Articles: chronic.
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Sleep disorders in children can compromise quality of life of both children and families and chronic sleep deprivations is associated with poorer developmental outcome, overweight and behavioral disturbances. Clinicians should incorporate questions about sleep into their routine health assessment, and the assessment of insomnia should follow a medical approach primary and secondary contributing factors should be assessed, as well as maladaptive behaviors related to sleep. ⋯ Polysomnography is not routinely indicated for children with insomnia, but actigraphy can give an objective estimation of sleep parameters. The Authors propose a new classification of pediatric insomnia, based on both genetic and clinical aspects, and suggest specific treatment options, including sleep hygiene, behavioral strategies and pharmacological treatment.
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Obstructive sleep apnea (OSA) is a chronic breathing disorder that contributes to many other health problems (Epstein et al., 2009). It is present but undiagnosed in a large percentage of the population (Adesanya, Lee, Grilich, & Joshi, 2010). Pain is recognized as a public health problem in the United States, affecting millions of people of all ages (Committee on Advancing Pain Research, Care, and Education Board on Health Sciences Policy, 2011). ⋯ Opioid analgesics used to treat pain may cause sedation and respiratory depression by themselves. When administered to individuals with OSA, the risk for harmful respiratory events increases. This article reviews the assessment and monitoring needed to administer opioids safely to individuals with OSA and identifies best practices from a review of the literature.
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Semin Respir Crit Care Med · Jun 2015
ReviewGene-environment interaction from international cohorts: impact on development and evolution of occupational and environmental lung and airway disease.
Environmental and occupational pulmonary diseases impose a substantial burden of morbidity and mortality on the global population. However, it has been long observed that only some of those who are exposed to pulmonary toxicants go on to develop disease; increasingly, it is being recognized that genetic differences may underlie some of this person-to-person variability. Studies performed throughout the globe are demonstrating important gene-environment interactions for diseases as diverse as chronic beryllium disease, coal workers' pneumoconiosis, silicosis, asbestosis, byssinosis, occupational asthma, and pollution-associated asthma. ⋯ No genetic test has yet emerged with sufficiently robust operating characteristics to be clearly useful or practicable in an occupational or environmental setting. In addition, occupational genetic testing raises serious ethical and policy concerns. Therefore, the primary objective must remain ensuring that the workplace and the environment are safe for all.
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Inflammation may contribute to the pathobiology of pulmonary arterial hypertension (PAH). Deciphering the PAH fingerprint on the inflammation orchestrated by dendritic cells (DCs) and T cells, key driver and effector cells, respectively, of the immune system, may allow the identification of immunopathologic approaches to PAH management. ⋯ We have highlighted T helper 17 cell immune polarization in patients with PAH, as has been previously demonstrated in other chronic inflammatory and autoimmune conditions.