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Pallan M, Mason F, Parretti HM, Adab P, Abbott S, Jolly K. Supporting healthcare professionals to address child weight with parents: a qualitative study. Br J Gen Pract 2024:BJGP.2023.0238. [PMID: 38575182 PMCID: PMC11005922 DOI: 10.3399/bjgp.2023.0238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/06/2023] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Primary care and community healthcare professionals (HCPs) are well placed to discuss child excess weight with parents and support them to make changes. However, HCPs have concerns about addressing this issue. There is a need to understand the factors that influence HCPs in initiating these conversations to inform strategies to support them. AIM To explore with HCPs, working in primary care and community settings, their experiences of having conversations about child weight with parents, and the factors that create barriers or facilitate them to have these conversations. DESIGN AND SETTING A qualitative study with GPs, primary care nurses (PNs), and school nurses (SNs) in England. METHOD GPs and PNs were recruited to participate in semi-structured interviews. SNs from a community healthcare NHS trust were recruited to participate in focus groups. Vignettes were used to stimulate discussion. Data were analysed guided by the Framework approach. RESULTS Thirteen GPs, seven PNs, and 20 SNs participated. The following three themes were identified regarding barriers to HCPs having conversations about child excess weight: structural and organisational; HCP related; and parent or family related. The themes identified for the factors that facilitate these conversations were: structural changes (for example, dedicated appointments, access to weight assessment data, joined-up working across agencies); HCP approaches (for example, providing appropriate dietary and physical activity advice); and HCP knowledge and skills (for example, enhancing HCPs' general and weight management-related skills and knowledge of child weight management services). CONCLUSION A range of barriers exist to HCPs addressing child excess weight with parents in primary care and community settings. Actions to effect structural changes and support HCPs in developing relevant knowledge and skills are required to overcome these barriers.
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Affiliation(s)
- Miranda Pallan
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham
| | - Frances Mason
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham
| | - Helen M Parretti
- Norwich Medical School, Faculty of Medicine and Health, University of East Anglia, Norwich
| | - Peymané Adab
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham
| | - Sally Abbott
- Research Centre for Healthcare and Communities, Institute for Health and Wellbeing, Coventry University, Coventry; Department of Dietetics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry
| | - Kate Jolly
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham
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2
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Fernandes G, Williams S, Adab P, Gale N, de Jong C, de Sousa JC, Cheng KK, Chi C, Cooper BG, Dickens AP, Enocson A, Farley A, Jolly K, Jowett S, Maglakelidze M, Maghlakelidze T, Martins S, Sitch A, Stamenova A, Stavrikj K, Stelmach R, Turner A, Pan Z, Pang H, Zhang J, Jordan RE. Engaging stakeholders to level up COPD care in LMICs: lessons learned from the "Breathe Well" programme in Brazil, China, Georgia, and North Macedonia. BMC Health Serv Res 2024; 24:66. [PMID: 38216986 PMCID: PMC10790249 DOI: 10.1186/s12913-023-10525-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 12/24/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Effective stakeholder engagement in health research is increasingly being recognised and promoted as an important pathway to closing the gap between knowledge production and its use in health systems. However, little is known about its process and impacts, particularly in low-and middle-income countries. This opinion piece draws on the stakeholder engagement experiences from a global health research programme on Chronic Obstructive Pulmonary Disease (COPD) led by clinician researchers in Brazil, China, Georgia and North Macedonia, and presents the process, outcomes and lessons learned. MAIN BODY Each country team was supported with an overarching engagement protocol and mentored to develop a tailored plan. Patient involvement in research was previously limited in all countries, requiring intensive efforts through personal communication, meetings, advisory groups and social media. Accredited training programmes were effective incentives for participation from healthcare providers; and aligning research findings with competing policy priorities enabled interest and dialogue with decision-makers. The COVID-19 pandemic severely limited possibilities for planned engagement, although remote methods were used where possible. Planned and persistent engagement contributed to shared knowledge and commitment to change, including raised patient and public awareness about COPD, improved skills and practice of healthcare providers, increased interest and support from clinical leaders, and dialogue for integrating COPD services into national policy and practice. CONCLUSION Stakeholder engagement enabled relevant local actors to produce and utilise knowledge for small wins such as improving day-to-day practice and for long-term goals of equitable access to COPD care. For it to be successful and sustained, stakeholder engagement needs to be valued and integrated throughout the research and knowledge generation process, complete with dedicated resources, contextualised and flexible planning, and commitment.
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Affiliation(s)
- Genevie Fernandes
- International Primary Care Respiratory Group, London, UK.
- Usher Institute, University of Edinburgh, Edinburgh, UK.
| | - Siân Williams
- International Primary Care Respiratory Group, London, UK
| | - Peymané Adab
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Nicola Gale
- Health Services Management Centre, School of Social Policy, College of Social Sciences, University of Birmingham, Birmingham, UK
| | - Corina de Jong
- International Primary Care Respiratory Group, London, UK
| | - Jaime Correia de Sousa
- International Primary Care Respiratory Group, London, UK
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- PT Government Associate Laboratory, ICVS/3B's, Braga/Guimarães, Portugal
| | - K K Cheng
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Chunhua Chi
- Department of General Practice, Peking University First Hospital, Beijing, China
| | | | - Andrew P Dickens
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Observational and Pragmatic Research Institute, Midview City, Singapore
| | - Alexandra Enocson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Amanda Farley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sue Jowett
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Maka Maglakelidze
- Georgian Respiratory Association, Tbilisi, Georgia
- Petre Shotadze Tbilisi Medical Academy, Tbilisi, Georgia
| | - Tamaz Maghlakelidze
- Georgian Respiratory Association, Tbilisi, Georgia
- Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia
| | - Sonia Martins
- Family Medicine, ABC Medical School, São Paolo, Brazil
| | - Alice Sitch
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Aleksandra Stamenova
- Faculty of Medicine, Institute of Social Medicine, Ss. Cyril and Methodius University in Skopje, Skopje, Republic of North Macedonia
| | - Katarina Stavrikj
- Center for Family Medicine, Faculty of Medicine, Ss.Cyril and Methodius University in Skopje, Skopje, Republic of North Macedonia
| | - Rafael Stelmach
- Pulmonary Division, Heart Institute (InCor), Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paolo, Brazil
| | - Alice Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Zihan Pan
- Department of General Practice, Peking University First Hospital, Beijing, China
| | - Hui Pang
- Department of Emergency, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jianxin Zhang
- Department of General Practice, Peking University First Hospital, Beijing, China
| | - Rachel E Jordan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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3
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Mavaddat N, Mavaddat N, Adab P, Fozdar S. Religion and health: complexities and contradictions. BMJ 2023; 382:p2246. [PMID: 37775139 DOI: 10.1136/bmj.p2246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Affiliation(s)
- Nasim Mavaddat
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Nahal Mavaddat
- School of Medicine, University of Western Australia, Australia
| | - Peymané Adab
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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4
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Pallan M, Adab P. Preventing obesity through school based approaches to improve nutrition. BMJ Med 2023; 2:e000463. [PMID: 36936267 PMCID: PMC9951380 DOI: 10.1136/bmjmed-2022-000463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 01/06/2023] [Indexed: 01/19/2023]
Affiliation(s)
- Miranda Pallan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Peymané Adab
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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5
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Martins SM, Dickens AP, Salibe-Filho W, Albuquerque Neto AA, Adab P, Enocson A, Cooper BG, Sousa LVA, Sitch AJ, Jowett S, Adams R, Cheng KK, Chi C, Correia-de-Sousa J, Farley A, Gale N, Jolly K, Maglakelidze M, Maghlakelidze T, Stavrikj K, Turner AM, Williams S, Jordan RE, Stelmach R. Accuracy and economic evaluation of screening tests for undiagnosed COPD among hypertensive individuals in Brazil. NPJ Prim Care Respir Med 2022; 32:55. [PMID: 36513683 PMCID: PMC9747958 DOI: 10.1038/s41533-022-00303-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/29/2022] [Indexed: 12/15/2022] Open
Abstract
In Brazil, prevalence of diagnosed COPD among adults aged 40 years and over is 16% although over 70% of cases remain undiagnosed. Hypertension is common and well-recorded in primary care, and frequently co-exists with COPD because of common causes such as tobacco smoking, therefore we conducted a cross-sectional screening test accuracy study in nine Basic Health Units in Brazil, among hypertensive patients aged ≥40 years to identify the optimum screening test/combinations to detect undiagnosed COPD. We compared six index tests (four screening questionnaires, microspirometer and peak flow) against the reference test defined as those below the lower limit of normal (LLN-GLI) on quality diagnostic spirometry, with confirmed COPD at clinical review. Of 1162 participants, 6.8% (n = 79) had clinically confirmed COPD. Peak flow had a higher specificity but lower sensitivity than microspirometry (sensitivity 44.3% [95% CI 33.1, 55.9], specificity 95.5% [95% CI 94.1, 96.6]). SBQ performed well compared to the other questionnaires (sensitivity 75.9% [95% CI 65.0, 84.9], specificity 59.2% [95% CI 56.2, 62.1]). A strategy requiring both SBQ and peak flow to be positive yielded sensitivity of 39.2% (95% CI 28.4, 50.9) and specificity of 97.0% (95% CI 95.7, 97.9). The use of simple screening tests was feasible within the Brazilian primary care setting. The combination of SBQ and peak flow appeared most efficient, when considering performance of the test, cost and ease of use (costing £1690 (5554 R$) with 26.7 cases detected per 1,000 patients). However, the choice of screening tests depends on the clinical setting and availability of resources.ISRCTN registration number: 11377960.
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Affiliation(s)
- S. M. Martins
- grid.412368.a0000 0004 0643 8839Family Medicine, ABC Medical School, Sao Paulo, Brazil
| | - A. P. Dickens
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, University of Birmingham, Birmingham, UK ,grid.500407.6Observational and Pragmatic Research Institute, Midview City, Singapore
| | - W. Salibe-Filho
- grid.412368.a0000 0004 0643 8839Family Medicine, ABC Medical School, Sao Paulo, Brazil ,grid.11899.380000 0004 1937 0722Respiratory Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - A. A. Albuquerque Neto
- grid.411249.b0000 0001 0514 7202Faculty of Medicine, Federal University of São Paulo, Sao Paulo, Brazil
| | - P. Adab
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - A. Enocson
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - B. G. Cooper
- grid.412563.70000 0004 0376 6589Lung Function & Sleep, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - L. V. A. Sousa
- grid.412368.a0000 0004 0643 8839Family Medicine, ABC Medical School, Sao Paulo, Brazil
| | - A. J. Sitch
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, University of Birmingham, Birmingham, UK ,grid.412563.70000 0004 0376 6589NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - S. Jowett
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - R. Adams
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - K. K. Cheng
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - C. Chi
- grid.411472.50000 0004 1764 1621Department of General Practice, Peking University First Hospital, Beijing, China
| | - J. Correia-de-Sousa
- International Primary Care Respiratory Group, Edinburgh, UK ,grid.10328.380000 0001 2159 175XLife and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga Portugal, ICVS/3B’s, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - A. Farley
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - N. Gale
- grid.6572.60000 0004 1936 7486Health Services Management Centre, School of Social Policy, College of Social Sciences, University of Birmingham, Birmingham, UK
| | - K. Jolly
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - M. Maglakelidze
- Georgian Respiratory Association, Tbilisi, Georgia ,grid.444026.00000 0004 0519 9653Petre Shotadze Tbilisi Medical Academy, Tblisi, Georgia
| | - T. Maghlakelidze
- Georgian Respiratory Association, Tbilisi, Georgia ,grid.26193.3f0000 0001 2034 6082Ivane Javakhishvili Tbilisi State University, Tblisi, Georgia
| | - K. Stavrikj
- grid.7858.20000 0001 0708 5391Center for Family Medicine, Faculty of Medicine, Ss.Cyril and Methodius University in Skopje, Skopje, North Macedonia
| | - A. M. Turner
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - S. Williams
- International Primary Care Respiratory Group, Edinburgh, UK
| | - R. E. Jordan
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - R. Stelmach
- grid.11899.380000 0004 1937 0722Respiratory Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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Kongsupon N, Walters GI, Adab P, Jordan RE. Screening tools for work-related asthma and their diagnostic accuracy: a systematic review protocol. BMJ Open 2022; 12:e058054. [PMID: 36153029 PMCID: PMC9511564 DOI: 10.1136/bmjopen-2021-058054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Work-related asthma (WRA) refers to asthma caused by exposures at work (occupational asthma) and asthma made worse by work conditions (work-exacerbated asthma). WRA is common among working-age adults with asthma and impacts individual health, work-life and income but is often not detected by healthcare services. Earlier identification can lead to better health and employment outcomes. However, the optimal tool for screening and its effectiveness in practice is not well established. Screening tools may include whole questionnaires, questionnaire items, physiological measurements and/or immunological tests. Since the publication of the most contemporary WRA or occupational asthma-specific guidelines, further studies evaluating tools for identifying WRA have been performed. Our systematic review aims to summarise and compare the performance of screening tools for identifying WRA in both clinical and workplace settings. METHODS AND ANALYSIS We will conduct a systematic review of observational and experimental studies (1975-2021) using MEDLINE, EMBASE, CINAHL Plus, Web of Science, CDSR, DARE, HTA, CISDOC databases and grey literature. Two independent reviewers will screen the studies using predetermined criteria, extract data according to a schedule and assess study quality using the Quality Assessment of Diagnostic Test Accuracy 2 tool. Screening tools and test accuracy measures will be summarised. Paired forest plots and summary receiver operating characteristic curves of sensitivities and specificities will be evaluated for heterogeneity between studies, using subgroup analyses, where possible. If the studies are sufficiently homogenous, we will use a bivariate random effect model for meta-analysis. A narrative summary and interpretation will be provided if meta-analysis is not appropriate. ETHICS AND DISSEMINATION As this is a systematic review and does not involve primary data collection, formal ethical review is not required. We will disseminate our findings through open access peer-reviewed publication as well as through other academic and social media. PROSPERO REGISTRATION NUMBER CRD42021246031.
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Affiliation(s)
- Ngamjit Kongsupon
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Gareth I Walters
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Birmingham Regional NHS Occupational Lung Disease Service, Birmingham Chest Clinic, Birmingham, UK
| | - Peymané Adab
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Rachel E Jordan
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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7
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Pang H, Pan Z, Adams R, Duncan E, Chi C, Kong X, Adab P, Cheng KK, Cooper BG, Correia-de-Sousa J, Dickens AP, Enocson A, Farley A, Gale N, Jolly K, Jowett S, Maglakelidze M, Maghlakelidze T, Martins S, Sitch A, Stavrik K, Stelmach R, Turner A, Williams S, Jordan RE. Community lung health service design for COPD patients in China by the Breathe Well group. NPJ Prim Care Respir Med 2022; 32:27. [PMID: 35985992 PMCID: PMC9388970 DOI: 10.1038/s41533-022-00286-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/24/2022] [Indexed: 12/04/2022] Open
Abstract
COPD is increasingly common in China but is poorly understood by patients, medications are not used as prescribed and there is no access to recommended non-pharmacological treatment. We explored COPD patients’ and general practitioners’ (GPs) knowledge of COPD, views on its management and the acceptability of a flexible lung health service (LHS) offering health education, exercise, self-management, smoking cessation and mental health support. Using a convergent mixed methods design, data were collected from patients and GPs using focus groups (FGs) in four Chinese cities, questionnaires were also used to collect data from patients. FGs were audio-recorded and transcribed. Quantitative data were analysed descriptively, thematic framework analysis was used for the qualitative data. Two-hundred fifty-one patients completed the questionnaire; 39 patients and 30 GPs participated in ten separate FGs. Three overarching themes were identified: patients’ lack of knowledge/understanding of COPD, current management of COPD not meeting patients’ needs and LHS design, which was well received by patients and GPs. Participants wanted COPD education, TaiChi, psychological support and WeChat for social support. 39% of survey responders did not know what to do when their breathing worsened and 24% did not know how to use their inhalers. 36% of survey respondents requested guided relaxation. Overall, participants did not fully understand the implications of COPD and current treatment was sub-optimal. There was support for developing a culturally appropriate intervention meeting Chinese patients’ needs, health beliefs, and local healthcare delivery. Further research should explore the feasibility of such a service.
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8
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Adams R, Jordan R, Adab P, Barrett T, Bevan S, Cooper L, DuRand I, Hardy P, Heneghan N, Jolly K, Jowett S, Marshall T, O'Hara M, Rai K, Rickards H, Riley R, Sadhra S, Tearne S, Walters G, Sapey E. Enhancing the health of NHS staff: eTHOS - protocol for a randomised controlled pilot trial of an employee health screening clinic for NHS staff to reduce absenteeism and presenteeism, compared with usual care. Pilot Feasibility Stud 2022; 8:155. [PMID: 35897113 PMCID: PMC9326142 DOI: 10.1186/s40814-022-01095-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 06/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Staff absenteeism and presenteeism incur high costs to the NHS and are associated with adverse health outcomes. The main causes are musculoskeletal complaints and mental ill-health, which are potentially modifiable, and cardiovascular risk factors are also common. We will test the feasibility of an RCT to evaluate the clinical and cost-effectiveness of an employee health screening clinic on reducing sickness absenteeism and presenteeism. METHODS This is an individually randomised controlled pilot trial aiming to recruit 480 participants. All previously unscreened employees from four hospitals within three UK NHS hospital Trusts will be eligible. Those randomised to the intervention arm will be invited to attend an employee health screening clinic consisting of a screening assessment for musculoskeletal (STarT MSK and STarT Back), mental (PHQ-9 and GAD-7) and cardiovascular (NHS Health Check if aged ≥ 40, lifestyle check if < 40 years) health. Screen positives will be given advice and/or referral to recommended services. Those randomised to the control arm will receive usual care. Participants will complete a questionnaire at baseline and 26 weeks; anonymised absenteeism and staff demographics will also be collected from personnel records. The co-primary outcomes are as follows: recruitment, referrals and uptake of recommended services in the intervention arm. Secondary outcomes include the following: results of screening assessments, uptake of individual referrals, reported changes in health behaviours, acceptability and feasibility of intervention, indication of contamination and costs. Outcomes related to the definitive trial include self-reported and employee records of absenteeism with reasons. Process evaluation to inform a future trial includes interviews with participants, intervention delivery staff and service providers receiving referrals. Analyses will include presentation of descriptive statistics, framework analysis for qualitative data and costs and consequences presented for health economics. DISCUSSION The study will provide data to inform the design of a definitive RCT which aims to find an effective and cost-effective method of reducing absenteeism and presenteeism amongst NHS staff. The feasibility study will test trial procedures, and process outcomes, including the success of strategies for including underserved groups, and provide information and data to help inform the design and sample size for a definitive trial. TRIAL REGISTRATION ISRCTN reference number 10237475 .
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Affiliation(s)
- Rachel Adams
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Rachel Jordan
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Peymané Adab
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Tim Barrett
- Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK
| | - Sheriden Bevan
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Lucy Cooper
- Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK
| | - Ingrid DuRand
- Hereford County Hospital, Stonebow Road, Hereford, HR1 2ER, UK
| | - Pollyanna Hardy
- National Perinatal Epidemiology Unit Clinical Trials Unit, University of Oxford, Oxford, UK
| | - Nicola Heneghan
- School of Sport, Exercise and Rehabilitation, University of Birmingham, Birmingham, B15 2TT, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Sue Jowett
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Tom Marshall
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Margaret O'Hara
- Public and Patient Involvement and Engagement, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
| | - Kiran Rai
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Hugh Rickards
- Institute of Clinical Sciences, University of Birmingham, Birmingham, B15 2TT, UK.,National Centre for Mental Health, Barberry Building, 25 Vincent Drive, Birmingham, B15 2FG, UK
| | - Ruth Riley
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Steven Sadhra
- Institute of Clinical Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Sarah Tearne
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Gareth Walters
- Birmingham Heartlands Hospital, Bordesley Green East, Birmingham, B9 5SS, UK
| | - Elizabeth Sapey
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT, UK.,Respiratory Medicine and General Internal Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, B15 2TH, UK
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9
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Affiliation(s)
- Peymané Adab
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Shamil Haroon
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Margaret E O'Hara
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Rachel E Jordan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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10
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Zanganeh M, Adab P, Li B, Pallan M, Liu WJ, Rong L, Liu W, Martin J, Cheng KK, Frew E. Relationship Between Weight Status and Health-Related Quality of Life in School-age Children in China. J Health Econ Outcomes Res 2022; 9:75-81. [PMID: 35342771 PMCID: PMC8901243 DOI: 10.36469/jheor.2022.32414] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/10/2022] [Indexed: 06/14/2023]
Abstract
Background: Some studies from high-income countries suggest that overweight and/or obesity in children are negatively associated with health-related quality of life (HRQOL). However, the relationship between weight status and HRQOL is not well established in China, where obesity trends follow a different pattern compared with high-income countries. The risk of obesity is greater in children from higher socioeconomic backgrounds and higher in boys compared with girls. Objective: The aim of this study was to examine the relationship between weight status and HRQOL in children between 6 and 7 years old in this unique country context. Methods: Baseline HRQOL and demographic data were collected from children recruited to the CHIRPY DRAGON obesity prevention trial in China. HRQOL was measured using the Chinese version of the Child Health Utility-9D (CHU-9D-CHN) and the Pediatric Quality of Life Inventory™ (PedsQL™) instruments. CHU-9D-CHN utility scores were generated using 2 scoring algorithms (UK and Chinese tariffs). Height and weight measures were taken at school by trained researchers using standardized methods, and BMI z scores were calculated using the World Health Organization 2007 growth charts. The relationship between HRQOL and weight status was examined using multivariable analyses, adjusting for age, gender, and socioeconomic status. Results: Full data were available for 1539 children (mean age, 6 years). In both unadjusted and adjusted analyses, HRQOL, using both the CHU-9D-CHN and the PedsQL™, was marginally higher in children who were overweight or living with obesity compared with children with healthy weight, although this difference did not reach statistical significance. Separate analyses and models by gender showed that the relationship between weight status and HRQOL scores was similar in boys and girls. Conclusions: Our results suggest no statistically significant difference in HRQOL between children with overweight/obesity compared with those with healthy weight. These results have implications for the methods of economic evaluation for obesity treatment and prevention interventions within this population cohort and country setting, as there appears to be no discernible consequences on children's HRQOL from living with overweight and obesity.
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Affiliation(s)
- Mandana Zanganeh
- Centre for Health Economics, Warwick Medical School, University of Warwick
| | - Peymané Adab
- Institute of Applied Health Research, University of Birmingham
| | - Bai Li
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol
| | - Miranda Pallan
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham
| | - Wei J Liu
- School Health Unit, Centre for Disease Control and Prevention, Guangzhou, China
| | - Lin Rong
- School Health Unit, Centre for Disease Control and Prevention, Guangzhou, China
| | - Wei Liu
- School Health Unit, Centre for Disease Control and Prevention, Guangzhou, China
| | - James Martin
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham
| | - Kar K Cheng
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham
| | - Emma Frew
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham
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11
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Adab P, Jordan RE, Fitzmaurice D, Ayres JG, Cheng KK, Cooper BG, Daley A, Dickens A, Enocson A, Greenfield S, Haroon S, Jolly K, Jowett S, Lambe T, Martin J, Miller MR, Rai K, Riley RD, Sadhra S, Sitch A, Siebert S, Stockley RA, Turner A. Case-finding and improving patient outcomes for chronic obstructive pulmonary disease in primary care: the BLISS research programme including cluster RCT. Programme Grants Appl Res 2021. [DOI: 10.3310/pgfar09130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
Chronic obstructive pulmonary disease is a major contributor to morbidity, mortality and health service costs but is vastly underdiagnosed. Evidence on screening and how best to approach this is not clear. There are also uncertainties around the natural history (prognosis) of chronic obstructive pulmonary disease and how it impacts on work performance.
Objectives
Work package 1: to evaluate alternative methods of screening for undiagnosed chronic obstructive pulmonary disease in primary care, with clinical effectiveness and cost-effectiveness analyses and an economic model of a routine screening programme. Work package 2: to recruit a primary care chronic obstructive pulmonary disease cohort, develop a prognostic model [Birmingham Lung Improvement StudieS (BLISS)] to predict risk of respiratory hospital admissions, validate an existing model to predict mortality risk, address some uncertainties about natural history and explore the potential for a home exercise intervention. Work package 3: to identify which factors are associated with employment, absenteeism, presenteeism (working while unwell) and evaluate the feasibility of offering formal occupational health assessment to improve work performance.
Design
Work package 1: a cluster randomised controlled trial with household-level randomised comparison of two alternative case-finding approaches in the intervention arm. Work package 2: cohort study – focus groups. Work package 3: subcohort – feasibility study.
Setting
Primary care settings in West Midlands, UK.
Participants
Work package 1: 74,818 people who have smoked aged 40–79 years without a previous chronic obstructive pulmonary disease diagnosis from 54 general practices. Work package 2: 741 patients with previously diagnosed chronic obstructive pulmonary disease from 71 practices and participants from the work package 1 randomised controlled trial. Twenty-six patients took part in focus groups. Work package 3: occupational subcohort with 248 patients in paid employment at baseline. Thirty-five patients took part in an occupational health intervention feasibility study.
Interventions
Work package 1: targeted case-finding – symptom screening questionnaire, administered opportunistically or additionally by post, followed by diagnostic post-bronchodilator spirometry. The comparator was routine care. Work package 2: twenty-three candidate variables selected from literature and expert reviews. Work package 3: sociodemographic, clinical and occupational characteristics; occupational health assessment and recommendations.
Main outcome measures
Work package 1: yield (screen-detected chronic obstructive pulmonary disease) and cost-effectiveness of case-finding; effectiveness of screening on respiratory hospitalisation and mortality after approximately 4 years. Work package 2: respiratory hospitalisation within 2 years, and barriers to and facilitators of physical activity. Work package 3: work performance – feasibility and acceptability of the occupational health intervention and study processes.
Results
Work package 1: targeted case-finding resulted in greater yield of previously undiagnosed chronic obstructive pulmonary disease than routine care at 1 year [n = 1278 (4%) vs. n = 337 (1%), respectively; adjusted odds ratio 7.45, 95% confidence interval 4.80 to 11.55], and a model-based estimate of a regular screening programme suggested an incremental cost-effectiveness ratio of £16,596 per additional quality-adjusted life-year gained. However, long-term follow-up of the trial showed that at ≈4 years there was no clear evidence that case-finding, compared with routine practice, was effective in reducing respiratory admissions (adjusted hazard ratio 1.04, 95% confidence interval 0.73 to1.47) or mortality (hazard ratio 1.15, 95% confidence interval 0.82 to 1.61). Work package 2: 2305 patients, comprising 1564 with previously diagnosed chronic obstructive pulmonary disease and 741 work package 1 participants (330 with and 411 without obstruction), were recruited. The BLISS prognostic model among cohort participants with confirmed airflow obstruction (n = 1894) included 6 of 23 candidate variables (i.e. age, Chronic Obstructive Pulmonary Disease Assessment Test score, 12-month respiratory admissions, body mass index, diabetes and forced expiratory volume in 1 second percentage predicted). After internal validation and adjustment (uniform shrinkage factor 0.87, 95% confidence interval 0.72 to 1.02), the model discriminated well in predicting 2-year respiratory hospital admissions (c-statistic 0.75, 95% confidence interval 0.72 to 0.79). In focus groups, physical activity engagement was related to self-efficacy and symptom severity. Work package 3: in the occupational subcohort, increasing dyspnoea and exposure to inhaled irritants were associated with lower work productivity at baseline. Longitudinally, increasing exacerbations and worsening symptoms, but not a decline in airflow obstruction, were associated with absenteeism and presenteeism. The acceptability of the occupational health intervention was low, leading to low uptake and low implementation of recommendations and making a full trial unfeasible.
Limitations
Work package 1: even with the most intensive approach, only 38% of patients responded to the case-finding invitation. Management of case-found patients with chronic obstructive pulmonary disease in primary care was generally poor, limiting interpretation of the long-term effectiveness of case-finding on clinical outcomes. Work package 2: the components of the BLISS model may not always be routinely available and calculation of the score requires a computerised system. Work package 3: relatively few cohort participants were in paid employment at baseline, limiting the interpretation of predictors of lower work productivity.
Conclusions
This programme has addressed some of the major uncertainties around screening for undiagnosed chronic obstructive pulmonary disease and has resulted in the development of a novel, accurate model for predicting respiratory hospitalisation in people with chronic obstructive pulmonary disease and the inception of a primary care chronic obstructive pulmonary disease cohort for longer-term follow-up. We have also identified factors that may affect work productivity in people with chronic obstructive pulmonary disease as potential targets for future intervention.
Future work
We plan to obtain data for longer-term follow-up of trial participants at 10 years. The BLISS model needs to be externally validated. Our primary care chronic obstructive pulmonary disease cohort is a unique resource for addressing further questions to better understand the prognosis of chronic obstructive pulmonary disease.
Trial registration
Current Controlled Trials ISRCTN14930255.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 13. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Peymané Adab
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Rachel E Jordan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - David Fitzmaurice
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jon G Ayres
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - KK Cheng
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Brendan G Cooper
- Lung Function and Sleep, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Amanda Daley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Andrew Dickens
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Alexandra Enocson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sheila Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Shamil Haroon
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sue Jowett
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Tosin Lambe
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - James Martin
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Martin R Miller
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kiran Rai
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Richard D Riley
- Centre for Prognosis Research, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Steve Sadhra
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Alice Sitch
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Robert A Stockley
- Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Alice Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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12
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Pan Z, Dickens AP, Chi C, Kong X, Enocson A, G Cooper B, Adab P, Cheng KK, Sitch AJ, Jowett S, Adams R, Correia-de-Sousa J, Farley A, Gale NK, Jolly K, Maglakelidze M, Maglakelidze T, M Martins S, Stavrikj K, Stelmach R, Turner AM, Williams S, E Jordan R. Accuracy and cost-effectiveness of different screening strategies for identifying undiagnosed COPD among primary care patients (≥40 years) in China: a cross-sectional screening test accuracy study: findings from the Breathe Well group. BMJ Open 2021; 11:e051811. [PMID: 34556515 PMCID: PMC8461701 DOI: 10.1136/bmjopen-2021-051811] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES To examine the accuracy and cost-effectiveness of various chronic obstructive pulmonary disease (COPD) screening tests and combinations within a Chinese primary care population. DESIGN Screening test accuracy study. SETTING Urban and rural community health centres in four municipalities of China: Beijing (north), Chengdu (southwest), Guangzhou (south) and Shenyang (northeast). PARTICIPANTS Community residents aged 40 years and above who attended community health centres for any reason were invited to participate. 2445 participants (mean age 59.8 (SD 9.6) years, 39.1% (n=956) male) completed the study (February-December 2019), 68.9% (n=1684) were never-smokers and 3.6% (n=88) had an existing COPD diagnosis. 13.7% (n=333) of participants had spirometry-confirmed airflow obstruction. INTERVENTIONS Participants completed six index tests (screening questionnaires (COPD Diagnostic Questionnaire, COPD Assessment in Primary Care To Identify Undiagnosed Respiratory Disease and Exacerbation Risk (CAPTURE), Chinese Symptom-Based Questionnaire (C-SBQ), COPD-SQ), microspirometry (COPD-6), peak flow (model of peak flow meters used in the study (USPE)) and the reference test (ndd Easy On-PC). PRIMARY AND SECONDARY OUTCOMES Cases were defined as those with forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) below the lower limit of normal (LLN-GLI) on the reference test. Performance of individual screening tests and their combinations was evaluated, with cost-effectiveness analyses providing cost per additional true case detected. RESULTS Airflow measurement devices (sensitivities 64.9% (95% CI 59.5% to 70.0%) and 67.3% (95% CI 61.9% to 72.3%), specificities 89.7% (95% CI 88.4% to 91.0%) and 82.6% (95% CI 80.9% to 84.2%) for microspirometry and peak flow, respectively) generally performed better than questionnaires, the most accurate of which was C-SBQ (sensitivity 63.1% (95% CI 57.6% to 68.3%) specificity 74.2% (95% CI 72.3% to 76.1%)). The combination of C-SBQ and microspirometry used in parallel maximised sensitivity (81.4%) (95% CI 76.8% to 85.4%) and had specificity of 68.0% (95% CI 66.0% to 70.0%), with an incremental cost-effectiveness ratio of £64.20 (CNY385) per additional case detected compared with peak flow. CONCLUSIONS Simple screening tests to identify undiagnosed COPD within the primary care setting in China is possible, and a combination of C-SBQ and microspirometry is the most sensitive and cost-effective. Further work is required to explore optimal cut-points and effectiveness of programme implementation. TRIAL REGISTRATION NUMBER ISRCTN13357135.
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Affiliation(s)
- Zihan Pan
- General Practice Department, Peking University First Hospital, Beijing, People's Republic of China
- Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, People's Republic of China
| | - Andrew P Dickens
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
| | - Chunhua Chi
- General Practice Department, Peking University First Hospital, Beijing, People's Republic of China
| | - Xia Kong
- General Practice Department, Peking University First Hospital, Beijing, People's Republic of China
| | - Alexandra Enocson
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
| | - Brendan G Cooper
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
- Lung Investigation Unit, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Peymané Adab
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
| | - Kar Keung Cheng
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
- General Practice Development and Research Centre, Peking University Health Science Centre, Beijing, People's Republic of China
| | - Alice J Sitch
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Sue Jowett
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
| | - Rachel Adams
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
| | - Jaime Correia-de-Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- International Primary Care Respiratory Group, London, UK
- ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Amanda Farley
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
| | - Nicola K Gale
- Health Services Management Centre,School of Social Policy, College of Social Sciences, University of Birmingham, Birmingham, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
| | - Mariam Maglakelidze
- Georgian Respiratory Association, Georgia
- Petre Shotadze Tbilisi Medical Academy, Georgia
| | | | | | - Katarina Stavrikj
- Center for Family Medicine, Faculty of Medicine, Ss.Cyril and Methodius University in Skopje, North Macedonia
| | - Rafael Stelmach
- Pulmonary Division, Heart Institute (InCor), Hospital das Clinicas da Faculdade de Medicina da, Uinversidade de Sao Paulo, Sao Paulo, Brazil
| | - Alice M Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
| | - Sian Williams
- International Primary Care Respiratory Group, London, UK
| | - Rachel E Jordan
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
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13
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Sheikh A, Campbell H, Balharry D, Adab P, Barreto ML, Bauld L, Cooper P, Cruz A, Davidson FM, Dodd P, Enocson A, Fitch N, Griffiths C, Grigg J, Heyderman RS, Jordan R, Katikireddi SV, Kuo S, Kwambana-Adams B, Leyland AH, Mortimer K, Mosler G, Obasi A, Orme M, Readshaw A, Savio M, Siddiqi K, Sifaki-Pistolla D, Singh S, Squire B, Tsiligianni I, Williams S. The UK's Global Health Respiratory Network: Improving respiratory health of the world's poorest through research collaborations. J Glob Health 2020; 9:020104. [PMID: 31893026 PMCID: PMC6927736 DOI: 10.7189/jogh.09.020104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Aziz Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, UK.,On behalf of the NIHR Global Health Research Unit on Respiratory Health (RESPIRE)
| | - Harry Campbell
- Usher Institute, The University of Edinburgh, Edinburgh, UK.,On behalf of the NIHR Global Health Research Unit on Respiratory Health (RESPIRE)
| | - Dominique Balharry
- Usher Institute, The University of Edinburgh, Edinburgh, UK.,On behalf of the NIHR Global Health Research Unit on Respiratory Health (RESPIRE)
| | - Peymané Adab
- University of Birmingham, Birmingham, UK.,On behalf of the NIHR Global Health Research Group on Global COPD in Primary Care (Breathe Well)
| | - Mauricio L Barreto
- On behalf of the NIHR Global Health Research Group on Social Policy and Health Inequalities
| | - Linda Bauld
- Usher Institute, The University of Edinburgh, Edinburgh, UK.,On behalf of the GCRF funded Tobacco Control Capacity Programme (TCCP)
| | - Philip Cooper
- St George's University of London, London, UK.,On behalf of the NIHR Global Health Research Group on Asthma Attacks Causes and Prevention Study in Urban Latin America (ATTACK)
| | - Alvaro Cruz
- Federal University of Bahia, Salvador, Brazil.,On behalf of the NIHR Global Health Research Group on Asthma Attacks Causes and Prevention Study in Urban Latin America (ATTACK)
| | - Fiona M Davidson
- Usher Institute, The University of Edinburgh, Edinburgh, UK.,On behalf of the GCRF funded Tobacco Control Capacity Programme (TCCP)
| | - Peter Dodd
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Alexandra Enocson
- University of Birmingham, Birmingham, UK.,On behalf of the NIHR Global Health Research Group on Global COPD in Primary Care (Breathe Well)
| | - Neil Fitch
- Usher Institute, The University of Edinburgh, Edinburgh, UK.,University of Birmingham, Birmingham, UK.,CIDACS, Salvador, Brazil.,St George's University of London, London, UK.,Federal University of Bahia, Salvador, Brazil.,School of Health and Related Research, University of Sheffield, Sheffield, UK.,International Primary Care Respiratory Group (IPCRG).,Queen Mary University of London, London, UK.,University College London, London, UK.,MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.,Liverpool School of Tropical Medicine, Liverpool, UK.,University of Leicester, Leicester, UK.,Department of Health Sciences, The University of York, York, UK.,On behalf of the NIHR Global Health Research Unit on Respiratory Health (RESPIRE).,On behalf of the GCRF funded Tobacco Control Capacity Programme (TCCP).,On behalf of the NIHR Global Health Research Group on Global COPD in Primary Care (Breathe Well).,On behalf of the NIHR Global Health Research Group to Address Smokeless Tobacco and build Research capacity in South Asia (ASTRA).,On behalf of the NIHR Global Health Research Group on Asthma Attacks Causes and Prevention Study in Urban Latin America (ATTACK).,On behalf of the NIHR Global Health Research Group on Social Policy and Health Inequalities.,On behalf of the NIHR Global Health Research Unit on Mucosal Pathogens (MPRU).,On behalf of the NIHR Global Health Research Unit on Lung Health and TB in Africa (IMPALA).,On behalf of the NIHR Global Health Research Group on Achieving Control of Asthma in Children In Africa (ACACIA).,On behalf of the NIHR Global Health Research Group on Respiratory Rehabilitation (Global RECHARGE).,Coordinators of the Global Health Research Network (GHRN)
| | - Chris Griffiths
- On behalf of the NIHR Global Health Research Group on Achieving Control of Asthma in Children In Africa (ACACIA)
| | - Jonathan Grigg
- On behalf of the NIHR Global Health Research Group on Achieving Control of Asthma in Children In Africa (ACACIA)
| | - Robert S Heyderman
- University College London, London, UK.,On behalf of the NIHR Global Health Research Unit on Mucosal Pathogens (MPRU)
| | - Rachel Jordan
- University of Birmingham, Birmingham, UK.,On behalf of the NIHR Global Health Research Group on Global COPD in Primary Care (Breathe Well)
| | - S Vittal Katikireddi
- On behalf of the NIHR Global Health Research Group on Social Policy and Health Inequalities
| | - Steven Kuo
- University College London, London, UK.,On behalf of the NIHR Global Health Research Unit on Mucosal Pathogens (MPRU)
| | - Brenda Kwambana-Adams
- University College London, London, UK.,On behalf of the NIHR Global Health Research Unit on Mucosal Pathogens (MPRU)
| | - Alastair H Leyland
- On behalf of the NIHR Global Health Research Group on Social Policy and Health Inequalities
| | - Kevin Mortimer
- On behalf of the NIHR Global Health Research Unit on Lung Health and TB in Africa (IMPALA)
| | - Gioia Mosler
- Queen Mary University of London, London, UK.,On behalf of the NIHR Global Health Research Group on Achieving Control of Asthma in Children In Africa (ACACIA)
| | - Angela Obasi
- On behalf of the NIHR Global Health Research Unit on Lung Health and TB in Africa (IMPALA)
| | - Mark Orme
- University of Leicester, Leicester, UK.,On behalf of the NIHR Global Health Research Group on Respiratory Rehabilitation (Global RECHARGE)
| | - Anne Readshaw
- CIDACS, Salvador, Brazil.,On behalf of the NIHR Global Health Research Group to Address Smokeless Tobacco and build Research capacity in South Asia (ASTRA)
| | - Martina Savio
- On behalf of the NIHR Global Health Research Unit on Lung Health and TB in Africa (IMPALA)
| | - Kamran Siddiqi
- CIDACS, Salvador, Brazil.,On behalf of the NIHR Global Health Research Group to Address Smokeless Tobacco and build Research capacity in South Asia (ASTRA)
| | - Dimitra Sifaki-Pistolla
- Usher Institute, The University of Edinburgh, Edinburgh, UK.,University of Birmingham, Birmingham, UK.,CIDACS, Salvador, Brazil.,St George's University of London, London, UK.,Federal University of Bahia, Salvador, Brazil.,School of Health and Related Research, University of Sheffield, Sheffield, UK.,International Primary Care Respiratory Group (IPCRG).,Queen Mary University of London, London, UK.,University College London, London, UK.,MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.,Liverpool School of Tropical Medicine, Liverpool, UK.,University of Leicester, Leicester, UK.,Department of Health Sciences, The University of York, York, UK.,On behalf of the NIHR Global Health Research Unit on Respiratory Health (RESPIRE).,On behalf of the GCRF funded Tobacco Control Capacity Programme (TCCP).,On behalf of the NIHR Global Health Research Group on Global COPD in Primary Care (Breathe Well).,On behalf of the NIHR Global Health Research Group to Address Smokeless Tobacco and build Research capacity in South Asia (ASTRA).,On behalf of the NIHR Global Health Research Group on Asthma Attacks Causes and Prevention Study in Urban Latin America (ATTACK).,On behalf of the NIHR Global Health Research Group on Social Policy and Health Inequalities.,On behalf of the NIHR Global Health Research Unit on Mucosal Pathogens (MPRU).,On behalf of the NIHR Global Health Research Unit on Lung Health and TB in Africa (IMPALA).,On behalf of the NIHR Global Health Research Group on Achieving Control of Asthma in Children In Africa (ACACIA).,On behalf of the NIHR Global Health Research Group on Respiratory Rehabilitation (Global RECHARGE).,Coordinators of the Global Health Research Network (GHRN)
| | - Sally Singh
- University of Leicester, Leicester, UK.,On behalf of the NIHR Global Health Research Group on Respiratory Rehabilitation (Global RECHARGE)
| | - Bertie Squire
- On behalf of the NIHR Global Health Research Unit on Lung Health and TB in Africa (IMPALA)
| | - Ioanna Tsiligianni
- Usher Institute, The University of Edinburgh, Edinburgh, UK.,University of Birmingham, Birmingham, UK.,CIDACS, Salvador, Brazil.,St George's University of London, London, UK.,Federal University of Bahia, Salvador, Brazil.,School of Health and Related Research, University of Sheffield, Sheffield, UK.,International Primary Care Respiratory Group (IPCRG).,Queen Mary University of London, London, UK.,University College London, London, UK.,MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.,Liverpool School of Tropical Medicine, Liverpool, UK.,University of Leicester, Leicester, UK.,Department of Health Sciences, The University of York, York, UK.,On behalf of the NIHR Global Health Research Unit on Respiratory Health (RESPIRE).,On behalf of the GCRF funded Tobacco Control Capacity Programme (TCCP).,On behalf of the NIHR Global Health Research Group on Global COPD in Primary Care (Breathe Well).,On behalf of the NIHR Global Health Research Group to Address Smokeless Tobacco and build Research capacity in South Asia (ASTRA).,On behalf of the NIHR Global Health Research Group on Asthma Attacks Causes and Prevention Study in Urban Latin America (ATTACK).,On behalf of the NIHR Global Health Research Group on Social Policy and Health Inequalities.,On behalf of the NIHR Global Health Research Unit on Mucosal Pathogens (MPRU).,On behalf of the NIHR Global Health Research Unit on Lung Health and TB in Africa (IMPALA).,On behalf of the NIHR Global Health Research Group on Achieving Control of Asthma in Children In Africa (ACACIA).,On behalf of the NIHR Global Health Research Group on Respiratory Rehabilitation (Global RECHARGE).,Coordinators of the Global Health Research Network (GHRN)
| | - Siân Williams
- Usher Institute, The University of Edinburgh, Edinburgh, UK.,University of Birmingham, Birmingham, UK.,CIDACS, Salvador, Brazil.,St George's University of London, London, UK.,Federal University of Bahia, Salvador, Brazil.,School of Health and Related Research, University of Sheffield, Sheffield, UK.,International Primary Care Respiratory Group (IPCRG).,Queen Mary University of London, London, UK.,University College London, London, UK.,MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.,Liverpool School of Tropical Medicine, Liverpool, UK.,University of Leicester, Leicester, UK.,Department of Health Sciences, The University of York, York, UK.,On behalf of the NIHR Global Health Research Unit on Respiratory Health (RESPIRE).,On behalf of the GCRF funded Tobacco Control Capacity Programme (TCCP).,On behalf of the NIHR Global Health Research Group on Global COPD in Primary Care (Breathe Well).,On behalf of the NIHR Global Health Research Group to Address Smokeless Tobacco and build Research capacity in South Asia (ASTRA).,On behalf of the NIHR Global Health Research Group on Asthma Attacks Causes and Prevention Study in Urban Latin America (ATTACK).,On behalf of the NIHR Global Health Research Group on Social Policy and Health Inequalities.,On behalf of the NIHR Global Health Research Unit on Mucosal Pathogens (MPRU).,On behalf of the NIHR Global Health Research Unit on Lung Health and TB in Africa (IMPALA).,On behalf of the NIHR Global Health Research Group on Achieving Control of Asthma in Children In Africa (ACACIA).,On behalf of the NIHR Global Health Research Group on Respiratory Rehabilitation (Global RECHARGE).,Coordinators of the Global Health Research Network (GHRN)
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14
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Dickens AP, Fitzmaurice DA, Adab P, Sitch A, Riley RD, Enocson A, Jordan RE. Accuracy of Vitalograph lung monitor as a screening test for COPD in primary care. NPJ Prim Care Respir Med 2020; 30:2. [PMID: 31900421 PMCID: PMC6941963 DOI: 10.1038/s41533-019-0158-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 11/13/2019] [Indexed: 11/25/2022] Open
Abstract
Microspirometry may be useful as the second stage of a screening pathway among patients reporting respiratory symptoms. We assessed sensitivity and specificity of the Vitalograph® lung monitor compared with post-bronchodilator confirmatory spirometry (ndd Easy on-PC) among primary care chronic obstructive pulmonary disease (COPD) patients within the Birmingham COPD cohort. We report a case–control analysis within 71 general practices in the UK. Eligible patients were aged ≥40 years who were either on a clinical COPD register or reported chronic respiratory symptoms on a questionnaire. Participants performed pre- and post-bronchodilator microspirometry, prior to confirmatory spirometry. Out of the 544 participants, COPD was confirmed in 337 according to post-bronchodilator confirmatory spirometry. Pre-bronchodilator, using the LLN as a cut-point, the lung monitor had a sensitivity of 50.5% (95% CI 45.0%, 55.9%) and a specificity of 99.0% (95% CI 96.6%, 99.9%) in our sample. Using a fixed ratio of FEV1/FEV6 < 0.7 to define obstruction in the lung monitor, sensitivity increased (58.8%; 95% CI 53.0, 63.8) while specificity was virtually identical (98.6%; 95% CI 95.8, 99.7). Within our sample, the optimal cut-point for the lung monitor was FEV1/FEV6 < 0.78, with sensitivity of 82.8% (95% CI 78.3%, 86.7%) and specificity of 85.0% (95% CI 79.4%, 89.6%). Test performance of the lung monitor was unaffected by bronchodilation. The lung monitor could be used in primary care without a bronchodilator using a simple ratio of FEV1/FEV6 as part of a screening pathway for COPD among patients reporting respiratory symptoms.
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Affiliation(s)
- A P Dickens
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
| | - D A Fitzmaurice
- Warwick Medical School - Health Sciences, University of Warwick, Coventry, UK
| | - P Adab
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
| | - A Sitch
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - R D Riley
- Centre for Prognosis Research, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - A Enocson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - R E Jordan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Graham J, Tudor K, Jebb SA, Lewis A, Tearne S, Adab P, Begh R, Jolly K, Daley A, Farley A, Lycett D, Nickless A, Aveyard P. The equity impact of brief opportunistic interventions to promote weight loss in primary care: secondary analysis of the BWeL randomised trial. BMC Med 2019; 17:51. [PMID: 30819170 PMCID: PMC6396456 DOI: 10.1186/s12916-019-1284-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 02/08/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Guidelines recommend that clinicians should make brief opportunistic behavioural interventions to patients who are obese to increase the uptake of effective weight loss programmes. The objective was to assess the effect of this policy on socioeconomic equity. METHODS One thousand eight hundred eighty-two consecutively attending patients with obesity and who were not seeking support for weight loss from their GP were enrolled in a trial. Towards the end of each consultation, GPs randomly assigned participants to one of two 30-s interventions. In the active intervention (support arm), the GP offered referral to a weight management group. In the control intervention (advice arm), the GP advised the patient that their health would benefit from weight loss. Agreement to attend a behavioural weight loss programme, attendance at the programme and weight loss at 12 months were analysed by socioeconomic status, measured by postcode using the Index of Multiple Deprivation (IMD). RESULTS Mean weight loss was 2.43 kg (sd 6.49) in the support group and 1.04 kg (sd 5.50) for the advice only group, but these effects were moderated by IMD (p = 0.039 for the interaction). In the support arm, weight loss was greater in higher socioeconomic groups. Participants from lower socioeconomic backgrounds were more likely to accept the offer and equally likely to attend a weight loss referral but attended fewer sessions. Adjusting for these sequentially reduced the gradient for the association of socioeconomic status with weight loss from + 0.035 to - 0.001 kg/IMD point. In the advice only arm, 10% took effective action to promote weight loss. The decision to seek support for weight loss outside of the trial did not differ by socioeconomic status, but weight loss among deprived participants who used external support was greater than among more affluent participants (p = 0.025). CONCLUSION Participants' responses to GPs' brief opportunistic interventions to promote weight loss differed by socioeconomic status and trial arm. In the support arm, more deprived people lost less weight because they attended fewer sessions at the programme. In the advice arm, more deprived people who sought and paid for support for weight loss themselves lost more weight than more affluent people who sought support. TRIAL REGISTRATION This trial is registered with the ISRCTN registry, number ISRCTN26563137 . Date of registration: January 3, 2013; date of first participant recruited: June 4, 2014.
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Affiliation(s)
- J Graham
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, OX2 6GG, UK
| | - K Tudor
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, OX2 6GG, UK.
| | - S A Jebb
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, OX2 6GG, UK
| | - A Lewis
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - S Tearne
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, OX2 6GG, UK
| | - P Adab
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - R Begh
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, OX2 6GG, UK
| | - K Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - A Daley
- School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK
| | - A Farley
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - D Lycett
- Faculty Research Centre for Advances in Behavioural Science, Coventry University, Coventry, CV1 5FB, UK
| | - A Nickless
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, OX2 6GG, UK
| | - P Aveyard
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, OX2 6GG, UK
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Abstract
Background Several studies have assessed the impact of chronic obstructive pulmonary disease (COPD) on work ability and work productivity; however, this relationship is poorly understood. Aims To undertake a systematic review to assess the effects of COPD on employment, absenteeism and presenteeism. Methods A comprehensive search using CINAHL, Embase, MEDLINE and the Cochrane Library was conducted to include epidemiological studies from 1937 to August 2017. One reviewer screened all citations. Shortlisted full-text articles were independently assessed by a second reviewer. Data were extracted by one reviewer with a random sample of papers (45%) checked by a second reviewer. Results Forty-four studies were included; the majority of evidence was from cross-sectional studies, and some cohort studies. COPD patients had lower employment rates than those without COPD. Among those in work, most studies showed patients with COPD took more time off work than those without and reported poorer work performance (presenteeism), although evidence for this association was weaker. The influence of disease severity on these outcomes was unclear; however, it appeared that increasing severity of airflow obstruction was associated with reduced likelihood of being employed. A number of methodological limitations were found among the evidence, including the lack of adjustment for important confounders. Conclusions Future studies are required which assess the impact of COPD on presenteeism using validated presenteeism instruments and consistent reporting methods. Robust studies are now needed to identify modifiable factors associated with these poorer working outcomes to inform future interventions aimed at improving work productivity among those with COPD.
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Affiliation(s)
- K K Rai
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK
| | - P Adab
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK
| | - J G Ayres
- Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - R E Jordan
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK
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17
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Adab P, Fitzmaurice DA, Dickens AP, Ayres JG, Buni H, Cooper BG, Daley AJ, Enocson A, Greenfield S, Jolly K, Jowett S, Kalirai K, Marsh JL, Miller MR, Riley RD, Siebert WS, Stockley RA, Turner AM, Cheng KK, Jordan RE. Cohort Profile: The Birmingham Chronic Obstructive Pulmonary Disease (COPD) Cohort Study. Int J Epidemiol 2018; 46:23. [PMID: 27378796 DOI: 10.1093/ije/dyv350] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2015] [Indexed: 11/12/2022] Open
Affiliation(s)
- P Adab
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - D A Fitzmaurice
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - A P Dickens
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - J G Ayres
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - H Buni
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - B G Cooper
- Lung Function & Sleep, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - A J Daley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - A Enocson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - S Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - K Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - S Jowett
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - K Kalirai
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - J L Marsh
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - M R Miller
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - R D Riley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - W S Siebert
- Business School, University of Birmingham, Birmingham, UK
| | - R A Stockley
- Queen Elizabeth Hospital Research Laboratories, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - A M Turner
- School of Inflammation & Aging, University of Birmingham, UK
| | - K K Cheng
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - R E Jordan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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18
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Miller MR, Haroon S, Jordan RE, Sitch AJ, Dickens AP, Enocson A, Fitzmaurice DA, Adab P. Clinical characteristics of patients newly diagnosed with COPD by the fixed ratio and lower limit of normal criteria: a cross-sectional analysis of the TargetCOPD trial. Int J Chron Obstruct Pulmon Dis 2018; 13:1979-1986. [PMID: 29950827 PMCID: PMC6016600 DOI: 10.2147/copd.s146914] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background Consensus on the definition of airflow obstruction to diagnose COPD remains unresolved. Methods We undertook systematic case finding for COPD in primary care using the fixed ratio (FR) criterion (forced expiratory volume in 1 s/forced vital capacity [FEV1/FVC] <0.7) for defining airflow obstruction and also using the lower limit of normal (LLN). We then compared the clinical characteristics of those identified by the 2 criteria. Results A total of 3,721 individuals reporting respiratory symptoms were invited for spirometry. A total of 2,607 attended (mean age 60.4 years, 52.8% male, 29.8% current smokers) and 32.6% had airflow obstruction by FR ("FR+") and 20.2% by LLN ("LLN+"). Compared with the LLN+/FR+ group, the LLN-/FR+ group (12.4%) was significantly older, had higher FEV1 and FEV1/FVC, lower COPD assessment test scores, and less cough, sputum, and wheeze, but was significantly more likely to report a diagnosis of heart disease (14.2% versus 6.9%, p<0.001). Compared with the LLN+/FR+ group, the LLN-/FR- group was younger, had a higher body mass index, fewer pack-years, a lower prevalence of respiratory symptoms except for dyspnea, and lower FVC and higher FEV1. The probability of known heart disease was significantly lower in the LLN+/FR+ group compared with those with preserved lung function (LLN-/FR-) (adjusted odds ratio 0.62, 95% CI: 0.43-0.90) but this was not seen in the LLN-/FR+ group (adjusted odds ratio 0.90, 95% CI: 0.63-1.29). Conclusion In symptomatic individuals, defining airflow obstruction by FR instead of LLN identifies a significant number of individuals who have less respiratory and more cardiac clinical characteristics.
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Affiliation(s)
- Martin R Miller
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Shamil Haroon
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Rachel E Jordan
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Alice J Sitch
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Andrew P Dickens
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Alexandra Enocson
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - David A Fitzmaurice
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Peymané Adab
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
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19
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Adab P, Marshall T. Sarah Walters. Assoc Med J 2018. [DOI: 10.1136/bmj.k1818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
Schools are seen as important contributors to obesity prevention, yet face barriers in fulfilling this function. This qualitative study investigates headteacher views on the primary school role in preventing obesity. Semi-structured interviews were held with 22 headteachers from ethnically and socio-economically diverse schools in the West Midlands, UK. Data analysis was conducted using the framework approach. Two over-arching categories were identified: 'School roles and responsibilities' and 'Influencing factors'. Participants agreed that although schools contribute towards obesity prevention in many ways, a moral responsibility to support children's holistic development was the principal motivator, rather than preventing obesity per se. The perceived impact on learning was a key driver for promoting health. Parents were believed to have the main responsibility for preventing obesity, but barriers were identified. Whilst headteachers recognized the advantageous position of schools in offering support to parents, opinion varied on the degree to which schools could and should take on this role. Headteachers serving more deprived areas reported adopting certain responsibilities that elsewhere were fulfilled by parents, and were more likely to view working with families on healthy lifestyles as an important school function. Several factors were perceived as barriers to schools doing more to prevent obesity, including academic pressure, access to expert support and space. In conclusion, school leaders need more support, through resources and government policy, to enable them to maximize their role in obesity prevention. Additionally, school-based obesity prevention should be an integral part of the education agenda rather than bolt-on initiatives.
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Affiliation(s)
- J L Clarke
- Institute of Applied Health Research, Public Healthbuilding, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - M J Pallan
- Institute of Applied Health Research, Public Healthbuilding, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - E R Lancashire
- Institute of Applied Health Research, Public Healthbuilding, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - P Adab
- Institute of Applied Health Research, Public Healthbuilding, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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21
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Rai KK, Adab P, Ayres JG, Siebert WS, Sadhra SS, Sitch AJ, Fitzmaurice DA, Jordan RE. Factors associated with work productivity among people with COPD: Birmingham COPD Cohort. Occup Environ Med 2017; 74:859-867. [PMID: 28899966 DOI: 10.1136/oemed-2016-104014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 03/30/2017] [Accepted: 05/17/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) are more likely to take time off work (absenteeism) and report poor performance at work (presenteeism) compared to those without COPD. Little is known about the modifiable factors associated with these work productivity outcomes. AIM To assess the factors associated with work productivity among COPD patients. METHODS Cross-sectional analysis of baseline data from a subsample (those in paid employment) of the Birmingham COPD Cohort study. Absenteeism was defined by self-report over the previous 12 months. Presenteeism was assessed using the Stanford Presenteeism Scale. Logistic regression analysis was used to assess the effects of sociodemographic, clinical and occupational characteristics on work productivity. RESULTS Among 348 included participants, increasing dyspnoea was the only factor associated with both absenteeism and presenteeism (p for trend<0.01). Additionally, increasing history of occupational exposure to vapours, gases, dusts or fumes (VGDF) was independently associated with presenteeism (p for trend<0.01). CONCLUSIONS This is the first study to identify important factors associated with poor work productivity among patients with COPD. Future studies should evaluate interventions aimed at managing breathlessness and reducing occupational exposures to VGDF on work productivity among patients with COPD.
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Affiliation(s)
- Kiran K Rai
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Peymané Adab
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jon G Ayres
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - W Stanley Siebert
- The Department of Business and Labour Economics, The University of Birmingham, Birmingham, UK
| | - Steven S Sadhra
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Alice J Sitch
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - David A Fitzmaurice
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Rachel E Jordan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Griffin TL, Clarke JL, Lancashire ER, Pallan MJ, Adab P. Process evaluation results of a cluster randomised controlled childhood obesity prevention trial: the WAVES study. BMC Public Health 2017; 17:681. [PMID: 28851329 PMCID: PMC5576245 DOI: 10.1186/s12889-017-4690-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 08/21/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Increasing prevalence of childhood obesity and its related consequences emphasises the importance of developing and evaluating interventions aimed at prevention. The importance of process evaluation in health intervention research is increasingly recognised, assessing implementation and participant response, and how these may relate to intervention success or failure. A comprehensive process evaluation was designed and undertaken for the West Midlands ActiVe lifestyle and healthy Eating in School children (WAVES) study that tested the effectiveness of an obesity prevention programme for children aged 6-7 years, delivered in 24 UK schools. The four intervention components were: additional daily school-time physical activity (PA); cooking workshops for children and parents; Villa Vitality (VV), a 6-week healthy lifestyle promotion programme run by a local football club; and signposting to local PA opportunities. METHODS Data relating to six dimensions (Fidelity, Reach, Recruitment, Quality, Participant Responsiveness, Context) were collected via questionnaires, logbooks, direct observations, focus groups and interviews. Multiple data collection methods allowed for data triangulation and validation of methods, comparing research observations with teacher records. The 6-stage WAVES study model ((i) Data collection, (ii) Collation, (iii) Tabulation, (iv) Score allocation and discussion, (v) Consultation, (vi) Final score allocation) was developed to guide the collection, assimilation and analysis of process evaluation data. Two researchers independently allocated school scores on a 5-point Likert scale for each process evaluation dimension. Researchers then discussed school score allocations and reached a consensus. Schools were ranked by total score, and grouped to reflect low, medium or high intervention implementation. RESULTS The intervention was predominantly well-implemented and well-received by teachers, parents and children. The PA component was identified as the most challenging, VV the least. Median implementation score across schools was 56/75 (IQR, 51.0 - 60.8). Agreement between teacher logbooks and researcher observations was generally high, the main discrepancies occurred in session duration reporting where in some cases teachers' estimations tended to be higher than researchers'. CONCLUSIONS The WAVES study model provides a rigorous and replicable approach to undertaking and analysing a multi-component process evaluation. Challenges to implementing school-based obesity prevention interventions have been identified which can be used to inform future trials. TRIAL REGISTRATION ISRCTN97000586 . 19 May 2010.
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Affiliation(s)
- T. L. Griffin
- Institute of Applied Health Research, Public Health Building, University of Birmingham, Birmingham, B15 2TT UK
| | - J. L. Clarke
- Institute of Applied Health Research, Public Health Building, University of Birmingham, Birmingham, B15 2TT UK
| | - E. R. Lancashire
- Institute of Applied Health Research, Public Health Building, University of Birmingham, Birmingham, B15 2TT UK
| | - M. J. Pallan
- Institute of Applied Health Research, Public Health Building, University of Birmingham, Birmingham, B15 2TT UK
| | - P. Adab
- Institute of Applied Health Research, Public Health Building, University of Birmingham, Birmingham, B15 2TT UK
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Rai KK, Jordan RE, Siebert WS, Sadhra SS, Fitzmaurice DA, Sitch AJ, Ayres JG, Adab P. Birmingham COPD Cohort: a cross-sectional analysis of the factors associated with the likelihood of being in paid employment among people with COPD. Int J Chron Obstruct Pulmon Dis 2017; 12:233-242. [PMID: 28138233 PMCID: PMC5238806 DOI: 10.2147/copd.s119467] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Employment rates among those with chronic obstructive pulmonary disease (COPD) are lower than those without COPD, but little is known about the factors that affect COPD patients' ability to work. METHODS Multivariable analysis of the Birmingham COPD Cohort Study baseline data was used to assess the associations between lifestyle, clinical, and occupational characteristics and likelihood of being in paid employment among working-age COPD patients. RESULTS In total, 608 of 1,889 COPD participants were of working age, of whom 248 (40.8%) were in work. Older age (60-64 years vs 30-49 years: odds ratio [OR] =0.28; 95% confidence interval [CI] =0.12-0.65), lower educational level (no formal qualification vs degree/higher level: OR =0.43; 95% CI =0.19-0.97), poorer prognostic score (highest vs lowest quartile of modified body mass index, airflow obstruction, dyspnea, and exercise (BODE) score: OR =0.10; 95% CI =0.03-0.33), and history of high occupational exposure to vapors, gases, dusts, or fumes (VGDF; high VGDF vs no VGDF exposure: OR =0.32; 95% CI =0.12-0.85) were associated with a lower probability of being employed. Only the degree of breathlessness of BODE was significantly associated with employment. CONCLUSION This is the first study to comprehensively assess the characteristics associated with employment in a community sample of people with COPD. Future interventions should focus on managing breathlessness and reducing occupational exposures to VGDF to improve the work capability among those with COPD.
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Affiliation(s)
| | | | | | - Steven S Sadhra
- Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | | | | | - Jon G Ayres
- Institute of Applied Health Research
- Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, UK
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Jordan RE, Jowett S, Fitzmaurice D, Adab P. COPD case finding: effective, but also cost-effective? – Authors' reply. The Lancet Respiratory Medicine 2016; 4:e50. [DOI: 10.1016/s2213-2600(16)30267-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 08/16/2016] [Indexed: 11/29/2022]
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Hurley K, Pallan M, Lancashire E, Adab P. Is an energy-dense, low fibre diet pattern related to adiposity in UK children? Appetite 2016. [DOI: 10.1016/j.appet.2016.02.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Leong WB, Jadhakhan F, Taheri S, Chen YF, Adab P, Thomas GN. Effect of obstructive sleep apnoea on diabetic retinopathy and maculopathy: a systematic review and meta-analysis. Diabet Med 2016; 33:158-68. [PMID: 26031931 DOI: 10.1111/dme.12817] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2015] [Indexed: 02/06/2023]
Abstract
AIMS To summarize the association between obstructive sleep apnoea and diabetic retinopathy and diabetic maculopathy, and to examine the effects of oxygen desaturation index, mean and minimum oxygen saturation and time spent with < 90% oxygen saturation on diabetic retinopathy and diabetic maculopathy. METHODS A systematic search was performed for papers published from inception to January 2014 in MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews using indexed terms and free text. Additional searches were carried out for grey literature. Two authors conducted the study selection and quality assessment. Data extraction was performed by the main author and checked by the other authors. RESULTS One cohort study and 15 cross-sectional studies were included for narrative synthesis and three for meta-analyses. There was no convincing evidence that obstructive sleep apnoea was associated with diabetic retinopathy, although some evidence suggested that obstructive sleep apnoea was associated with greater severity of diabetic retinopathy and advanced diabetic retinopathy in people with Type 2 diabetes. Only six studies examined the impact of obstructive sleep apnoea on diabetic maculopathy and our narrative review suggests there is an association in Type 2 diabetes. Oxygen desaturation index, mean oxygen saturation or time spent with < 90% oxygen saturation were not associated with diabetic retinopathy, and insufficient evidence was available to draw conclusions on their effects on diabetic maculopathy; however, there was evidence from both narrative synthesis and meta-analysis that minimum oxygen saturation had an impact on diabetic retinopathy (pooled odds ratio 0.91, 95% CI 0.87-0.95; I(2) = 0%). CONCLUSIONS There is a need for large cohort studies with long-term follow-up data to examine the long-term effects of obstructive sleep apnoea and other sleep variables on advanced retinal disease in diabetes.
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Affiliation(s)
- W B Leong
- School of Clinical and Experimental Medicine and Birmingham and Black Country NIHR CLAHRC, University of Birmingham, Birmingham, UK
- Specialist Weight Management Services, Heart of England NHS Foundation Trust, Birmingham, UK
| | - F Jadhakhan
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - S Taheri
- Department of Medicine, Weill Cornell Medical College in New York, NY, USA and Doha, Qatar
- Department of Medicine, King's College London, London, UK
| | - Y F Chen
- Division of Health Sciences, University of Warwick, Coventry, UK
| | - P Adab
- Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
| | - G N Thomas
- Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
- Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University, Mannheim, Germany
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Leong WB, Jadhakhan F, Taheri S, Thomas GN, Adab P. The Association between Obstructive Sleep Apnea on Diabetic Kidney Disease: A Systematic Review and Meta-Analysis. Sleep 2016; 39:301-8. [PMID: 26414891 DOI: 10.5665/sleep.5432] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 08/28/2015] [Indexed: 01/29/2023] Open
Abstract
STUDY OBJECTIVE This systematic review aims to investigate the association between obstructive sleep apnea (OSA) and diabetic kidney disease (DKD). METHODS MeSH terms and free text searches were performed on MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews from inception to April 2015. Zetoc and OpenGrey databases were queried for grey literature, and lastly, hand searches were carried out. Study selection and quality assessment were conducted by two authors. One author carried out data extraction, which was checked by other authors. The relationships between apneahypopnea index (AHI), oxygen desaturation index (ODI), time spent under 90% oxygen saturation (%TST < 90), and minimum and mean oxygen saturation (O2) on DKD were examined. RESULTS Two longitudinal and ten cross-sectional studies were included for our narrative synthesis, and seven studies for meta-analysis. Studies that performed multi-variable analysis demonstrated significant associations between OSA (assessed using either apnea-hypopnea index or ODI) and DKD in type 2 diabetes mellitus (T2DM). This was confirmed by meta-analysis (pooled OR 1.73, 95% CI: 1.13-2.64). There was some evidence to suggest that %TST < 90 may have an association with DKD. There was insufficient evidence to conclude on the relationship between minimum and mean oxygen saturation on DKD. There was no evidence available on the associations between OSA and other respiratory parameters in type 1 diabetes mellitus populations. CONCLUSIONS There is moderate evidence that OSA is associated with DKD in patients with T2DM. Large prospective studies with long-term follow up are needed to assess the possible bi-directional mechanisms between OSA and DKD.
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Affiliation(s)
- Wen Bun Leong
- School of Health and Population Sciences, University of Birmingham
| | | | - Shahrad Taheri
- Department of Medicine and Clinical Research Core, Weill Cornell Medical College, New York and Doha Qatar.,Department of Medicine, King's College London, London, UK
| | - G Neil Thomas
- Public Health, Epidemiology and Biostatistics, University of Birmingham, UK.,Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University, Mannheim, Germany
| | - Peymané Adab
- Public Health, Epidemiology and Biostatistics, University of Birmingham, UK
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Au Yeung SL, Jiang C, Cheng KK, Adab P, Lam KB, Liu B, Zhang W, Lam TH, Leung GM, Schooling CM. Aldehyde Dehydrogenase 2—a Potential Genetic Risk Factor for Lung Function among Southern Chinese in China: the Guangzhou Biobank Cohort Study. Int J Epidemiol 2015. [DOI: 10.1093/ije/dyv096.432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lin Q, Adab P, Hemming K, Yang L, Qin H, Li M, Deng J, Shi J, Chen J. Health allowance for improving the nutritional status and development of 3-5-year-old left-behind children in poor rural areas of China: study protocol for a cluster randomised trial. Trials 2015; 16:361. [PMID: 26282845 PMCID: PMC4539730 DOI: 10.1186/s13063-015-0897-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 08/03/2015] [Indexed: 11/22/2022] Open
Abstract
Background Left-behind children (LBC) are recognised as a new social group in China. LBC are young children who are abandoned in rural villages whilst their parents travel to distant urban centres for employment (a new generation of migrant workers). Following the rapid growth in the number of migrant workers, the LBC population is also rapidly increasing. These children are usually left to be raised by elderly grandparents, a single parent, or sometimes distant relatives or neighbours who have limited resources, tend to have a poor education and sometimes are in frail health. Over 40 % of the 61 million LBC in China who are under 5 years old are undernourished, which affects their long-term health and abilities. An intervention that combines a conditional cash transfer (CCT) with nutrition education offers a potential solution. Methods/Design A cluster randomised controlled trial design will be used to allocate 40 villages to the intervention arm (20 villages) or control arm (20 villages). The caregivers and all of the 3–5-year-old LBC will be the target population. Caregivers in the intervention arm will receive a cash allowance conditional on attending nutrition education sessions, ensuring that the LBC will use basic public health services over a 12-month period. At the baseline, midterm (month 6) and end (month 12) of the intervention period, evaluations will be conducted in all 40 villages. Multilevel generalised linear models will be used to analyse the impact of the intervention on nutrition status and other outcomes, adjusting for baseline levels using an analysis of covariance approach. The cost of the intervention will also be estimated. Discussion If found to be cost-effective, the findings will inform the development of a sustainable model to improve nutrition status among LBC in rural areas of China. Trial registration Chinese Trial Register (ChiCTR) identifier: CTXY-140003-2. Registered on 19 Aug 2014.
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Affiliation(s)
- Qian Lin
- School of Public Health, Central South University, 110 Xiangya Road, Changsha, 410078, Hunan, China.
| | - Peymané Adab
- Department of Public Health, Epidemiology & Biostatistics, University of Birmingham, Birmingham, UK.
| | - Karla Hemming
- Department of Public Health, Epidemiology & Biostatistics, University of Birmingham, Birmingham, UK.
| | - Lina Yang
- School of Public Health, Central South University, 110 Xiangya Road, Changsha, 410078, Hunan, China.
| | - Hong Qin
- School of Public Health, Central South University, 110 Xiangya Road, Changsha, 410078, Hunan, China.
| | - Mingzhi Li
- School of Public Health, Central South University, 110 Xiangya Road, Changsha, 410078, Hunan, China.
| | - Jing Deng
- School of Public Health, Central South University, 110 Xiangya Road, Changsha, 410078, Hunan, China.
| | - Jingcheng Shi
- School of Public Health, Central South University, 110 Xiangya Road, Changsha, 410078, Hunan, China.
| | - Jihua Chen
- School of Public Health, Central South University, 110 Xiangya Road, Changsha, 410078, Hunan, China.
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Li B, Adab P, Cheng KK. The role of grandparents in childhood obesity in China - evidence from a mixed methods study. Int J Behav Nutr Phys Act 2015; 12:91. [PMID: 26122955 PMCID: PMC4507318 DOI: 10.1186/s12966-015-0251-z] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 06/19/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The current literature on the influences of family environment on childhood obesity is predominantly based on western populations and has focused on the role of parents. This study examined the influence of grandparents on the development of obesity among Chinese primary school aged children. METHODS A mixed methods study was conducted in four socioeconomically distinct primary school communities in two cities of southern China. The qualitative study (17 focus groups and four personal interviews) involved parents, grandparents, school staff, and food retailers in the vicinity of the schools (n = 99) and explored perceived causes of childhood obesity. The cross-sectional study examined the association between children's objectively measured weight status and reported health behaviours, and the presence and role of grandparents in the household. It included children from three randomly selected third grade (8 to 10 years) classes from each school (n = 497). RESULTS Grandparents were commonly perceived to contribute to childhood obesity through inappropriate perception (e.g. fat children are healthy and well cared for), knowledge (e.g. obesity related diseases can only happen in adults; the higher the dietary energy/fat content, the more nutritious the food), and behaviour (e.g. overfeeding and indulging through excusing the children from household chores). Conflicting child care beliefs and practices between grandparents and parents, and between grandparents and school teachers, were felt to undermine efforts to promote healthy behaviours in children. In the cross-sectional study, children who were mainly cared for by their grandparents were more likely to be overweight/obese (adjusted OR = 2.03; 95 % CI = 1.19 to 3.47); and to consume more sugar-added drinks and unhealthy snacks (B = 2.13, 95 % CI = 0.87 to 3.40), than children who were mainly cared for by their parents or other adult. Children who lived with two or more grandparents in the household were more likely to be overweight/obese than children who did not live with any grandparent (adjusted OR = 1.72; 95 % CI = 1.00 to 2.94). CONCLUSIONS Involvement of grandparents in childcare is an important factor contributing to childhood obesity in China. Future preventive interventions should include strategies that target grandparents.
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Affiliation(s)
- Bai Li
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Peymané Adab
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Kar Keung Cheng
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
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Majothi S, Jolly K, Heneghan NR, Price MJ, Riley RD, Turner AM, Bayliss SE, Moore DJ, Singh SJ, Adab P, Fitzmaurice DA, Jordan RE. Supported self-management for patients with COPD who have recently been discharged from hospital: a systematic review and meta-analysis. Int J Chron Obstruct Pulmon Dis 2015; 10:853-67. [PMID: 25995625 PMCID: PMC4425235 DOI: 10.2147/copd.s74162] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Although many hospitals promote self-management to chronic obstructive pulmonary disease (COPD) patients post discharge from hospital, the clinical effectiveness of this is unknown. We undertook a systematic review of the evidence as part of a Health Technology Assessment review. METHODS A comprehensive search strategy with no language restrictions was conducted across relevant databases from inception to May 2012. Randomized controlled trials of patients with COPD, recently discharged from hospital after an acute exacerbation and comparing a self-management intervention with control, usual care or other intervention were included. Study selection, data extraction, and risk of bias assessment were undertaken by two reviewers independently. RESULTS Of 13,559 citations, 836 full texts were reviewed with nine randomized controlled trials finally included in quantitative syntheses. Interventions were heterogeneous. Five trials assessed highly supported multi-component interventions and four trials were less supported with fewer contacts with health care professionals and mainly home-based interventions. Total sample size was 1,466 (range 33-464 per trial) with length of follow-up 2-12 months. Trials varied in quality; poor patient follow-up and poor reporting was common. No evidence of effect in favor of self-management support was observed for all-cause mortality (pooled hazard ratio =1.07; 95% confidence interval [0.74 to 1.55]; I (2)=0.0%, [n=5 trials]). No clear evidence of effect on all-cause hospital admissions was observed (hazard ratio 0.88 [0.61, 1.27] I (2)=66.0%). Improvements in St George's Respiratory Questionnaire score were seen in favor of self-management interventions (mean difference =3.84 [1.29 to 6.40]; I (2)=14.6%), although patient follow-up rates were low. CONCLUSION There is insufficient evidence to support self-management interventions post-discharge. There is a need for good quality primary research to identify effective approaches.
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Affiliation(s)
- Saimma Majothi
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Kate Jolly
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Nicola R Heneghan
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Malcolm J Price
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Richard D Riley
- Research Institute of Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | - Alice M Turner
- Queen Elizabeth Hospital Research Laboratories, Birmingham, UK
| | - Susan E Bayliss
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - David J Moore
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Sally J Singh
- Centre for Exercise and Rehabilitation Science, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
| | - Peymané Adab
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - David A Fitzmaurice
- Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Rachel E Jordan
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
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Clarke J, Griffin T, Lancashire E, Pallan M, Adab P. Parent and child perspectives on a school-based obesity prevention intervention. The West Midlands ActiVe lifestyle and healthy Eating in School children (WAVES) study. Appetite 2015. [DOI: 10.1016/j.appet.2014.12.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Clarke J, Lancashire E, Pallan M, Adab P. Headteacher perspectives on the role of the primary school in preventing childhood obesity. Appetite 2015. [DOI: 10.1016/j.appet.2014.12.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Griffin T, Clarke J, Lancashire E, Pallan M, Passmore S, Adab P. Teacher experiences of delivering an obesity prevention programme (The WAVES study intervention) in a primary school setting. Appetite 2015. [DOI: 10.1016/j.appet.2014.12.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kalirai K, Adab P, Jordan R, Ayres J, Sadhra S. M147 Feasibility Of Delivering An Occupational Health Intervention Aimed At Improving Work Productivity, Among Working Copd Patients. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Jordan RE, Adab P, Jowett S, Marsh JL, Riley RD, Enocson A, Miller MR, Cooper BG, Turner AM, Ayres JG, Cheng KK, Jolly K, Stockley RA, Greenfield S, Siebert S, Daley A, Fitzmaurice DA. TargetCOPD: a pragmatic randomised controlled trial of targeted case finding for COPD versus routine practice in primary care: protocol. BMC Pulm Med 2014; 14:157. [PMID: 25280869 PMCID: PMC4271517 DOI: 10.1186/1471-2466-14-157] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 09/26/2014] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Many people with clinically significant chronic obstructive pulmonary disease (COPD) remain undiagnosed worldwide. There are a number of small studies which have examined possible methods of case finding through primary care, but no large RCTs that have adequately assessed the most cost-effective approach. METHODS/DESIGN In this study, using a cluster randomised controlled trial (RCT) in 56 general practices in the West Midlands, we plan to investigate the effectiveness and cost-effectiveness of a Targeted approach to case finding for COPD compared with routine practice. Using an individual patient RCT nested in the Targeted arm, we plan also to compare the effectiveness and cost-effectiveness of Active case finding using a postal questionnaire (with supplementary opportunistic questionnaires), and Opportunistic-only case finding during routine surgery consultations.All ever-smoking patients aged 40-79 years, without a current diagnosis of COPD and registered with participating practices will be eligible. Patients in the Targeted arm who report positive respiratory symptoms (chronic cough or phlegm, wheeze or dyspnoea) using a brief questionnaire will be invited for further spirometric assessment to ascertain whether they have COPD or not. Post-bronchodilator spirometry will be conducted to ATS standards using an Easy One spirometer by trained research assistants.The primary outcomes will be new cases of COPD and cost per new case identified, comparing targeted case finding with routine care, and two types of targeted case finding (active versus opportunistic). A multilevel logistic regression model will be used to model the probability of detecting a new case of COPD for each treatment arm, with clustering of patients (by practice and household) accounted for using a multi-level structure.A trial-based analysis will be undertaken using costs and outcomes collected during the trial. Secondary outcomes include the feasibility, efficiency, long-term cost-effectiveness, patient and primary care staff views of each approach. DISCUSSION This will be the largest RCT of its kind, and should inform how best to identify undiagnosed patients with COPD in the UK and other similar healthcare systems. Sensitivity analyses will help local policy-makers decide which sub-groups of the population to target first. TRIAL REGISTRATION Current controlled trials ISRCTN14930255.
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Affiliation(s)
- Rachel E Jordan
- />School of Health and Populations Sciences, University of Birmingham, Birmingham, UK
| | - Peymané Adab
- />School of Health and Populations Sciences, University of Birmingham, Birmingham, UK
- />Public Health, Epidemiology & Biostatistics, Public Health Building, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT UK
| | - Sue Jowett
- />School of Health and Populations Sciences, University of Birmingham, Birmingham, UK
| | - Jen L Marsh
- />School of Health and Populations Sciences, University of Birmingham, Birmingham, UK
| | - Richard D Riley
- />School of Health and Populations Sciences, University of Birmingham, Birmingham, UK
| | - Alexandra Enocson
- />School of Health and Populations Sciences, University of Birmingham, Birmingham, UK
| | - Martin R Miller
- />School of Health and Populations Sciences, University of Birmingham, Birmingham, UK
| | - Brendan G Cooper
- />Lung Investigation Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Alice M Turner
- />Queen Elizabeth Hospital Research Laboratories, Mindelsohn Way, Birmingham, UK
| | - Jon G Ayres
- />School of Health and Populations Sciences, University of Birmingham, Birmingham, UK
| | - Kar Keung Cheng
- />School of Health and Populations Sciences, University of Birmingham, Birmingham, UK
| | - Kate Jolly
- />School of Health and Populations Sciences, University of Birmingham, Birmingham, UK
| | - Robert A Stockley
- />Lung Investigation Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sheila Greenfield
- />School of Health and Populations Sciences, University of Birmingham, Birmingham, UK
| | | | - Amanda Daley
- />School of Health and Populations Sciences, University of Birmingham, Birmingham, UK
| | - David A Fitzmaurice
- />School of Health and Populations Sciences, University of Birmingham, Birmingham, UK
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Abstract
CONTEXT Obstructive sleep apnea (OSA) has been shown to be associated with type 2 diabetes mellitus (DM). Studies on healthy individuals found that OSA is associated with lower insulin sensitivity. We hypothesized that nocturnal hypoxemia from OSA is associated with poorer glycemia in severely obese DM individuals. DESIGN AND SETTING This was a retrospective observational study of 122 non-DM, 126 non-insulin-treated DM, and 35 insulin-treated DM patients. Data were collected on demographic characteristics, body mass index, and comorbidities. An overnight sleep study was performed in all patients, and OSA was defined as an apnea-hypopnea index of ≥5 events/h. RESULTS There were more males (P = .003) and a lower proportion of white Europeans (P = .010) among DM patients. The prevalence of OSA was 80.1% in DM and 63.1% in non-DM individuals (P = .001). DM individuals also had lower oxygen saturation (O2) (P = .0106), greater percentage of time spent under 90% oxygen saturation (%TST<90%) (P = .0067), and higher apnea-hypopnea index (P = .0085). Regression analysis showed that %TST<90% and minimum O2 saturations were associated with worse hemoglobin A1c results among DM individuals. Every 10% reduction in minimum O2 was associated with a 0.3% increase in HbA1c, whereas a 10% increase in %TST<90% was associated with a 0.2% increase in hemoglobin A1c after adjusting for a range of potential confounders. CONCLUSION The high OSA prevalence in DM individuals and a positive relationship between nocturnal hypoxemia and glycemia supports the need to assess correction of hypoxemia as a management strategy for glycemic control.
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Affiliation(s)
- Wen Bun Leong
- Specialist Weight Management Services (W.B.L., S.T.) and Academic Department of Sleep and Ventilation (D.B., M.N.), Heart of England National Health Service Foundation Trust, Birmingham, United Kingdom; Theme 8 (Diabetes) (W.B.L., S.T.), Birmingham and Black Country National Institute for Health Research Collaborations for Leadership in Applied Health Research and Care, University of Birmingham, Birmingham, B15, 2TT, United Kingdom; Thoracic and Sleep Medicine Department (D.B.), St Vincent's Hospital, Darlinghurst, Sydney, NSW 2010 Australia; National Health and Medical Research Council Centre for Integrated Research and Understanding Sleep (D.B,), Woolcock Institute of Medical Research, Glebe, Sydney, NSW 2037 Australia; Public Health, Epidemiology, and Biostatistics (P.A., G.N.T.), University of Birmingham, United Kingdom; Institute of Public Health (G.N.T.), Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University, Mannheim, D-68167, Germany; Department of Medicine (S.T.), Weill Cornell Medical College New York, New York 10021, and Doha, 24144, Qatar; and Department of Medicine (S.T.), King's College London, London, SE5 9RJ, United Kingdom
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Jiang CQ, Loerbroks A, Lam KBH, Bosch JA, Thomas GN, Zhang WS, Cheng KK, Lam TH, Adab P. Mental health and asthma in China: the Guangzhou Biobank Cohort Study. Int J Behav Med 2014; 20:259-64. [PMID: 22297917 DOI: 10.1007/s12529-012-9222-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND There is consistent evidence of the co-occurrence of poor mental health and asthma in Western populations. Since the experience and expression of mental health is partly culturally determined, it is of interest to examine if similar associations are found in other cultural settings. In that regard, very little is known about the association between mental health and asthma in Asian countries, such as China. PURPOSE The aim of this study was to investigate the relationship between mental health and asthma in a large sample from China. METHOD We used data from the Guangzhou Biobank Cohort Study phase 3 (n = 9,280). Participants reported physician-diagnosed asthma. Mental health measures included the 15-item Chinese version of the Geriatric Depression Scale (GDS-C) and the SF-12 Mental Component Summary (MCS) score. We compared the prevalence of asthma by GDS-C and MCS scores by estimating prevalence ratios (PRs) and their corresponding 95% confidence intervals (95% CI), using Poisson regression. RESULTS Compared to those without depression, the prevalence of asthma was higher in those with moderate or severe depression levels (PR = 2.63, 95% CI = 1.58–4.40 and PR = 4.43, 95% CI = 1.62–12.09, p for trend ≤0.0001). The prevalence of asthma increased by 46% with every 1 standard deviation increase of the GDS-C score (PR = 1.46, 95% CI = 1.24–1.73). The MCS score was not associated with asthma. CONCLUSION Depressive symptoms were associated with asthma prevalence in a Chinese population. Further research into the mechanism and potential directions of causality is warranted.
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Affiliation(s)
- Chao Qiang Jiang
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Adab P, Pallan MJ, Cade J, Ekelund U, Barrett T, Daley A, Deeks J, Duda J, Gill P, Parry J, Bhopal R, Cheng KK. Preventing childhood obesity, phase II feasibility study focusing on South Asians: BEACHeS. BMJ Open 2014; 4:e004579. [PMID: 24722198 PMCID: PMC3987740 DOI: 10.1136/bmjopen-2013-004579] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To assess feasibility and acceptability of a multifaceted, culturally appropriate intervention for preventing obesity in South Asian children, and to obtain data to inform sample size for a definitive trial. DESIGN Phase II feasibility study of a complex intervention. SETTING 8 primary schools in inner city Birmingham, UK, within populations that are predominantly South Asian. PARTICIPANTS 1090 children aged 6-8 years took part in the intervention. 571 (85.9% from South Asian background) underwent baseline measures. 85.5% (n=488) were followed up 2 years later. INTERVENTIONS The 1-year intervention consisted of school-based and family-based activities, targeting dietary and physical activity behaviours. The intervention was modified and refined throughout the period of delivery. MAIN OUTCOME MEASURES Acceptability and feasibility of the intervention and of measurements required to assess outcomes in a definitive trial. The difference in body mass index (BMI) z-score between arms was used to inform sample size calculations for a definitive trial. RESULTS Some intervention components (increasing school physical activity opportunities, family cooking skills workshops, signposting of local leisure facilities and attending day event at a football club) were feasible and acceptable. Other components were acceptable, but not feasible. Promoting walking groups was neither acceptable nor feasible. At follow-up, children in the intervention compared with the control group were less likely to be obese (OR 0.41; 0.19 to 0.89), and had lower adjusted BMI z-score (-0.15 kg/m(2); 95% CI -0.27 to -0.03). CONCLUSIONS The feasibility study informed components for an intervention programme. The favourable direction of outcome for weight status in the intervention group supports the need for a definitive trial. A cluster randomised controlled trial is now underway to assess the clinical and cost-effectiveness of the intervention. TRIAL REGISTRATION NUMBER ISRCTN51016370.
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Affiliation(s)
- Peymané Adab
- School of Health & Population Sciences (Public Health, Epidemiology and Biostatistics and Primary Care Clinical Sciences), University of Birmingham, Birmingham, UK
| | - Miranda J Pallan
- School of Health & Population Sciences (Public Health, Epidemiology and Biostatistics and Primary Care Clinical Sciences), University of Birmingham, Birmingham, UK
| | - Janet Cade
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Ulf Ekelund
- MRC Epidemiology Unit, Institute of Metabolic Science, Cambridge, UK
- Department of Sport Medicine, Norwegian School of Sport Sciences, Cambridge, UK
| | - Timothy Barrett
- School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
| | - Amanda Daley
- School of Health & Population Sciences (Public Health, Epidemiology and Biostatistics and Primary Care Clinical Sciences), University of Birmingham, Birmingham, UK
| | - Jonathan Deeks
- School of Health & Population Sciences (Public Health, Epidemiology and Biostatistics and Primary Care Clinical Sciences), University of Birmingham, Birmingham, UK
| | - Joan Duda
- School of Sport, Exercise and Rehabilitation Sciences, The University of Birmingham, Birmingham, UK
| | - Paramjit Gill
- School of Health & Population Sciences (Public Health, Epidemiology and Biostatistics and Primary Care Clinical Sciences), University of Birmingham, Birmingham, UK
| | - Jayne Parry
- School of Health & Population Sciences (Public Health, Epidemiology and Biostatistics and Primary Care Clinical Sciences), University of Birmingham, Birmingham, UK
| | - Raj Bhopal
- Edinburgh Ethnicity and Health Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - K K Cheng
- School of Health & Population Sciences (Public Health, Epidemiology and Biostatistics and Primary Care Clinical Sciences), University of Birmingham, Birmingham, UK
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Mohammadpour-Ahranjani B, Pallan MJ, Rashidi A, Adab P. Contributors to childhood obesity in Iran: the views of parents and school staff. Public Health 2013; 128:83-90. [PMID: 24332408 DOI: 10.1016/j.puhe.2013.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 10/07/2013] [Accepted: 10/12/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To explore the contextual influences on childhood obesity in Tehran, Iran to inform future development of an obesity prevention intervention for Iranian primary school children. STUDY DESIGN Qualitative study. METHODS Focus groups and interviews with parents and school staff were convened to explore their perceptions of the causes of childhood obesity. Eleven focus groups and three interviews were held with parents and school staff (88 participants in total) from three different socio-economic areas in Iran's capital city, Tehran. All the discussions were transcribed verbatim in Persian. An iterative thematic approach was used for data analysis. RESULTS Overall, the causes of childhood obesity were perceived to relate to macro-level policy influences, the school environment, sociocultural factors, and family and individual behavioural factors, acting in combination. A key emergent theme was the pervasive influence of Government policies on children's food intake and physical activity. Another key theme was the political and sociocultural context that does not support girls and women in Iran in having active lifestyles. CONCLUSION The findings suggest that parents and school staff have sophisticated views on the possible causes of childhood overweight and obesity which encompassed behavioural, structural and social causes. A prominent emerging theme was the need for state level intervention and support for a healthy environment. Any local initiatives in Iran are unlikely to be successful without such support. WHAT IS KNOWN ON THIS SUBJECT Childhood obesity is growing in Iran and it is seen as one of the features of the nutrition transition in developing countries. Findings from cross-sectional studies suggest a range of lifestyle factors contribute to obesity in the Iranian population. WHAT THIS STUDY ADDS This qualitative study explores the socioenvironmental changes contributing to childhood obesity in primary school-aged children in Iran. Findings have provided important contextual data on the perceived contributors to childhood obesity in Iran, such as macro-level policy influences on accessibility to healthy food and physical activity, competing priorities at school level, sociocultural influences on diet and physical activity and limited knowledge and skills of parents. This has laid the foundation for the development of appropriate childhood obesity prevention interventions.
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Affiliation(s)
- B Mohammadpour-Ahranjani
- National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Iran
| | - M J Pallan
- School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, United Kingdom.
| | - A Rashidi
- National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Iran
| | - P Adab
- School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, United Kingdom
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Kalirai K, Adab P, Jordan R, Fitzmaurice D, Ayres J. P21 The relationship between employment status, work productivity and quality of life among patients with COPD: Cross-sectional analysis of the Birmingham COPD Cohort. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Clarke J, Fletcher B, Lancashire E, Pallan M, Adab P. The views of stakeholders on the role of the primary school in preventing childhood obesity: a qualitative systematic review. Obes Rev 2013; 14:975-88. [PMID: 23848939 DOI: 10.1111/obr.12058] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 05/09/2013] [Accepted: 05/29/2013] [Indexed: 11/28/2022]
Abstract
Schools are increasingly recognized as an ideal setting for interventions to tackle childhood obesity. A better understanding of the views of key stakeholders would help to engage schools and inform the feasibility of such interventions in practice. This meta-synthesis of 18 qualitative studies explores the views of parents, school staff, school governors, school nurses and students on the role of the primary school in preventing childhood obesity. Six categories emerged: 'School as a key setting'; 'What schools should be doing to promote healthy eating (HE)'; 'What schools should be doing to promote physical activity (PA)'; 'General barriers'; 'Barriers to promoting HE at school'; and 'Barriers to promoting PA at school'. Thirty-seven finer-level themes emerged within these categories. Stakeholders agreed on the key role of the primary school as a setting for obesity prevention, the importance of schools providing and promoting opportunities for HE and PA, and the need for schools to work with parents. Some perceived barriers could be overcome at school level, e.g. using unhealthy foods as rewards/fundraisers or withholding PA for bad behaviour. Leadership and guidance from government were considered to be needed to counteract other observed barriers, particularly regarding school canteens, support for parents and time for PA.
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Affiliation(s)
- J Clarke
- Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
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Pallan M, Parry J, Cheng K, Adab P. Development of a childhood obesity prevention programme with a focus on UK South Asian communities. Prev Med 2013; 57:948-54. [PMID: 24012821 PMCID: PMC3842497 DOI: 10.1016/j.ypmed.2013.08.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 08/08/2013] [Accepted: 08/28/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We report the development of a childhood obesity prevention intervention for UK South Asian primary school-aged children, guided by the UK Medical Research Council (MRC) framework for complex intervention development and evaluation. METHODS We combined information gained from a literature review, stakeholder focus groups, an expert group, review of local resources and mapping to the Analysis Grid for Environments Linked to Obesity (ANGELO framework) in an intervention development process. The study took place in 2007 in Birmingham, UK. RESULTS Contextual information from the stakeholder focus groups was essential for informing intervention development. The expert group defined guiding principles for the intervention. Informing intervention design by assessing existing local resources addressed intervention sustainability. The use of the ANGELO framework ensured a comprehensive environmental approach to intervention development. The intervention consisted of two broad processes; increasing children's physical activity levels through school, and increasing skills of families through activity-based learning. The developed intervention is being evaluated in a major study. CONCLUSIONS The intervention development process has resulted in a tailored intervention programme to prevent childhood obesity in UK South Asian communities, but also intervention processes that could be applied to other communities and tailored to local context.
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Affiliation(s)
- Miranda Pallan
- School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Jayne Parry
- School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - K.K. Cheng
- School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Peymané Adab
- School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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Jordan RE, Majothi S, Heneghan NR, Turner A, Moore D, O'Brien D, Jowett S, Singh S, Adab P, Fitzmaurice D, Bayliss S, Riley R, Price M, Ayres J, Jolly CB. P46 Supported self-management for patients with moderate to severe COPD at or shortly after discharge from hospital: a systematic review of the evidence. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kalirai K, Adab P, Jordan R, Fitzmaurice D, Ayres J. T4 A cross-sectional analysis of the effect of COPD on work capability using the birmingham COPD cohort. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Daley A, Lewis A, Denley J, Adab P, Aveyard P, Jolly K. An RCT to compare the effectiveness of commercial and primary care led weight management programmes versus minimal intervention: The Lighten Up trial. J Sci Med Sport 2012. [DOI: 10.1016/j.jsams.2012.11.802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Lam KBH, Yin P, Jiang CQ, Zhang WS, Adab P, Miller MR, Thomas GN, Ayres JG, Lam TH, Cheng KK. Past dust and GAS/FUME exposure and COPD in Chinese: the Guangzhou Biobank Cohort Study. Respir Med 2012; 106:1421-8. [PMID: 22795505 DOI: 10.1016/j.rmed.2012.05.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 05/25/2012] [Accepted: 05/26/2012] [Indexed: 10/28/2022]
Abstract
The impact of occupational dust and gas/fume exposure on chronic obstructive pulmonary disease (COPD) in developing countries has not been quantified. We examined the relationship between past dust and fume exposure and prevalence of COPD and respiratory symptoms in a cross-sectional analysis of a large Chinese population sample. Participants in the Guangzhou Biobank Cohort Study (n = 8216; 27.3% men, mean age 61.9 ± 6.8 years) had spirometry and a structured interview including exposures, symptoms, and lifestyle. Self-reported intensity and duration of dust and gas/fume exposure was used to derive cumulative exposure. COPD was diagnosed from spirometry using lower limit of normal based on prediction equations. COPD was associated with high exposure to dust or gas/fume (exposed: 87/1206 v non-exposed: 191/3853; adjusted odds ratio: 1.41; 95% confidence interval (CI) 1.06, 1.87) with no evidence of effect modification by smoking. Respiratory symptoms were associated with exposures to dust and gas/fume, with adjusted odds ratios for chronic cough/phlegm of 1.57 (1.13, 2.17) and 1.39 (1.20, 1.60) for dyspnoea. The overall population attributable fraction for COPD due to occupational exposure was 10.4% (95% CI -0.9%, 19.5%). Occupational dust and gas/fume exposure is associated with an increased prevalence of COPD in this Chinese sample, independent of smoking. The population attributable fraction in Chinese is similar to that in Western populations.
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Affiliation(s)
- Kin Bong Hubert Lam
- Institute of Occupational and Environmental Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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Loerbroks A, Jiang CQ, Thomas GN, Adab P, Zhang WS, Lam KBH, Bosch JA, Cheng KK, Lam TH. COPD and Depressive Symptoms: Findings from the Guangzhou Biobank Cohort Study. Ann Behav Med 2012; 44:408-15. [DOI: 10.1007/s12160-012-9389-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Heathfield S, Parker B, Zeef L, Bruce I, Alexander Y, Collins F, Stone M, Wang E, Williams AS, Wright HL, Thomas HB, Moots RJ, Edwards SW, Bullock C, Chapman V, Walsh DA, Mobasheri A, Kendall D, Kelly S, Bayley R, Buckley CD, Young SP, Rump-Goodrich L, Middleton J, Chen L, Fisher R, Kollnberger S, Shastri N, Kessler BM, Bowness P, Nazeer Moideen A, Evans L, Osgood L, Williams AS, Jones SA, Nowell MA, Mahadik Y, Young S, Morgan M, Gordon C, Harper L, Giles JL, Paul Morgan B, Harris CL, Rysnik OJ, McHugh K, Kollnberger S, Payeli S, Marroquin O, Shaw J, Renner C, Bowness P, Nayar S, Cloake T, Bombardieri M, Pitzalis C, Buckley C, Barone F, Barone F, Nayar S, Cloake T, Lane P, Coles M, Buckley C, Williams EL, Edwards CJ, Cooper C, Oreffo RO, Dunn S, Crawford A, Wilkinson M, Le Maitre C, Bunning R, Daniels J, Phillips KLE, Chiverton N, Le Maitre CL, Kollnberger S, Shaw J, Ridley A, Wong-Baeza I, McHugh K, Keidel S, Chan A, Bowness P, Gullick NJ, Abozaid HS, Jayaraj DM, Evans HG, Scott DL, Choy EH, Taams LS, Hickling M, Golor G, Jullion A, Shaw S, Kretsos K, Bari SF, Rhys-Dillon B, Amos N, Siebert S, Phillips KLE, Chiverton N, Bunning RD, Haddock G, Cross AK, Le Maitre CL, Kate I, Phillips E, Cross A, Chiverton N, Haddock G, Bunning RAD, Le Maitre CL, Ceeraz S, Spencer J, Choy E, Corrigall V, Crilly A, Palmer H, Lockhart J, Plevin R, Ferrell WR, McInnes I, Hutchinson D, Perry L, DiCicco M, Humby F, Kelly S, Hands R, Buckley C, McInnes I, Taylor P, Bombardieri M, Pitzalis C, Mehta P, Mitchell A, Tysoe C, Caswell R, Owens M, Vincent T, Hashmi TM, Price-Forbes A, Sharp CA, Murphy H, Wood EF, Doherty T, Sheldon J, Sofat N, Goff I, Platt PN, Abdulkader R, Clunie G, Ismajli M, Nikiphorou E, Young A, Tugnet N, Dixey J, Banik S, Alcorn D, Hunter J, Win Maw W, Patil P, Hayes F, Main Wong W, Borg FA, Dasgupta B, Malaviya AP, Ostor AJ, Chana JK, Ahmed AA, Edmonds S, Hayes F, Coward L, Borg F, Heaney J, Amft N, Simpson J, Dhillon V, Ayalew Y, Khattak F, Gayed M, Amarasena RI, McKenna F, Amarasena RI, McKenna F, Mc Laughlin M, Baburaj K, Fattah Z, Ng N, Wilson J, Colaco B, Williams MR, Adizie T, Dasgupta B, Casey M, Lip S, Tan S, Anderson D, Robertson C, Devanny I, Field M, Walker D, Robinson S, Ryan S, Hassell A, Bateman J, Allen M, Davies D, Crouch C, Walker-Bone K, Gainsborough N, Gullick NJ, Lutalo PM, Davies UM, Walker-Bone K, Mckew JR, Millar AM, Wright SA, Bell AL, Thapper M, Roussou T, Cumming J, Hull RG, Thapper M, Roussou T, McKeogh J, O'Connor MB, Hassan AI, Bond U, Swan J, Phelan MJ, Coady D, Kumar N, Farrow L, Bukhari M, Oldroyd AG, Greenbank C, McBeth J, Duncan R, Brown D, Horan M, Pendleton N, Littlewood A, Cordingley L, Mulvey M, Curtis EM, Cole ZA, Crozier SR, Georgia N, Robinson SM, Godfrey KM, Sayer AA, Inskip HM, Cooper C, Harvey NC, Davies R, Mercer L, Galloway J, Low A, Watson K, Lunt M, Symmons D, Hyrich K, Chitale S, Estrach C, Moots RJ, Goodson NJ, Rankin E, Jiang CQ, Cheng KK, Lam TH, Adab P, Ling S, Chitale S, Moots RJ, Estrach C, Goodson NJ, Humphreys J, Ellis C, Bunn D, Verstappen SM, Symmons D, Fluess E, Macfarlane GJ, Bond C, Jones GT, Scott IC, Steer S, Lewis CM, Cope A, Mulvey MR, Macfarlane GJ, Symmons D, Lovell K, Keeley P, Woby S, Beasley M, McBeth J, Viatte S, Plant D, Lunt M, Fu B, Parker B, Galloway J, Solymossy C, Worthington J, Symmons D, Dixey J, Young A, Barton A, Williams FM, Osei-Bordom DC, Popham M, MacGregor A, Spector T, Little J, Herrick A, Pushpakom S, Ennis H, McBurney H, Worthington J, Newman W, Ibrahim I, Plant D, Hyrich K, Morgan A, Wilson A, Isaacs J, Barton A, Sanderson T, Hewlett S, Calnan M, Morris M, Raza K, Kumar K, Cardy CM, Pauling JD, Jenkins J, Brown SJ, McHugh N, Nikiphorou E, Mugford M, Davies C, Cooper N, Brooksby A, Bunn D, Symmons D, MacGregor A, Dures E, Ambler N, Fletcher D, Pope D, Robinson F, Rooke R, Hewlett S, Gorman CL, Reynolds P, Hakim AJ, Bosworth A, Weaver D, Kiely PD, Skeoch S, Jani M, Amarasena R, Rao C, Macphie E, McLoughlin Y, Shah P, Else S, Semenova O, Thompson H, Ogunbambi O, Kallankara S, Patel Y, Baguley E, Jani M, Halsey J, Severn A, Bukhari M, Selvan S, Price E, Husain MJ, Brophy S, Phillips CJ, Cooksey R, Irvine E, Siebert S, Lendrem D, Mitchell S, Bowman S, Price E, Pease CT, Emery P, Andrews J, Bombardieri M, Sutcliffe N, Pitzalis C, Lanyon P, Hunter J, Gupta M, McLaren J, Regan M, Cooper A, Giles I, Isenberg D, Griffiths B, Foggo H, Edgar S, Vadivelu S, Coady D, McHugh N, Ng WF, Dasgupta B, Taylor P, Iqbal I, Heron L, Pilling C, Marks J, Hull R, Ledingham J, Han C, Gathany T, Tandon N, Hsia E, Taylor P, Strand V, Sensky T, Harta N, Fleming S, Kay L, Rutherford M, Nicholl K, Kay L, Rutherford M, Nicholl K, Eyre T, Wilson G, Johnson P, Russell M, Timoshanko J, Duncan G, Spandley A, Roskell S, Coady D, West L, Adshead R, Donnelly SP, Ashton S, Tahir H, Patel D, Darroch J, Goodson NJ, Boulton J, Ellis B, Finlay R, Lendrem D, Mitchell S, Bowman S, Price E, Pease CT, Emery P, Andrews J, Bombardieri M, Sutcliffe N, Pitzalis C, Lanyon P, Hunter J, Gupta M, McLaren J, Regan M, Cooper A, Giles I, Isenberg D, Vadivelu S, Coady D, McHugh N, Griffiths B, Foggo H, Edgar S, Ng WF, Murray-Brown W, Priori R, Tappuni T, Vartoukian S, Seoudi N, Picarelli G, Fortune F, Valesini G, Pitzalis C, Bombardieri M, Ball E, Rooney M, Bell A, Merida AA, Isenberg D, Tarelli E, Axford J, Giles I, Pericleous C, Pierangeli SS, Ioannou J, Rahman A, Alavi A, Hughes M, Evans B, Bukhari M, Parker B, Zaki A, Alexander Y, Bruce I, Hui M, Garner R, Rees F, Bavakunji R, Daniel P, Varughese S, Srikanth A, Andres M, Pearce F, Leung J, Lim K, Regan M, Lanyon P, Oomatia A, Petri M, Fang H, Birnbaum J, Amissah-Arthur M, Gayed M, Stewart K, Jennens H, Braude S, Gordon C, Sutton EJ, Watson KD, Gordon C, Yee CS, Lanyon P, Jayne D, Isenberg D, Rahman A, Akil M, McHugh N, Ahmad Y, Amft N, D'Cruz D, Edwards CJ, Griffiths B, Khamashta M, Teh LS, Zoma A, Bruce I, Dey ID, Kenu E, Isenberg D, Pericleous C, Garza-Garcia A, Murfitt L, Driscoll PC, Isenberg D, Pierangeli S, Giles I, Ioannou Y, Rahman A, Reynolds JA, Ray DW, O'Neill T, Alexander Y, Bruce I, Segeda I, Shevchuk S, Kuvikova I, Brown N, Bruce I, Venning M, Mehta P, Dhanjal M, Mason J, Nelson-Piercy C, Basu N, Paudyal P, Stockton M, Lawton S, Dent C, Kindness K, Meldrum G, John E, Arthur C, West L, Macfarlane MV, Reid DM, Jones GT, Macfarlane GJ, Yates M, Loke Y, Watts R, MacGregor A, Adizie T, Christidis D, Dasgupta B, Williams M, Sivakumar R, Misra R, Danda D, Mahendranath KM, Bacon PA, Mackie SL, Pease CT. Basic science * 232. Certolizumab pegol prevents pro-inflammatory alterations in endothelial cell function. Rheumatology (Oxford) 2012. [DOI: 10.1093/rheumatology/kes108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Jordan RE, Miller MR, Lam KBH, Cheng KK, Marsh J, Adab P. Sex, susceptibility to smoking and chronic obstructive pulmonary disease: the effect of different diagnostic criteria. Analysis of the Health Survey for England. Thorax 2012; 67:600-5. [PMID: 22382600 DOI: 10.1136/thoraxjnl-2011-201384] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Some previous studies suggest there are sex differences in susceptibility to, and prevalence of, chronic obstructive pulmonary disease (COPD) but findings are inconsistent. In this study, whether different diagnostic criteria for COPD may contribute to these conflicting findings was examined. METHODS Cross sectional analysis of data from the 1995, 1996 and 2001 Health Survey for England was undertaken, including participants of white ethnicity, aged 40+ years with a valid smoking history and lung function data. COPD was defined using Global Initiative for Chronic Obstructive Lung Disease (GOLD), National Institute for Health and Clinical Excellence (NICE) and lower limit of normal (LLN) spirometric criteria, in the absence of a diagnosis of asthma. RESULTS COPD was present in 3035 (16.1%), 1304 (7.0%) and 1684 (9.0%) people, according to the GOLD, NICE and LLN criteria, respectively. With both the GOLD and NICE definitions, men had significant independent increased risks of COPD compared with women (OR 1.46 (95% CI 1.34 to 1.59) and 1.30 (1.15 to 1.48), respectively). With the LLN definition, this effect was removed (OR 0.96 (0.87 to 1.07). With the use of both the GOLD and NICE criteria, women had significantly greater susceptibility to COPD (25-30% higher risk) for the same level of pack years of exposure. This was not observed with the LLN criteria. CONCLUSIONS The study indicates that sex differences in risk of COPD reported in previous studies are influenced by the definition used for COPD. When using a statistically driven definition (LLN), no independent sex difference was found and there was no evidence of an increased susceptibility to COPD among female compared with male smokers.
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Affiliation(s)
- Rachel E Jordan
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, Public Health Building, University of Birmingham, B15 2TT, UK.
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