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PUBH7650 Clinical Epidemiology Question: Analyse and summarize the below articles: 1. Inappropriate prescribing of inhaled corticosteroids: are they being prescribed for respiratory tract infections? A retrospective cohort study. 2. Associations between central obesity and asthma in children and adolescents: a case–control study Answer: The first article is on the inappropriate prescription of inhaled corticosteroids is about the guidelines that recommend the regular use of inhaled Corticosteroid containing medications for patients with persistent asthma. It tested the hypothesis that ICS is often prescribed for the management of respiratory infections in patients who do not have chronic airway disease. medication is usually subsidized by the government, for example in Australia, the Pharmaceutical Benefits scheme subsidizes some or all the costs of the dispensed medication (Poulos, L.M., Ampon, R.D., Marks, G.B. and Reddel, H.K., 2013) The data used was obtained by identifying those who were dispensed with  one ICS containing medication and no other respiratory medications in a year. This information can be used to ensure that there is proper prescription of ICS only to patients with chronic airway disease. The involvement of the government helps in improving the clinical services offered to the patients. However, there is no evidence that a short course of this therapy is effective for any specific condition. Irregular dispensing is thought to be due to poor adherence by patients who were prescribed these medications for regular use (Poulos, Ampon, Marks, and Reddel, 2013). According to these points, the management of asthma becomes less effective using ICS because of the irregularities in prescriptions. It is therefore important to improve the adherence of the patients by making them aware of the risks involved. The second article is on the association between central obesity and asthma in children and adolescents. The case study examined associations between central obesity and asthma diagnosis. The data was obtained from a sample of 514 children and the findings indicated that a high proportion of the children with asthma were obese (Papoutsakis, Chondronikola, Antonogeorgos, and Priftis, 2015). This can help in recommending healthier lifestyle for the children and to understand the relationship between body fat distribution and asthma. Technological advancement has led the to the adoption of a lifestyle that impairs health. A less sedentary lifestyle can help in reducing obesity. Genetic and environmental factors have increased the prevalence of asthma (Papoutsakis, Chondronikola, Antonogeorgos, and Priftis, 2015). The children should be brought up in safe environments that ensure their good health. Recommendations include higher physical activity and safe environment for children. Breastfeeding of children at a young by the mother could also help in improving the health of the child (Reddel, Bateman, Becker, de Jongste, and Lemanske, 2015). The third article is on asthma prevalence in Melbourne schoolchildren. It seeks to determine the prevalence of asthma in Australian schoolchildren from 1993-2002. Variation in methods and lack of uniform diagnostic criteria has made comparisons between studies difficult. The International Study of Asthma and Allergy in Childhood (ISAAC) developed a standardized method (Robertson, Roberts, and Kappers, 2004). This allows for comparison between centers and monitoring changes over time. The ISAAC protocol was used to survey 6-7-year-old children from random primary school. The prevalence was reported to have fallen by 26% over 9 years (Robertson, Roberts, and Kappers, 2004). This shows that the increased awareness of asthma has helped in reducing its prevalence. However, it does not offer evidence for a change in more objective factors that may influence the prevalence of asthma. There is no evidence that suggests the established risk factors for the development of asthma in childhood (Robertson, Roberts, and Kappers, 2004). The awareness of these risk factors could help in reducing the prevalence of asthma. Recommendations would include improving and maintaining public awareness campaigns that will bring more awareness about the risk factors involved in the condition and its management. Recommendations One of the recommended actions in dealing with the issue includes regular monitoring of overall body weight mass status, which will help in identifying children at risk for asthma and providing them with remedies to stop its development while those already asthmatic should be given immediate medical attention (Papoutsakis, Chondronikola, Antonogeorgos, Papadakou, Matziou, Konstantaki, Papadimitriou, and Priftis 2015). Another recommended action is to reduce inappropriate prescribing of antibiotics and you improve the quality of prescribing ICS. Opposing arguments that arose included the level of awareness of the symptom complex in the community (Papoutsakis et al 2015). The recommended approach to these actions involves the involvement of statewide policies and administration of asthmatic drugs. Close monitoring of children during their development also plays a major role in fulfilling these actions (Reddel, Bateman, Becker, Boulet, Cruz, Drazen, Haahtela, Hurd, Inoue, de Jongste, and Lemanske 2015). References Papoutsakis, C., Chondronikola, M., Antonogeorgos and Priftis, K.N., 2015. Associations between central obesity and asthma in children and adolescents: a case–control study. Journal of Asthma, 52(2), pp.128-134. Poulos, L.M., Ampon, R.D., Marks, G.B. and Reddel, H.K., 2013. Inappropriate prescribing of inhaled corticosteroids: are they being prescribed for respiratory tract infections? A retrospective cohort study. Primary Care Respiratory Journal, 22, pp.201-208. Reddel, H.K., Bateman, E.D., Becker, de Jongste, J.C. and Lemanske, R.F., 2015. A summary of the new GINA strategy: a roadmap to asthma control. European Respiratory Journal, 46(3), pp.622-639. Robertson, C.F., Roberts, M.F. and Kappers, J.H., 2004. Asthma prevalence in Melbourne schoolchildren: have we reached the peak?Medical Journal of Australia, 180(6), pp.273-276.

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