath > or = 5 seconds), 11 physicians improved while 2 worsened (P=.006). Comparing global performance, there were 17 physicians that improved, 8 that worsened, and 13 with no change (P=.054). CONCLUSIONS: This study confirmed that many housestaff physicians do not demonstrate optimal MDI technique. While one educational session may somewhat improve their future performance, it is not sufficient to guarantee perfect technique. This suggests that repeated education needs to be given to housestaff physicians.