Quality of Asthma Management in Children Attending Health Centres in Kingston & St. Andrew, Jamaica Compared with International Clinical Practice Guidelines.

OBJECTIVES: To assess the quality of asthma care within the paediatric population who attended health centres in Kingston & St. Andrew (KSA) and compare this quality to Global Initiative for Asthma (GINA) guidelines. METHODS AND MATERIALS: Data were collected from 257 dockets of children aged 2-17 years old with asthma attending seven health centres in KSA. RESULTS: Children aged 6-10 years accounted for 36.6% of the sample and males accounted for the majority (54.1%). There was generally poor documentation of performance indicators for asthma including written asthma action plans (1%), peak expiratory flow measurements (0%), inhaler demonstration (2.1%), and asthma control assessment (8.4%). The best documentation was for controller (60.9%) and reliever medication (63.4%) prescriptions/review. CONCLUSION: The study indicates that the documentation of paediatric asthma management in health centres in Jamaica is not congruous with international clinical practice guidelines and change is required.

Alcohol Drinking among Primary School Children in Trinidad and Tobago: Prevalence and Associated Risk Factors

Background: Underage alcohol use is a pervasive problem with serious health, social and safety consequences. This study was undertaken to assess alcohol use by primary school children in Trinidad and Tobago, and to identify associated risk factors. Methods: We analysed data collected from 40 primary schools in Trinidad and Tobago by the National Alcohol and Drug Abuse Prevention Programme (NADAPP). The sample comprised of children aged 8 -15 years old, in standards 3, 4 and 5. Result: Out of the 2052 children, 648 (31.6%) have consumed alcohol in their lifetime, and same proportion reported ever being drunk (31.6%). Male gender was significantly associated with lifetime alcohol use (AOR =1.60, 95% CI= 1.25 - 2.05). Children not living with their father (AOR= 2.45, 95% CI=1.86- 3.24) and those whose fathers have either primary or secondary education (AOR = 1.88, 95%CI=1.07 - 3.31; AOR= 1.58, 95%CI=1.12 - 2.23 respectively) were at higher risk for lifetime alcohol consumption. However, age group 8 ­ 11 years was significantly inversely associated with lifetime alcohol consumption (AOR= 0.67, 95% CI=0.48 - 0.94). Conclusion: Being a male student, not living with father, and father attaining either primary or secondary education level were significantly associated with increased likelihood for lifetime alcohol use. However, children between 8 ­ 11 years were less likely to consume alcohol.

Investigating the Role of Alcohol in Behavioural Problems at School among Secondary School Students in Barbados

Background: The prevalence of alcohol use is quite high in the Caribbean region, and specifically, in Barbados. Alcohol use has been documented to negatively affect the way students behave within and outside school. This study set out to examine the role alcohol plays in students' behavioural problems at school. Methods: An analysis of crosssectional data collected during the National Secondary Schools Survey was done. Mean (and standard deviation), frequencies and percentages were computed, and differences in proportions among the groups were assessed using Pearson's Chi Square. Multivariate analysis using binary logistic regression was done to determine the association between explanatory variables and outcome variables. Results: In bivariate analysis, behavioural problems at school were significantly associated with age (p= 0.001), grade (p= 0.000), sense of belonging at school (p= 0.000), relationship with teachers (p= 0.000), and past month alcohol use (p= 0.007). In multivariate analysis, students' having frequent behavioural problems at school was significantly associated with neither past year nor past month alcohol use (AOR= 1.13, 95% CI= 0.91- 1.40, AOR= 1.02, 95% CI= 0.83- 1.24 respectively). Significant inverse associations were found between students' behavioural problems and age (11- 14 years: AOR= 0.53, 95% CI= 0.33- 0.84; AOR= 0.51, 95% CI= 0.32- 0.82 for models 1 and 2 respectively), and relationship with teachers (very good: AOR= 0.10, 95% CI= 0.07- 0.16; AOR= 0.13, 95% CI= 0.09- 0.20 for models 1 and 2 respectively). Conclusion: Neither past year nor past month alcohol consumption by students was associated with frequent behavioural problems at school. Students who were younger than 17 years, and who had a relationship with their teachers that was not very bad were significantly less likely to engage in frequent behavioural problems.

Parental Alcohol Drinking Habit as a Predictor of Alcohol Use among Secondary School Students in Barbados

Background: In Barbados and the wider Caribbean region, alcohol is widely consumed by adolescents and young people, including those in secondary schools. The high prevalence of alcohol use, and its potential adverse effects are a source of concern to policy makers and the general population, which calls for better understanding of the drivers of this problem. This study thus aimed at investigating whether parental alcohol drinking habit is a predictor of alcohol use among secondary school students in the country. Methods: The predictor variables and response variables in the study were categorical, and so descriptive, univariate analysis consisted of computation of frequencies and percentages. Bivariate analysis using Pearson's Chi Square was done to test for significant differences in the response variables among groups. Logistic regression modeling was used in multivariate analysis to determine the predictor variables that were significantly associated with the response variables. Results: Significant associations were seen between students' age, (P= 0.00), grade (P=0.00), fathers' drinking habit (P=0.00), mothers' drinking habit (P=0.00), and both past year and past month alcohol use, in bivariate analysis. Logit model shows that students whose fathers drink only on weekends, sometimes during the week, or every day, respectively, had significantly increased risk of alcohol use in the past month (AOR= 2.62, 95%CI= 1.81- 3.77; AOR= 1.85, 95%CI= 1.19- 2.85; AOR= 2.18, 95%CI= 1.49- 3.18). Students whose mothers drink only on special occasion had significantly higher risk of alcohol use in the past year and past month (AOR= 1.99, 95%CI= 1.06- 3.74; AOR= 2.30, 95%CI= 1.36- 3.89 respectively). Conclusion: Having fathers who drink only on weekend, sometimes during the week and every day were significantly positively associated with alcohol use in the past month. Having mothers who drink only on special occasion was a risk factor for past year and past month alcohol use. However, having mothers who drin

Mechanisms behind inter-individual differences in lung diffusing capacity.

We measured diffusing capacity (DLCO), alveolar membrane properties (D (m)), capillary lung volume (V (c)), and alveolar volume (V (A) ) in 20 healthy subjects (12 males; age 32.4 +/- 13 (SD); BMI 21.7 +/- 3; non smokers) at total lung capacity (TLC) and at approximately 80, 60, and 40% TLC. In all subjects, D (m) increased with lung volume, the increase being significantly greater for higher values of D (m)(TLC): the inter-individual differences can be interpreted by a greater number of alveolar units coupled to a lower thickness of the air-blood barrier (thus a higher alveolar surface to thickness ratio S (A)/tau). On the average, the volume-dependent increase of D (m) from approximately 40 to 100% TLC is less than expected based on geometrical increase of S (A) /tau. In fact, up to approximately 80% TLC, the increase in D (m) closely reflects only the increase of S (A), suggesting "unfolding" of the septa with no appreciable decrease in tau. Conversely, above 80% TLC, the decrease in tau due to parenchymal stretching becomes the main factor affecting D (m). In all subjects, V (c) decreased with increasing lung volume, in line with an increase in parenchymal stretching; the decrease was significantly larger for higher values of V (c) (40% TLC). Possibly reflecting differences in alveolar capillary density. No correlation was found between D (m)(TLC) and V (c)(40%TLC). The individual specificity in the lung volume dependence of V (c) and D (m) can be reasonably described by evaluating the V (c)/D (m) ratio at TLC and at approximately 40%TLC.

Impact of cumulative anthracycline dose, preparative regimen and chronic graft-versus-host disease on pulmonary and cardiac function in children 5 years after allogeneic hematopoietic stem cell transplantation: a prospective evaluation on behalf of the EBMT Pediatric Diseases and Late Effects Working Parties.

This prospective study focused on risk factors and clinical outcome of pulmonary and cardiac late effects after allogeneic hematopoietic stem cell transplantation (allo-HSCT). We prospectively evaluated 162 children by pulmonary function tests (PFTs) and cardiac shortening fraction (SF) before allo-HSCT and yearly up to the 5th year of follow-up. The 5-year cumulative incidence of lung and cardiac impairment was 35 (hazard rate=0.03) and 26% (hazard rate=0.06), respectively. Patients presenting abnormal PFTs and SF at last follow-up were 19 and 13%, respectively, with a median Lansky performance status of 90% (70-100). Chronic graft-versus-host disease (c-GVHD) was the major risk factor for reduced lung function in univariate (P=0.02) and multivariate analysis (P=0.02). Total body irradiation (TBI) alone and TBI together with pre-transplant anthracycline administration were significant risk factors for reduced cardiac function in univariate analysis, only (P=0.04 and 0.004, respectively). In conclusion, our prospective study demonstrates an asymptomatic post-allo-HSCT deterioration of pulmonary and cardiac function in some long-term survivors, who had been transplanted in childhood, and thus emphasizes the need for lifelong cardiopulmonary monitoring and the development of new strategies both to reduce pre-transplant cardiotoxic regimens and to treat more efficiently c-GVHD.

Cardiac and respiratory function after bone marrow transplantation in children with leukaemia.

Late cardiac and respiratory function changes were evaluated in children surviving disease-free more than 2 years after bone marrow transplantation (BMT) performed for haematological malignancies. Forty-one children received allogeneic and 10 autologous BMT. In all cases studied shortening fraction (SF) was always within normal limits from before BMT up to 4 years after BMT. SF, though still normal, was slightly lower in the group with higher pre-BMT cumulative anthracycline dose. Twenty-eight children underwent respiratory function tests regularly at all scheduled times (pre-BMT, +6 months, +1, +2, +3, +4 years after BMT). Vital capacity and total lung capacity showed a slight continuous decrease which was significant at 4 years after BMT (P = 0.015 and P = 0.003 respectively). The decline of forced expiratory volume in 1 s observed 1 year after BMT (P = 0.002) was roughly maintained over time. However, no children complained of symptoms attributable to respiratory dysfunction, and all indices studied were always within normal limits in almost all patients. So far late cardiac and lung changes following BMT in children seem to be negligible. However, whether such abnormalities could further worsen and impair adult quality of life remains to be ascertained.

The efficacy and safety of moguisteine in comparison with codeine phosphate in patients with chronic cough.

We conducted a multicentre, double-blind, parallel group study to compare the clinical efficacy of a new antitussive drug, moguisteine (100 mg t.i.d.), to that of a reference standard, codeine (15 and 30 mg, t.i.d.). Both drugs were given orally for a period of two days. A group of 119 patients (mean age 54 yrs; 61 females and 58 males) with chronic, dry or slightly productive cough, associated with various respiratory disorders (including chronic obstructive pulmonary disease, respiratory malignancies and pulmonary fibrosis) were enrolled at six participating centres. The percentage reduction in the number of morning coughs over a period of 6 h after the first administered dose compared to baseline assessment, was 21% with moguisteine (n = 39), 28% with codeine 15 mg (n = 38), and 29% with codeine 30 mg (n = 36). Differences between treatments were not significant. The percentage reduction in the number of nocturnal coughs per hour, after the last evening dose compared to baseline assessment, was 33, 46 and 52%, respectively. Subjective assessments (patients' visual analogue scale scores of cough frequency, cough intensity and sleep disturbance, and investigators' ranking of cough severity) indicated that there was a similar improvement in cough symptoms in all treatment groups. Adverse events were observed in two patients on moguisteine, three on codeine 15 mg, and five on codeine 30 mg. No event was serious, but discontinuation of treatment was required in two patients on codeine 30 mg. The results of our study suggest that moguisteine 100 mg t.i.d. is safe, and seems to have an antitussive activity similar to that of codeine 15-30 mg t.i.d.

Clinical trial of the efficacy and safety of moguisteine in patients with cough associated with chronic respiratory diseases.

This completely randomised, double-blind, placebo-controlled, multicentre trial was carried out to evaluate the antitussive activity and safety of a 200 mg t.i.d. regimen of moguisteine (20 mg/ml ready-to-use suspension) during four days in patients with cough associated to chronic respiratory disorders. A total of 87 patients were enrolled, 42 on moguisteine and 45 on placebo. All had persistent dry or slightly productive coughs associated with chronic respiratory disorders. Seventy three were submitted to per protocol efficacy analyses, and eighty-three to intention-to-treat efficacy analyses. All the patients who were administered the study drug were analysed for safety. The underlying disorders reported as being associated with the target symptom were chronic obstructive pulmonary disease, cough of unknown aetiology, respiratory tract malignant neoplasms and pulmonary fibrosis. The treatment groups appeared to have been homogeneous on admission. The number of coughs in the interval 8-10 a.m. on day four vs day one was reduced by 42% on moguisteine against 14% on placebo; the difference between treatments was statistically significant (p = 0.028). The mean percent reduction of ladder scale scores of cough frequency vs baseline was greater on moguisteine than on placebo both in the day-time (especially on days one and two), and at night. The antitussive activity of moguisteine did not show remarkable variations either by diagnosis or by type of cough (dry/slightly productive). No serious adverse events were reported. No changes/trends were identified in laboratory tests that might indicate functional or toxic effects of moguisteine on specific organs.