BackgroundOver 1 billion people suffer from chronic respiratory diseases such as asthma, COPD, rhinitis and rhinosinusitis. They cause an enormous burden and are considered as major non-communicable diseases. Many patients are still uncontrolled and the cost of inaction is unacceptable. A meeting was held in Vilnius, Lithuania (March 23, 2018) under the patronage of the Ministry of Health and several scientific societies to propose multisectoral care pathways embedding guided self-management, mHealth and air pollution in selected chronic respiratory diseases (rhinitis, chronic rhinosinusitis, asthma and COPD). The meeting resulted in the Vilnius Declaration that was developed by the participants of the EU Summit on chronic respiratory diseases under the leadership of Euforea.ConclusionThe Vilnius Declaration represents an important step for the fight against air pollution in chronic respiratory diseases globally and has a clear strategic relevance with regard to the EU Health Strategy as it will bring added value to the existing public health knowledge.
Studies of human airway virome are relatively recent and still very limited. Culture-independent microbial techniques showed growing evidence of numerous viral communities in the respiratory microbial ecosystem. The significance of different acute respiratory viruses is already known in the pathogenesis of chronic conditions, such as asthma, cystic fibrosis (CF), or chronic obstructive lung disease (COPD), and their exacerbations. Viral pathogens, such as influenza, metapneumovirus, parainfluenza, respiratory syncytial virus, or rhinovirus, have been associated with impaired immune response, acute exacerbations, and decrease in lung function in chronic lung diseases. However, more data have attributed a role to Herpes family viruses or the newly identified Anelloviridae family of viruses in chronic diseases, such as asthma, idiopathic pulmonary fibrosis (IPF), or CF. Impaired antiviral immunity, bacterial colonization, or used medication, such as glucocorticoids or antibiotics, contribute to the imbalance of airway microbiome and may shape the local viral ecosystem. A specific part of virome, bacteriophages, frames lung microbial communities through direct contact with its host, the specific bacteria known as Pseudomonas aeruginosa or their biofilm formation. Moreover, antibiotic resistance is induced through phages via horizontal transfer and leads to more severe exacerbations of chronic airway conditions. Morbidity and mortality of asthma, COPD, CF, and IPF remains high, despite an increased understanding and knowledge about the impact of respiratory virome in the pathogenesis of these conditions. Thus, more studies focus on new prophylactic methods or therapeutic agents directed toward viral–host interaction, microbial metabolic function, or lung microbial composition rearrangement.
Vaikų sveikatos priežiūros poreikių pokyčiai skatina Europos šalis peržiūrėti vaikų sveikatos priežiūros sistemas, kad visiems vaikams būtų prieinama efektyvi ir tinkama sveikatos priežiūra. Atlikta atrinktų mokslinių publikacijų, rekomendacijų ir studijų apžvalga parodė Europos šalių vaikų sveikatos priežiūros sistemų skirtumus, ypač pirminės vaikų sveikatos priežiūros organizavimo. Išskiriamos trys vaikų pirminės sveikatos priežiūros sistemos: pediatrinė, šeimos gydytojo ir mišri. Ne visos šalys vadovaujasi PSO Europos regiono biuro parengta Vaikų ir paauglių sveikatos strategija 2015-2020 m., skirta padėti šalims įdiegti įrodymais pagrįstą sistemą, siekiant patobulinti vaikų ir paauglių poreikius atitinkančią sveikatos priežiūrą. Pastebima, kad vaiko centriškumo principas nėra įdiegtas ne tik daugelio šalių sveikatos priežiūros sistemose, bet ir kitose gyvenimo srityse. Modeliuojant bendrą sveikatos priežiūros sistemą, neišskiriant vaikų, dažniausiai remiamasi didžiosios gyventojų dalies – suaugusiųjų poreikiais, nuvertinant vaikų poreikius. Vaikystės sveikatos problemos gali turėti įtakos visam gyvenimui. Sveikatos priežiūros netolygumų problemos sprendimas, mažinant socialinių veiksnių įtaką sveikatai, apsaugotų vaikų populiaciją. Kūdikių mirtingumo rodikliai žemesni tose Europos šalyse, kuriose geresnė ekonominė situacija ir didesnis dėmesys skiriamas gyventojų gerovei. Augančio vaiko sveikatos priežiūros poreikiai yra specifiniai daugelyje sričių, pradedant specifinėmis žiniomis, kurių reikia vaikų ligų gydymui ir baigiant vaikų atstovavimo ypatumais, todėl sveikatos priežiūros paslaugos turi būti pritaikytos vaikams, o specialistai turi turėti specifinių kompetencijų.
Objective. The aim of this study was to estimate the significance of nasal potential difference (NPD) in the diagnosis of cystic fibrosis (CF) in children with clinical symptoms suggestive of the disease, positive sweat test results, and/or genetically confirmed diagnosis. Material and Methods. NPD measurements according to the modifications by Alton were performed in 50 children with clinical CF symptoms supported by positive sweat test results, 50 children with other obstructive lung diseases, and 50 healthy children. A subgroup of 17 children with the diagnosis confirmed by 2 identified mutations in the CF transmembrane regulatory gene was analyzed individually. Results. The mean NPD value recorded in 50 children with clinical symptoms of CF supported by positive sweat test results and/or genetic analysis was –28.0 mV [SD, 10.2]. The mean NPD value in the subgroup of children with 2 identified mutations in the CF gene (n=17) was more negative than in the subgroup of children with unrecognized mutations (n=33) (–37.1 mV [SD, 7.0] vs. –23.4 mV [SD, 8.3], P<0.001). The mean NPD value in patients with other obstructive lung diseases and healthy children was significantly more positive than in the group of CF children with positive sweat test results and/or identified mutations (–18.1 mV [SD, 3.6] and –15.5 mV [SD, 4.3] vs. –28.0 mV [SD, 10.2], P<0.001). The NPD cut point value for the genetically confirmed diagnosis of CF was –35.0 mV (sensitivity, 93.9%; specificity, 88.2%), while in general, the NPD prognostic value was –24.0 mV (sensitivity, 58.0%; specificity, 98.0%) Conclusions. The NPD measurement is a valuable tool for the diagnosis of CF in children, but further studies are necessary to establish NPD values related to the CF genotype and to reduce the intrasubject variability of this test.
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