Parental understanding of wheeze and its impact on asthma prevalence estimates

The epidemiology of wheeze in children, when assessed by questionnaires, is dependent on parents' understanding of the term "wheeze". In a questionnaire survey of a random population sample of 4,236 children aged 6-10 yrs, parents' definition of wheeze was assessed. Predictors of a correct definition were determined and the potential impact of incorrect answers on prevalence estimates from the survey was assessed. Current wheeze was reported by 13.2% of children. Overall, 83.5% of parents correctly identified "whistling or squeaking" as the definition of wheeze; the proportion was higher for parents reporting wheezy children (90.4%). Frequent attacks of reported wheeze (adjusted odds ratio (OR) 3.0), maternal history of asthma (OR 1.5) and maternal education (OR 1.5) were significantly associated with a correct answer, while the converse was found for South Asian ethnicity (OR 0.6), first language not English (OR 0.6) and living in a deprived neighbourhood (OR 0.6). In summary, the present study showed that misunderstanding could lead to an important bias in assessing the prevalence of wheeze, resulting in an underestimation in children from South Asian and deprived family backgrounds. Prevalence estimates for the most severe categories of wheeze might be less affected by this bias and questionnaire surveys on wheeze should incorporate measures of parents' understanding of the term wheeze.

The therapy of pre-school wheeze: appropriate and fair?

The current study aimed to assess prevalence and distribution of use of asthma medication for wheeze in pre-school children in the community. We sent a postal questionnaire to the parents of a random population-based sample of 4,277 UK children aged 1-5 years; 3,410 participated (children of south Asian decent were deliberately over-represented). During the previous 12 months, 18% of the children were reported to have received bronchodilators, 8% inhaled corticosteroids (ICS) and 3% oral corticosteroids. Among current wheezers these proportions were 55%, 25%, and 12%, respectively. Use of ICS increased with reported severity of wheeze, but did not reach 60% even in the most severe category. In contrast, 42% of children receiving ICS reported no or very infrequent recent wheeze. Among children with the episodic viral wheeze phenotype, 17% received ICS compared with 40% among multiple-trigger wheezers. Use of ICS by current wheezers was less common in children of South Asian ethnicity and in girls. Although a high proportion of pre-school children in the community used asthma inhalers, treatment seemed to be insufficiently adjusted to severity or phenotype of wheeze, with relative under-treatment of severe wheeze with ICS, especially in girls and South Asian children, but apparent over-treatment of mild and episodic viral wheeze and chronic cough.

Snoring in preschool children: prevalence, severity and risk factors

Epidemiological data on snoring from preschool children are scarce, although habitual snoring (snoring on almost all nights) has been associated with poor long-term outcomes. In a population survey of 6,811 children aged 1-4 yrs (from Leicestershire, UK) the present authors determined prevalence, severity and risk factors for snoring, especially habitual snoring. In 59.7% of the children, parents reported snoring in the previous 12 months, including 7.9% with habitual snoring and 0.9% with habitual snoring and sleep disturbance. Prevalence of habitual snoring increased with age from 6.6% in 1-yr-olds to 13.0% in 4-yr-olds. Habitual snoring was associated with: one and both parents smoking (adjusted odds ratio (OR) 1.46 and 2.09, respectively); road traffic (OR 1.23); single parent (OR 1.60); and in White but not South Asian children, socioeconomic deprivation (OR 1.25 and 2.03 for middle and upper thirds of Townsend score, respectively). Respiratory tract symptoms related to atopic disorders and to respiratory infections were strongly associated with snoring; however, body mass index was not. In conclusion, habitual snoring is common in preschool children with one-third of cases attributable to avoidable risk factors. The strong association with atopic disorders, viral infections and environmental exposures suggests a complex aetiology, based on a general vulnerability of the respiratory tract.

Enabling Access to Welfare Services - the Place of Social Solidarity and Dialogue

The welfare state in the UK presents immigrant communities with a set of institutions, which are potentially new and unknown. What is the best way to ensure that the questions of access to the welfare institutions are best managed? Trusting, understanding and feeling solidarity with the welfare state will obviously help with this problem. In order to shed light on this phenomenon, this paper presents a qualitative exploratory study dealing with elements of solidarity as perceived by members of the South Asian Community in the UK. Six indepth interviews with South Asian first generation immigrants who had never experienced mental health problems were conducted. They were asked questions about who their support networks would be in the event of them experiencing mental health problems. The thematic analysis of the interviews suggests that the respondents believed that solidarity and support ties are found to be present in families, within the south Asian community and also with welfare institutions. It is concluded that there although things are far from perfect, assimilation and integration based on dialogue is an observable positive aspect of mental health service provision in the UK.

Domestic Violence

Since the 1960s, there has been growing awareness regarding the issue of domestic violence as a form of violence against women, which has been largely influenced by the work of feminist activist and scholars in North America and Europe (Dobash and Dobash 1992). Other terms have been used to describe the same phenomenon, including domestic abuse, spousal abuse, wife battering, marital violence, intimate partner violence. Though there is no doubt that this problem has existed for much more than five decades, the tendency to label it as ‘private matters’ or ‘marital disagreements’ has obscured the reality of women living with abuse in their home. At a general level, domestic violence can be defined as the means used by a man in order to assert his control and domination over his intimate partner, whether they are married or not (Mullender 1996). It can involve incidents of physical and sexual violence, as well as verbal, psychological and financial abuse. Though some of its manifestations may be associated with particular cultural or religious groups – e.g. forced marriage and honour killing in South-Asian communities – domestic violence affects women from all classes and backgrounds.

Prescriptions of Chinese medicinal herbs in Switzerland: the example of suan zao ren (Ziziphi Spinosae Semen)

Introduction According to the Swiss Health Survey 2007, 1.7% of the adult population use traditional Chinese medicine (including Chinese herbal medicine, but excluding acupuncture). In contrast to conventional drugs, that contain single chemically defined substances, prescriptions of Chinese herbs are mixtures of up to 40 ingredients (parts of plants, fungi, animal substances and minerals). Originally they were taken in the form of decoctions, but nowadays granules are more popular. Medium daily dosages of granules range between 8 to 12g. In a recent work we identified the most commonly used Chinese herbs (all ingredients are referred to as herbs for reasons of simplicity) and classical formulas (mixtures). Here we present a short overview and the example of suan zao ren (Ziziphi Spinosae Semen), which is used in the treatment of insomnia and anxiety and contains saponins that have been shown to increase sleep in animal studies. Material and Methods A random sample of 1,053 prescriptions was drawn from the database of Lian Chinaherb AG, Switzerland, and analysed according to the most frequently used individual herbs and classical formulas. Cluster analysis (Jaccard similarity coefficient, complete linkage method) was applied to identify common combinations of herbs. Results The most frequently used herbs were dang gui (Angelicae Sinensis Radix), fu ling (Poria), bai shao (Paeoniae Radix Alba), and gan cao (Glycyrrhizae Radix et Rhizoma); the most frequently used classical formulas were gui pi tang (Restore the Spleen Decoction) and xiao yao san (Rambling Powder). The average number of herbs per prescription was 12.0, and the average daily dosage of granules was 8.7g. 74.3% of the prescriptions were for female, 24.8% for male patients. Suan zao ren was present in 14.2% of all prescriptions. These prescriptions contained on average 13.7 herbs, and the daily dosage of granules was 8.9g. Suan zao ren was more frequently prescribed by practitioners of non-Asian than of Asian origin but equally often for female and male patients. Cluster analysis grouped suan zao ren with yuan zhi (Polygalae Radix), bai zi ren (Platycladi Semen), sheng di huang (Rehmanniae Radix) and dan shen (Salviae Miltiorrhizae Radix et Rhizoma). Discussion Prescriptions including suan zao ren contained on average slightly more herbs than other prescriptions. This might be due to the fact that two of the three most popular classical formulas with suan zao ren are composed of 13 and 12 herbs with the possibility of adding more ingredients when necessary. Cluster analysis resulted in the clustering of suan zao ren with other herbs of the classical formula tian wang bu xin dan (Emperor of Heaven’s Special Pill to Tonify the Heart), indicating the use of suan zao ren for the treatment of insomnia and irritability. Unfortunately, the diagnoses of the patients were unavailable and thus correlations between use of suan zao ren and diseases could not be analysed.

Ancient History as a Means of Transforming Colonial India in the Late-Eighteenth and Early-Nineteenth Centuries

This article focuses on the studies and discourses of mostly British scholars of the early colonial period belonging to two schools of thought. It shows how the studies of both schools – European orientalism and utilitarianism – were intricately connected to the political development of the emerging British paramountcy over the South Asian sub-continent, as both were looking for means of establishing and/or strengthening colonial rule. Nevertheless, the debate was not just a continuation of discussions in Europe. Whereas the ideas of the European Enlightenment had some influence, the transformation of the Mughal Empire and especially the idea of a decline of Muslim rule offered ample opportunities for understanding the early history of India either as some sort of “Golden Age,” as the orientalists and their indigenous supporters did, or as something static and degenerate, as the utilitarians did, and from which the population of sub-continent had to be saved by colonial rule and colonial values. Fearing the spread of the ideas of the French Revolution, the first group of British scholars sought to persuade the native elites of South Asia to take the lessons of their past for the future development of their homeland. Just as the classicists back in Europe, these scholars were convinced that large-scale explanations of the past could also teach political and moral lessons for the present although it was important to deal with the distant past in an empirical manner. The utilitarians on the other hand believed that India had to be saved from its own depravity through the English language and Western values, which amounted to nothing less than the modern transformation of the true Classical Age.

"Attacks" or "Whistling": Impact of Questionnaire Wording on Wheeze Prevalence Estimates.

BACKGROUND Estimates of prevalence of wheeze depend on questionnaires. However, wording of questions may vary between studies. We investigated effects of alternative wording on estimates of prevalence and severity of wheeze, and associations with risk factors. METHODS White and South Asian children from a population-based cohort (UK) were randomly assigned to two groups and followed up at one, four and six years (1998, 2001, 2003). Parents were asked either if their child ever had "attacks of wheeze" (attack group, N=535), or "wheezing or whistling in the chest" (whistling group, N=2859). All other study aspects were identical, including questions about other respiratory symptoms. RESULTS Prevalence of wheeze ever was lower in the attack group than in the whistling group for all surveys (32 vs. 40% in white children aged one year, p<0.001). Prevalence of other respiratory symptoms did not differ between groups. Wheeze tended to be more severe in the attack group. The strength of association with risk factors was comparable in the two groups. CONCLUSIONS The wording of questions on wheeze can affect estimates of prevalence, but has less impact on measured associations with risk factors. Question wording is a potential source of between-study-heterogeneity in meta-analyses.

"Power to the people" : De la Hegemonía al Policentrismo: Una mirada desde las Antípodas sobre el devenir del inglés en el contexto postcolonial de Asia del Sur

Esta tesis buscará diferencias y similitudes sobre el fenómeno "Imperialismo Lingüístico" en contextos poscoloniales desde la mirada de lingüistas angloparlantes, por un lado occidentales, para quienes el inglés es su lengua materna, como así también orientales, para quienes es una segunda lengua. Creemos que los fuertes procesos de apropiación, naturalización, indigenización y re-significación de la lengua inglesa por parte de la población de Asia del Sur han hecho del inglés una lengua de carácter policéntrico, lengua de cultura (Guitarte, 1991) más que una lengua de carácter hegemónico, lengua de culto (Guitarte, 1991). Esta lengua poli/pluricéntrica, lejos de ser una lengua que perpetúe la inequidad social, como proponen los teóricos occidentales, es una lengua que empodera a sus hablantes, inclusive a aquellos más excluidos del sistema social como los dalits. Los textos para el análisis corresponden a las variedades postcoloniales del inglés indio (Indian English) y sri lankeano (Sri Lankean English) que se ubican dentro de los denominados inglés[es] Sud asiático[s] (South Asian English[es]). La evaluación en India y Sri Lanka (colonizados) respecto de la imposición de la Lengua Inglesa es altamente positiva, no sólo en los estratos sociales elevados sino también en los estratos sociales de menores recursos (los dalits). Esto se opone a la evaluación del mismo fenómeno visto desde occidente (colonizadores), quienes consideran haber cometido, a través de la imposición, una especie de genocidio lingüístico de las lenguas locales. Si bien, ambas posturas coinciden en ver al inglés como a un medio capaz de crear un nuevo estrato social: ?la casta de los hablantes bilingües del inglés?, creemos que la diferencia principal radica en que esta capacidad es vista como exclusiva por parte de los occidentales, y es vista como inclusiva por los orientales. Mientras que los primeros se preguntan quiénes quedan afuera del uso predominante del inglés para la comunicación y el acceso a la tecnología, la ciencia, la educación y la cultura; los orientales se preguntan quiénes quedan adentro del uso del inglés para las distintas funciones intra e internacionales. Los autores del este dan un paso más allá de la mera descripción del estado de cosas y proponen políticas lingüísticas que contemplan sus variedades estandarizadas. Queremos también mostrar que la capacidad de transformar algo negativo en positivo; algo que ha sido impuesto, en algo propio es característica de la cultura india. Esto se refleja también en otros ámbitos, como el audiovisual, el gastronómico o el religioso

"Power to the people" : De la Hegemonía al Policentrismo: Una mirada desde las Antípodas sobre el devenir del inglés en el contexto postcolonial de Asia del Sur

Esta tesis buscará diferencias y similitudes sobre el fenómeno "Imperialismo Lingüístico" en contextos poscoloniales desde la mirada de lingüistas angloparlantes, por un lado occidentales, para quienes el inglés es su lengua materna, como así también orientales, para quienes es una segunda lengua. Creemos que los fuertes procesos de apropiación, naturalización, indigenización y re-significación de la lengua inglesa por parte de la población de Asia del Sur han hecho del inglés una lengua de carácter policéntrico, lengua de cultura (Guitarte, 1991) más que una lengua de carácter hegemónico, lengua de culto (Guitarte, 1991). Esta lengua poli/pluricéntrica, lejos de ser una lengua que perpetúe la inequidad social, como proponen los teóricos occidentales, es una lengua que empodera a sus hablantes, inclusive a aquellos más excluidos del sistema social como los dalits. Los textos para el análisis corresponden a las variedades postcoloniales del inglés indio (Indian English) y sri lankeano (Sri Lankean English) que se ubican dentro de los denominados inglés[es] Sud asiático[s] (South Asian English[es]). La evaluación en India y Sri Lanka (colonizados) respecto de la imposición de la Lengua Inglesa es altamente positiva, no sólo en los estratos sociales elevados sino también en los estratos sociales de menores recursos (los dalits). Esto se opone a la evaluación del mismo fenómeno visto desde occidente (colonizadores), quienes consideran haber cometido, a través de la imposición, una especie de genocidio lingüístico de las lenguas locales. Si bien, ambas posturas coinciden en ver al inglés como a un medio capaz de crear un nuevo estrato social: ?la casta de los hablantes bilingües del inglés?, creemos que la diferencia principal radica en que esta capacidad es vista como exclusiva por parte de los occidentales, y es vista como inclusiva por los orientales. Mientras que los primeros se preguntan quiénes quedan afuera del uso predominante del inglés para la comunicación y el acceso a la tecnología, la ciencia, la educación y la cultura; los orientales se preguntan quiénes quedan adentro del uso del inglés para las distintas funciones intra e internacionales. Los autores del este dan un paso más allá de la mera descripción del estado de cosas y proponen políticas lingüísticas que contemplan sus variedades estandarizadas. Queremos también mostrar que la capacidad de transformar algo negativo en positivo; algo que ha sido impuesto, en algo propio es característica de la cultura india. Esto se refleja también en otros ámbitos, como el audiovisual, el gastronómico o el religioso

Late Miocene palaeoflora and palaeoclimate of Lincang (China)

The Miocene Lincang leaf assemblage is used in this paper as proxy data to reconstruct the palaeoclimate of southwestern Yunnan (SW China) and the evolution of monsoon intensity. Three quantitative methods were chosen for this reconstruction, i.e. Leaf Margin Analysis (LMA), Climate Leaf Analysis Multivariate Program (CLAMP), and the Coexistence Approach (CA). These methods, however, yield inconsistent results, particularly for the precipitation, as also shown in European and other East Asian Cenozoic floras. The wide range of the reconstructed climatic parameters includes the Mean Annual Temperature (MAT) of 18.5-24.7 °C and the Mean Annual Precipitation (MAP) of 1213-3711 mm. Compared with the modern Lincang climate (MAT, 17.3 °C; MAP, 1178.7 mm), the Miocene climate is slightly warmer, wetter and has a higher temperature seasonality. A detailed comparison on the palaeoclimatic variables with the coeval Late Miocene Xiaolongtan flora from the eastern part of Yunnan allows us to investigate the development and interactions of both South Asian and East Asian monsoons during the Late Miocene in southwest China, now under strong influence of these monsoon systems. Our results suggest that the monsoon climate has already been established in southwest Yunnan during the Late Miocene. Furthermore, our results support that both Southeast Asian and East Asian monsoons co-occurred in Yunnan during the Late Miocene.