Cells of Larynx May Have Significant Immune Functions
The larynx, formerly thought to exist merely for voice production, contains immune cells that may prove key in asthma emergence.

Up until now, the biology of the larynx has been virtually ignored, according to Martin Birchall, MD, who heads a laryngeal research group in the United Kingdom.

“It’s almost certain [the cells of the larynx] have a role in stopping cancer. And we think these immune cells are crucial in the development of asthma,” said Birchall at the Laryngopharyngeal Reflux, Dysphagia, and Laryngology conference held at the Wake Forest University Baptist Medical Center in Winston-Salem, NC, in May. “We are designing experiments to test these hypotheses.”

The British researcher and his colleagues are trying to understand how the lining of the larynx responds to different stimuli, including acid reflux and laryngopharyngeal reflux in the voice box, which Birchall suspects might interfere with the lining’s role in tolerating inhaled antigens. In addition, the researchers will look for ways to stimulate the laryngeal mucosa to fend off harmful antigens that cause asthma or to wipe out cancer cells, as they are designed to do, Birchall said.

Patients With Chronic Illness Stop Taking Medicine Properly
Patients need more support when starting on new medication for a chronic condition, and new services may be required to provide this, according to the authors of a recent study of chronic disease sufferers.

The researchers found that patients prescribed a medication for a long-term condition, such as asthma or heart disease, rapidly stopped taking the medicine as prescribed.

Of 258 patients involved in the southern England study, nearly a third, 10 days after diagnosis, and one in four, 4 weeks after diagnosis, were not taking their new medicines properly.

Surveyed by questionnaire and telephone, most patients reported problems with their medicine. Authors of the study, published in Quality and Safety in Health Care, say the findings suggest that these patients need to be provided with more information about their treatment and its side effects.

Some of the nonadherence to medication instructions was intentional while some was not. At 10 days, 45% of those still taking their medication reported intentional non-adherence, and a similar proportion was reported at 4 weeks. Nonadherence included not taking the right dose, and/or at the right time, and/or at the right frequency.

Textbook Spotlights ICU Simulator Education
Simulators in Critical Care and Beyond, a textbook on concepts and applications in critical care medicine simulator education, is designed for educators of critical care physicians, nurses, and paramedical personnel. Released by the Society of Critical Care Medicine (SCCM) and edited by William F. Dunn, MD, an associate professor of medicine and director of the Mayo multidisciplinary critical care fellowship at the Mayo Clinic in Rochester, Minn, the textbook addresses an array of simulation techniques, including simulated patients, mannequin human patient simulators, and task trainers. It also develops crisis team training concepts, making the textbook applicable to simulation-based education in medicine and surgery. To order, contact SCCM at (847) 827-6888 or visit www.sccm.org.

d03a.jpg (16704 bytes)Mold Liable for Some Breathing Problems, Not Linked to Other Ills
While its bad health reputation is not entirely undeserved, mold may not be causing the array of illnesses some thought it was.

A new report, from the Institute of Medicine of the National Academy of Sciences and sponsored by the Centers for Disease Control and Prevention, links mold that grows in damp areas of homes and other structures to asthma symptoms, coughing, wheezing, and upper respiratory tract symptoms in both people with the chronic disorder and those who do not suffer from asthma. The report also found an association between indoor mold exposure and hypersensitivity pneumonitis, an uncommon ailment, in genetically susceptible people. However, available scientific evidence does not support an association between either indoor dampness or mold and the wide range of other health complaints, including fatigue and neuropsychiatric disorders, that have been ascribed to them, the report says.

“An exhaustive review of the scientific literature made it clear to us that it can be very hard to tease apart the health effects of exposure to mold from all the other factors that may be influencing health in the typical indoor environment,” says committee chair Noreen Clark, dean, School of Public Health, University of Michigan, Ann Arbor. “Even though the available evidence does not link mold or other factors associated with building moisture to all the serious health problems that some attribute to them, excessive indoor dampness is a widespread problem that warrants action at the local, state, and national levels.”

The committee recommended that excessive indoor dampness be addressed through a broad range of public health initiatives and changes in how buildings are designed, constructed, and maintained.