bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of a Smoking Prevention Intervention Aimed at Youth: Pataclope
Authors: Loiseau Stéphanie , Le Cain Anne , Sasco Annie J. , Mourouga Philippe , Sancho-Garnier Hélème
Published: June 2018

Tobacco is responsible for 66,000 deaths per year in France, which makes it one of the most important national public health priorities. Preadolescents, at the age where this addiction usually begins, are a particularly interesting target group for the implementation of prevention activities. It is for this reason that in 1990, the French National League against Cancer established a set of non-smoking youth clubs (“Pataclope”) of which the main objective is to prevent adolescents from starting to smoke. An evaluation programme was put into place in 1999 in order to better understand the impact of these clubs on the prevalence of smoking in 15 year olds, which corresponds to the age of former participants one year after leaving the clubs.

A comparison between a group of youth having participated in the Pataclope clubs and a group of adolescents taken from the general population was carried out at the national level. Those selected were 15 years of age and were in high school. An anonymous self-questionnaire on their tobacco habits and factors of addiction was distributed to the two groups. The analysis involved a total of 3274 questionnaires, 899 of which were from Pataclope participants and 2375 from the sample population.

The primary results show that the prevalence rates according to sex essentially mirror those of the Baromètre santé 2000, among other accepted statistics (25.5% for girls and 19.9% for boys versus 31.6% for girls and 18.1% for boys in the Baromètre santé 2000). One year after leaving the clubs, the former Pataclope members see their risk of becoming a smoker reduced by 26% with respect to those who were not club members (OR = .74 adjusted for the factors of addiction), within a model which regroups smokers and ex-smokers versus non-smokers. In utilising this model which takes into account the ex-smokers and smokers as two distinct categories (the reference always being non-smokers), the reduction of risk in being a smoker is always significant, and goes up to 50% less risk (OR= 0.5) for members of Pataclope. The probability of being an ex-smoker is identical in the two groups: given that once one has taken up smoking, the Pataclope members present the same smoking behaviours as the general population (same consumption, same age of quitting, and the same frequency of quitting).

The activity of the Pataclope clubs has been encouraging in at least slowing or hindering the commencement of smoking in youth aged 15 years. However, these results require a confirmation in the long term. The lack of impact on the ex-smokers tends to demonstrate that the mesSAGE of clubs reinforces a non-smoking behaviour but remains ineffective on quitting, once smoking has been taken up.
Model for the Systematic Classification of Outcomes in Health Promotion and Prevention
Authors: Cloetta Bernhard , Spencer Brentia , Spörri Adrian , Ruckstuhl Brigitte , Broesskamp-Stone Ursel , Ackermann Günter
Published: June 2018

Successful demonstration of the effects of health promotion calls for systematic documentation and comparison of the outcome of different measures and projects. A model has been developed in the form of an outcome categorisation system for this purpose and is presented here. The model includes four categories covering the intermediate outcomes of health promotion measures, and three categories for outcomes at the level of health determinants (conditions necessary for health). Each category includes three to four sub-categories, for which examples of possible indicators are presented. The model can be applied both in the planning and in the evaluation stage of a project. This makes it possible for health promotion agencies and institutions responsible for funding and promotion to obtain a general overview of the outcome of their work.
Preffi 2.0- a Quality Assessment Tool
Authors: Molleman Gerard R.M. , Ploeg Machteld A. , Hosman Clemens M.H. , Peters Louk H. M.
Published: June 2018

The findings of many meta-studies into the effects of health promotion programmes indicate that there is still much room for improvement in the quality of these programmes. Insights gained from research are rarely applied in practice. Practitioners and policymakers often find it hard to assess the value of the many and sometimes contradictory research findings, partly because the necessary contextual information is usually lacking. Practical considerations force them to respond to specific problems at short notice in the form of programmes that are as effective as possible. Hence, effective health promotion requires not only the dissemination of effective programmes but also insights into principles of effectiveness and the way professionals use these insights. It is against this background that the Netherlands Institute for Health Promotion and Disease Prevention (NIGZ) has developed and implemented the Preffi instrument. Preffi consists of a set of guidelines with items relevant to the effectiveness of health promotion and prevention projects, reflecting scientific and practical knowledge about effect predictors.

This article describes the systematic, seven-step development process of the second version of the instrument, Preffi 2.0, a process in which scientists and practitioners were closely involved throughout. The article also describes the Preffi model and its scoring method. The draft version of Preffi 2.0 was tested for usefulness among 35 experienced practitioners from a range of health promotion institutes. They were asked to use the draft version to assess two project descriptions and to comment on their experiences using Preffi 2.0. They gave the instrument an average overall mark of 7.7 on a scale of 10, and the large majority of them evaluated the instrument as valuable, complete, clear, well-organised and innovative. The findings of this trial implementation were used to construct the definitive version of Preffi 2.0.

To an experienced user, applying Preffi to assess a project takes less than an hour. Preffi is used as a diagnostic quality assurance instrument at various stages of a project, either to critically evaluate one's own project or to comment on projects proposed by others. Assessing other people's projects may be difficult if the necessary information is lacking or unclear. A supplementary discussion with the project manager is always required. Users have commented that applying Preffi to a project yields a balanced and useful assessment, as well as a clear overview of points in the project that could be improved.
Health Promotion Competencies for the Israeli Workforce
Authors: Melville Lilach , Howat Peter , Shilton Trevor , Weinstein Ruth
Published: June 2018

Health promotion competencies can help inform health promotion training and practice. Competency sets have been developed in countries with formal educational, professional and policy infrastructures for health promotion, but little action has occurred in countries where such infrastructures are only emerging. This study examines the views of Israeli health promotion practitioners about the competencies relevant for health promotion practice and compares them with the perceptions held by their Australian counterparts.

This study builds on a growing body of literature addressing health promotion competencies and workforce planning. It examines the views of Israeli health promotion practitioners about the competencies relevant for health promotion practice in Israel, a country where health promotion is in its infancy and compares them with the perceptions held by their counterparts in Australia, another multi-cultural country, where health promotion practitioners are readily employed, academic teaching is established and discourse regarding health promotion competencies had been studied.

Methodology used in a previous Australian study was adapted to suit Israeli requirements. A literature search was conducted and an expert panel recruited to review and amend the list of competencies compiled in Australia. The original questionnaire was modified to suit Israeli requirements. Several new competencies were added. The questionnaire was posted to 97 health promotion professionals. The returned questionnaires were analysed and compared to the Australian results. Differences were found mainly in areas requiring specific health promotion training.
Motivational Factors and Stages of Change for Physical Activity among College Students in Amman, Jordan
Authors: Madanat Hala , Merrill Ray M.
Published: June 2018

The purpose of this study was to investigate physical activity levels across the five stages of change for physical activity and to identify motivational factors for physical activity according to these stages of change among college students in Amman, Jordan. Analyses were based on a cross-sectional survey of 431 students, with a mean age of 21.1 (SD=0.16) and 67.5% female. Based on the recommendation that physical activity requires at least 30 minutes of physical activity 3 or more days per week, men were more likely than women to classify themselves in later stages: 7.3% vs. 9.5% in the precontemplation stage, 17.4% vs. 14.7% in the contemplation stage, 50.0% vs. 63.5% in the preparation stage, 9.4% vs. 5.6% in the action stage, and 15.9% vs. 6.7% in the maintenance stage [X2(4) = 14.04, p = 0.0072]. Seven potential motivational items for physical activity were assessed using factor analysis: experience better self-worth, prevent chronic disease, relieve stress, stay in shape, longevity, recreation/fun, and social benefits. Two factor groupings were identified from these items. The first factor included the first five items, labeled as “Physical and Mental”. The second factor included the last two items, labeled as “Social and Recreational.” “Physical and Mental” items compared with “Social and Recreational” items were most likely to motivate physical activity across the stages of change for physical activity. The strongest motivator of physical activity was to stay in shape. The weakest motivator of physical activity was for social reasons. The influence of the intermediate motivational factors was slightly affected by the students’ stage of change for physical activity. Motivators for physical activity did not differ according to sex. These results provide important information about the motivational factors for physical activity for college-aged students in Jordan that can be useful in developing effective physical activity intervention programs.
New Horizons for Public Health in Kazakhstan
Authors: Aringazina Altyn , Macdonald Gordon
Published: June 2018

This paper, the first ever to review and critique public health developments in Kazakhstan, suggests ways in which public health can be improved strategically. The paper outlines the main threats to health in a dynamic economically developing country, but argues that with a health care reform agenda in place, and the Governments apparent support of public health policy initiatives, the time is right for new opportunities in the promotion of health.

The paper utilises the Ottawa Charter, but suggests novel, more appropriate headings for Kazakhstan, to galvanise policy makers and professionals into tackling the growing burden of disease.

It concludes by calling for greater transparency in relation to Government policy initiatives, and the need for greater national and international collaboration.
Maintaining Population Health in a Period of Welfare State Decline: Political Economy as the Missing Dimension in Health Promotion Theory and Practice
Authors: Raphael Dennis , Bryant Toba
Published: June 2018

There is increasing recognition in the health promotion and population health fields that the primary determinants of health lay outside the health care and behavioural risk arenas. Many of these factors involve public policy decisions made by governments that influence the distribution of income, degree of social security, and quality and availability of education, food, and housing, among others. These non-medical and non-lifestyle factors have come to be known as the social determinants of health. In many nations – and this is especially the case in North America – recent policy decisions are undermining these social determinants of health. A political economy analysis of the forces supporting as well as threatening the welfare state is offered as a means of both understanding these policy decisions and advancing the health promotion and population health agendas. The building blocks of social democracies – the political systems that seem most amenable to securing the social determinants of health - are identified as key to promoting health. Health promoters and population health researchers need to “get political” and recognize the importance of political and social action in support of health.
Revitalizing Health Promotion: A Case Study from Serbia
Authors: Hill Eleanor , Jankovic Svetlana
Published: June 2018

The last two decades of the twentieth century were difficult ones for health promotion in Serbia. The political, economic and social upheaval resulting from the civil conflict in the former Republic of Yugoslavia put enormous pressure on the health system overall and undermined a previously strong and effective health education and promotion service. In recent years the government, supported by external donors, has refocused attention on the need for high quality public health, including preventive activities as a central goal of the health reform process. This process is reviewed through a case study of a high profile health promotion campaign recently completed within the country. The potential for Serbia to regain its position as an innovator in community-based health care as well as the obstacles to be overcome are analysed.
Appréhender les conceptions locales de l'équité pour formuler les politiques publiques de santé au Burkina Faso
Authors: Ridde Valéry
Published: June 2018

L'équité est un concept central de la promotion de la santé et doit donc figurer au cœur de la formulation des politiques publiques de santé. Cependant l'équité, concept interchangeable avec celui de la justice sociale, est un terme polysémique et contextuel dont la définition doit être une émanation des discours et des valeurs de la société où les politiques sont mises en œuvre. À l'aide d'une étude de cas au Burkina Faso, nous tentons de montrer que l'absence de prise en compte des conceptions locales de la justice sociale dans l'élaboration des politiques explique, en partie, leurs échecs relatifs à l'égard de l'objectif d'équité. Les méthodes de collecte de données employées sont variées (entrevues individuelles, entrevues de groupes, cartographies conceptuelles, observations participantes, analyses documentaires) et les analyses tant quantitatives que qualitatives. Les quatre groupes d'acteurs habituellement concernés par le déroulement des politiques publiques ont participé à la collecte des données. Sans prétention à être généralisés à l'ensemble du pays, les résultats montrent que la théorie de la justice majoritairement mobilisée par les acteurs sociaux est de type égalitariste. Les inégalités de santé ou sociales sont comprises par les individus comme des faits sur lesquels il n'est pas enviSAGEable d'agir tandis que les inégalités d'accès aux soins sont qualifiées d'injustes, et il est possible d'intervenir pour les réduire dans le cas où des mesures incitatives à cet effet sont prises. On constate également une certaine difficulté sociale à concevoir des sous-groupes de la population et une volonté farouche de ne pas déstabiliser la paix sociale, ce qu'une justice distributive en faveur des indigents pourrait provoquer. Cette recherche permet de mieux appréhender la perspective émique de l'équité et semble confirmer l'importance de considérer les conceptions locales des valeurs, et notamment de la justice sociale, lorsque l'on définit les politiques publiques.
The Heartfile Lodhran CVD Prevention Project- end of Project Evaluation
Authors: Nishtar Sania , Badar Asma , Kamal Mohammad Umer , lqbal Azhar , Bajwa Rashid , Shah Tauqeer , Larik Zahid , Karim Fazle , Mehmood Mahmood ul Hassan , Jehangir Haroon , Azam Syed Iqbal , Mirza Yasir Abbas , Khan Shahzad Ali , Qayyum Aamra , Aqeel Fauzia , Bakir Abdul , Rahim Ejaz
Published: June 2018

Mainstream preventive interventions often fail to reach poor populations with a high risk of cardiovascular diseases (CVDs) in Pakistan. A community-based CVD primary prevention project aimed at developing approaches to reduce risk factors in such populations was established by Heartfile in collaboration with the National Rural Support Program in the district of Lodhran. The project implemented a range of activities integrated with existing social and health service mechanisms during a three year intervention period 2000/01-03/04. These were targeted in 4 key settings: community health education, mass media interventions, training of health professionals and health education through Lady Health Workers. The project received support from the Department for International Development, UK. At the community level, a pre-test-post-test quasi-experimental design was used for examining project outcomes related to the community component of the intervention. Pre and post-intervention (training) evaluations were conducted involving all health care providers in randomly selected workshops in order to determine baseline levels of knowledge and the impact of training on knowledge level. In order to assess practices of physician and non-physician health care providers patient interviews, with control comparisons were conducted at each health care facility. Significant positive changes were observed in knowledge levels at a community level in the district of intervention compared with baseline knowledge levels particularly in relation to a heart healthy diet, beneficial level of physical activity, the causes of high blood pressure and heart attack and the effects of high blood pressure and active and passive smoking on health. Significant changes in behaviors at a practice level were not shown in the district of intervention. However the project played a critical role in spurring national action for the prevention and control of non-communicable diseases and introducing sustainable public health interventions for poor communities in Pakistan.
Knowledge Synthesis, Translation and Exchange in Public Health and Health Promotion: The Role of a Cochrane Review Group
Authors: Waters Elizabeth , Armstrong Rebecca
Published: June 2018

The Cochrane Collaboration is an international non-profit organisation that aims to produce high quality systematic reviews of the effectiveness of health interventions. This work is conducted by 51 Review Groups that span a range of topics (e.g. pregnancy and childbirth, HIV/AIDS). The role of Fields within the Collaboration has been to actively engage relevant stakeholders internationally to improve the quality and relevance of reviews.

Since the inception in 1996 of the Cochrane Public Health and Health Promotion Field, the Cochrane Collaboration has begun to embrace reviews related to public health and health promotion and is adapting to the changing needs of end-users. The introduction of a Cochrane health promotion and public health review group will help ensure that reviews will be oriented towards building evidence for equity and reducing inequalities and best meet the needs of decision-makers, practitioners and consumers. Our role as a Field has led to us working with a range of partners including reviewers, researchers, practitioners and consumers. Knowledge synthesis, translation and exchange (KST&E) has emerged as an issue in need of further exploration for practice to influence decision-makers and for policy to influence practitioners.

2007 will be an exciting year for evidence-informed Health Promotion and Public Health (HPPH) both within the Cochrane Collaboration and for our partners in policy, practice and research.
Adolescent Peers and Anti-Smoking Activities
Authors: Asian Dilek , Sahin Ayten
Published: June 2018

In this paper, we aim to evaluate and discuss the details of a five days’ peer education training program, including creative drama techniques, which was then used to carry out anti-smoking activities among a group of 10th grade adolescents at a high school in Ankara, Turkey. Participatory methods/approaches were used during the training of the peers. Interactive (icebreakers, feedback of the peers about each day of the training, role play, brain storming discussions, case studies, video recording, etc) and creative drama techniques were the two major training methods used during the process. Although the smoking prevalence in the study school did not significantly decrease after the intervention, this method contributed to increasing students’ awareness of anti-smoking issues. Change in the knowledge and attitudes of the students in the study school were significantly different from the change in the control school. This study was also an opportunity for the peer leaders to be part of an enjoyable educational activity. The findings of the study suggest that peer counselors, well trained, and with on-going supervision, can have a positive effect on “knowledge” and “attitudes” about smoking among their friends. Changing behaviors may require a longer time. Peer counseling programs in which the intervention component lasts at least 6 months are recommended to be carried out among similar groups.
Changing Communities, Changing Spaces: The Challenges of Health Promotion Outreach in cyberspace
Authors: Hallett Jonathan , Brown Graham , Maycock Bruce , Langdon Patricia
Published: June 2018

This article is a case study of an Internet chat room outreach project in Perth, Western Australia. The CyberReach project sought to adapt current peer based health promotion outreach, training and supervision frameworks to an online outreach setting in a way that was effective and supported by the online community. It targeted marginalised groups to trial the provision of online mental and sexual health promotion incorporating a participatory action research model into its development and implementation. Three 6-week trial periods were conducted and significant changes were made in response to changes in the online environment and to improve sustainability and effectiveness of the protocols. Four themes arose from CyberReach's experience: online group processes are unique due to the creation of extensive personal networks and occurrence of disclosure without face-to-face contact across potentially large geographic barriers; flexibility is required to adapt to technological changes and online community flux; enforcing boundaries and delineating peer education from therapeutic support can be challenging when only using text-based communication; and Internet outreach can be time intensive with small returns in actual community engagement and constant technological up-skilling of staff may be required. Based on the project's experiences we offer the following recommendations when planning similar Internet outreach strategies: Funding and planning groups need to be aware that the Internet environment is constantly changing and planning and funding arrangements need to reflect a capacity to remain flexible; Programs need to be firmly connected to the communities they are outreaching therefore a peer-based education component is strongly encouraged; Careful consideration should be taken regarding data collection so that the environment and the individuals within are respected; Further research needs to be conducted to understand the styles and approaches of different online interactions, and the relative influence of technical platforms, gender and age.
Mediated Personalization of Executive European Union Politics: Examining Patterns in the Broadsheet Coverage of the European Commission, 1992–2016
Authors: Gattermann Katjana
Published: June 2018

The personalization of politics is a popular thesis but often challenged when it comes to media personalization. While previous research compared the prominence of different types of political actors across national political contexts, this article situates its research in the context of European Union (EU) politics and, thereby, studies similar reference points across countries. Its focus lies on the European Commission and its members. Personalization is conceptualized as individualization and presidentialization, respectively. The article proposes that the EU integration process provides journalists with the opportunity to report more often about individual politicians, while political developments should further incentivize journalists to personalize their news from Brussels. To test this argument, the article investigates personalization patterns in seven broadsheets from Ireland, Britain, France, the Netherlands, Denmark, Italy, and Poland. In total, 119,070 articles are analyzed by automated content analysis over a period of twenty-five years. The article finds no pan-European trend toward greater personalization of politics with respect to news coverage of EU executive politics. The findings nonetheless provide important implications for future research. The article particularly discusses the universal applicability of the phenomenon, the time frame for analysis, and journalistic styles in covering European politics.
Steps to Stock: Keeping Students Safe With Fully Implemented Stock Epinephrine
Authors: Moritz Sandra , Schoessler Sally
Published: June 2018

Laws have been passed across the United States to either allow or mandate the use of stock epinephrine in the school setting. The challenge remains for our schools to fully implement the use of this life-saving medication. Barriers to implementation exist, but quality tools are available to support the school nurse.
Shaping Your Practice and Changing Mindsets: Framework for 21st Century School Nursing Practice™
Authors:   National Association of School Nurses (NASN)
Published: June 2018

NASN’s Framework for 21st Century School Nursing Practice™ (the Framework) provides a graphic illustration of the key principles of professional school nursing practice, reflects NASN’s stance for evidence-based best practice and provides a focus when prioritizing school nursing activity. In order to ensure fidelity of the Framework and to provide professional development for school nurses, NASN is embarking on an exciting new project: Focus on the Framework, a series of five Continuing Nursing Education (CNE) modules, along with a certificate of proficiency in the Framework, which will be earned after the completion of all five modules and the successful completion of a culminating activity. We invite your feedback and suggestions as the certificate process is developed.
Survivin and cortactin expression in sinonasal schneiderian (inverted) papilloma and associated carcinoma
Authors: Marioni Gino , Brescia Giuseppe , Nicolè Lorenzo , Marchese-Ragona Rosario , Barion Umberto , Giacomelli Luciano , Marino Filippo , Martini Alessandro , Ottaviano Giancarlo
Published: June 2018

Background:

Sinonasal inverted (schneiderian) papilloma (IP) is histologically benign but shows a propensity for malignant transformation. Survivin, a member of the inhibitor of the apoptosis family of proteins that controls cell division, apoptosis, metastasis, and, probably, also neoangiogenesis, is overexpressed in essentially all human cancers. Overexpression of the multidomain protein cortactin has also been associated with increased cell migration, invasion, and metastatic potential in several malignancies.

Objective:

The aim of the present study was to preliminarily investigate survivin and cortactin expression in a consecutive series of sinonasal IPs, and IP-associated squamous cell carcinomas (SCC).

Methods:

Immunohistochemical expression of nuclear survivin and cortactin was measured in 19 consecutive sinonasal IPs and 3 IP-associated SCCs.

Results:

The mean ± standard deviation nuclear survivin expression was 9.4 ± 9.2% and 31.7% ± 15.4% in sinonasal IPs and SCCs, respectively (p < 0.0001). Results of cortactin immunostaining was strongly positive in the cytoplasm of both sinonasal IPs and SCCs: no significant difference emerged between the IP and SCC epithelial components.

Conclusion:

Nuclear survivin expression was significantly higher in SCCs than in IPs. Prospective, multi-institutional prognostic studies, preferably on an international scale (given the few cases treated at single institutions), are needed to confirm the role of survivin in IP malignant transformation.
Discordance in Preoperative and Postoperative Histopathology of Sinonasal Tumors
Authors: Ganti Ashwin , Tajudeen Bobby A. , Plitt Max A. , Rossi Isolina , Gattuso Paolo , Batra Pete S.
Published: June 2018

Background

Head and neck surgical pathology has been shown to be prone to histopathologic diagnostic error that can adversely impact patient care due to inappropriate management. Sinonasal tumors, in particular, present a diagnostic challenge given the relative rarity and diversity in histology and thus may have higher rates of discordant histology.

Objective

The purpose of this study is to determine the rate of discrepancy between preoperative and postoperative diagnoses of sinonasal tumors.

Methods

Retrospective chart review was performed on 52 patients treated for sinonasal tumors between January 2013 and December 2016. Initial diagnosis on preoperative biopsy was compared to postoperative diagnosis rendered at a single tertiary care referral center. A discrepant diagnosis was regarded as any change in diagnosis that resulted in further refinement of therapy or prognosis.

Results

Eleven (21.2%) patients had discrepancy between the preliminary pathology and postsurgical diagnosis. Of these diagnoses, four involved a change from a benign to a more aggressive benign or malignant process, three involved reclassification of a malignant tumor to a more aggressive histology, and four involved change from an aggressive process to benign histology. In all 11 cases, alteration in management strategy was rendered. The majority of discordant diagnoses were of fibro-osseous lesions and small round blue cell tumors.

Conclusion

Sinonasal tumors exhibit a high degree of discordance from preoperative to postoperative diagnosis. Critical decision-making should be reserved until careful review of operative specimens is performed to minimize patient morbidity and unnecessary interventions.
Does Heating up Saline for Nasal Irrigation Improve Mucociliary Function in Chronic Rhinosinusitis?
Authors: Nimsakul Suthanma , Ruxrungtham Saran , Chusakul Supinda , Kanjanaumporn Jesada , Aeumjaturapat Songklot , Snidvongs Kornkiat
Published: June 2018

Background

Mucociliary function is affected by temperature. Exposure to cold air may impair ciliary beat frequency. While saline nasal irrigation improves in ciliary beat activity, there is no evidence supporting the use of heated saline irrigation in treating patients with chronic rhinosinusitis.

Objective

To compare the effects of heated saline to room-temperature saline nasal irrigation on mucociliary clearance in chronic rhinosinusitis patients.

Methods

Adult patients with chronic rhinosinusitis were randomized into two groups receiving either heated saline or room-temperature saline nasal irrigation. Healthy subjects were included as control. Saccharin transit time was measured before and after nasal irrigation. Nasal patency was assessed by peak nasal inspiratory flow, anterior rhinomanometry, acoustic rhinometry, nasal obstruction score, and breathe-comfort score. Any adverse events were reported.

Results

Twenty-three patients with chronic rhinosinusitis and nine healthy subjects were enrolled. Saccharin transit time was decreased after nasal irrigation in both heated saline subgroup (baseline 12.3 ± 4.5 min vs. postirrigation 8.4 ± 4.9 min, p = 0.05) and room-temperature subgroup (baseline 12.8 ± 5.0 min vs. postirrigation 8.9 ± 4.2 min, p = 0.01). The saccharin transit time improvement was not different between heated saline (3.8 ± 6.2 min) and room-temperature saline (3.8 ± 4.0 min), p = 0.13. Postheated saline irrigation saccharin transit time of chronic rhinosinusitis patients (8.4 ± 4.9 min) was not different to healthy subjects (9.2 ± 3.7 min), p = 0.69. Nasal patency was not different between groups. There was no adverse event reported.

Conclusion

Nasal saline irrigation is beneficial to patients with chronic rhinosinusitis on mucociliary improvement. Warming saline is not necessary and adds no additional benefit to room-temperature saline irrigation.
Effects of a Thermosensitive In Situ Gel Containing Mometasone Furoate on a Rat Allergic Rhinitis Model
Authors: Altuntaş Ebru , Yener Gülgün , Doğan Remzi , Aksoy Fadlullah , Şerif Aydın Mehmet , Karataş Ersin
Published: June 2018

Background

Mometasone furoate, one of the second generation intranasal corticosteroids, is currently used in suspension form due to its poor solubility. However, this is not favorable for nasal application because of the rapid elimination of the instilled drug from the nasal cavity by mucociliary clearance and delayed onset of action due to the slow dissolution of drug in suspension.

Objective

The aim of this study was to determine the antiallergic effects of mucoadhesive thermosensitive in situ gel containing mometasone furoate that we developed previously to prolong the contact between the drug and nasal mucosa and to prevent drainage of the formulation in an ovalbumin-induced rat model of allergic rhinitis.

Methods

An experimental allergic rhinitis model was developed in female Wistar albino rats by intraperitoneal injection of ovalbumin every 2 days for 14 days followed by its repeated intranasal instillation for 7 consecutive days. Intranasal instillation of ovalbumin was continued every other day for 14 days. Mometasone furoate in situ gel (5 μg/10 µl), mometasone furoate suspension (5 μg/10 µl), and physiological saline (10 µl) were administered into the bilateral nasal cavities from day 22 to day 35. Antiallergic effects were evaluated through histopathological evaluation, analysis of ovalbumin-specific serum immunoglobulin E, and a symptom score.

Results

Mometasone furoate in situ gel significantly decreased the nasal symptoms and ovalbumin-specific serum immunoglobulin E level as compared with mometasone furoate suspension and physiological saline. Additionally, inflammatory histological symptoms such as mucosal edema, vascular dilatation, eosinophil infiltration, and loss of cilia within the nasal mucosa of allergic rhinitis model rats were remarkably improved with the treatment of mometasone furoate in situ gel.

Conclusion

These results suggest that mometasone furoate in situ gel has a better therapeutic potential for the treatment of allergic rhinitis compared to mometasone furoate suspension.
A Pilot Comparison between Caregiver’s and Patient’s Perceived Quality of Life in Chronic Rhinosinusitis
Authors: Adams Katherine N. , Farquhar Douglas , Senior Brent A. , Thorp Brian D. , Zanation Adam M. , Ebert Charles S.
Published: June 2018

Introduction

Chronic rhinosinusitis negatively impacts a patient’s quality of life, but current studies only address the patient’s perception of their disease. Caregivers living with the patient may have an alternative perception of the severity of the quality of life disturbance that patient’s experience with chronic rhinosinusitis.

Methods

This was a prospective cohort study that enrolled patients with a confirmed chronic rhinosinusitis diagnosis who presented to clinic with a caregiver. At the initial visit, patients completed a Rhinosinusitis Disability Index. The caregiver completed a Rhinosinusitis Disability Index based on their perception of the patient’s symptoms in addition to a Modified Caregiver Strain Index and a Short Form-36 to assess caregiving strain and overall health, respectively. Statistical analyses were performed with significance defined as P < 0.05 a priori.

Results

A total of 44 total subjects (22 patient and caregiver pairs) were enrolled. Patients reported a total Rhinosinusitis Disability Index of 36.8 (confidence interval: 26.9, 46.6), and caregivers reported a total Rhinosinusitis Disability Index of 50.4 [confidence interval: 38.8, 61.9] ( P = 0.02). The principal differences between patient and caregiver scores were noted in the emotional and physical domains ( P = 0.01 and P = 0.05, respectively). Only the functional domain was not statistically different ( P = 0.20). The patient’s total Rhinosinusitis Disability Index is positively correlated with the caregiver’s total Modified Caregiver Strain Index with a spearman coefficient of .60 (p ≤ 0.005).

Conclusions

Caregivers experience greater strain as the patient’s quality of life declines. Caregivers perceive patients to have worse quality of life than patients report. Based on these data, caregivers may provide additional insight to the quality of life disturbance of chronic rhinosinusitis. In addition, the societal impact of chronic rhinosinusitis may be underestimated.
Remodeling of the Paradoxical Middle Turbinate: Preserving Function While Gaining Access
Authors: Belcher Ryan H. , Ikeda Allison K. , DelGaudio John M.
Published: June 2018

Background

Endoscopic sinus surgery is performed for many reasons, most commonly for chronic rhinosinusitis refractory to medical treatment. A paradoxical middle turbinate is an anatomic variant that can hinder endoscopic access to the sinuses. No publication has addressed how to surgically treat a paradoxical middle turbinate.

Method

We present a basic endoscopic surgical approach to conservatively resect a paradoxical middle turbinate in order to improve access to the middle meatus and the sinuses while preserving support and function.

Conclusion

Conservative remodeling of the paradoxical middle turbinate can provide access to the sinuses while maintaining a significant portion of the middle turbinate.
Endoscopic Resection of Sinonasal Inverted Papilloma: Systematic Review and Meta-Analysis
Authors: Goudakos John K. , Blioskas Sarantis , Nikolaou Angelos , Vlachtsis Konstantinos , Karkos Peter , Markou Konstantinos D.
Published: June 2018

Background

Pure endoscopic surgery (functional endoscopic sinus surgery) has been increasingly replacing external approaches in the management of sinonasal inverted papillomas.

Objective

To analyze and compare the effectiveness of pure endoscopic procedure with external or combined procedures to paranasal inverted papillomas, including the experience from two institutions in North Greece, over a 20-year period.

Methods

Systematic literature searches of MEDLINE (1952–2016), EMBASE (1974–2016), and the Cochrane Central Register of Controlled Trials. Review of all English-language studies comparing endoscopic and open techniques. Odds ratios (ORs), risk ratio, 95% confidence intervals (CIs), and tests for heterogeneity were reported. Recurrence rates according to initial tumor stage.

Results

In total, 2451 patients had been enrolled in the 23 studies, published between 1992 and 2014. All the included articles are graded as level IV evidence. Among the 1526 patients of the endoscopic group, 212 (13.8%) had recurrence, with the mean time of recurrence to range from 14 to 46.6 months. In the external approach group, 111 (18.7%) of the 592 patients had recurrence, with the time of recurrence to range from 7 to 92 months. The recurrence rate in the combined approach group was 12.9%. The occurrence rate of recurrence attributable to the surgical choice was significantly different between endoscopic and external group (OR: 0.61; 95% CI: 0.40–0.92; P = 0.02; 14.9% vs. 18.8% in endoscopic and external group, respectively).

Conclusions

The present systematic review and meta-analysis indicates that endoscopic approach seems a favorable treatment option of sinonasal inverted papillomas and confirms the global recommendation that is the gold standard in the treatment of such nose lesions, revealing a lower recurrence rate compared to external approaches.
Bevacizumab for Epistaxis in Hereditary Hemorrhagic Telangiectasia: An Evidence-based Review
Authors: Halderman Ashleigh A. , Ryan Matthew W. , Marple Bradley F. , Sindwani Raj , Reh Douglas D. , Poetker David M.
Published: June 2018

Objective

Epistaxis is a primary complaint in 90% to 96% of patients with hereditary hemorrhagic telangiectasia (HHT). Numerous surgical and medical treatments aim to decrease the frequency and severity of epistaxis in this patient population. Bevacizumab is a recombinant, humanized monoclonal antibody to vascular endothelial growth factor, an angiogenic factor elevated in HHT. It has been used in several forms to treat epistaxis in HHT but thus far, evidence-based recommendations are limited.

Study Design

Systematic review with evidence-based recommendations.

Methods

A systematic review of the literature following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed using Embase, MEDLINE, MEDLINE In-Process/Epub, and Cochrane databases. English language abstracts were reviewed for relevance.

Results

Eleven manuscripts met inclusion criteria and were analyzed. Submucosal injection, submucosal injection plus laser coagulation, intravenous (IV), and topical formulations of bevacizumab were evaluated for their therapeutic impact on epistaxis in patients with HHT. Three randomized controlled trials failed to show topical bevacizumab to be more effective in controlling epistaxis than saline or other moisturizers.

Conclusions

The use of submucosal and IV bevacizumab shows promise, but further study is necessary to determine the true efficacy in the treatment of epistaxis as only grade C level exists currently. Based on the available literature, the use of topical bevacizumab is not recommended (grade B).
Blood Eosinophil and Basophil Values Before and After Surgery for Eosinophilic-type Sinonasal Polyps
Authors: Brescia Giuseppe , Parrino Daniela , Zanotti Claudia , Tealdo Giulia , Barion Umberto , Sfriso Paolo , Marioni Gino
Published: June 2018

Background

Blood eosinophil and basophil levels have recently been considered for the purpose of endotyping chronic rhinosinusitis with nasal polyps (CRSwNP). Histologically, eosinophilic-type CRSwNPs have been associated with high recurrence rates after treatment.

Objective

The present study was the first to compare blood eosinophil and basophil counts in eosinophilic-type CRSwNP patients before and after endoscopic sinus surgery.

Methods

The study concerned 79 consecutive patients with histologically confirmed eosinophilic-type CRSwNP treated with endoscopic sinus surgery.

Results

A significant drop in mean blood eosinophil counts and percentages occurred from before to after endoscopic sinus surgery in the cohort as a whole. Mean blood eosinophil counts and percentages were also reduced after surgery in the subcohorts of CRSwNP patients with (i) asthma, (ii) aspirin-exacerbated respiratory disease (AERD), and (iii) no allergy. Although blood eosinophil and basophil counts correlated directly before and after surgery, a statistical reduction in blood basophil counts and percentages after surgery emerged only in the subcohort of nonallergic CRSwNP patients.

Conclusion

Endoscopic sinus surgery can clear polyps, remove inflammatory tissue, and reduce inflammatory cytokine levels. Consistently with the biological mechanism described, endoscopic sinus surgery could coincide with a reduction in blood eosinophils in eosinophilic-type CRSwNP.
Assessment of a Lateral Nasal Wall Block Technique for Endoscopic Sinus Surgery Under Local Anesthesia
Authors: Scott Grace M. , Diamond Chris , Micomonaco Damian C.
Published: June 2018

Introduction

With increasingly limited operative resources and patient desires for minimally invasive procedures, there is a trend toward local endoscopic procedures being performed in the outpatient clinic setting. However, there remain limited data supporting a technique to adequately anesthetize the lateral nasal wall and provide patient comfort during these procedures. The objective of this study is to assess the efficacy of a novel lateral nasal wall block for use in office-based endoscopic sinus surgery.

Methods

A prospective cohort study assessing consecutive patients undergoing office-based endoscopic sinus surgery using our described lateral nasal wall block anesthesia technique. Procedural patient comfort was assessed using the Iowa Satisfaction with Anesthesia Scale (ISAS), completed by participants immediately following an office-based endoscopic procedure and prior to discharge from clinic. Postoperative analgesic use was assessed at the first postoperative visit.

Results

Thirty-five consecutive patients undergoing office-based outpatient endoscopic sinus surgery for chronic rhinosinusitis (with and without polyps) were assessed. The mean ISAS score was 2.83 (95% confidence interval: [2.69, 2.97]). All participants (100%) agree or strongly agree that they were satisfied with their anesthesia care and would want the same anesthetic again. No participant required narcotic analgesia, and 80% used no oral analgesia following the procedure.

Conclusions

Recent advances in office-based endonasal surgical procedures must be accompanied by the assessment and validation of local anesthetic techniques. The described novel lateral nasal wall block is well tolerated, provides patient satisfaction, and allows for limited use of postprocedure oral analgesics.
Effect of MeCP2 on TGF-β1-induced Extracellular Matrix Production in Nasal Polyp-derived Fibroblasts
Authors: Shin Jae-Min , Um Ji-Young , Lee Seoung-Ae , Park Il-Ho , Lee Soo-Hyung , Lee Heung-Man
Published: June 2018

Purpose

Methyl-CpG-binding protein 2 (MeCP2), known as a transcriptional regulator, has been suggested to play an important role in myofibroblast differentiation in the lung. The purpose of this study was to investigate the role of MeCP2 in transforming growth factor (TGF)- β1-induced myofibroblast differentiation and extracellular matrix (ECM) production in nasal polyp-derived fibroblasts (NPDFs).

Methods

To identify the expression of MeCP2 in nasal polyp tissues, immunohistochemistry staining and Western blot were performed. TGF- β1-induced NPDFs were treated with 5-azacytidine, a DNA methylation inhibitor, and the expression levels of α-SMA and fibronectin were determined by semiquantitative reverse transcription polymerase chain reaction, immunoﬂuorescent staining, and Western blotting. The total soluble collagen was analyzed by the Sircol collagen assay. MeCP2 silenced by MeCP2-specific small interference ( si) RNA was verified by Western blot.

Results

The expression levels of MeCP2 increased in nasal polyp tissues compared to normal inferior turbinate tissues. 5-Azacytidine significantly inhibited the expression of α-SMA and fibronectin mRNA in a dose-dependent manner. In addition, 5-azacytidine suppressed collagen production and the expression of MeCP2 in the same manner. The expression levels of a-SMA and collagen production were significantly blocked by MeCP2 silencing in TGF- β1-induced NPDFs.

Conclusions

Our data suggest that MeCP2 plays an essential role in TGF- β1-induced myofibroblast differentiation and ECM production in NPDFs.