American National Health Research Articles

Using weight-for-age as a screening tool for metabolic syndrome in apparently healthy adolescents.

The increasing prevalence of metabolic syndrome (MetS) among adolescents necessitates a simple and easy-to-use screening tool. This study aimed to develop and validate a simple model based on age, sex, race, and weight-for-age or BMI-for-age to identify adolescents with MetS. A cross-sectional study of adolescents (aged 12-18 years) who participated in the American National Health and Nutrition Examination Survey (NHANES) was performed. Participants with pre-existing hypertension, diabetes or dyslipidemia were excluded. Data from 2005-2018 were randomly divided into training (70%) and validation (30%) sets. Anthropometric, demographic data, and MetS criteria were extracted. The training group included 1974 adolescents (52% boys, median age 15 years), and the validation group included 848 adolescents (50% boys, median age 14 years). Both weight- and BMI-for-age demonstrated good discrimination ability in the training group (AUC = 0.897 and 0.902, respectively), with no significant difference between them (p = 0.344). Multivariable models showed similar discrimination ability. Therefore, weight-for-age was chosen and using Youden's index, the 93rd weight-for-age percentile (SDS 1.5) was identified as the optimal cut-off value for MetS. Similar values were observed in the validation group. Among adolescents aged 12-18 years, weight-for-age percentiles are an easy-to-use primary screening indicator for the presence of MetS. The prevalence of metabolic syndrome in adolescents is increasing. An early detection screening tool is required to prevent related adulthood morbidity. Screening adolescents for metabolic syndrome is challenging. This study suggests the use of weight-for-age as a single criterion for primary screening of adolescents aged 12-18. Using weight-for-age as a single predictor of metabolic syndrome is expected to increase screening rates compared to using BMI-for-age, due to its simplicity.

Concordance between essential medicines lists and diabetes guidelines in Latin America and the CaribbeanConcordância entre as listas de medicamentos essenciais e diretrizes para diabetes na América Latina e no Caribe

Conduct an analysis to determine the existence and updating of national essential medicines lists (EMLs) and clinical practice guidelines (CPGs) for the treatment of diabetes in Latin America and the Caribbean (LAC); and compare the medicines included in each country's list and guidelines both with each other and with those of the World Health Organization (WHO). Cross-sectional study. EMLs and CPGs for diabetes were found on the websites of the Pan American Health Organization and national health authorities. Medicines were noted and analyzed according to pharmacological group, based on the fourth level of nomenclature of the Anatomical Therapeutic Chemical (ATC) classification system. F1 scoring was used to assess the proximity of EMLs to the WHO Model List of Essential Medicines (MLEM). Of the total number of countries, 87.2% have EMLs, and 91% have CPGs (78% and 45% updated in the last five years, respectively). Compared to the six hypoglycemic groups of the MLEM, the EMLs had a median (range) of 6 (4-13) and an F1 score of 0.80; This indicates proper alignment. CPGs had a median (range) of 12 (1-12) hypoglycemic drugs compared to eight in the WHO guidelines. CPGs had a median of 15 more drugs than their respective EMLs. While most LAC countries have EMLs and CPGs for diabetes, the lack of concordance among them limits their effectiveness. It is necessary to align the processes and criteria for the development of these two tools for policymaking on medicines.

Assessing pandemic preparedness, response, and lessons learned from the COVID-19 pandemic in four south American countries: agenda for the future.

The COVID-19 pandemic emerged in a context that lacked adequate prevention, preparedness, and response (PPR) activities, and global, regional, and national leadership. South American countries were among world's hardest hit by the pandemic, accounting for 10.1% of total cases and 20.1% of global deaths. This study explores how pandemic PPR were affected by political, socioeconomic, and health system contexts as well as how PPR may have shaped pandemic outcomes in Argentina, Brazil, Colombia, and Peru. We then identify lessons learned and advance an agenda for improving PPR capacity at regional and national levels. We do this through a mixed-methods sequential explanatory study in four South American countries based on structured interviews and focus groups with elite policy makers. The results of our study demonstrate that structural and contextual barriers limited PPR activities at political, social, and economic levels in each country, as well as through the structure of the health care system. Respondents believe that top-level government officials had insufficient political will for prioritizing pandemic PPR and post-COVID-19 recovery programs within their countries' health agendas. We recommend a regional COVID-19 task force, post-pandemic recovery, social and economic protection for vulnerable groups, improved primary health care and surveillance systems, risk communication strategies, and community engagement to place pandemic PPR on Argentina, Brazil, Colombia, and Peru and other South American countries' national public health agendas.

Value of C-Reactive Protein-Triglyceride Glucose Index in Predicting Cancer Mortality in the General Population: Results from National Health and Nutrition Examination Survey

Background Cancer is one of the leading causes of death. The current work aims to investigate the association between C-reactive protein-triglyceride glucose index (CTI) and the risk of incident cancer mortality and to evaluate the usefulness of CTI to refine the risk stratification of cancer mortality. Methods The study enrolled 19,957 subjects from American National Health and Nutrition Examination Survey. CTI was defined as 0.412*Ln(CRP) + ln[T.G. (mg/dL) × FPG (mg/dL)/2]. Cox regression was performed to investigate the association. Results During a follow-up of 215417.52 person-years, 736 subjects died due to malignant tumors, and the incidence of cancer mortality was 3.42 per 1,000 person-years. Kaplan–Meier curve revealed that the fourth quartile group had the lowest cancer mortality-free rate (Log-Rank p < 0.001). After full adjustment, each SD increase of CTI cast a 32.7% additional risk of incident cancer mortality. Furthermore, cancer mortality risk elevated proportionally with the increase of CTI. Finally, ROC and reclassification analyses supported the usefulness of CTI in improving the risk stratification of incident cancer mortality. Conclusion The study revealed a significant association between CTI and cancer mortality risk, suggesting the value of CTI in improving the risk stratification of incident cancer mortality. KEY MESAGES C-reactive protein-triglyceride glucose index (CTI) is positively associated with cancer mortality risk in the general population. The association was linear in the whole range of CTI. CTI could improve the risk prediction of cancer mortality in the general population.

A new metabolic syndrome prediction model for self-evaluation as a primary screening tool in an apparently MetS-free population

BackgroundMetabolic syndrome (MetS) is a growing global public health concern associated with increased morbidity and mortality. The study aimed to establish a simple self-evaluated prediction model to identify MetS. MethodsA cross-sectional study based on the American National Health and Nutrition Examination Survey database was performed. Participants aged ≥20 in the 2009–2018 surveys, with no current pregnancy or major morbidities, were included. The model was built with data from 2009 to 2016 and validated using 2017–2018 data. MetS was defined according to AHA/NHLBI guidelines. Multivariable logistic regression was applied to build a prediction model. The area under the receiver operating characteristic curve (AUC) was used to assess the discrimination ability and the maximal Youden's index was used to identify the optimal cut-off value. ResultsThe study included 4245 individuals (median age 37, IQR 28–49, 51.8% females) in the training group and 911 individuals (median age 37, IQR 28–52, 52.5% females) in the validation group. Older age, male gender, non-Black race, no postsecondary education, and higher BMI were significantly associated with increased risk of MetS. The final model included age, gender, race, education, and BMI, and showed good discrimination ability (AUC = 0.810, 95% CI 0.793–0.827, sensitivity 80.4%, specificity 66.2%, positive likelihood ratio 2.379, negative likelihood ratio 0.296, PPV 59.6% and NPV 84.5%). ConclusionA new model for self-evaluation may serve as a primary, easy-to-use screening tool to identify MetS in an apparently MetS-free population. A simple application may serve for primary and secondary prevention, thus enabling risk reduction in the development of cardiovascular morbidity and health expenditure.

Resilience Family of Receiver Operating Characteristic Curves

A new semiparameteric model of the receiver operating characteristic (ROC) curve based on the resilience family or proportional reversed hazard family is proposed, which is an alternative to the existing models. The resulting ROC curve and its summary indices (such as area under the curve and Youden index) have simple analytic forms. The partial likelihood method is applied to estimate the ROC curve. Moreover, the estimation methodologies of the resilience family of the ROC curve have been developed based on area under the curve estimators exploiting Mann&#x2013;Whitney statistics and the Rojo approach. A simulation study has been carried out to assess the performance of all considered estimators. Real data from the American National Health and Nutrition Examination Survey has been analyzed in detail based on the proposed model and the usual binormal model prevalent in the literature. Real data in the context of brain injury-related biomarkers are also analyzed in order to compare our model with the Lehmann family of the ROC curves. Finally, we show that the proposed model may be applicable in the misspecification scenario through the Ducheme muscular dystrophy data.

The relationship between vitamin K and metabolic dysfunction-associated fatty liver disease among the United States population: National Health and Nutrition Examination Survey 2017-2018.

The effect of vitamin K is associated with several pathological processes in fatty liver. However, the association between vitamin K levels and metabolic dysfunction-associated fatty liver disease (MAFLD) remains unclear. Here, we investigated the relationship between vitamin K intake and MAFLD risk by employing the American National Health and Nutrition Examination Surveys (NHANES) including 3,571 participants. MAFLD was defined as hepatic steatosis with one or more of the following: overweight or obesity, type 2 diabetes, or >2 other metabolic risk abnormalities. The total vitamin K was the sum of dietary and supplement dietary intake. The relationship of between log10(vitamin K) and MAFLD was investigated using survey-weighted logistic regression and stratified analysis, with or without dietary supplementation. The MAFLD population had a lower vitamin K intake than the non-MAFLD population (p = 0.024). Vitamin K levels were inversely associated with MAFLD in the fully adjusted model (OR = 0.488, 95% CI: 0.302-0.787, p = 0.006). Consistent results were seen in the group without dietary supplements (OR = 0.373, 95% CI: 0.186-0.751, p = 0.009) but not in the group consuming dietary supplements (OR = 0.489, 95% CI: 0.238-1.001, p = 0.050). Vitamin K intake may be a protective factor for MAFLD, especially for individual not using dietary supplements. Nevertheless, more high-quality prospective studies are needed to clarify the causal relationship between them.

Association Between Different Parameters of Adipose Distribution and Transient Elastography-Assessed Hepatic Steatosis in American Adults with Diabetes, Prediabetes and Normal Glucose Tolerance.

To investigate the association between adipose distribution and hepatic steatosis in American adults and to assess whether this association varies among different blood glucose states. Data from the American National Health and Nutrition Examination Survey (NHANES) 2017-2018 were analyzed. The subjects were divided into three groups: diabetes, prediabetes and normal glucose tolerance (NGT). Hepatic steatosis was quantified by median controlled attenuation parameter (CAP), which was measured by ultrasound transient elastography. Total abdominal fat volume, visceral adipose tissue (VAT) volume, total percent fat, trunk percent fat, android percent fat and android to gynoid ratio (AGR) was measured by dual-energy X-ray absorptiometry (DXA). Data pertaining to 2986 participants (1581 with hepatic steatosis) were included in the analysis. In the NGT group, the proportion of S0 (<5% of the hepatocytes with fatty infiltration) was 58.9%, and 25.2% for S3 (≥66% of the hepatocytes with fatty infiltration). In contrast, the proportion of S0 was 11.1%, while S3 accounts for as high as 68.7% in the diabetes group. In the NGT group, all parameters of fat distribution revealed a positive relation with the occurrence of hepatic steatosis (p<0.05) except total percent fat (p=0.872) after adjusting for confounding factors. In the prediabetes group, VAT volume, trunk percent fat, android percent fat and AGR had significant influence on hepatic steatosis (p<0.05). As for diabetes, only AGR remained significantly correlated with hepatic steatosis (p=0.004). For NGT individuals, high level of total abdominal fat volume, VAT volume, trunk percent fat, android percent fat and AGR all can be used to predict hepatic steatosis. For diabetes, only AGR can predict hepatic steatosis among the surveyed parameters of adipose distribution.

Fatty liver disease reverses the obesity paradox in chronic kidney disease stages 3-5: A follow-up study of NHANES III.

High body mass index (BMI) has been associated with better survival in patients with end‐stage kidney disease. Individuals with fatty liver disease (FLD) have a higher risk of chronic kidney disease. It remains unclear whether the survival benefit of high BMI in patients with chronic kidney disease is present when there is concomitant FLD. This study used the data set from the Third American National Health and Nutrition Examination Survey and the corresponding survival data. The Cox proportional hazards model was used to evaluate the effect of BMI on mortality. A total of 12,445 participants were included. The prevalence of FLD was 39.8%. The median follow‐up time (with interquartile range) was 22.8 (20.8–24.8) years. During this period, 3749 (30.1%, 14.4 of 1000 person‐year) deaths were observed. Among these, 1169 (31.2%) died within the first 10 years. The Cox regression analysis showed that the BMI level was not associated with 25‐year mortality in patients with decreased glomerular filtration rate (GFR < 60 ml/min/1.73 m2), but 10‐year mortality was significantly lower in patients with BMI ≥ 25 kg/m2 than in those with BMI < 25 kg/m2 (p = 0.049). Multivariate analysis showed BMI ≥ 25 kg/m2 was an independent protective factor for 10‐year mortality (hazard ratio [HR] 0.691, 95% confidence interval [CI] 0.559–0.856; p = 0.001). This protective effect of higher BMI was lost in patients with FLD (HR 0.884, 95% CI 0.585–1.335; p = 0.557) but persisted in the non‐FLD group (HR 0.625, 95% CI 0.479–0.816; p = 0.001). The survival benefit of overweight/obesity for patients with decreased GFR, which was attenuated by the presence of FLD, only existed in the first decade.

Association between urinary concentrations of bisphenol A substitutes and diabetes in adults.

BACKGROUNDDue to new restrictions on the use of bisphenol A (BPA), industries are beginning to replace it with derived molecules such as bisphenol S and F (BPS and BPF). There is extensive evidence in the academic literature on the potential health effects of BPA, which is known to be a diabetogenic molecule. However, there are few publications related to new compounds derived from BPA.AIMTo perform an epidemiological study of urinary BPS and BPF in the American National Health and Nutrition Examination Survey (NHANES) cohort, and analyze their possible relationship with diabetes mellitus.METHODSNHANES datasets from 2013 to 2016 were used due to the urinary BPF and BPS availability. Data from 3658 adults were analyzed to perform regression analysis exploring the possible relationship between BPA-derived compounds and diabetes.RESULTSDescriptive statistics, linear regression modeling, and logistic regression analysis revealed a significant relationship between urinary BPS, but not BPF, and diabetes risk. Additionally, a relationship was observed between both compounds and hypertension and a slight relationship between BPF and dyslipidemia.CONCLUSIONIn the present study, a strong relationship between urinary BPS, not BPF, and diabetes risk has been determined. BPA substitute molecules do not exempt the population from potential health risks.

Associations between dietary patterns and stages of chronic kidney disease

BackgroundStudies have revealed that patients with chronic kidney disease (CKD) have dietary patterns different from those of the general population. However, no studies have compared the dietary patterns of between patients with early-stages (stages 1–3a) and late-stages (stages 3b–5) of CKD. Our objective was to investigate the associations between dietary patterns in early and late-stage CKD.MethodsWe analyzed 4480 participants with CKD at various stages based on the data recorded between 2007 and 2016 from the database of the American National Health and Nutrition Examination Survey.ResultsIn total, 3683 and 797 participants had early and late-stage CKD, respectively. Through principal components analysis, the dietary intake dimension was reduced from 63 variables to 3 dietary patterns. We adopted logistic regression for analysis. The three dietary patterns are as follows: (1) saturated fatty acids and mono-unsaturated fatty acids (MUFA); (2) vitamins and minerals; and (3) cholesterols and polyunsaturated fatty acids (PUFA). These 3 patterns explained > 50% of dietary nutrient intake. Results indicated that among participants with dietary patterns 2 (vitamins and minerals) and 3 (cholesterols and PUFA), those with low intakes were more likely to have late-stage CKD. The odds ratios for patterns 2 and 3 were 1.74 (95% CI: 1.21–2.50) and 1.66 (95% CI: 1.13–2.43), respectively.ConclusionsThis study revealed that intakes of vitamins and minerals and cholesterols and PUFA were associated with the stages of CKD.

Abstract 6936: American versus Canadian National Funding for Immigrant Cardiovascular Health

Introduction: The high number of immigrants in North America underscores the need for cardiovascular (CV) health and promotion in these racially and ethnically diverse populations. Although some immigrant races/ethnicities have high cardiovascular mortality, it remains unclear whether there are investments in cardiovascular health promotion and prevention for immigrants for both the United States and America. We aimed to compare American and Canadian national investments cardiovascular health promotion and prevention for immigrants. Methods: We queried the National Institute of Health (NIH) and the Canadian Institute of Health Research (CIHR) databases from 2006 to 2019 for grants supporting projects in diseases prevention and promotion targeting immigrants. We compiled annual funding and normalized the annual data for the number of immigrants and Gross Domestic Product (GDP). We completed normalized descriptive statistics for comparative analysis and presented funding trends over a 14-year period. Results: There were 74 and 50 project grants awarded by the NIH and CIHR, respectively. Between 2007 to 2013, the NIH spent relatively less per immigrant than the CIHR. From 2014 onward, funding trends reversed as the NIH outspent the CIHR. Over the 14-year period, the NIH and the CIHR funded an annual mean of $59.8/1000 immigrants and $79.1/1000 immigrants, respectively. Conclusion: Although the number of immigrants is rising, the relative national funding for CV health promotion and prevention in the USA and Canada is generally decreasing over the last 5 years. Absolute CIHR funding is progressively decreasing since 2008, while NIH grant expenditure has demonstrated an overall pattern of increase over the last 14 years. Policymakers should consider more comprehensive investment in CV health promotion and prevention for immigrants.

Interaction of sex, age, body mass index and race on hypertension risk in the American population: a cross-sectional study.

The joint effects of sex, age, body mass index (BMI) and race on hypertension have not been fully addressed. Herein, we carried out this study aiming to investigate the possible effects of the interaction of sex, age, BMI and race on risk of hypertension. By using the data of a sample-adjusted 2656 women and 2515 men in American National Health and Nutrition Examination Survey 2015-16, we analyzed the interaction of sex, age, BMI and race by logistic regression models, followed by strata-specific analyses. Hypertension was defined as a systolic blood pressure ≥130 mmHg/diastolic blood pressure ≥80 mmHg or taking anti-hypertensive medication. A total of 5171 participants were included in analysis, and the prevalence of hypertension was 53.68%. The interactive effect of sex and age, BMI and age, race and age were statistically significant on hypertension. Strata-specific analyses showed that female at 40 years and above were positively associated with hypertension than those at 20-39 years. The associations also persistence in male. The risk estimates for age ≥40 on hypertension were consistently positive across all overweight/obesity and race groups. The effect was most prominent among overweight populations aged 60-80 years and Other Hispanic aged 40 years and above. There exists interactive effect of sex and age, BMI and age, race and age on hypertension in American population. The effect of age on hypertension was more prominent in female, overweight populations and Other Hispanic populations. Differences in age, BMI and race should be considered when providing corresponding antihypertensive measures.

Prevalence of Visual Acuity Loss or Blindness in the US

Globally, more than 250 million people live with visual acuity loss or blindness, and people in the US fear losing vision more than memory, hearing, or speech. But it appears there are no recent empirical estimates of visual acuity loss or blindness for the US. To produce estimates of visual acuity loss and blindness by age, sex, race/ethnicity, and US state. Data from the American Community Survey (2017), National Health and Nutrition Examination Survey (1999-2008), and National Survey of Children's Health (2017), as well as population-based studies (2000-2013), were included. All relevant data from the US Centers for Disease Control and Prevention's Vision and Eye Health Surveillance System were included. The prevalence of visual acuity loss or blindness was estimated, stratified when possible by factors including US state, age group, sex, race/ethnicity, and community-dwelling or group-quarters status. Data analysis occurred from March 2018 to March 2020. The prevalence of visual acuity loss (defined as a best-corrected visual acuity greater than or equal to 0.3 logMAR) and blindness (defined as a logMAR of 1.0 or greater) in the better-seeing eye. For 2017, this meta-analysis generated an estimated US prevalence of 7.08 (95% uncertainty interval, 6.32-7.89) million people living with visual acuity loss, of whom 1.08 (95% uncertainty interval, 0.82-1.30) million people were living with blindness. Of this, 1.62 (95% uncertainty interval, 1.32-1.92) million persons with visual acuity loss are younger than 40 years, and 141 000 (95% uncertainty interval, 95 000-187 000) persons with blindness are younger than 40 years. This analysis of all available data with modern methods produced estimates substantially higher than those previously published.

Lifestyle characteristics influencing hypertension in middle-age to old people: comparison of two populations

Background: Hypertension is a significant global public health problem and the data suggest a wide health disparity in hypertension prevalence worldwide. Our objective was to assess some epidemiological determinants in individuals ≥ 50 years influencing blood pressure/hypertension in United States and Croatia and derive some meaningful conclusions and recommendations. Material and methods: We used the American National Health and Nutrition Examination Survey (NHANES) (n = 1,556; 48.9% women) and the Croatian Adult Health Cohort Study (CroHort) (n = 2,182; 66% women), both taken in 2008. The health indicators compared were anthropometries, blood pressure, socioeconomic and marital status, education and lifestyle, including physical activity, alcohol and coffee consumption, smoking and presence of dyslipidemia and diabetes. Results: Prevalence of hypertension based either on medication use or blood pressure values was significantly higher in Croatian men and women compared to American (all p < 0.001). Waist circumference was the main positive predictor and education a negative predictor for blood pressure in CroHort; significance was not reached in NHANES, although the trends were similar. Taking medications for diabetes decreased the odds for hypertension in NHANES, while taking medications for both diabetes and dyslipidemia decreased the odds in CroHort. Conclusions: Croatian people older than 50 years have higher prevalence of hypertension compared to their counterparts in the U.S. The difference in the prevalence of hypertension in two populations cannot be explained by different prevalence of risk factors examined, except education level. Higher prevalence of hypertension diagnosed by medication use indicates a relatively good control of the disease in both populations.

Objectives, methods, and results in critical health systems and policy research: evaluating the healthcare market

BackgroundSince the 1980s, markets have turned increasingly to intangible goods – healthcare, education, the arts, and justice. Over 40 years, the authors investigated healthcare commoditisation to produce policy knowledge relevant to patients, physicians, health professionals, and taxpayers. This paper revisits their objectives, methods, and results to enlighten healthcare policy design and research.Main textThis paper meta-analyses the authors’ research that evaluated the markets impact on healthcare and professional culture and investigated how they influenced patients’ timely access to quality care and physicians’ working conditions. Based on these findings, they explored the political economic of healthcare.In low-income countries the analysed research showed that, through loans and cooperation, multilateral agencies restricted the function of public services to disease control, with subsequent catastrophic reductions in access to care, health de-medicalisation, increased avoidable mortality, and failure to attain the narrow MDGs in Africa.The pro-market reforms enacted in middle-income countries entailed the purchaser-provider split, privatisation of healthcare pre-financing, and government contracting of health finance management to private insurance companies. To establish the materiality of a cause-and-effect relationship, the authors compared the efficiency of Latin American national health systems according to whether or not they were pro-market and complied with international policy standards.While pro-market health economists acknowledge that no market can offer equitable access to healthcare without effective regulation and control, the authors showed that both regulation and control were severely constrained in Asia by governance and medical secrecy issues.In high-income countries they questioned the interest for population health of healthcare insurance companies, whilst comparing access to care and health expenditures in the European Union vs. the U.S., the Netherlands, and Switzerland. They demonstrated that commoditising healthcare increases mortality and suffering amenable to care considerably and carries professional, cultural, and ethical risks for doctors and health professionals. Pro-market policies systems cause health systems inefficiency, inequity in access to care and strain professionals’ ethics.ConclusionPolicy research methodologies benefit from being inductive, as health services and systems evaluations, and population health studies are prerequisites to challenge official discourse and to explore the historical, economic, sociocultural, and political determinants of public policies.

Insurance Coverage and Health Care Utilization Among Asian Youth Before and After the Affordable Care Act.

We examined changes in insurance coverage and health care utilization associated with the Affordable Care Act (ACA) among subgroups of Asian youth relative to non-Latino white youth. Data were from the 2010 to 2017 American Community Survey and National Health Interview Survey. Difference-in-difference models were used to examine changes in insurance coverage and health care utilization associated with the ACA among subgroups of Asian youth relative to white youth and subgroups of Asian youth in households below 200% of the federal poverty level relative to comparable white youth. Since the implementation of the ACA, insurance coverage increased among all Asian subgroups and white youth. The magnitude of the increase in insurance coverage was larger among Asian subgroups than white youth. More pronounced increases were found among almost all Asian subgroups in households below 200% federal poverty level. Changes in health care utilization were limited and varied by subgroup. Increases in well-child visits were observed only among Chinese and "other" Asian youth. Insurance coverage increased among Asian youth after the implementation of the ACA. Improvements in health care utilization were limited and differed by subgroups. Programs to improve health care utilization should be tailored to Asian youth according to subgroup.

Impact of Adenoidectomy on Bronchial Asthma in Children

Backgoudn: asthma is one of the most prevalent chronic diseases of childhood, data from the American national health interview survey revealed the prevalence in children 14 years of age and younger to be 9.0%. Objictive: the aim of this work is to assess the effect of adenoidectomy on bronchial asthma. The conclusions of this study may aid in counseling patients and their families regarding the impact of surgical intervention on the modulation of asthma symptoms. Patients and Methods: this was a prospective case series study. Patients were selected from those attending asthma pediatric clinic at Al-Azhar University Hospitals (Sayed Galal and Al-Hussain hospitals). After exclusion and inclusion criteria were applied, 50 children with diagnosis of chronic adenotonsillitis associated with bronchial asthma were enrolled in the study. Results: there was a significant improvement of asthma control test and SN-5 questionnaire results in both urban and rural inhabitants comparing preoperative and postoperative state. There was a non-significant difference between urban and rural residence regarding improvement of bronchial asthma after. There was a significant improvement in both sexes regarding asthma control test and SN-5 questionnaire results comparing preoperative and postoperative state. On the other hand, there was a non-significant difference between male and female gender regarding such improvement after AT. Conclusion: adenotonsillectomy in asthmatic patients with chronic adenotonsillitis may lead to significant improvement in asthma symptoms control and most of the patients are able to eliminate their medications and improve quality of their life style.

Impact of Adenoidectomy on Bronchial Asthma in Children

Backgoudn: asthma is one of the most prevalent chronic diseases of childhood, data from the American national health interview survey revealed the prevalence in children 14 years of age and younger to be 9.0%. Objictive: the aim of this work is to assess the effect of adenoidectomy on bronchial asthma. The conclusions of this study may aid in counseling patients and their families regarding the impact of surgical intervention on the modulation of asthma symptoms. Patients and Methods: this was a prospective case series study. Patients were selected from those attending asthma pediatric clinic at Al-Azhar University Hospitals (Sayed Galal and Al-Hussain hospitals). After exclusion and inclusion criteria were applied, 50 children with diagnosis of chronic adenotonsillitis associated with bronchial asthma were enrolled in the study. Results: there was a significant improvement of asthma control test and SN-5 questionnaire results in both urban and rural inhabitants comparing preoperative and postoperative state. There was a non-significant difference between urban and rural residence regarding improvement of bronchial asthma after. There was a significant improvement in both sexes regarding asthma control test and SN-5 questionnaire results comparing preoperative and postoperative state. On the other hand, there was a non-significant difference between male and female gender regarding such improvement after AT. Conclusion: adenotonsillectomy in asthmatic patients with chronic adenotonsillitis may lead to significant improvement in asthma symptoms control and most of the patients are able to eliminate their medications and improve quality of their life style.

Nanodiagnostics and Nanodelivery Applications in Genetic Alterations.

Genetic alterations cause Hereditary Diseases (HDs) with a wide range of incidences. Some, like cystic fibrosis, occur frequently (1/1,000 newborns), whilst others, such as Pompe disease and other metabolic disorders are very rare (1/100,000 newborns). They are well under the threshold of 1/3,000, denoted by the European Community as Rare Diseases (RDs). Genetic alterations are also associated with multifactorial disorders like diabetes, and underline both somatic and germline mutations in cancer. Nowadays, thanks to the interventions of the European Union and the American National Health Institute as well as others, Hds are under an international lense, which has stimulated discussions and research targeting gene identification, prenatal diagnosis and care optimization leading to the development of new treatment options. Nanomedicine is paving the way toward some highly appealing clinical and research avenues in HDs. Nanotechnologies lend themselves to many aspects in human healthcare, such as in vitro diagnostics (nanobiosensors and nanoplatforms), drug delivery (nanovectors), drug monitoring (nanosensors) and artificial organs to study the genome variant meaning (nanostructures). With a significant reduction in costs and simplified healthcare delivery, nanodiagnostics can potentially provide the tools to diagnose diseases at an early stage with precision. In vitro nanodiagnostics are already diagnosing RDs, with many nanodevices having been successfully introduced over the last few decades. Nanovectors represent an emerging approach in drug delivery and treatment for several diseases such as cancers, infectious diseases, cardiovascular disorders and neurological pathologies. Artificial tissues have valuable implications in replacing compromised organs, thus offering unique opportunities to explore pathogenic mechanisms as well as new drug targets in a personalized context. This article outlines and discusses the recent progress in nanotechnology and its potential applications in HDs. It is a pivotal field for research and innovation in healthcare, with emphasis on diagnostics, disease monitoring, biomarker assaying and drug delivery. We underlined the nanomethod's capacity to identify genetic alterations and the follow up of important aspects of the disease course, including therapies. We extensively described the new field of nanodelivery for experimental drugs, focusing on new genetic therapies and their implications in hereditary disorders. We also detailed innovative tools as artificial tissues based on nanomatrices and their use to identify or study genetic alterations.