Biomedical risk assessment as an aid for smoking cessation.

BACKGROUND: A possible strategy for increasing smoking cessation rates could be to provide smokers who have contact with healthcare systems with feedback on the biomedical or potential future effects of smoking, e.g. measurement of exhaled carbon monoxide (CO), lung function, or genetic susceptibility to lung cancer. We reviewed systematically data on smoking cessation rates from controlled trials that used biomedical risk assessment and feedback. OBJECTIVES: To determine the efficacy of biomedical risk assessment provided in addition to various levels of counselling, as a contributing aid to smoking cessation. SEARCH STRATEGY: We systematically searched he Cochrane Collaboration Tobacco Addiction Group Specialized Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966 to 2004), and EMBASE (1980 to 2004). We combined methodological terms with terms related to smoking cessation counselling and biomedical measurements. SELECTION CRITERIA: Inclusion criteria were: a randomized controlled trial design; subjects participating in smoking cessation interventions; interventions based on a biomedical test to increase motivation to quit; control groups receiving all other components of intervention; an outcome of smoking cessation rate at least six months after the start of the intervention. DATA COLLECTION AND ANALYSIS: Two assessors independently conducted data extraction on each paper, with disagreements resolved by consensus. MAIN RESULTS: From 4049 retrieved references, we selected 170 for full text assessment. We retained eight trials for data extraction and analysis. One of the eight used CO alone and CO + Genetic Susceptibility as two different intervention groups, giving rise to three possible comparisons. Three of the trials isolated the effect of exhaled CO on smoking cessation rates resulting in the following odds ratios (ORs) and 95% confidence intervals (95% CI): 0.73 (0.38 to 1.39), 0.93 (0.62 to 1.41), and 1.18 (0.84 to 1.64). Combining CO measurement with genetic susceptibility gave an OR of 0.58 (0.29 to 1.19). Exhaled CO measurement and spirometry were used together in three trials, resulting in the following ORs (95% CI): 0.6 (0.25 to 1.46), 2.45 (0.73 to 8.25), and 3.50 (0.88 to 13.92). Spirometry results alone were used in one other trial with an OR of 1.21 (0.60 to 2.42).Two trials used other motivational feedback measures, with an OR of 0.80 (0.39 to 1.65) for genetic susceptibility to lung cancer alone, and 3.15 (1.06 to 9.31) for ultrasonography of carotid and femoral arteries performed in light smokers (average 10 to 12 cigarettes a day). AUTHORS' CONCLUSIONS: Due to the scarcity of evidence of sufficient quality, we can make no definitive statements about the effectiveness of biomedical risk assessment as an aid for smoking cessation. Current evidence of lower quality does not however support the hypothesis that biomedical risk assessment increases smoking cessation in comparison with standard treatment. Only two studies were similar enough in term of recruitment, setting, and intervention to allow pooling of data and meta-analysis.

Building the niche through time: using 13,000 years of data to predict the effects of climate change on three tree species in Europe

Aim Species distribution models (SDMs) based on current species ranges underestimate the potential distribution when projected in time and/or space. A multi-temporal model calibration approach has been suggested as an alternative, and we evaluate this using 13,000 years of data. Location Europe. Methods We used fossil-based records of presence for Picea abies, Abies alba and Fagus sylvatica and six climatic variables for the period 13,000 to 1000yr bp. To measure the contribution of each 1000-year time step to the total niche of each species (the niche measured by pooling all the data), we employed a principal components analysis (PCA) calibrated with data over the entire range of possible climates. Then we projected both the total niche and the partial niches from single time frames into the PCA space, and tested if the partial niches were more similar to the total niche than random. Using an ensemble forecasting approach, we calibrated SDMs for each time frame and for the pooled database. We projected each model to current climate and evaluated the results against current pollen data. We also projected all models into the future. Results Niche similarity between the partial and the total-SDMs was almost always statistically significant and increased through time. SDMs calibrated from single time frames gave different results when projected to current climate, providing evidence of a change in the species realized niches through time. Moreover, they predicted limited climate suitability when compared with the total-SDMs. The same results were obtained when projected to future climates. Main conclusions The realized climatic niche of species differed for current and future climates when SDMs were calibrated considering different past climates. Building the niche as an ensemble through time represents a way forward to a better understanding of a species' range and its ecology in a changing climate.

Subclinical hypothyroidism and the risk of coronary heart disease: a meta-analysis.

PURPOSE: Subclinical hypothyroidism has been associated with elevated cholesterol and increased risk for atherosclerosis, but data on the risk of coronary heart disease (CHD) are conflicting. We performed a systematic review to determine whether subclinical hypothyroidism is associated with CHD in adults. METHODS: We searched MEDLINE from 1966 to April 2005, and the bibliographies of key articles to identify studies that provided risk estimates for CHD or cardiovascular mortality associated with subclinical hypothyroidism. Two authors independently reviewed each potential study for eligibility, assessed methodologic quality, and extracted the data. RESULTS: We identified 14 observational studies that met eligibility criteria. Subclinical hypothyroidism increased the risk of CHD (summary odds ratio [OR]: 1.65, 95% confidence interval [CI], 1.28-2.12). The summary OR for CHD was 1.81 (CI, 1.38-2.39) in 9 studies adjusted or matched for demographic characteristics, and 2.38 (CI, 1.53-3.69) after pooling the studies that adjusted for most cardiovascular risk factors. Sensitivity analyses including only population-based studies and those with formal outcome adjudication procedures yielded similar results. Subgroup analyses by type of study design showed a similar trend, but lower risk, in the 5 prospective cohort studies (OR 1.42, CI, 0.91-2.21), compared with the case-control and cross-sectional studies (OR 1.72, CI, 1.25-2.38). CONCLUSION: Our systematic review indicates that subclinical hypothyroidism is associated with an increased risk of CHD. Clinical trials are needed to assess whether thyroxine replacement reduces the risk of CHD in subjects with subclinical hypothyroidism.

Efficient targeted transcript discovery via array-based normalization of RACE libraries.

Rapid amplification of cDNA ends (RACE) is a widely used approach for transcript identification. Random clone selection from the RACE mixture, however, is an ineffective sampling strategy if the dynamic range of transcript abundances is large. To improve sampling efficiency of human transcripts, we hybridized the products of the RACE reaction onto tiling arrays and used the detected exons to delineate a series of reverse-transcriptase (RT)-PCRs, through which the original RACE transcript population was segregated into simpler transcript populations. We independently cloned the products and sequenced randomly selected clones. This approach, RACEarray, is superior to direct cloning and sequencing of RACE products because it specifically targets new transcripts and often results in overall normalization of transcript abundance. We show theoretically and experimentally that this strategy leads indeed to efficient sampling of new transcripts, and we investigated multiplexing the strategy by pooling RACE reactions from multiple interrogated loci before hybridization.

Meta-analysis: subclinical thyroid dysfunction and the risk for coronary heart disease and mortality

BACKGROUND: Data on the association between subclinical thyroid dysfunction and coronary heart disease (CHD) and mortality are conflicting. PURPOSE: To summarize prospective evidence about the relationship between subclinical thyroid dysfunction and CHD and mortality. DATA SOURCES: MEDLINE (1950 to January 2008) without language restrictions and reference lists of retrieved articles were searched. STUDY SELECTION: Two reviewers screened and selected cohort studies that measured thyroid function and then followed persons prospectively to assess CHD or mortality. DATA EXTRACTION: By using a standardized protocol and forms, 2 reviewers independently abstracted and assessed studies. DATA SYNTHESIS: Ten of 12 identified studies involved population-based cohorts that included 14 449 participants. All 10 population-based cohort studies examined risks associated with subclinical hypothyroidism (2134 CHD events and 2822 deaths), whereas only 5 examined risks associated with subclinical hyperthyroidism (1392 CHD events and 1993 deaths). In a random-effects model, the relative risk (RR) for subclinical hypothyroidism for CHD was 1.20 (95% CI, 0.97 to 1.49; P for heterogeneity = 0.14; I(2 )= 33.4%). Risk estimates were lower when higher-quality studies were pooled (RR, 1.02 to 1.08) and were higher among participants younger than 65 years (RR, 1.51 [CI, 1.09 to 2.09] for studies with mean participant age <65 years and 1.05 [CI, 0.90 to 1.22] for studies with mean participant age > or =65 years). The RR was 1.18 (CI, 0.98 to 1.42) for cardiovascular mortality and 1.12 (CI, 0.99 to 1.26) for total mortality. For subclinical hyperthyroidism, the RR was 1.21 (CI, 0.88 to 1.68) for CHD, 1.19 (CI, 0.81 to 1.76) for cardiovascular mortality, and 1.12 (CI, 0.89 to 1.42) for total mortality (P for heterogeneity >0.50; I(2 )= 0% for all studies). LIMITATIONS: Individual studies adjusted for different potential confounders, and 1 study provided only unadjusted data. Publication bias or selective reporting of outcomes could not be excluded. CONCLUSION: Subclinical hypothyroidism and hyperthyroidism may be associated with a modest increased risk for CHD and mortality, with lower risk estimates when pooling higher-quality studies and larger CIs for subclinical hyperthyroidism

Atherosclerosis screening by noninvasive imaging for cardiovascular prevention: a systematic review.

BACKGROUND: Noninvasive imaging of atherosclerosis is being increasingly used in clinical practice, with some experts recommending to screen all healthy adults for atherosclerosis and some jurisdictions mandating insurance coverage for atherosclerosis screening. Data on the impact of such screening have not been systematically synthesized. OBJECTIVES: We aimed to assess whether atherosclerosis screening improves cardiovascular risk factors (CVRF) and clinical outcomes. DESIGN: This study is a systematic review. DATA SOURCES: We searched MEDLINE and the Cochrane Clinical Trial Register without language restrictions. STUDY ELIGIBILITY CRITERIA: We included studies examining the impact of atherosclerosis screening with noninvasive imaging (e.g., carotid ultrasound, coronary calcification) on CVRF, cardiovascular events, or mortality in adults without cardiovascular disease. RESULTS: We identified four randomized controlled trials (RCT, n=709) and eight non-randomized studies comparing participants with evidence of atherosclerosis on screening to those without (n=2,994). In RCTs, atherosclerosis screening did not improve CVRF, but smoking cessation rates increased (18% vs. 6%, p=0.03) in one RCT. Non-randomized studies found improvements in several intermediate outcomes, such as increased motivation to change lifestyle and increased perception of cardiovascular risk. However, such data were conflicting and limited by the lack of a randomized control group. No studies examined the impact of screening on cardiovascular events or mortality. Heterogeneity in screening methods and studied outcomes did not permit pooling of results. CONCLUSION: Available evidence about atherosclerosis screening is limited, with mixed results on CVRF control, increased smoking cessation in one RCT, and no data on cardiovascular events. Such screening should be validated by large clinical trials before widespread use.

The hemodynamics of septic shock: a historical perspective.

In the late 19th century, it was already known that severe infections could be associated with cardiovascular collapse, a fact essentially attributed to cardiac failure. A major experimental work in the rabbit, published by Romberg and Pässler in 1899, shifted attention to disturbed peripheral vascular tone as the mechanism of hypotension in these conditions. In the first half of the 20th century, great progresses were made in the pathophysiologic understanding of hemorrhagic and traumatic shocks, while researchers devoted relatively little attention to septic shock. Progress in the hemodynamic understanding of septic shock resumed with the advent of critical care units. The hyperdynamic state was recognized in the late fifties and early sixties. The present short review ends with landmark studies by Max Harry Weil, demonstrating the importance of venous pooling, and John H. Siegel, which introduced the concept of deficient peripheral utilization of oxygen, inspiring later work on the microvascular disturbances of septic shock.

Mediterranean diet and risk of endometrial cancer: a pooled analysis of three italian case-control studies.

BACKGROUND: Some components of the Mediterranean diet have favourable effects on endometrial cancer, and the Mediterranean diet as a whole has been shown to have a beneficial role on various neoplasms. METHODS: We analysed this issue pooling data from three case-control studies carried out between 1983 and 2006 in various Italian areas and in the Swiss Canton of Vaud. Cases were 1411 women with incident, histologically confirmed endometrial cancer, and controls were 3668 patients in hospital for acute diseases. We measured the adherence to the Mediterranean diet using a Mediterranean Diet Score (MDS), based on the nine dietary components characteristics of this diet, that is, high intake of vegetables, fruits/nuts, cereals, legumes, fish; low intake of dairy products and meat; high monounsaturated to saturated fatty acid ratio; and moderate alcohol intake. We estimated the odds ratios (OR) and the corresponding 95% confidence intervals (CI) for increasing levels of the MDS (varying from 0, no adherence, to 9, maximum adherence) using multiple logistic regression models, adjusted for major confounding factors. RESULTS: The adjusted OR for a 6-9 components of the MDS (high adherence) compared with 0-3 (low adherence) was 0.43 (95% CI 0.34-0.56). The OR for an increment of one component of MDS diet was 0.84 (95% CI 0.80-0.88). The association was consistent in strata of various covariates, although somewhat stronger in older women, in never oral contraceptive users and in hormone-replacement therapy users. CONCLUSIONS: Our study provides evidence for a beneficial role of the Mediterranean diet on endometrial cancer risk, suggesting a favourable effect of a combination of foods rich in antioxidants, fibres, phytochemicals, and unsaturated fatty acids.

Konsernitilinpäätöksen yhdistelyt IFRS-standardien mukaan

Tutkimuksen tavoitteena on IFRS-standardien eli uusien kansainvälisten raportointistandardien tuomien muutosten selvittäminen koskien konsernitilinpäätöksen yhdistelyjä. Tutkimusmenetelmä on normatiivinen, teoreettinen ja kvalitatiivinen. IAS/IFRS (International Accounting Standards / International Financial Reporting Standards eli kansainväliset raportointistandardit) tulee pakolliseksi pörssiyrityksille 1.1.2005 alkaen Euroopan Unionin alueella. IAS/IFRS:n mukaan tytäryritykset yhdistellään hankintamenomenetelmällä, osakkuusyritykset pääomaosuusmenetelmällä ja yhteisyritykset suhteellisella yhdistelyllä. Yritysten yhteenliittymät – standardi on olennaisesti uudistettu 31.3.2004. Pooling-menetelmä kiellettiin kokonaan. Hankintamenomenetelmässä kaikki yksilöitävissä olevat varat ja velat arvostetaan käypiin arvoihin. Aineettomien hyödykkeiden ryhmittelyssä on tapahtunut muutoksia. Yksilöitävissä olevat aineettomat hyödykkeet, esimerkiksi asiakassuhteet, aktivoidaan taseeseen ja poistetaan. Aineettomat hyödykkeet, joille ei ole määriteltävissä rajallista käyttöikää, tulee testata pakollisilla arvonalentumistestauksella. Siihen ryhmään kuuluu esimerkiksi liikearvo.

International cash management and how to optimize it in China, Case: Stora Enso Oyj School of Business

The aim of this study was to analyze and give proposals for the case-company how to optimize cash management in China. The purpose of the theoretical part was to enlighten the liquidity and cash management practices in an international environment and apply these into the different, regulated environment of China. In the theoretical part both domestic and international literature, articles and journals were used. The results of the empirical part are based on the in-formation from the case-company and its associates. Information was gathered mainly via internal questionnaire which was sent to the case com¬pany's subsidiaries involved with the study. Mainly company-internal factors were studied. The main result of the study implies that China is a challenging environment to optimize cash management, as the structures used elsewhere can not be applied to China as such. The study clarified the picture of the current cash management situation within the case company's China units. Can be seen, that by optimizing their cash management it is possible to especially increase control, and interest earnings and utilize internal liquidity more efficiently.

La desigualdad en el consumo familiar. Diferencias de género en la España contemporánea (1850-1930)

In the last few years, Economic Theory has revised two basic ideas around the economics of the household: that family income is the result of the individual income of each of its members (income pooling), and that all family members living in the household have equal access to its resources. Unequal access to family resources (among women and men, on the one hand, and among the elderly, adults and children, on the other), is now understood as an input (for instance, that women eat less food and of worst quality than men), and as an output (for instance that women have poorer health, higher epidemic mortality, or are less tall than men as a result, among other things, of having received less food and poorer medical care, and/or of a heavier workload). Despite the fact that inequality in intra‐family consumption has become the center of attention in academic and international agencies, it can still not be found in the agenda of Economic History. In this paper we look at some of the resources consumed by Spanish families in the 19th century: food, alcoholic beverages, clothes and shoes. Medical topographies, our main source, suggest that unequal access to family resources among household members had a strong impact on their health and wellbeing.

Ilmavoimat ulko- ja turvallisuuspolitiikan välineenä Suomessa vuonna 2025

Suomen puolustuspolitiikka nojaa tulevaisuudessa yhä enemmän kansainväliseen yhteistyöhön ja verkottuneen puolustuksen periaatteisiin. Puolustusmateriaalikustannusten kasvaminen ohjaa kumppaneita hakemaan uusia yhteistoimintatapoja ns. Pooling & Sharing ja Smart Defense-periaatteiden mukaisesti. Viimeisen vuosikymmenen aikana Suomen asema turvallisuuspoliittisessa kontekstissa on merkittävästi muuttunut eurooppalaisen, pohjoismaisen sekä Suomen ja Yhdysvaltojen tiivistyneen yhteistyön seurauksena. Suomen saavuttama asema Naton rauhankumppanina, pohjoismainen NORDEFCO-sotilasyhteistyö sekä kumppanuus Yhdysvaltojen kanssa muodostavat merkittävän ulkopoliittisen viestin geopoliittiseen ympäristöömme. Eräs Suomen ulkopolitiikan tärkeimmistä tavoitteista on sotilaallisen hyökkäyksen kohteeksi joutumisen välttäminen. Päämäärä pyritään saavuttamaan ulkopolitiikan ja diplomatian keinoin sekä ylläpitämällä uskottavaa kansallista puolustuskykyä. Keskeinen tekijä Suomen puolustuksen uskottavuudelle on kansainvälinen sotilasyhteistyö ja asevoimien järjestelmien sekä käyttö- ja toimintaperiaatteiden yhteentoimivuus. Puolustusvoimille hankittava pitkän kantaman ilmasta maahan –kyky, JASSM-ohjus (Joint Air-to-Surface Standoff Missile), mahdollistaa tulevaisuudessa operaatioiden ulottamisen vastustajan syvyyteen. Tällä suorituskyvyllä voi olla ennaltaehkäisevä vaikutus Suomen joutumiseksi sotilaallisen hyökkäyksen kohteeksi tai Suomen alueen hyväksi käyttämiseksi sotilaallisen uhkan kohdistuessa lähialueen Nato jäsenmaihin. Arvioitaessa Suomen puolustuksen uskottavuutta tarkastellaan useimmiten Venäjän sotilaspoliittista ja materiaalista kehitystä Suomen lähialueella. Tarkastelu rajoittuu usein geopoliittisesti Itämeren ympäristöön, jolloin globaalit muutostekijät tai Suomen muuttunut asema kansainvälisessä järjestelmässä jäävät huomioimatta. Asevoimien käyttäminen valtion ulkopoliittisten päämäärien tukemiseksi on kuulunut erityisesti suurvaltojen politiikkaan. Ranskassa la diplomatie aérienne ja Yhdysvalloissa Air Diplomacy käsittävät yleiseen diplomatiaan perustuvia toiminnan osa-alueita, joilla ilmavoimat voivat joko yhteistyön tai sotilaallisen pelotteen keinoin vaikuttaa valtioidensa ulkopolitiikkaan tai kansallisiin intresseihin. Tämän tutkimuksen pääongelmaksi muodostui kysymys, miten Suomen ilmavoimat voisi tukea ulkopoliittisten päämäärien saavuttamista Suomessa vuonna 2025. Ongelman ratkaisemiseksi selvitettiin, millainen on mahdollinen Suomen turvallisuuspoliittinen toimintaympäristö vuonna 2025 ja mitä tarkoittavat käsitteet la diplomatie aérienne ja Air Diplomacy. Tutkimus toteutettiin tulevaisuuden tutkimuksen menetelmin luomalla tutkittavasta ilmiöstä systeeminen malli (systeemiajattelu) sekä toteuttamalla 18 asiantuntijan argumentoiva Delfoi-paneeli. Systeemissä huomioitiin Suomen geopoliittiseen ympäristöön vaikuttavia muutostekijöitä. Tutkimus osoitti, että suomalainen sotilasstrategia sekä ulkopolitiikan ja puolustusvoimien välinen suhde toisiinsa ovat osittain jäsentymättä. Puolustusvoimien tehtävät eivät nykyisessä muodossaan tue kenttäohjesäännössä määriteltyjen Suomen puolustuksen ulottuvuuksien mukaisia ulkopoliittisia päämääriä. Puolustusvoimien tehtäviin eivät sisälly Islannin ilmavalvonnan tyyppiset, ulkopoliittisia päämääriä tavoittelevat tehtävät. Asevoimadiplomatian keinoin on mahdollista nostaa Suomen painoarvoa kansainvälisessä järjestelmässä ja vahvistaa uskottavaa puolustuskykyä suhteessa muihin valtioihin. Geopoliittisessa ympäristössämme asevoimadiplomatia voi lisätä lähialueen vakautta ja korottaa mahdollisen vastustajan kynnystä kohdistaa Suomeen sotilaallisia operaatioita jopa ilman sotilaallista liittoutumista. Ilmavoimadiplomatia-käsitteelle ei toistaiseksi koettu tarvetta. Tutkimus osoitti, että Suomen ilmavoimien korkea yhteensopivuus, tiivis kansainvälinen yhteistyö sekä monipuolinen keinovalikoima mahdollistavat tulevaisuudessa valtion ulkopoliittisten päämäärien tukemisen. Tärkeimpiä ilmavoimadiplomatian keinoja vuonna 2025 ovat osallistuminen sotilaalliseen kriisinhallintaan, kansainvälinen harjoitusyhteistyö, ilmavoimien korkean valmiuden ja suorituskyvyn osoittaminen ulkovalloille sekä sotilaallinen tiedonvaihto. 2020-luvulla ulkopoliittisesti merkittävä ratkaisu on päätös Hornetin seuraajan hankinnasta.

Euroopan puolustusneuvosto Boydilaisena tulkintana

Tutkielmassa tutkitaan Euroopan puolustusviraston toiminnallisia mahdollisuuksia boydilaisessa viitekehyksessä. Eversti John Boyd on tunnettu ja arvostettu yhdysvaltalainen strategi, jonka kehittämää OODA-mallia sovelletaan laajasti yhteiskunnan eri osa-alueilla. Päätutkimuskysymyksenä on, millaisia toiminnallisia mahdollisuuksia Euroopan puolustusvirastolla on, ja olisiko perusteltua vaihtaa Puolustusviraston nimi Turvallisuusvirastoksi. Tutkimus on metodologiselta lähtökohdaltaan kvalitatiivinen eli laadullinen kirjallisuus-analyysi. Deduktiivista sisällönanalyysiä käytetään tutkimuksessa luomaan selkeä runko asiakirjoista ja lähteistä, joita tutkimuksen tarpeisiin on kerätty. Aineistona käytetään Boydin omaa materiaalia sekä EU:n asiakirjoja turvallisuudesta, Puolustusviraston perustamisesta ja sen tehtävistä. Tarkasteltaessa Euroopan puolustusvirastoa boydilaisessa viitekehyksessä voidaan havaita viraston tämänhetkisten tehtävien mahdottomuus. Viraston resurssit, tehtävät ja roolitus eivät ole tasapainossa, jolloin tehtävien hoitaminen tuloksellisesti ei ole mahdollista. OODA-mallin soveltuminen viraston tehtävien tukemiseen on vähintäänkin kyseenalaista, koska malli sivuuttaa Euroopan unionin virastojen tärkeimmän elementin, politiikan. Lisäksi malli on liian kaavamainen ja se yksinkertaistaa liikaa monimutkaisia ilmiöitä.

Risk factors for glucose intolerance in active acromegaly

In the present retrospective study we determined the frequency of glucose intolerance in active untreated acromegaly, and searched for risk factors possibly supporting the emergence of the diabetic condition. Among 43 patients, 8 (19%; 95% CI: 8-33%) had diabetes mellitus and 2 (5%; 1-16%) impaired glucose tolerance. No impaired fasting glycemia was demonstrable. The frequency of diabetes was on average 4.5 times higher than in the general Slovak population. Ten factors suspected to support progression to glucose intolerance were studied by comparing the frequency of glucose intolerance between patients with present and absent risk factors. A family history of diabetes and arterial hypertension proved to have a significant promoting effect (P<0.05, chi-square test). A significant association with female gender was demonstrated only after pooling our data with literature data. Concomitant prolactin hypersecretion had a nonsignificant promoting effect. In conclusion, the association of active untreated acromegaly with each of the three categories of glucose intolerance (including impaired fasting glycemia, not yet studied in this connection) was defined as a confidence interval, thus permitting a sound comparison with the findings of future studies. Besides a family history of diabetes, female gender and arterial hypertension were defined as additional, not yet described risk factors.

Effect of asthma severity on symptom perception in childhood asthma

Individual ability to perceive airway obstruction varies substantially. The factors influencing the perception of asthma are probably numerous and not well established in children. The present study was designed to examine the influence of asthma severity, use of preventive medication, age and gender on the association between respiratory symptoms (RS) and peak expiratory flow (PEF) rates in asthmatic children. We followed 92 asthmatic children, aged 6 to 16 years, for five months. Symptom scores were recorded daily and PEF was measured twice a day. The correlations among variables at the within-person level over time were analyzed for each child and for the pooled data by multivariate analysis. After pooling the data, there was a significant (P<0.05) correlation between each symptom and PEF; 60% of the children were accurate perceivers (defined by a statistically significant correlation between symptoms and PEF across time) for diurnal symptoms and 37% for nocturnal symptoms. The accuracy of perception was independent of asthma severity, age, gender or the use of preventive medication. Symptom perception is inaccurate in a substantial number of asthmatic children, independently of clinical severity, age, gender or use of preventive medication. It is not clear why some asthmatic patients are capable of accurately perceiving the severity of airway obstruction while others are not.