The current and long-term effects of famine and malnutrition on cognitive and behavioral development are reviewed. The brain is vulnerable to the effects of insults during critical periods of brain development from the second trimester of pregnancy until 2 years of age. Malnutrition experienced at these ages will have lifelong consequences that are not reversed by adequate nutrition. Long-term effects of prenatal, postnatal and childhood malnutrition have been reported even after a long period of recovery from the illness itself. We summarize results of our longitudinal study in Barbados in which we followed individuals, now 28-34 years of age, who experienced moderate to severe malnutrition during their first year of life and a healthy comparison group from the same classrooms. Our studies showed that malnutrition had a negative impact on cognitive and behavioral functioning throughout childhood and adolescence, even after controlling for socioeconomic conditions and other factors in the home environment. The most striking finding in our series of studies was a fourfold increase from 15% to 60% in the frequency of attention deficit disorder following infantile malnutrition. Attention deficits persisted at least through adolescence and was closely associated with poor performance on a national high school examination at 11 years of age. We conclude that, under conditions of famine, it is important to include early and comprehensive interventions to reverse not only medical conditions resulting from malnutrition, but also cognitive and behavioral deficits arising from famine. In the absence of appropriate interventions, compromised behavioral function may continue long beyond the episode, may impact on the quality of life over the longterm of survivors, and increase costs to society.
Poster sessions
A184Thorax 2012;67(Suppl 2):A1-A204exacerbations was calculated from 01-01-1999 to 31-12-2003. To explore the potential relationship between exacerbations and comorbidities, we also explored antibiotic and antiviral prescriptions as well as treatments for seasonal allergic rhinitis in this cohort.Results 38,439 patients with current asthma were identified. Prednisolone exacerbations decreased from the beginning of the year until summer, at which point there was a peak in June (Figure: solid line). They then increased in autumn peaking at the end of October, then increasing throughout winter. During the summer there was a similar peak observed in both prednisolone exacerbations and seasonal allergic rhinitis prescriptions in this cohort. From September through to May the trends observed in prednisolone exacerbations were similar to those seen in antiviral and antibiotic prescriptions. Conclusions Within the seasonal trends observed, there appears to be some correlation between the summer peak in exacerbations and seasonal allergic rhinitis prescriptions. There are also similarities seen in exacerbations during the beginning and end of the year and antibiotic and antiviral prescriptions. These findings suggest that infections and seasonal allergic rhinitis might be drivers for asthma exacerbations in adults.Abstract P273 Figure 1
AbstractsArch Dis Child 2013;98(Suppl 1):A1-A117 A65 toothpaste fluoride concentrations, brushing techniques, and frequency of dental visits. Results 50 staff members were approached; 30 doctors and 20 nurses. 38% had more than 10 years' experience.Abstract G137(P) Table 1
Overall INP prescribing was found to be safe and effective. This review enabled education of the respiratory team of prescribing practices via a local audit meeting. The positive contribution that INPs provide to patient care was highlighted as they improve the patient journey and support the MDT. The demand for INP prescribing in particular with CF has provided opportunity for a pharmacist prescriber to join the CF MDT. It is recommended medical and pharmacist prescribing to be reviewed.
Omalizumab is effective treatment for patients with severe asthma. It is reserved for patients with truly severe disease as it is expensive and associated with significant treatment burden. Identifying this small number of patients in problematic severe asthma (PSA) group is challenging. We evaluated the impact of multidisciplinary severe asthma (SA) protocol on identifying those with severe disease and on potential use of omalizumab. After initial clinic visit, 19 patients aged between 6-15yrs with PSA underwent specialist nurse led SA protocol which included: assessment of clinical status, lung function, atopy, inhaler technique, asthma control test (ACT), quality of life (QoL); home visit for further assessment of environment, adherence and psychosocial comorbidities; school contact to address impact on education. Before SA protocol, 17/19 patients met criteria for use of omalizumab. After SA protocol, only 6(35%)were eligible as modifiable factors were identified in 11(65%). They included poor adherence, ongoing allergen exposure and psychological issues. 5/6 patients received omalizumab and 4(80%) improved. Of other 11 patients, clinical status improved in 6 (55%), unchanged but stable in 4(36%), worsened in 1(9%) after assessment. SA protocol identified modifiable factors in significant proportion of PSA children limiting omalizumab use to those with truly severe disease. Home visit assessment is essential to identify these factors which would otherwise be unrecognised. We hypothesise that proper recognition and management of these factors might not only ensure appropriate use of omalizumab but also improve its effectiveness.
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