DSpace Collection:

Comparative analysis of the asthma phenotypes with and without exercise induced bronchoconstriction in school age children (results of cluster analysis)

2021-01-21T17:59:47Z

Title: Comparative analysis of the asthma phenotypes with and without exercise induced bronchoconstriction in school age children (results of cluster analysis) Authors: Arora, G.K.; Bogutska, N.K. Abstract: Well known association between bronchial asthma (BA) and exercise induced bronchoconstriction (EIB) was revealed long ago, but the exact mechanisms of this association are not fully defined. Patients with persistent moderate and severe BA were included in alternative clinical groups: in particular, 30 children with EIB BA phenotype and 30 patients without EIB BA were examined. EIB was diagnosed in case of the presence of bronchospasm after exercise in the patient’s history and spirometric index of bronchospasm after a dosed physical activity of at least 15%. According to the main characteristics (sex, age and place of residence) the groups were comparable. Hierarchical probabilistic approach and cluster analysis (CA) with the K-means method were used for statistical analysis. While analyzing the clinical and paraclinical characteristics of the phenotypes of BA with and without EIB in school-age children, it was found that a severe variant of the disease, allergic burden only after father's pedigree, the total number of points of clinical manifestations of exacerbation of BA higher than 15 before treatment, complaints of chest tightness during the last exacerbation, higher than 4% eosinophil count and more than 1.0 G/l absolute T lymphocyte content in the peripheral blood, and the need for constant use of short-acting beta-agonists in the remission period statistically significantly increased the chances of diagnosing BA with EIB. The bronchial lability index more than 25% most significantly increased the chances of detecting the BA phenotype with EIB, this diagnostic marker was characterized by significant reproducibility and validity (80%), while bronchial nonspecific hyperresponsiveness test to histamine (PC20H) of inhalation less than 0.8 mg/ml histamine concentration, which caused 20% FEV1 fall, also most significantly increased the chances of diagnosing of BA with EIB in children of school age. CA of a whole cohort of patients indicated a significant clinical similarity of BA phenotypes with and without EIB in children, because the first and second clusters were formed of 56% and 44% and 43% and 57% of children with phenotypes with and without EIB correspondingly. Thus, the results of CA of the cohort of pediatric patients with alternative phenotypes of the disease due to exercise induced bronchoconstriction showed a significant similarity between two clinical subclusters and the difference existed mainly due to markers of atopic reactivity.

Parental psychological characteristics in families of school-age children with severe and moderate persistent bronchial asthma

2021-01-21T17:57:44Z

Title: Parental psychological characteristics in families of school-age children with severe and moderate persistent bronchial asthma Authors: Mohamed, A. A.; Bogutska, N.K. Abstract: In children with any chronic disease the risk of psychological disadaptation disorders is significantly higher in comparison with healthy ones. In order to improve the verification of the severity of the course of bronchial asthma (BA) we investigated the psychological parameters of the patients’ families. The I group was formed by 32 children of school age with severe BA, and the II group included 30 children with moderate persistent BA. Psychological examination of parents was carried out using Parental Attitudes Questionnaire (A. Varga, V. Stolin), family relationships were investigated using Parental Attitude Research Instrument (PARI) by E.S. Schaefer and R.Q. Bell adapted by T.V. Neshcheret. The lower mother’s educational level was poorly correlated with the more severe course of the child’s BA (r=0.30, p<0.02), and the lower general level of education of the family - with a lower degree of disease control (r=0.29, p<0.05). Low / satisfactory children school educational achievements associated with severe BA (OR=2.0; 95%CI:0.9-7.8). According to PARI questionnaire of the families in group of severe BA there were more frequent: problematic aspect of mother's relation to family role (83.3±7.6% vs. 53.3±12.9%, p<0.05); excessive emotional distance with a child (16.7±7.6% vs. 0, p>0.26); excessive concentration on a child (12,5±6,8% vs. 0, p>0,15). Low scores on the scale of the socially desirable parental relationship with the maximum cooperation was noted in 40.9±10.5% in families of children with severe BA vs. 14.3±9.4% in controls (p<0.1) There was a significant difference in the proportion of children in whom parents revealed significant behavioral changes after diagnosis of BA (53.8 vs. 23.6%, OR=3.8; 95%CI:1.0-14.8), which prevailed in the group with severe BA. There was a direct correlation between the existing behavioral changes in children with more severe course (r=0.33, p<0.03) and the lower level of control of BA (r=0.35, p<0.03). Thus, excessive emotional distance in mother-child relationships and problematic aspects of mother's role in family life, as well as changes in the child’s behavior were revealed in families of patients with severe BA, which associated with more pronounced manifestations of the disease. Excessive mother’s concentration in the child correlated with the less pronounced characteristics of child’s BA.

Anxiety, alexithymia and attitude to the disease in children with severe bronchial asthma

2021-01-21T17:58:41Z

Title: Anxiety, alexithymia and attitude to the disease in children with severe bronchial asthma Authors: Brar, J.S.; Bogutska, N.K. Abstract: The study of psychological characteristics of the children with bronchial asthma (BA) is extremely relevant in determining the severity of the course of the disease. The purpose of the study was to examine associations between BA severity and personal psychological characteristics. Levels of state (SA), trait (TA) and school anxiety (ScA) with self-reported State Trait Anxiety Inventory (Spielberger and Hanin), School Anxiety Inventory (Phillips) were examined, a Bekhterev institute personality questionnaire (LOBI) was used in order to diagnose the types of attitudes to BA, an adapted Toronto Alexithymia Scale (by G. Taylor) was used to detect alexithymia. The first clinical group was formed by 32 children with severe BA, and the II group of comparison included 30 children with moderate BA (GINA). High TA scores were observed in 26.6±1.7% of patients with severe BA versus 9.1±6.1% of children in control group (OR=4,0; 95%CI:0,75-21,2). High SA scores were revealed in 25±8.2% versus 22.7±8.3% of patients with severe and nonsevere BA correspondingly (p>0.05). The patients’ TA levels were associated with more severe children’s fears (r=0.3; p<0.03) and the presence of early warning signs of the BA attack (r=0.3; p <0.04). The experience of child’s social stress was associated with night attacks (r = 0.27; p <0.04). The higher level of ScA correlated with a child’s negative attitude to the need of daily medicines use (r=0.3; p<0.03) and higher scores of the bronchial lability (r=0.36; p<0.01). The high level of SA was a predictor of the lower efficacy of control treatment with inhaled corticosteroids (r=-0.6; p<0.02). The mean scores of the Toronto Alexithymia Scale were 71.2±2.1 versus 70.3±2.7 in groups of comparison (p>0.05), however, the presence of alexithymia correlated with the number of asthma attacks per year (r=0.36; p<0.05), the negative attitude toward hospitalization (r=0.37; p<0.04) and the need of daily intake of drugs (r=0.26; p<0.05). The neurasthenic and / or sensitized type of attitude to the disease was more often noted in children with severe asthma (OR=5.3; 95% CI:1.3-24.7), and euphoric / anosognosic types of attitudes were associated with lower levels of disease control and non-compliance to basic therapy. Thus, there was a tendency to higher TA, ScA and presence of the neurasthenic and / or sensitized type of attitude to the disease in children with severe BA.

Basic cardiopulmonary resuscitation graduates’training with pediatric manikins

2021-01-21T17:59:05Z

Title: Basic cardiopulmonary resuscitation graduates’training with pediatric manikins Authors: Bogutska, N.K. Abstract: Approved national pediatric cardiopulmonary resuscitation (CPR) recommendations are not still available in Ukraine, nevertheless CPR history starts since 1740, when the Paris Academy of Sciences offi cially recommended mouthto-mouth resuscitation for drowning victims. In 1960 modern CPR was developed. In 2005 American Heart Association (AHA) developed a revolutionary product that allowed anyone to learn the core skills of basic CPR, use of automated external defi brillators (AED) and choking relief in just 20 minutes. In 2015 some Pediatric basic life support (PBLS) guideline changes have been made both by European Resuscitation Council and AHA with slight differences in approaches. CPR practical skill with peculiarities in childhood is a stage of a fi nal practically oriented exam in Pediatrics. We have chosen AHA PBLS guidelines for graduates’ training in 2017-2018 as a stage in preparing to the fi nal exam in Pediatrics. The aim of the CPR training was to recognize need of CPR and master basic CPR skills in children of two age groups (up to 1 year old and 1-8 years old) except neonates. In order to achieve this aim the following components were included in the course: high-quality CPR for children and infants; the chain of survival, specifi cally the BLS components; use of an AED; effective ventilations using a barrier device; importance of teams in multirescuer resuscitation and performance as an effective team member during multirescuer CPR; relief of foreign-body airway obstruction (choking) for infants and elder children. Two low-fi delity and one mid-fi delity manikins (two infants, one toddler) were used to master CPR skills. Training class was incorporated within module 5 for Ukrainian speaking 6 year students (medical faculty ¹2, groups ¹23-31, medical faculty ¹4, groups ¹1-4, specialty “Pediatrics”, “Medical Psychology”) and modules 5/6 for English speaking groups ¹41-51, medical faculty ¹2, totally 25 groups, 19 of which already have passed the training course. The place of course was a modernly equipped class based on the Chernivtsi Hospital for Emergency Care. The course duration was 1,5 hours. Finally course was divided in 7 stages: (1) initial paper testing – 10 min; (2) instructor’s introduction – 5 min; (3) demonstration of 6 short training videos – 25 min; (4) comments and discussion – 5 min; (5) students’ practice with manikins – 30 min; (6) cross-exam and debriefi ng – 5 min; (7) fi nal paper testing – 10 min. Testing (stages 1 and 7) was approved since spring semester. Teachers previously were trained by certifi ed instructor working in the Intensive Care Unit of the Municipal Medical Institution “Regional Children’s Clinical Hospital”. Totally 6 trained teachers played a role of instructors. Students (groups of 5 up to 15) were working with the teacher/instructor to complete BLS skills practice and skills testing. Students also complete a written initial and fi nal testing. Youtube video-based course with real scenarios was demonstrated via big smart board. Instructor-led, hands-on practical class training format reinforced skills profi ciency. Emphasis is done on high-quality CPR including a team dynamics classroom activity especially in stages 4-6. In the instructor-led course, students participated in simulated clinical scenarios and learning stations. Recommended by AHA duration for full BLS provider course is approximately 4.5 hours to complete, and for BLS renewal course is approximately 3 hours to complete, including skills practice and testing, which means that our training was at least twice shorter as compared to minimal recommended by AHA such course duration. Shortening may be explained by the need of mastering only pediatric peculiarities of BLS. One more discussed issue was the availability of the AED use in Ukraine, especially for the pediatric patients. Nevertheless students have passed some CPR training on another departments, initially they demonstrated some skills loss, especially due to recent frequent CPR updates. Conclusions. Pediatric basic CPR training course allowed to master the basics of child CPR with breaths, child choking relief and general awareness of AED. The BLS course trained students to promptly recognize several life-threatening emergencies, give high-quality chest compressions, deliver appropriate ventilations and provide early use of an AED. Recommendations of diminishing number of students up to 6 in a group, increase of the course duration up to 3 hours and questionable duration of validity of the completed basic CPR training are to be discussed.