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Barro Lugo S, Flamarich Gol C, González Martínez MÁ, Sampedro Elvira Á, Saperas Pérez C, Sánchez Collado C. [Chronic communicable and non-communicable pathology and skin pathology of the migrant patient]. Aten Primaria 2024; 56:102922. [PMID: 38583414 PMCID: PMC11002854 DOI: 10.1016/j.aprim.2024.102922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 02/06/2024] [Indexed: 04/09/2024] Open
Abstract
The care of migrant patients includes initial screening and lifelong monitoring, highlighting the importance of preventing and tracking chronic, communicable and non-communicable diseases. The prevalence of hypertension, diabetes mellitus, dyslipidemia, and obesity varies by ethnicity, influenced by genetic factors, lifestyle, and socio-economic status. Preventive measures, health promotion, and risk factor identification are crucial. Chronic communicable diseases may manifest years after transmission, underscoring the necessity of primary care screening, especially for populations from endemic or high-risk areas. Imported skin lesions are a common reason for consultation among migrant and traveller patients. Their ethiology is varied, ranging from common conditions such as scabies, mycoses, and urticaria to tropical dermatoses like filariasis and leprosy.
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Affiliation(s)
- Silvia Barro Lugo
- Centro de Atención Primaria Larrard, Parc Sanitari Pere Virgili, Barcelona, España; Grupo de Trabajo Cooperación y Salud Internacional (COCOOPSI), Sociedad Catalana de Medicina Familiar y Comunitaria.
| | - Clara Flamarich Gol
- Grupo de Trabajo Cooperación y Salud Internacional (COCOOPSI), Sociedad Catalana de Medicina Familiar y Comunitaria; Equipo de Atención Primaria Sant Roc, Institut Català de la Salut, IDIAP Jordi Gol Gorina, Badalona, Barcelona, España
| | - M Ángeles González Martínez
- Grupo de Trabajo Cooperación y Salud Internacional (COCOOPSI), Sociedad Catalana de Medicina Familiar y Comunitaria; Centro de Atención Primaria Trinitat Vella, Institut Català de la Salut, Sant Andreu, Barcelona, España
| | - Ángela Sampedro Elvira
- Grupo de Trabajo Cooperación y Salud Internacional (COCOOPSI), Sociedad Catalana de Medicina Familiar y Comunitaria; Centro de Atención Primaria Gornal, L'Hospitalet de Llobregat, Institut Català de la Salut, L'Hospitalet de Llobregat, Barcelona, España
| | - Carme Saperas Pérez
- Grupo de Trabajo Cooperación y Salud Internacional (COCOOPSI), Sociedad Catalana de Medicina Familiar y Comunitaria; Centro de Atención Primaria Plana Lledó, Mollet del Vallès, Institut Català de la Salut, Metropolitana Nord, Mollet del Vallès, Barcelona, España
| | - Consuelo Sánchez Collado
- Grupo de Trabajo Cooperación y Salud Internacional (COCOOPSI), Sociedad Catalana de Medicina Familiar y Comunitaria; Centro de Atención Primaria Garrotxa-Olot Nord, Institut Català de la Salut, Girona, Olot, Girona, España
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2
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Wills TA, Kaholokula JK, Pokhrel P, Pagano I. Ethnic differences in respiratory disease for Native Hawaiians and Pacific Islanders: Analysis of mediation processes in two community samples. PLoS One 2023; 18:e0290794. [PMID: 37624834 PMCID: PMC10456168 DOI: 10.1371/journal.pone.0290794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
OBJECTIVE The prevalence of asthma and chronic obstructive pulmonary disorder (COPD) is elevated for Native Hawaiians but the basis for this differential is not well understood. We analyze data on asthma and COPD in two samples including Native Hawaiians Pacific Islanders, and Filipinos to determine how ethnicity is related to respiratory disease outcomes. METHODS We analyzed the 2016 and 2018 Behavioral Risk Factor Surveillance Survey (BRFSS), a telephone survey of participants ages 18 and over in the State of Hawaii. Criterion variables were a diagnosis of asthma or COPD by a health professional. Structural equation modeling tested how five hypothesized risk factors (cigarette smoking, e-cigarette use, second-hand smoke exposure, obesity, and financial stress) mediated the ethnic differential in the likelihood of disease. Age, sex, and education were included as covariates. RESULTS Structural modeling with 2016 data showed that Native Hawaiian ethnicity was related to higher levels of the five risk factors and each risk factor was related to a higher likelihood of respiratory disease. Indirect effects were statistically significant in almost all cases, with direct effects to asthma and COPD also observed. Mediation effects through comparable pathways were also noted for Pacific Islanders and Filipinos. These findings were replicated with data from the 2018 survey. CONCLUSIONS Native Hawaiian and Pacific Islander ethnicity is associated with greater exposure to five risk factors and this accounts in part for the ethnic differential in respiratory disease outcomes. The results support a social-ecological model of health disparities in this population. Implications of the findings for preventive interventions are discussed.
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Affiliation(s)
- Thomas A. Wills
- Cancer Prevention in the Pacific Program, University of Hawaii Cancer Center, Honolulu, Hawaii, United States of America
| | - Joseph Keawe’aimoku Kaholokula
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii, United States of America
| | - Pallav Pokhrel
- Cancer Prevention in the Pacific Program, University of Hawaii Cancer Center, Honolulu, Hawaii, United States of America
| | - Ian Pagano
- Cancer Prevention in the Pacific Program, University of Hawaii Cancer Center, Honolulu, Hawaii, United States of America
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3
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Lee PN, Coombs KJ, Hamling JS. Evidence relating cigarette, cigar and pipe smoking to lung cancer and chronic obstructive pulmonary disease: Meta-analysis of recent data from three regions. World J Meta-Anal 2023; 11:228-252. [DOI: 10.13105/wjma.v11.i5.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/10/2023] [Accepted: 05/30/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND There is a need to have up-to-date information for various diseases on the risk related to the use of different smoked products and the use of other nicotine-containing products. Here, we contribute to the information pool by presenting up-to-date quantitative evidence for North America, Europe and Japan and for both lung cancer and chronic obstructive pulmonary disease (COPD) on the relative risk (RR) relating to current vs never product use for each of the three smoked tobacco products, cigarettes, cigars and pipes.
AIM To estimate lung cancer and COPD current smoking RRs for the three products using recent data for the three regions.
METHODS Publications in English from 2010 to 2020 were considered that, based on epidemiological studies in the three regions, estimated the current smoking RR of lung cancer and/or COPD for one or more of the three products. The studies should involve at least 100 cases of the disease considered, not be restricted to specific lung cancer types or populations with specific medical conditions, and should be of cohort or nested case-control study design or randomized controlled trials. Literature searches were conducted on MEDLINE separately for lung cancer and for COPD, examining titles and abstracts initially, and then full texts. Additional papers were sought from reference lists of selected papers, reviews and meta-analyses. For each study identified, the most recent available data on each product were entered on current smoking, as well as on characteristics of the study and the RR estimates. Combined RR estimates were derived using random-effects meta-analysis. For cigarette smoking, where far more data were available, heterogeneity was studied by a wide range of factors. For cigar and pipe smoking, a more limited heterogeneity analysis was carried out. Results were compared with those from previous meta-analyses published since 2000.
RESULTS Current cigarette smoking: For lung cancer, 44 studies (26 North American, 14 European, three Japanese, and one in multiple continents), gave an overall estimate of 12.14 [95% confidence interval (CI) 10.30-14.30]. The estimates were higher (heterogeneity P < 0.001) for North American (15.15, CI 12.77-17.96) and European studies (12.30, CI 9.77-15.49) than for Japanese studies (3.61, CI 2.87-4.55), consistent with previous evidence of lower RRs for Asia. RRs were higher (P < 0.05) for death (14.85, CI 11.99-18.38) than diagnosis (10.82, CI 8.61-13.60). There was some variation (P < 0.05) by study population, with higher RRs for international and regional studies than for national studies and studies of specific populations. RRs were higher in males, as previously reported, the within-study male/female ratio of RRs being 1.52 (CI 1.20-1.92). RRs did not vary significantly (P ≥ 0.05) by other factors. For COPD, RR estimates were provided by 18 studies (10 North American, seven European, and one Japanese). The overall estimate of 9.19 (CI 6.97-12.13), was based on heterogeneous data (P < 0.001), and higher than reported earlier. There was no (P > 0.1) variation by sex, region or exclusive use, but limited evidence (0.05 < P < 0.1) that RR estimates were greater where cases occurring shortly after baseline were ignored; where bronchiectasis was excluded from the COPD definition; and with greater confounder adjustment. Within-study comparisons showed adjusted RRs exceeded unadjusted RRs. Current cigar smoking: Three studies gave an overall lung cancer RR of 2.73 (CI 2.36-3.15), with no heterogeneity, lower than the 4.67 (CI 3.49-6.25) reported in an earlier review. Only one study gave COPD results, the RR (2.44, CI 0.98-6.05) being imprecise. Current pipe smoking: Four studies gave an overall lung cancer RR of 4.93 (CI 1.97-12.32), close to the 5.20 (CI 3.50-7.73) given earlier. However, the estimates were heterogeneous, with two above 10, and two below 3. Only one study gave COPD results, the RR (1.12, CI 0.29-4.40), being imprecise. For both diseases, the lower RR estimates for cigars and for pipes than for current smoking of cigarettes aligns with earlier published evidence.
CONCLUSION Current cigarette smoking substantially increases lung cancer and COPD risk, more so in North America and Europe than Japan. Limited evidence confirms lower risks for cigars and pipes than cigarettes.
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Affiliation(s)
- Peter Nicholas Lee
- Medical Statistics and Epidemiology, P.N.Lee Statistics and Computing Ltd., Sutton SM2 5DA, Surrey, United Kingdom
| | - Katharine J Coombs
- Statistics, P.N.Lee Statistics and Computing Ltd, Sutton SM2 5DA, Surrey, United Kingdom
| | - Jan S Hamling
- Statistics, RoeLee Statistics Ltd, Sutton SM2 5DA, United Kingdom
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4
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Kanaya AM, Hsing AW, Panapasa SV, Kandula NR, Araneta MRG, Shimbo D, Wang P, Gomez SL, Lee J, Narayan KMV, Mau MKLM, Bose S, Daviglus ML, Hu FB, Islam N, Jackson CL, Kataoka-Yahiro M, Kauwe JSK, Liu S, Ma GX, Nguyen T, Palaniappan L, Setiawan VW, Trinh-Shevrin C, Tsoh JY, Vaidya D, Vickrey B, Wang TJ, Wong ND, Coady S, Hong Y. Knowledge Gaps, Challenges, and Opportunities in Health and Prevention Research for Asian Americans, Native Hawaiians, and Pacific Islanders: A Report From the 2021 National Institutes of Health Workshop. Ann Intern Med 2022; 175:574-589. [PMID: 34978851 PMCID: PMC9018596 DOI: 10.7326/m21-3729] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Asian Americans (AsA), Native Hawaiians, and Pacific Islanders (NHPI) comprise 7.7% of the U.S. population, and AsA have had the fastest growth rate since 2010. Yet the National Institutes of Health (NIH) has invested only 0.17% of its budget on AsA and NHPI research between 1992 and 2018. More than 40 ethnic subgroups are included within AsA and NHPI (with no majority subpopulation), which are highly diverse culturally, demographically, linguistically, and socioeconomically. However, data for these groups are often aggregated, masking critical health disparities and their drivers. To address these issues, in March 2021, the National Heart, Lung, and Blood Institute, in partnership with 8 other NIH institutes, convened a multidisciplinary workshop to review current research, knowledge gaps, opportunities, barriers, and approaches for prevention research for AsA and NHPI populations. The workshop covered 5 domains: 1) sociocultural, environmental, psychological health, and lifestyle dimensions; 2) metabolic disorders; 3) cardiovascular and lung diseases; 4) cancer; and 5) cognitive function and healthy aging. Two recurring themes emerged: Very limited data on the epidemiology, risk factors, and outcomes for most conditions are available, and most existing data are not disaggregated by subgroup, masking variation in risk factors, disease occurrence, and trajectories. Leveraging the vast phenotypic differences among AsA and NHPI groups was identified as a key opportunity to yield novel clues into etiologic and prognostic factors to inform prevention efforts and intervention strategies. Promising approaches for future research include developing collaborations with community partners, investing in infrastructure support for cohort studies, enhancing existing data sources to enable data disaggregation, and incorporating novel technology for objective measurement. Research on AsA and NHPI subgroups is urgently needed to eliminate disparities and promote health equity in these populations.
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Affiliation(s)
- Alka M Kanaya
- University of California, San Francisco, San Francisco, California (A.M.K., S.L.G., T.N., J.Y.T.)
| | - Ann W Hsing
- Stanford University, Stanford, California (A.W.H., P.W., L.P.)
| | | | | | | | - Daichi Shimbo
- Columbia University Irving Medical Center, New York, New York (D.S.)
| | - Paul Wang
- Stanford University, Stanford, California (A.W.H., P.W., L.P.)
| | - Scarlett L Gomez
- University of California, San Francisco, San Francisco, California (A.M.K., S.L.G., T.N., J.Y.T.)
| | - Jinkook Lee
- University of Southern California, Los Angeles, California (J.L., V.W.S.)
| | | | | | - Sonali Bose
- Icahn School of Medicine at Mount Sinai, New York, New York (S.B., B.V.)
| | | | - Frank B Hu
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts (F.B.H.)
| | - Nadia Islam
- New York University Grossman School of Medicine, New York, New York (N.I., C.T.)
| | - Chandra L Jackson
- National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, Maryland (C.L.J.)
| | | | | | - Simin Liu
- Brown University, Providence, Rhode Island (S.L.)
| | - Grace X Ma
- Temple University, Philadelphia, Pennsylvania (G.X.M.)
| | - Tung Nguyen
- University of California, San Francisco, San Francisco, California (A.M.K., S.L.G., T.N., J.Y.T.)
| | | | - V Wendy Setiawan
- University of Southern California, Los Angeles, California (J.L., V.W.S.)
| | - Chau Trinh-Shevrin
- New York University Grossman School of Medicine, New York, New York (N.I., C.T.)
| | - Janice Y Tsoh
- University of California, San Francisco, San Francisco, California (A.M.K., S.L.G., T.N., J.Y.T.)
| | | | - Barbara Vickrey
- Icahn School of Medicine at Mount Sinai, New York, New York (S.B., B.V.)
| | - Thomas J Wang
- University of Texas Southwestern Medical Center, Dallas, Texas (T.J.W.)
| | - Nathan D Wong
- University of California, Irvine, Irvine, California (N.D.W.)
| | - Sean Coady
- National Heart, Lung, and Blood Institute, Bethesda, Maryland (S.C., Y.H.)
| | - Yuling Hong
- National Heart, Lung, and Blood Institute, Bethesda, Maryland (S.C., Y.H.)
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5
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Andersén H, Kankaanranta H, Tuomisto LE, Piirilä P, Sovijärvi A, Langhammer A, Backman H, Lundbäck B, Rönmark E, Lehtimäki L, Ilmarinen P. Multimorbidity in Finnish and Swedish speaking Finns; association with daily habits and socioeconomic status - Nordic EpiLung cross-sectional study. Prev Med Rep 2021; 22:101338. [PMID: 33732608 PMCID: PMC7937573 DOI: 10.1016/j.pmedr.2021.101338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 01/12/2021] [Accepted: 02/09/2021] [Indexed: 12/23/2022] Open
Abstract
Multimorbidity is an emerging public health priority. This study aims to assess the role of lifestyle and socioeconomic status in the prevalence of multimorbidity and chronic diseases by using two language groups that are part of the same genetic subgroup but differ by daily habits. We conducted a cross-sectional survey in 2016 with randomly selected population sample with 4173 responders (52.3%) aged 20-69 years in Western Finland. We included 3864 Finnish participants with Swedish (28.1%) or Finnish (71.9%) as a native language. We used a questionnaire to assess participants' chronic diseases and lifestyle. We determined multimorbidity as a disease count ≥ 2. Finnish speakers were more likely to have a diagnosis of COPD, heart failure, diabetes, reflux disease, chronic kidney failure, and painful conditions than Swedish speakers. The prevalence of multimorbidity was higher for Finnish speakers in the age group of 60-69 years (41.0% vs. 32.0%, p = 0.018) than Swedish speakers. A higher proportion of Finnish speakers smoked, were obese, inactive, and had lower socioeconomic status compared to Swedish speakers. All these factors, in addition to age and female sex, were significant risk factors for multimorbidity. Prevalence of multimorbidity was different in two language groups living in the same area and was associated with differences in lifestyle factors such as smoking, physical inactivity and obesity.
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Affiliation(s)
- Heidi Andersén
- Karolinska University Hospital, Thoracic Oncology Unit, Tema Cancer, Stockholm, Sweden
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Hannu Kankaanranta
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
- Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Leena E Tuomisto
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Päivi Piirilä
- Unit of Clinical Physiology, HUS Medical Diagnostic Center, Helsinki University Central Hospital, Finland
- University of Helsinki, Helsinki, Finland
| | - Anssi Sovijärvi
- Unit of Clinical Physiology, HUS Medical Diagnostic Center, Helsinki University Central Hospital, Finland
- University of Helsinki, Helsinki, Finland
| | - Arnulf Langhammer
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Levanger, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Helena Backman
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden
- Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
| | - Bo Lundbäck
- Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Eva Rönmark
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden
| | - Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Pinja Ilmarinen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
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6
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Zhang X, Chen H, Gu K, Chen J, Jiang X. Association of Body Mass Index with Risk of Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis. COPD 2021; 18:101-113. [PMID: 33590791 DOI: 10.1080/15412555.2021.1884213] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The association between body mass index (BMI) and chronic obstructive pulmonary disease (COPD) remains controversial. Therefore, a meta-analysis was conducted to further evaluate the relationship. A comprehensive literature search was performed in PubMed, Web of Science, EMBASE, China National Knowledge Infrastructure (CNKI), and Wanfang databases to identify eligible articles until July 15, 2020. Random effect model (REM) was used to compute the pooled results with 95% confidence intervals (CIs). We conducted meta-regression and subgroup analysis to explore potential sources of heterogeneity. Publication bias was evaluated by funnel plots and Egger's test. Thirty articles with 1,578,449 participants were included in the meta-analysis. The pooled OR of COPD was 1.96 (95% CI: 1.78-2.17) for the underweight group, 0.80 (95% CI: 0.73-0.87) for overweight group, and 0.86 (95% CI: 0.73-1.02) for obesity group. After further excluding 5 studies of high between-study heterogeneity in sensitivity analysis, the pooled OR of COPD was 0.77 (95% CI: 0.68-0.86) for the obesity group. This meta-analysis indicated that BMI was associated with COPD. Specifically, underweight might increase the risk of COPD; overweight and obesity might reduce the risk of COPD.
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Affiliation(s)
- Xiaofei Zhang
- Department of Epidemiology and Health Statistics, the School of Public, Health of Qingdao University, Qingdao, Shandong Province, China
| | - Hongru Chen
- Department of Epidemiology and Health Statistics, the School of Public, Health of Qingdao University, Qingdao, Shandong Province, China
| | - Kunfang Gu
- Department of Epidemiology and Health Statistics, the School of Public, Health of Qingdao University, Qingdao, Shandong Province, China
| | - Jiahao Chen
- Department of Epidemiology and Health Statistics, the School of Public, Health of Qingdao University, Qingdao, Shandong Province, China
| | - Xiubo Jiang
- Department of Epidemiology and Health Statistics, the School of Public, Health of Qingdao University, Qingdao, Shandong Province, China
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Mohebbichamkhorami M, Arbabi M, Mirzaei M, Ahmadi A, Hassanvand MS, Rouhi H. Ambient air particulate matter (PM 10) satellite monitoring and respiratory health effects assessment. JOURNAL OF ENVIRONMENTAL HEALTH SCIENCE & ENGINEERING 2020; 18:1247-1258. [PMID: 33312639 PMCID: PMC7721783 DOI: 10.1007/s40201-020-00542-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 09/11/2020] [Accepted: 09/14/2020] [Indexed: 06/12/2023]
Abstract
PURPOSE Air particulate matter with an aerodynamic diameter of 10 µm or less (PM10) is one of the main causes of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). This study explored the relationship between PM10 by remote sensing and AECOPD in Chaharmahal-o-Bakhtiari province from 2014 to2018. METHOD PM10 concentrations were predicted and validated based on aerosol optical depth (AOD) from 161 images processed by MODIS sensor and ground air quality monitoring station data. Demographic information and spirometric indices of 2038 patients with AECOPD were collected and analyzed from the hospital during the studied periods. SPSS software was used to analyze the relationships between these two categories of information. RESULTS There was a significant negative relationship between PM10 and FVC, FVC%, FEV1, FEV1%, FEF25-75, FEV1/FVC, PEF, and FEF25FVC indices (p < 0.05). The results showed that over 2014-2018, the annual mean of PM10 concentrations varied from 35 to 52 µg/m3. The result of the regression model showed that the patient's age, body mass index (BMI), and PM10 concentrations were the most affecting variables on the two important spirometric indices i.e., FVC% and FEV1%. The PM10 concentrations and number of AECOPD patients had a similar pattern during the studied period. The women group, age group above 74 years, normal BMI, and non-smoking patients showed the most sensitivity to the PM10 concentrations. CONCLUSIONS Our findings provide supplementary scientific information on PM10 concentration related to the incidence of AECOPD and as a variable affecting the most important spirometry indicators by providing local decision-makers information needed to set a priority of air pollution control measures as well as health services.
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Affiliation(s)
- Mahssa Mohebbichamkhorami
- Department of Environmental Health Engineering, School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Mohsen Arbabi
- Department of Environmental Health Engineering, School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
- Social Determinants of Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Mohsen Mirzaei
- Department of Environment, Faculty of Natural Resources and Marine Sciences, Tarbiat Modares University, Tehran, Iran
| | - Ali Ahmadi
- Modeling in Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Mohammad Sadegh Hassanvand
- Centre for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Rouhi
- Department of pulmonary, School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
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8
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Li X, Cai L, Cui WL, Wang XM, Li HF, He JH, Golden AR. Association of socioeconomic and lifestyle factors with chronic non-communicable diseases and multimorbidity among the elderly in rural southwest China. J Public Health (Oxf) 2020; 42:239-246. [PMID: 30860582 DOI: 10.1093/pubmed/fdz020] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 12/19/2018] [Accepted: 02/15/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This study estimates the prevalence of five chronic non-communicable disease (NCDs) (hypertension, diabetes, CHD, COPD and stroke) and its multimorbidity, and examines the relationship between SES and lifestyle factors and multimorbidity among older adults in rural southwest China. METHODS A cross-sectional survey of 4833 consenting adults aged ≥60 years was conducted in 2017. Data on the demographics, smoking, drinking, height, weight, blood pressure and fasting blood glucose were collected. RESULTS Among the participants, the overall prevalence of hypertension, diabetes, stroke, COPD and CHD was 50.6, 10.2, 6.4, 5.4 and 5.5%, respectively, and of multimorbidity was 16.1%. Females had a higher prevalence of hypertension, diabetes and multimorbidity of chronic NCDs, but a lower prevalence of COPD than males (P < 0.05). Older adults with good household assets and access to medical services were less likely to experience multimorbidity, whereas obese and centrally obese participants, current smokers, current drinkers and those with a family history of chronic NCDs had a greater probability of multimorbidity. CONCLUSIONS The findings suggest that effective strategies for prevention and control of chronic NCDs and its multimorbidity are urgently needed, especially for low-income, elderly, ethnic minority adults with poor access to medical services.
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Affiliation(s)
- Xiao Li
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming 650500, China
| | - Le Cai
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming 650500, China
| | - Wen-Long Cui
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming 650500, China
| | - Xu-Ming Wang
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming 650500, China.,First Affiliated Hospital of Kunming Medical University, China
| | - Hui-Fang Li
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming 650500, China.,First Affiliated Hospital of Kunming Medical University, China
| | - Jian-Hui He
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming 650500, China
| | - Allison Rabkin Golden
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming 650500, China
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9
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Tiew PY, Ko FWS, Narayana JK, Poh ME, Xu H, Neo HY, Loh LC, Ong CK, Mac Aogáin M, Tan JHY, Kamaruddin NH, Sim GJH, Lapperre TS, Koh MS, Hui DSC, Abisheganaden JA, Tee A, Tsaneva-Atanasova K, Chotirmall SH. "High-Risk" Clinical and Inflammatory Clusters in COPD of Chinese Descent. Chest 2020; 158:145-156. [PMID: 32092320 PMCID: PMC7339237 DOI: 10.1016/j.chest.2020.01.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 12/10/2019] [Accepted: 01/12/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND COPD is a heterogeneous disease demonstrating inter-individual variation. A high COPD prevalence in Chinese populations is described, but little is known about disease clusters and prognostic outcomes in the Chinese population across Southeast Asia. We aim to determine if clusters of Chinese patients with COPD exist and their association with systemic inflammation and clinical outcomes. RESEARCH QUESTION We aim to determine if clusters of Chinese patients with COPD exist and their association with clinical outcomes and inflammation. STUDY DESIGN AND METHODS Chinese patients with stable COPD were prospectively recruited into two cohorts (derivation and validation) from six hospitals across three Southeast Asian countries (Singapore, Malaysia, and Hong Kong; n = 1,480). Each patient was followed more than 2 years. Clinical data (including co-morbidities) were employed in unsupervised hierarchical clustering (followed by validation) to determine the existence of patient clusters and their prognostic outcome. Accompanying systemic cytokine assessments were performed in a subset (n = 336) of patients with COPD to determine if inflammatory patterns and associated networks characterized the derived clusters. RESULTS Five patient clusters were identified including: (1) ex-TB, (2) diabetic, (3) low comorbidity: low-risk, (4) low comorbidity: high-risk, and (5) cardiovascular. The cardiovascular and ex-TB clusters demonstrate highest mortality (independent of Global Initiative for Chronic Obstructive Lung Disease assessment) and illustrate diverse cytokine patterns with complex inflammatory networks. INTERPRETATION We describe clusters of Chinese patients with COPD, two of which represent high-risk clusters. The cardiovascular and ex-TB patient clusters exhibit high mortality, significant inflammation, and complex cytokine networks. Clinical and inflammatory risk stratification of Chinese patients with COPD should be considered for targeted intervention to improve disease outcomes.
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Affiliation(s)
- Pei Yee Tiew
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - Fanny Wai San Ko
- Department of Medicine and Therapeutics The Chinese University of Hong Kong, Hong Kong
| | - Jayanth Kumar Narayana
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Indian Institute of Science Education and Research, Pune, India
| | - Mau Ern Poh
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Huiying Xu
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore
| | - Han Yee Neo
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore
| | - Li-Cher Loh
- Department of Medicine, RCSI-UCD Malaysia Campus, Georgetown, Penang, Malaysia
| | - Choo Khoon Ong
- Department of Medicine, RCSI-UCD Malaysia Campus, Georgetown, Penang, Malaysia
| | - Micheál Mac Aogáin
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | | | | | - Gerald Jiong Hui Sim
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
| | - Therese S Lapperre
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore; Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Mariko Siyue Koh
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - David Shu Cheong Hui
- Department of Medicine and Therapeutics The Chinese University of Hong Kong, Hong Kong
| | | | - Augustine Tee
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
| | - Krasimira Tsaneva-Atanasova
- Living Systems Institute and Department of Mathematics, College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, UK; PSRC Centre for Predictive Modelling in Healthcare, University of Exeter, Exeter, UK
| | - Sanjay H Chotirmall
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
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Kaluza J, Harris HR, Linden A, Wolk A. Alcohol Consumption and Risk of Chronic Obstructive Pulmonary Disease: A Prospective Cohort Study of Men. Am J Epidemiol 2019; 188:907-916. [PMID: 30877760 DOI: 10.1093/aje/kwz020] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 01/21/2019] [Accepted: 01/22/2019] [Indexed: 12/18/2022] Open
Abstract
Studies indicate an inverse association between moderate alcohol consumption and chronic inflammatory diseases; however, the association between alcohol consumption and chronic obstructive pulmonary disease (COPD) incidence has not been widely studied. We investigated the associations of total alcohol consumption and intake of specific alcoholic beverages with risk of COPD in a population-based prospective cohort study, the Cohort of Swedish Men (n = 44,254). Alcohol consumption was assessed with a self-administered questionnaire in 1997. During follow-up (1998-2014), 2,177 COPD cases were ascertained. Moderate alcohol consumption was associated with the lowest risk of COPD. A J-shaped association was observed for ethanol consumption (P for nonlinearity = 0.003) and beer consumption (P for nonlinearity < 0.001); for wine consumption, a U-shaped association was observed (P for nonlinearity < 0.001). Defining a "standard drink" as 12 g of ethanol, the multivariable-adjusted hazard ratios were 0.77 (95% confidence interval (CI): 0.66, 0.90) and 0.92 (95% CI: 0.81, 1.05) for beer consumption of 4.1-6.0 and >6.0 standard drinks/week (SDW) versus <1.0 SDW, respectively; 0.80 (95% CI: 0.69, 0.93) and 1.00 (95% CI: 0.83, 1.21) for wine consumption of 2.0-4.0 and >4.0 SDW versus <1.0 SDW, respectively; and 1.10 (95% CI: 0.98, 1.24) and 1.20 (95% CI: 0.99, 1.44) for liquor consumption of 2.0-4.0 and >4.0 SDW versus <1.0 SDW, respectively. In conclusion, our findings suggest that moderate beer and wine consumption, but not liquor consumption, may decrease risk of COPD. Additional studies are needed to confirm these associations.
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Affiliation(s)
- Joanna Kaluza
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Human Nutrition, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences, Warsaw, Poland
| | - Holly R Harris
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Anders Linden
- Unit for Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
| | - Alicja Wolk
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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11
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Golabi P, Paik J, Hwang JP, Wang S, Lee HM, Younossi ZM. Prevalence and outcomes of non-alcoholic fatty liver disease (NAFLD) among Asian American adults in the United States. Liver Int 2019; 39:748-757. [PMID: 30597715 DOI: 10.1111/liv.14038] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/21/2018] [Accepted: 12/25/2018] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS Non-alcoholic fatty liver disease (NAFLD) affects about 25% of the general population worldwide. Although epidemiology of NAFLD is well studied in the United States, there is paucity of data for the Asian Americans. Our aim was to assess the prevalence and risk factors for NAFLD among Asian Americans. METHODS We utilized NHANES data for 2011-2016. We defined NAFLD using recently derived US-FLI. Relative risks (RRs) and population attributable fractions (PAFs) of metabolic components on atherosclerotic cardiovascular disease (ASCVD) and advanced fibrosis were calculated for Asian Americans, and these rates were compared to non-Hispanic whites. RESULTS NAFLD prevalence was 18.3% among Asian Americans and 28.4% among non-Hispanic whites. Asian Americans with NAFLD had lower BMI and waist circumference than non-Hispanic whites with NAFLD and were less likely to have metabolic syndrome, cardiovascular disease (CVD), chronic obstructive pulmonary disease, cancer and incident ASCVD (P < 0.05). Hyperlipidaemia had the highest attributable fraction (76.6%) for risk of ASCVD among Asian Americans with NAFLD, followed by diabetes (24.0%), current smoking (9.2%), and obesity (3.7%). Advanced fibrosis in Asian American with NAFLD was independently associated with presence of type 2 diabetes (RR = 2.70, 95% CI: 1.00-7.27). CONCLUSIONS Asian Americans have lower prevalence of NAFLD than non-Hispanic whites. However, Asian Americans with NAFLD have similar risk factors for advanced fibrosis and ASCVD than non-Hispanic Whites.
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Affiliation(s)
- Pegah Golabi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia
| | - James Paik
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia
| | - Jessica P Hwang
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Su Wang
- Center for Asian Health, Saint Barnabas Medical Center, Florham Park, New Jersey
| | - Hannah M Lee
- Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University, Richmond, Virginia
| | - Zobair M Younossi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia.,Center for Liver Disease and Department of Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia
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12
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Nugmanova D, Sokolova L, Feshchenko Y, Iashyna L, Gyrina O, Malynovska K, Mustafayev I, Aliyeva G, Makarova J, Vasylyev A, Tariq L. The prevalence, burden and risk factors associated with bronchial asthma in commonwealth of independent states countries (Ukraine, Kazakhstan and Azerbaijan): results of the CORE study. BMC Pulm Med 2018; 18:110. [PMID: 29976177 PMCID: PMC6034253 DOI: 10.1186/s12890-018-0676-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 06/13/2018] [Indexed: 12/26/2022] Open
Abstract
Background In the Commonwealth of Independent States (CIS) countries epidemiology of Bronchial Asthma (BA) is poorly characterized. The objective of this analysis is to present the prevalence, burden and risk factors associated with BA in the CIS countries as part of the CORE study (Chronic Obstructive REspiratory diseases). Methods A total of 2842 adults (≥18 years) were recruited (964 in Kiev, Ukraine, 945 in Almaty, Kazakhstan, and 933 in Baku, Azerbaijan) in 2013–2015 during household visits. A two-step cluster random sampling strategy was used. All respondents were interviewed about respiratory symptoms, smoking, medical history. Two definitions were used: (i) “doctor diagnosed asthma” when the respondent reported that he/she had ever been diagnosed with BA by a doctor, (ii) “wheezing symptoms” (when the respondent reported wheezing at the ATS Respiratory Symptoms Questionnaire during the study) using GINA (2012) recommendations. Chi-square tests were used to assess differences in proportions. Binary logistic regression was used to estimate odds ratios (OR) and 95% CI for association between risk factors and BA. Results Prevalence of “doctor diagnosed asthma” was 12.5, 19.0 and 26.8 per 1000 persons, and prevalence of “wheezing symptoms” was 74.4, 254.8 and 123.4 per 1000 in Ukraine, Kazakhstan, and Azerbaijan, respectively. Statistically significant relationship with “wheezing symptoms” was shown for smoking (OR 1.99 (CI 1.22–3.27) in Ukraine, 2.08 (CI 1.54–2.81) in Kazakhstan, 8.01 (CI 5.24–12.24) in Azerbaijan); overweight/obesity (OR: 1.66 (CI 1.02–2.72); 1.94 (CI 1.44–2.62); 1.77 (CI 1.18–2.68), respectively) and dusty work (OR: 3.29 (CI 1.57–6.89); 1.68 (CI 1.18–2.39); 2.36 (CI 1.56–3.59), respectively), and for tuberculosis in Azerbaijan (OR: 10.11 (CI 3.44–29.69)). Co-morbidities like hypertension, cardiovascular diseases, abnormal blood lipids and a history of pneumonia occurred significantly (p < 0.05) more frequently in respondents with BA compared to those without BA across all participating countries. Conclusion In CIS countries (Ukraine, Kazakhstan and Azerbaijan) the prevalence of doctor diagnosed asthma was significantly lower compared to prevalence of wheezing symptoms underlining that BA is likely to be underreported in these countries. The information provided in this paper will be helpful for healthcare policy makers in CIS countries to instruct BA management strategies and to allocate healthcare resources accordingly.
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Affiliation(s)
| | | | - Yuriy Feshchenko
- National Institute of Phthisiology and Pulmonology F.G. Yanovsky of NAMS, Kiev, Ukraine
| | - Liudmila Iashyna
- National Institute of Phthisiology and Pulmonology F.G. Yanovsky of NAMS, Kiev, Ukraine
| | - Olga Gyrina
- National Medical University named after A.A. Bogomoltz, Kiev, Ukraine
| | | | - Ilgar Mustafayev
- Scientific Research Institute of Lung Diseases, Baku, Azerbaijan
| | - Gulzar Aliyeva
- Scientific Research Institute of Lung Diseases, Baku, Azerbaijan
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13
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The prevalence, burden and risk factors associated with chronic obstructive pulmonary disease in Commonwealth of Independent States (Ukraine, Kazakhstan and Azerbaijan): results of the CORE study. BMC Pulm Med 2018; 18:26. [PMID: 29382317 PMCID: PMC5791247 DOI: 10.1186/s12890-018-0589-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 01/15/2018] [Indexed: 11/29/2022] Open
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14
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Thakur N, White MJ, Burchard EG. Race and Ethnicity. Respir Med 2017. [DOI: 10.1007/978-3-319-43447-6_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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15
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Hu Y, Cantarero-Arévalo L, Frølich A, Jacobsen R. Ethnic Inequalities in COPD Outcomes: a Register-Based Study in Copenhagen, Denmark. J Racial Ethn Health Disparities 2016; 4:1159-1164. [DOI: 10.1007/s40615-016-0321-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 11/24/2016] [Accepted: 11/27/2016] [Indexed: 10/20/2022]
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Asai K, Hirata K, Hashimoto S, Fukuchi Y, Kitawaki T, Ikeda K, Fogel R, Banerji D. Efficacy and safety of indacaterol/glycopyrronium in Japanese patients with COPD: Pooled analysis of SHINE and ARISE. Respir Investig 2016; 54:428-435. [PMID: 27886854 DOI: 10.1016/j.resinv.2016.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/14/2016] [Accepted: 06/27/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND To better evaluate the efficacy and safety of the indacaterol/glycopyrronium (IND/GLY) fixed-dose combination versus tiotropium in Japanese patients, a pooled data analysis was conducted from the SHINE and ARISE studies, which were part of the IND/GLY clinical trial program. METHODS Japanese patients with moderate-to-severe COPD were included in the analysis. Efficacy in terms of pre-dose forced expiratory volume in one second (FEV1) at Week 12 and Week 24/26 (ARISE/SHINE) and FEV1 at 30min and 60min post-dose at Day 1, Week 12, and Week 24/26 was evaluated. Health status using the St. George׳s Respiratory Questionnaire (SGRQ) score, rescue medication use (number of puffs/day), safety, and tolerability were also assessed. RESULTS In total, 340 patients (IND/GLY, n=161; IND, n=41; GLY, n=40; tiotropium, n=79; and placebo, n=19) were included in the analysis that focused on comparing IND/GLY versus tiotropium since they were included in both studies. At Week 12 and Week 24/26, pre-dose FEV1 was significantly improved with IND/GLY compared with tiotropium (treatment differences=70mL and 80mL, respectively; both P≤0.001). FEV1 at 30min and 60min post-dose, the SGRQ total score, and rescue medication use were more statistically significant with IND/GLY than with tiotropium for all assessed time-points. The overall incidence of adverse events (AEs) and serious AEs was similar between the IND/GLY- and tiotropium-treated groups. CONCLUSIONS Compared to tiotropium, IND/GLY provided significant improvements in lung function, health status, and rescue medication use, while having a good safety profile in Japanese patients with moderate-to-severe COPD.
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Affiliation(s)
- Kazuhisa Asai
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan.
| | - Kazuto Hirata
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan.
| | | | - Yoshinosuke Fukuchi
- Department of Respiratory Medicine, Juntendo University School of Medicine, Tokyo, Japan.
| | | | | | - Robert Fogel
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, United States.
| | - Donald Banerji
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, United States.
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Poureslami I, Kwan S, Lam S, Khan NA, FitzGerald JM. Assessing the effect of culturally specific audiovisual educational interventions on attaining self-management skills for chronic obstructive pulmonary disease in Mandarin- and Cantonese-speaking patients: a randomized controlled trial. Int J Chron Obstruct Pulmon Dis 2016; 11:1811-22. [PMID: 27536093 PMCID: PMC4976815 DOI: 10.2147/copd.s105408] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patient education is a key component in the management of chronic obstructive pulmonary disease (COPD). Delivering effective education to ethnic groups with COPD is a challenge. The objective of this study was to develop and assess the effectiveness of culturally and linguistically specific audiovisual educational materials in supporting self-management practices in Mandarin- and Cantonese-speaking patients. METHODS Educational materials were developed using participatory approach (patients involved in the development and pilot test of educational materials), followed by a randomized controlled trial that assigned 91 patients to three intervention groups with audiovisual educational interventions and one control group (pamphlet). The patients were recruited from outpatient clinics. The primary outcomes were improved inhaler technique and perceived self-efficacy to manage COPD. The secondary outcome was improved patient understanding of pulmonary rehabilitation procedures. RESULTS Subjects in all three intervention groups, compared with control subjects, demonstrated postintervention improvements in inhaler technique (P<0.001), preparedness to manage a COPD exacerbation (P<0.01), ability to achieve goals in managing COPD (P<0.01), and understanding pulmonary rehabilitation procedures (P<0.05). CONCLUSION Culturally appropriate educational interventions designed specifically to meet the needs of Mandarin and Cantonese COPD patients are associated with significantly better understanding of self-management practices. Self-management education led to improved proper use of medications, ability to manage COPD exacerbations, and ability to achieve goals in managing COPD. CLINICAL IMPLICATION A relatively simple culturally appropriate disease management education intervention improved inhaler techniques and self-management practices. Further research is needed to assess the effectiveness of self-management education on behavioral change and patient empowerment strategies.
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Affiliation(s)
- Iraj Poureslami
- Respiratory Division, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Department of Graduate Studies, Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Susan Kwan
- Respiratory Department, Burnaby Hospital, University of British Columbia, Burnaby, Canada
| | - Stephen Lam
- Respiratory Division, University of British Columbia, Vancouver, Canada; Department of Integrative Oncology, BC Cancer Research Centre, Vancouver, Canada
| | - Nadia A Khan
- Department of Internal Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Department of Internal Medicine, Providence Health Care Authority, Vancouver, Canada
| | - John Mark FitzGerald
- VGH Divisions of Respiratory Medicine, University of British Columbia, Vancouver, Canada; Respiratory Medicine, Vancouver Coastal Health Authority, Vancouver Coastal Health Research Institute, Institute for Heart and Lung Health, The Lung Centre, Gordon and Leslie Diamond Health Care Centre, Vancouver, Canada
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Risk factors associated with acute exacerbation of chronic obstructive pulmonary disease in HIV-infected and uninfected patients. AIDS 2016; 30:455-63. [PMID: 26765938 DOI: 10.1097/qad.0000000000000940] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To determine the association between HIV infection and other risk factors for acute exacerbation of chronic obstructive pulmonary disease (AECOPD). DESIGN Longitudinal, national Veterans Aging Cohort Study including 43 618 HIV-infected and 86 492 uninfected veterans. METHODS AECOPD was defined as an inpatient or outpatient COPD ICD-9 diagnosis accompanied by steroid and/or antibiotic prescription within 5 days. We calculated incidence rate ratios (IRR) and 95% confidence intervals (CI) for first AECOPD over 2 years and used Poisson regression models to adjust for risk factors. RESULTS Over 234 099 person-years of follow-up, 1428 HIV-infected and 2104 uninfected patients had at least one AECOPD. HIV-infected patients had an increased rate of AECOPD compared with uninfected (18.8 vs. 13.3 per 1000 person-years, P < 0.001). In adjusted models, AECOPD risk was greater in HIV-infected individuals overall (IRR 1.54; 95% CI 1.44-1.65), particularly in those with more severe immune suppression when stratified by CD4 cell count (cells/μl) compared with uninfected (HIV-infected CD4 < 200: IRR 2.30, 95% CI 2.10-2.53, HIV-infected CD4 ≥ 200-349: IRR 1.32, 95% CI 1.15-1.51, HIV-infected CD4 ≥ 350: IRR 0.99, 95% CI 0.88-1.10). HIV infection also modified the association between current smoking and alcohol-related diagnoses with risk for AECOPD such that interaction terms for HIV and current smoking or HIV and alcohol-related diagnoses were each significantly associated with AECOPD. CONCLUSION HIV infection, especially with lower CD4 cell count, is an independent risk factor for AECOPD. Enhanced susceptibility to harm from current smoking or unhealthy alcohol use in HIV-infected patients may also contribute to the greater rate of AECOPD.
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Bhopal R, Steiner MF, Cezard G, Bansal N, Fischbacher C, Simpson CR, Douglas A, Sheikh A. Risk of respiratory hospitalization and death, readmission and subsequent mortality: scottish health and ethnicity linkage study. Eur J Public Health 2015; 25:769-74. [DOI: 10.1093/eurpub/ckv064] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Beck AF, Huang B, Simmons JM, Moncrief T, Sauers HS, Chen C, Ryan PH, Newman NC, Kahn RS. Role of financial and social hardships in asthma racial disparities. Pediatrics 2014; 133:431-9. [PMID: 24488745 PMCID: PMC3934338 DOI: 10.1542/peds.2013-2437] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Health care reform offers a new opportunity to address child health disparities. This study sought to characterize racial differences in pediatric asthma readmissions with a focus on the potential explanatory role of hardships that might be addressed in future patient care models. METHODS We enrolled 774 children, aged 1 to 16 years, admitted for asthma or bronchodilator-responsive wheezing in a population-based prospective observational cohort. The outcome was time to readmission. Child race, socioeconomic status (measured by lower income and caregiver educational attainment), and hardship (caregivers looking for work, having no one to borrow money from, not owning a car or home, and being single/never married) were recorded. Analyses used Cox proportional hazards. RESULTS The cohort was 57% African American, 33% white, and 10% multiracial/other; 19% were readmitted within 12 months. After adjustment for asthma severity classification, African Americans were twice as likely to be readmitted as whites (hazard ratio: 1.98; 95% confidence interval: 1.42 to 2.77). Compared with whites, African American caregivers were significantly more likely to report lower income and educational attainment, difficulty finding work, having no one to borrow money from, not owning a car or home, and being single/never married (all P ≤ .01). Hardships explained 41% of the observed racial disparity in readmission; jointly, socioeconomic status and hardship explained 49%. CONCLUSIONS African American children were twice as likely to be readmitted as white children; hardships explained >40% of this disparity. Additional factors (eg, pollution, tobacco exposure, housing quality) may explain residual disparities. Targeted interventions could help achieve greater child health equity.
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Affiliation(s)
- Andrew F. Beck
- Divisions of General and Community Pediatrics,,Hospital Medicine, and
| | - Bin Huang
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | | | | | - Hadley S. Sauers
- Divisions of General and Community Pediatrics,,Hospital Medicine, and
| | - Chen Chen
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Patrick H. Ryan
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
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Tran HN, Li Y, Siu S, Baer D, Friedman GD, Udaltsova N, Klatsky AL. Predictors of lung cancer: noteworthy cell type differences. Perm J 2013; 17:23-9. [PMID: 23704839 DOI: 10.7812/tpp/12-104] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To study risk factors for cell types of lung cancer. METHODS Cohort study of 126,293 persons with 1852 subjects with incident cancer. We performed Cox proportional hazards models (8 covariates) to estimate risk of the 4 most numerous specific cell types: adenocarcinoma, squamous cell carcinoma, small cell carcinoma, and bronchioloalveolar carcinoma. RESULTS Smoking 1 or more cigarette packs per day was a powerful predictor (p < 0.0001) of all cell types, with hazard ratios ranging from 5.8 for bronchioloalveolar to 62.7 for squamous cell carcinoma. Other hazard ratio ranges included male/female from 0.6 (bronchioloalveolar, p < 0.05) to 2.0 (squamous, p < 0.001); black/white from 0.8 (small cell, p < 0.05) to 1.7 (squamous, p < 0.001); Asian/white from 0.8 (small cell) to 1.9 (bronchioloalveolar); and alcohol intake of 3 or more drinks per day from 1.0 (squamous) to 1.5 (adenocarcinoma, p < 0.01). College graduation and increasing body mass index were inversely related to risk of several cell types. Noteworthy sex-specific associations included increased risk of Asian vs white women for adenocarcinoma, squamous cell carcinoma and bronchioloalveolar carcinoma and substantially increased risk of adenocarcinoma in women with alcohol intake of 3 or more drinks per day. CONCLUSIONS These risk factor disparities for lung cancer cell types presumably reflect biologic differences. Future investigation may contribute to increased understanding of tumorigenesis and optimal treatment.
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Abstract
The last years have witnessed novel findings with exciting developments in the field of allergy-related diseases including asthma, bronchial hyperresponsiveness, eczema, and atopy that have enormously increased over the past few years. This issue of the Reviews is timely dedicated to comprehensive articles discussing the current trends in the study of these conditions. In particular, the impact of new data in genomics, environmental factors through epigenetics and proteomics will be reviewed and critically discussed.
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Affiliation(s)
- Carlo Selmi
- Department of Medicine, Autoimmunity and Metabolism Unit, IRCCS Istituto Clinico Humanitas, via A. Manzoni 56, 20089, Rozzano, Milan, Italy.
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