Upper Respiratory Infections (upper + respiratory_infections)

Distribution by Scientific Domains

Selected Abstracts

Viral Upper Respiratory Infections

APRN-C, Mary Jo Goolsby EdD
Clinical practice guidelines (CPG) hold great potential for providing a summary of large volumes of clinical evidence and a related set of practical recommendations. Nurse practitioners should become aware of the range of available CPGs and methods by which they can be evaluated for use. Appropriate evaluation of CPGs should include their overall reliability and validity, as well as their applicability in specific situations. This article is part of an ongoing series presenting individual CPGs. [source]

Declining Antibiotic Prescriptions for Upper Respiratory Infections, 1993,2004

Stefan G. Vanderweil BA
Abstract Objectives: To examine antibiotic prescribing trends for U.S. emergency department (ED) visits with upper respiratory tract infections (URIs) between 1993 and 2004. Methods: Data were compiled from the National Hospital Ambulatory Medical Care Survey (NHAMCS). URI visits were identified by using ICD-9-CM code 465.9, whereas antibiotics were identified using the National Drug Code Directory class Antimicrobials. A multivariate logistic regression model revealed sociodemographic and geographic factors that were independently associated with receipt of an antibiotic prescription for URIs. Results: There were approximately 23.4 million ED visits diagnosed as URIs between 1993 and 2004. Although the proportion of URI diagnoses remained relatively stable (p trend = 0.26), a significant decrease in provision of antibiotic prescriptions for URIs occurred during this 12-year period, from a maximum of 55% in 1993, to a minimum of 35% in 2004. Patients who were prescribed antibiotics were more likely to be white than African American and to have been treated in EDs located in the southern United States. Conclusions: Antibiotic prescribing for URIs continues to decrease, a favorable trend that suggests that national efforts to reduce inappropriate antibiotic usage are having some success. Nevertheless, the frequency of antibiotic treatment for URI in the ED remains high (35%). Future efforts to reduce inappropriate antibiotic prescribing may focus on patients and physicians in southern U.S. EDs. Additional work is needed to address continued evidence of race-related disparities in care. [source]

Seasonal variation of enteric infections and inflammatory bowel disease

Amnon Sonnenberg MD
Abstract Background: The time trends of inflammatory bowel disease are characterized by short-term variations that affect Crohn's disease and ulcerative colitis alike. The aim of the present study was to test whether these variations might be related to exacerbations of inflammatory bowel disease secondary to superimposed gastrointestinal infection. Methods: The Hospital Episode Statistics (HES) comprises a data set of all patients admitted to hospitals throughout England, which includes inpatients and day cases. This data set was used to analyze the monthly variations in all hospital admissions for Crohn's disease (ICD10 code K50), ulcerative colitis (K51), bacterial intestinal infections (A04), viral intestinal infections (A08), diarrhea and infectious gastroenteritis (A09), upper respiratory infections (J06), pneumonia secondary to unspecified organism (J18), and unspecified acute lower respiratory infection (J22). Results: The temporal analysis revealed similar monthly fluctuations of hospital admissions for Crohn's disease, ulcerative colitis, and bacterial intestinal infections. Viral intestinal infections and infectious gastroenteritis were characterized by different seasonal variations that showed no relationship with any of the fluctuations of inflammatory bowel disease or bacterial intestinal infections. Similarly, respiratory infections resulted in marked cyclical variations in hospital admissions unrelated to any changes in inflammatory bowel disease or enteric infections. Conclusions: The similarity in the time trends of Crohn's disease, ulcerative colitis, and bacterial intestinal infections suggests that superinfection by intestinal bacteria are responsible for the fluctuations in hospital admissions for inflammatory bowel disease. (Inflamm Bowel Dis 2008) [source]

Influence of antigenic drift on the intensity of influenza outbreaks: Upper respiratory tract infections of military conscripts in Finland

Reijo Pyhl
Abstract A total of 102,600 upper respiratory infections (URI) were recorded among young military conscripts in the Finnish Defence Forces during the study period from October 1991 to March 1994. This period covered three outbreaks caused by H3N2-subtype influenza A virus and one outbreak of influenza B. During the 1991/92 outbreak caused by A/Beijing/353/89-like virus, the calculated influenza A incidence was 2,206/10,000 men. During the 1992/93 outbreak when influenza B was the predominant virus, a new drift variant of influenza A that belonged to the lineage of A/Beijing/32/92-like and A/Shangdong/9/93-like viruses circulated but the incidence of influenza A was not more than 1,044/10,000. A higher incidence, 2,810/10,000, was recorded during the 1993/94 outbreak, when the circulating virus was similar to the 1992/93 virus antigenically and with regard to haemagglutinin and neuraminidase (NA) gene sequences. Crossreactive haemagglutination-inhibition antibodies induced in 1991/92 probably were sufficient to restrict the epidemic activity in 1992/93 but no longer in 1993/94. Furthermore, during the 1991/92 outbreak, some of the A/Beijing/353/89-like viruses already had shared the NA sequence markers characteristic of the viruses in 1992/93 and 1993/94, which may also have strengthened protection in 1992/93. J. Med. Virol. 72:275,280, 2004. 2004 Wiley-Liss, Inc. [source]

Occurrence and management of acute respiratory illnesses in early childhood

Merci MH Kusel
Aim: Acute respiratory illnesses (ARI) impose massive economic burden on health services. The growing costs, limited benefits of pharmacotherapeutic agents, and alarming rise in antibiotic resistance poses a major health challenge. Analysis of the nature and burden of ARI through well-designed epidemiologic studies will help in the development of a uniform public health approach to identify methods to reduce disease transmission and maximise prevention strategies. The aim of this study was to analyse the nature and magnitude of the burden of ARI encountered by a cohort of children in the first 5 years of life. Methods: This community-based prospective study of ARI followed a cohort of children from birth until 5 years of age. Information on all episodes of ARI encountered, and their management, was collected through daily symptom diary and fortnightly telephone calls. Results: Four episodes of ARI/year were reported in the first 2 years and 2,3 episodes/year between 2 and 5 years. The majority were upper respiratory infections. 53% had at least one lower respiratory infection in the first year. For the majority, symptoms lasted 1,2 weeks. 53% were treated with antitussives or cough mixtures, 44% with paracetamol and 23% with antibiotics. A total of 46% of the episodes presented to a family physician, with younger children and those with lower respiratory infection more likely to seek attention. Conclusion: ARI are common in childhood and although symptoms may last for 4 weeks, the majority resolve spontaneously. Use of medication does not appear to significantly alter the course or duration of symptoms of ARI. [source]

Nurse Practitioner Student Prescriptive Patterns

CS-FNP M, Susan A. Fontana PhD
ABSTRACT As employment of nurse practitioners (NPs) increases in health care systems, there is a need to have current data on their prescribing practices and patterns, and to implement a system for updating such data. This study reports prescriptive data based upon 10,421 primary care visits conducted by 55 family NP students over a 15-month period in 1997 and 1998. Numbers of over-the-counter drugs taken regularly, prescription drugs currently prescribed and prescription drugs prescribed or refilled at the visit were recorded in addition to types of drugs, compliance issues, diagnoses rendered and socio-demographic information. Individual student data were aggregated and analyzed using Epi Info (Epidimiology Program Office of the Centers for Disease Control) and SPSS-PC. Results identified that: 1) the majority of patient visits involved the prescription of 1-2 drugs (88%); 2) major compliance issues included financial concerns, knowledge deficits, and complexity/demands of treatment; 3) commonly rendered diagnoses at drug visits for chronic conditions were hypertension and diabetes; for acute conditions, otitis sinusitis and upper respiratory infections; 4) anti-microbial agents, drugs used for relief of pain, and cardiovascular drugs account for 60% of drug mentions; and 5) the numbers of drugs prescribed or refilled at visits were similar by type of preceptor, except fewer single drugs were prescribed or refilled at visits supervised by nurse preceptors. Findings are discussed relative to deepening the understanding of advanced practice nursing education and the prescribing practices of NP students and their preceptors. [source]

Ozone exposure and its influence on the worsening of childhood asthma

ALLERGY, Issue 7 2009
S. I. V. Sousa
Background:, It is well documented that high levels of many airborne pollutants can adversely affect many systems of the human body. The aim of this study was to evaluate the specific impact of ozone (O3) on the worsening of childhood asthma, comparing children living at regions with high and low O3 concentrations (reference site) without the confounding effects of other pollutants. Methods:, Pollutant concentrations were monitored and data concerning asthma prevalence were collected through a questionnaire. The studied population consisted of 478 children aged 6,13 years old enrolled in four schools of the municipalities where monitoring was performed. Remote sites were identified with very low concentrations of nitrogen dioxide and volatile organic compounds and high concentrations of O3. Results:, The prevalence of wheeze for lifetime period and in the past year was 15.9% and 6.3%, respectively. Asthmatic children were identified when dyspnoea and wheezing were simultaneously mentioned in the absence of upper respiratory infections; according to that, the lifetime prevalence of asthmatic symptoms at the remote sites was 7.1%. The comparison with other previous studies was difficult because the criteria for analysis are not conveniently established. Conclusion:, The prevalence of childhood asthmatic symptoms was about 4% higher at the high O3 site than at the low O3 site. [source]

Psoriasis in childhood and adolescence: evaluation of demographic and clinical features

Abstract Background: The present study was aimed to define the gender ratio, familial occurrence, age of onset, precipitating factors, clinical types, nail and joint involvement of psoriasis in childhood and adolescence in Turkey. Methods: A total of 61 children with psoriasis under 18 years old were evaluated retrospectively, for age, gender, age of disease onset, family history, concomitant disease, the clinical type of psoriasis, clinical localization, nail and joint involvement and treatment modalities. Results: Of the patients, 23 (37.70%) were boys and 38 (62.30%) were girls. Mean age was 9.28 4.02 years in girls and 11.18 3.85 years in boys (9.96 4.03 years in all children). Mean age at the onset of the disease was 6.81 4.11 years in girls and 7.03 4.28 years in boys (6.89 4.14 years in all patients). In 14 (23%) cases, a positive family history was detected. The most frequent probable triggering factors were upper respiratory tract infections (14.8%) and positive throat culture for A group -hemolytic streptococcus (21.3%). Frequency of emotional stress and psychiatric morbidity were 54% and 9.8%, respectively. The most frequent localizations at onset were trunk (44.3%), extremities (54.0%), and scalp (36.0%). Three children (4.9%) had a history of dissemination from psoriatic diaper rash. In total, 51 (83.6%) patients presented with psoriasis vulgaris, eight (13.1%) with generalized pustular psoriasis, and the remaining two (3.3%) with erythrodermic psoriasis. Conclusion: The incidence of psoriasis among dermatological patients in childhood and adolescence was 3.8%. The disease tends to appear earlier in girls than boys. The authors suggested that stress and upper respiratory infections are the most important triggering factors in childhood and adolescence psoriasis. [source]

Rhinovirus enhances various bacterial adhesions to nasal epithelial cells simultaneously

Jong Hwan Wang MD
Abstract Objectives/Hypothesis: Viral upper respiratory tract infections are often followed by secondary bacterial infections in the form of acute rhinosinusitis. We investigate the effect of rhinovirus infection on the expression of cell adhesion molecules and bacterial adherence to primary human nasal epithelial cells. Methods: Cells were infected with rhinovirus serotype 16 (RV-16), and then Staphylococcus aureus, Streptococcus pneumoniae, or Hemophilus influenzae were added to the culture. Rhinovirus-induced expression of fibronectin, platelet-activating factor receptor, and carcinoembryonic antigen-related cell adhesion molecule, was assayed by confocal microscopy, real-time polymerase chain reaction, and Western blot analysis. Bacterial adhesion to cells was assessed by confocal microscopy and the fluorescence intensity of adherent bacteria was analyzed using Image-Pro Plus 5.1 (Media Cybernetics, Inc., Bethesda, MD). Results: RV-16 infection significantly increased the gene and protein expression of fibronectin, platelet-activating factor receptor, and carcinoembryonic antigen-related cell adhesion molecule in nasal epithelial cells. Compared with rhinovirus-uninfected control cells, the adhesion of S. aureus, S. pneumoniae, and H. influenzae increased significantly to 2.53-fold, 1.51-fold, and 2.74-fold of control levels, respectively, in rhinovirus-infected nasal epithelial cells. Conclusions: These findings suggest that increased expression of host cell adhesion molecules may be the mechanism accounting for the increase in susceptibility to bacterial rhinosinusitis associated with rhinovirus-induced upper respiratory infections. Laryngoscope, 2009 [source]

Otolaryngologic Aspects of the Lewis & Clark Expedition, 1803,1806,

Marc D. Eisen MD
Abstract Medical difficulties related to otolaryngology that occurred during the Lewis & Clark Expedition (1803,1806) are highlighted. These difficulties included ear and face frostbite, upper respiratory infections, temporal vessel laceration from an air gun accident, neck scrofula, and a pediatric neck mass. The custom of Clatsop Indian head flattening is also described. These descriptions also aim to illustrate the state of otolaryngology during the early 19th century in America. [source]

Antibiotic Prescriptions Are Associated with Increased Patient Satisfaction With Emergency Department Visits for Acute Respiratory Tract Infections

Cordelia R. Stearns
Abstract Objectives:, Health care providers cite patient satisfaction as a common reason for prescribing antibiotics for viral acute upper respiratory infections (URIs), even though quality performance measures emphasize nonantibiotic treatment for these conditions. In a secondary analysis of a cluster-randomized trial to test a combined patient and physician educational intervention to reduce antibiotic prescribing for URIs, the authors examined whether satisfaction is greater among patients diagnosed with URIs who are prescribed antibiotics in emergency department (ED) settings. Methods:, This was a follow-up telephone survey of 959 patients who received care for acute respiratory infections at any of eight Veterans Administration (VA) hospital EDs or eight location-matched non-VA hospital EDs around the United States. Patients reported their satisfaction with the amount of time spent in the ED, the explanation of treatment, the provider treatment, and overall satisfaction on a five-point Likert scale. The primary measure of effect was the association between antibiotic prescription and visit satisfaction, adjusted for patient and visit characteristics. Results:, Antibiotic treatment was significantly associated with increased overall visit satisfaction in non-VA EDs (adjusted odds ratio [OR] = 1.97, 95% confidence interval [CI] = 1.23 to 3.17), but not VA EDs (adjusted OR = 1.13, 95% CI = 0.81 to 1.58). Patients managed in non-VA EDs who received antibiotics were also significantly more likely to be satisfied with the explanation of treatment and the manner in which they were treated by the provider. Conclusions:, Antibiotic prescriptions are associated with increased overall patient satisfaction in non-VA, but not VA, ED visits for URIs. Continued efforts to reduce unnecessary prescriptions in these settings must address ways to maintain patient satisfaction and still reduce antibiotic prescriptions. [source]

Paediatric utilization of a general emergency department in a developing country

AY Goh
Aim: Knowledge of the spectrum and frequencies of paediatric emergencies presenting to an emergency department (ED) of individual developing countries is vital in optimizing the quality of care delivered locally. Methods: A prospective 6 wk review of all paediatric (< 18y) attendees to an urban ED was done, with patient age, presenting complaints, diagnoses, time of arrival and disposition recorded. Results: Complete data were available on 1172 patients, with an age range of 4 d to 18 y (mean SD 6.9 5.6 y); 43% were aged ,4 y. The main presenting complaints were injuries (26.9%), fever (24%) and breathing difficulties (16.6%). The most common diagnosis was minor trauma (24.2%), with soft-tissue injuries predominating (80.6%). The other diagnoses were asthma (12.6%), upper respiratory infections (12.1%), other infections (12.1%) and gastroenteritis (11.8%). Equal proportions of patients were seen throughout the day. 25% of patients were admitted. Young age (<1 y); presence of past medical history, general practitioner referrals, diagnosis of bronchiolitis and pneumonia were significantly associated with risk of admission. Conclusion: A wide spectrum of paediatric illnesses was seen in the ED, with an overrepresentation of young children. This supports the decision to have either a separate paediatric ED or paediatric residents on the staff. The training curricula should emphasize the management of paediatric trauma, infections and asthma. Alternatively, developing guidelines for the five most common presenting complaints would account for 82% of all attendees and could be directed towards all staff on the ED. [source]

Disease patterns of outpatient visits by Japanese expatriate children in Thailand

Rie Sakai
Abstract Aim: To clarify the health-related conditions of Japanese expatriate children in Thailand. Methods: Records of Japanese children who consulted outpatient clinics at Bangkok Hospital in 2005 and 2006 (n = 2141) were analysed, and then compared with data from the patient survey conducted by the Ministry of Health, Labour and Welfare of Japan in 2005 (n = 575 400). Results: ,diseases of the respiratory system', categorized as chapter X under ICD-10 was the most frequent category in both Thailand and Japan. Although ,certain infectious and parasitic diseases' (chapter I) was the second most frequent category in Thailand, it was infrequent in Japan. In the subcategories of ,diseases of the respiratory system', ,acute upper respiratory infections' was frequent and asthma was infrequent in Thailand. Conversely, ,acute upper respiratory infections' showed a low percentage and asthma was the most frequently observed disease in Japan. Conclusion: This study examined Japanese children having the same genetic background but divided into two groups according to different living environments. Results demonstrate that children living in Japan contract asthma more frequently than infectious diseases, whereas those living in Thailand show the opposite trend, which supports the hygiene hypothesis that infections may protect against the development of allergic diseases, such as asthma. [source]