Type Of Respiratory Infection Research Articles

PAR5: DIRECT AND INDIRECT COSTS OF RESPIRATORY INFECTIONS

OBJECTIVES: Morbidity due to respiratory infections leads to significant adverse societal and economic consequences. This study investigates the extent to which treatment for respiratory infections imposes a financial burden on an employer, and documents variations in employer payments between specific respiratory infections. METHODS: The data source is a rich administrative claims database for a national, Fortune 100 manufacturer. It includes 1997 medical, pharmaceutical, and disability claims for employees, spouses, dependents, and retirees (n> 100,000) under age 65. The research sample consists of individual patients with one or more medical or disability claims for at least one of eleven respiratory infection condition. Resource utilization is contrasted with a 10 percent random sample of the employer's overall beneficiary population. RESULTS: Direct (medical and pharmaceutical) and indirect (disability and sporadic absenteeism) costs are analyzed. The average per capita annual costs are: for the entire employer population, $2,368; for all respiratory infections patients, $4,397; and for respiratory infections employees eligible for disability, $6,838. Total costs for respiratory infections patients are 1.8 times those for the typical beneficiary. Total costs are highest for patients with pneumonia ($11,544) and lowest for patients with acute tonsillitis and acute pharyngitis ($2,180). Medical and pharmaceutical treatment account for 65% of total costs for all respiratory infections employees, while the remaining 35% of costs are attributable to disability and sporadic absenteeism. CONCLUSIONS: Respiratory infections impose a significant financial burden on the employer. Resource utilization by respiratory infections patients is substantial, not only for the direct treatment of respiratory infections, but also for the treatment of co-morbid medical conditions of respiratory infections patients. These costs also vary considerably by type of respiratory infection. The study also shows that respiratory infections impose substantial indirect costs on employers from work loss associated with these infections.

Assessment of Antibiotic Prescription in Acute Respiratory Infections in Adults

Objective: This study aims to ascertain the variability in the use of antibiotics for the treatment of acute respiratoryinfections in several hospital emergency services in Spain, as well as the appropriateness of antibiotics prescription through evaluation by a panel of experts using available scientific evidence.Method: A cross-sectional study was carried out in the emergency services of 10 hospitals in different Spanish regions. We chose patients diagnosed as having acute respiratory infection, aged over 14 years. Among the collected variables were: type of respiratory infection, antibiotic prescription, comorbidity, qualification of the prescribing doctor andhospital admission. The consensus conference held by a panel of experts established first choice treatment and the alternative and inappropriate use for each respiratory infection, based on the available scientific evidence. All the observed prescriptions in our study were classified according to this pattern.Results: A sample of 2899 acute respiratory infections was studied (5.5% of all emergencies). Antibacterial agenttreatment was prescribed in 82.6% of these, varying according to the infection between 98.5% of pneumonias and 49% of croup-influenza-common cold. The most commonly used antibiotics were amoxicillin-clavulanate and cefuroxime. The global percentage of inappropriate prescription was 40.5% (95% CI; 35.4–45.5). The prescriptions were inappropriate in 16.9% of cases of pharyngotonsillitis, 17.8% of chronic bronchitis, 26.9% of acute bronchitis, 29.3% of pneumonias, 30.8% of otitis and sinusitis and in 70.8% of croup, flu, common cold and non-specified infections. Significant variability among participating centres was observed, both in choice of antibiotics and in their degree of appropriateness.Conclusions: There is excessive use of antimicrobial drugs in acute respiratory infections, and the majority are used for viral infections. There is indiscriminate use of broad spectrum antibiotics, which are valid in some infections but clearlyinappropriate in others. Similarly, there are important differences in the choice of antibiotics and their degree ofappropriateness among hospitals.

Asthma and airway hyper-responsiveness in adults who required hospital admission for bronchiolitis in early childhood

Viral respiratory infections in infancy may contribute to the development of airway hyper-responsiveness (AHR) in childhood but their effects on respiratory function at the adult age are still uncertain. A group of 42 subjects aged 17–35 with a pediatrician-made diagnosis of severe bronchiolitis in infancy (Br) were compared for the presence of asthma and AHR to a control group (C) paired for age and gender, without evidence of lower respiratory disease in infancy. All had a respiratory and environmental questionnaire, allergy skin prick tests, blood eosinophil count, total serum IgE determination and measurements of expiratory flows and airway response to methacholine. In Br and C groups, respectively, 38 and 12% of subjects had a physician-made diagnosis of asthma, 26 and 7% used bronchodilators and 12 and 0% an inhaled corticosteroid; 71 and 67%, respectively, were atopic, 50 and 24% were smokers and 43 and 17% had a first-degree relative with asthma. Mean baseline FEV1and FEV1/FVC ratio were lower in the Br than in the C group, with 94/103% (P=0·002) and 80/87 (P<0·0001) of the predicted value, respectively. Geometric mean PC20methacholine was significantly lower in the Br than in the C group 3·9/20·3 mg ml−1(P<0·0001). Mean blood eosinophil count and serum IgE levels were similar in both groups (P>0·05).In conclusion, asthma and AHR were found more frequently in young adults with a past history of bronchiolitis, suggesting that this type of respiratory infection may contribute to altered pulmonary function in adulthood, although it may also represent an early manifestation of asthma. The influence of potential confounding factors, such as familial predisposition and exposure to cigarette smoke on the development of asthma and AHR in the Br group, cannot be excluded.

Medicine is war: and other medical metaphors.

When I worked in a paediatric casualty department children were forever being told that after being stitched, x rayed, or covered in plaster they would be bionic. The desire to be more like is apparently widespread?inevitably perhaps, in an age when technology is both idolised and feared. Medicine is strewn with mechanistic language and concepts, and metaphor the body is a machine suffuses much of language of pathology and physi? ology. I write here about some of linguistic forms that underlie way we talk about medicine and way that they limit as well as advance our thinking. Examining metaphors behind language is worth while because it clarifies our assumptions. Seeing body as a machine, for example, has been useful?the heart, after all, is much like a pump and treating it as one has provided many insights. The success of mechanistic approach, however, has meant that we have often imbued body with other like attributes. All too easily patients become?like machines?identical, passive and fixable. Medicine, as has often been pointed out, has become dominated by a mechanistic hubris, which sees machines and engineered solutions to ill health as favourite way forward. All this, of course, begs question of relation between language we use and things it describes. Some have felt that any language may actually prevent its native speakers from perceiving world in ways that are quite normal in other tongues.1 According to this view, language more or less determines reality. A more orthodox position is that language and our perception of world evolve together, both influencing each other. The particular vocabulary and syntax of any given language do not make it impossible to express certain things, they merely make it more difficult to express them.2 The vocabulary of medicine is certainly one example of way linguistic forms affect our perception of world. As Dixon has pointed out, we have 20 rubrics for different types of respiratory infection but only one word for poverty.3 Differentiating respiratory syncytial virus from mycoplasma thus becomes possible, but we still have only general terms with which to express, say, overcrowding. Our language thus drives important factors to margins of consciousness.

The Treatment of Bronchial Lesions by the Inhalation of Nebulized Solution of Sodium Sulfathiazole

1) A group of 50 patients with diverse infectious bronchial lesions, refractory to other forms of therapy, was treated by the inhalation of nebulized solution (5%) of sodium sulfathiazole. 2) The method of study and of the procedure was described. 3) In 43 cases or 86 per cent of the series there was a definite improvement. 4) Several illustrative case reports were presented. 5) Modifications of the procedure were suggested for further clinical trials. 6) This preliminary survey indicates the promising therapeutic possibility of sulfa nebulization in a resistant type of respiratory infection.

REVIEW OF LITERATURE ON RESPIRATORY DISEASES

<h3>INFLUENZA</h3> <i>Etiology</i>.—The concensus of opinion is one expressed by Winchell and Stillman¹in discussing the relationship of<i>B. influenzæ</i>to epidemic influenza. He believes that no matter what the etiologic relationship is, there can be no doubt about its importance as a secondary invader in this type of respiratory infection. The frequency of occurrence of<i>B. influenzæ</i>in the throats of normal persons has been as great in the period subsequent to the epidemic as it was during that time. It may persist in the throats of healthy carriers for a considerable length of time. Kolmer,²as a result of complement fixation, phagocytosis and agglutination tests, reaches the same conclusion, and shows that<i>B. influenzæ</i>played the most important rôle in the disease as an organism of secondary infection, if not the actual or primary etiologic agent. However, no definite proof has been submitted that<i>B.</i>

REVIEW OF LITERATURE ON RESPIRATORY DISEASES

INFLUENZA Etiology .—The concensus of opinion is one expressed by Winchell and Stillman 1 in discussing the relationship of B. influenzae to epidemic influenza. He believes that no matter what the etiologic relationship is, there can be no doubt about its importance as a secondary invader in this type of respiratory infection. The frequency of occurrence of B. influenzae in the throats of normal persons has been as great in the period subsequent to the epidemic as it was during that time. It may persist in the throats of healthy carriers for a considerable length of time. Kolmer, 2 as a result of complement fixation, phagocytosis and agglutination tests, reaches the same conclusion, and shows that B. influenzae played the most important role in the disease as an organism of secondary infection, if not the actual or primary etiologic agent. However, no definite proof has been submitted that B.