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      Exploring association between gastrointestinal heat retention syndrome and recurrent respiratory tract infections in children: a prospective cohort study

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          Abstract

          Background

          Recurrent respiratory tract infections (RRTIs) have a negative impact on both children’s health and family wellbeing. Deficiency of ZhengQi used to be an instinct factor driving RRTI in Traditional Chinese Medicine (TCM). Our clinical observations suggest that children with gastrointestinal heat retention syndrome (GHRS) may have a greater risk of catching respiratory tract infections (RTIs). GHRS is a new predisposing factor for RRTI and it is dietary related. This study is aimed to explore association between GHRS and RRTI.

          Methods

          A prospective cohort study has been conducted in Beijing, China; children aged 1–18 were enrolled. TCM symptoms, demographic and physiological characteristics were recorded by using semi-structured questionnaire. GHRS was considered as a predisposing factor. Children were followed up for next 12 months. We contacted with their parents using a face-to-face questionnaire survey, via email or phone every 3 months. Episodes of RTIs were recorded in detail.

          Results

          Three hundred thirty four children were enrolled and 307 (91.92 %) followed up for 12 months. The incidence of RTI was 4.32 episodes per child-year (95 % CI 4.03–4.61). 69 (43.13 %) children in the group with GHRS suffered from RRTI; there were 48 (32.65 %) children in group without GHRS. The risk ratio (RR) value of RRTI occurrence was 1.32 (95 % CI 0.91–1.91, P = 0.139), and the attributable risk percent (AR%) was 24.28 %. Dry stool and irritability were positively correlated with RTI episodes, age and BMI were negatively correlated with RTI episodes in a linear regression model. Dry stool (OR = 1.510) was positively correlated with RRTI occurrence, age (OR = 0.889) and BMI (OR = 0.858) were negatively correlated with RRTI occurrence in our logistic regression model.

          Conclusions

          GHRS is associated with RRTI in this cohort. Dry stool was positively associated with RRTI, and BMI was negatively associated with RRTI. Studies with larger sample size and longer follow up are needed to further evaluate this association. Relieving GHRS should be considered when TCM practitioners treat RRTI children, and this may protect children from suffering RTIs.

          Trial registration

          Chinese Clinical Trial Registry Number: ChiCTR-CCH-13003756

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          Most cited references28

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          Estimates of world-wide distribution of child deaths from acute respiratory infections.

          Acute respiratory infections (ARI) are among the leading causes of childhood mortality. Estimates of the number of children worldwide who die from ARI are needed in setting priorities for health care. To establish a relation between deaths due to ARI and all-cause deaths in children under 5 years we show that the proportion of deaths directly attributable to ARI declines from 23% to 18% and then 15% (95% confidence limits range from +/- 2% to +/- 3%) as under-5 mortality declines from 50 to 20 and then to 10/1000 per year. Much of the variability in estimates of ARI in children is shown to be inherent in the use of verbal autopsies. This analysis suggests that throughout the world 1.9 million (95% CI 1.6-2.2 million) children died from ARI in 2000, 70% of them in Africa and southeast Asia.
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            Social, economic, and health impact of the respiratory syncytial virus: a systematic search

            Background Bronchiolitis caused by the respiratory syncytial virus (RSV) and its related complications are common in infants born prematurely, with severe congenital heart disease, or bronchopulmonary dysplasia, as well as in immunosuppressed infants. There is a rich literature on the different aspects of RSV infection with a focus, for the most part, on specific risk populations. However, there is a need for a systematic global analysis of the impact of RSV infection in terms of use of resources and health impact on both children and adults. With this aim, we performed a systematic search of scientific evidence on the social, economic, and health impact of RSV infection. Methods A systematic search of the following databases was performed: MEDLINE, EMBASE, Spanish Medical Index, MEDES-MEDicina in Spanish, Cochrane Plus Library, and Google without time limits. We selected 421 abstracts based on the 6,598 articles identified. From these abstracts, 4 RSV experts selected the most relevant articles. They selected 65 articles. After reading the full articles, 23 of their references were also selected. Finally, one more article found through a literature information alert system was included. Results The information collected was summarized and organized into the following topics: 1. Impact on health (infections and respiratory complications, mid- to long-term lung function decline, recurrent wheezing, asthma, other complications such as otitis and rhino-conjunctivitis, and mortality; 2. Impact on resources (visits to primary care and specialists offices, emergency room visits, hospital admissions, ICU admissions, diagnostic tests, and treatments); 3. Impact on costs (direct and indirect costs); 4. Impact on quality of life; and 5. Strategies to reduce the impact (interventions on social and hygienic factors and prophylactic treatments). Conclusions We concluded that 1. The health impact of RSV infection is relevant and goes beyond the acute episode phase; 2. The health impact of RSV infection on children is much better documented than the impact on adults; 3. Further research is needed on mid- and long-term impact of RSV infection on the adult population, especially those at high-risk; 4. There is a need for interventions aimed at reducing the impact of RSV infection by targeting health education, information, and prophylaxis in high-risk populations.
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              Effectiveness of adenoidectomy in children with recurrent upper respiratory tract infections: open randomised controlled trial

              Objective To assess the effectiveness of adenoidectomy in children with recurrent upper respiratory tract infections. Design Open randomised controlled trial. Setting 11 general hospitals and two academic centres. Participants 111 children aged 1-6 with recurrent upper respiratory tract infections selected for adenoidectomy. Intervention A strategy of immediate adenoidectomy with or without myringotomy or a strategy of initial watchful waiting. Main outcome measure Primary outcome measure: number of upper respiratory tract infections per person year calculated from data obtained during the total follow-up (maximum 24 months). Secondary outcome measures: days with upper respiratory tract infection per person year, middle ear complaints with fever in episodes and days, days with fever, prevalence of upper respiratory tract infections, and health related quality of life. Results During the median follow-up of 24 months, there were 7.91 episodes of upper respiratory tract infections per person year in the adenoidectomy group and 7.84 in the watchful waiting group (difference in incidence rate 0.07, 95% confidence interval −0.70 to 0.85). No relevant differences were found for days of upper respiratory tract infections and middle ear complaints with fever in episodes and days, nor for health related quality of life. The prevalence of upper respiratory tract infections decreased over time in both groups. Children in the adenoidectomy group had significantly more days with fever than the children in the watchful waiting group. Two children had complications related to surgery. Conclusion In children selected for adenoidectomy for recurrent upper respiratory tract infections, a strategy of immediate surgery confers no clinical benefits over a strategy of initial watchful waiting. Trial registration Dutch Trial Register NTR968: ISRCTN03720485.
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                Author and article information

                Contributors
                dongfei@bucm.edu.cn
                yuhe221@126.com
                pdsmajiaju@163.com
                13164272790@163.com
                liutiegang2009@163.com
                lgk123456@126.com
                296231058@qq.com
                644287964@qq.com
                gl3@soton.ac.uk
                guxh1003@126.com
                Journal
                BMC Complement Altern Med
                BMC Complement Altern Med
                BMC Complementary and Alternative Medicine
                BioMed Central (London )
                1472-6882
                27 February 2016
                27 February 2016
                2016
                : 16
                : 82
                Affiliations
                [ ]School of Basic Medical Science, Beijing University of Chinese Medicine, Beijing, China
                [ ]Beijing Hospital of Traditional Chinese Medicine, Beijing, China
                [ ]Dongfang Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
                [ ]Beilun Hospital of Chinese Medicine, Ningbo City, China
                [ ]Complementary and Integrated Medicine Research Unit, Primary Care and Population Sciences, Southampton University, Southampton, UK
                Article
                1062
                10.1186/s12906-016-1062-8
                4769561
                26921252
                7178423e-2cbf-4f48-bfea-bc2b2918ff4f
                © Dong et al. 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 14 October 2015
                : 19 February 2016
                Funding
                Funded by: Beijing Educational Committee cooperation projects
                Award ID: 1000062520115
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;
                Award ID: 81273994
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2016

                Complementary & Alternative medicine
                gastrointestinal heat retention syndrome,recurrent respiratory tract infection,children,prospective cohort study

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