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Böscke R. [Difficult-to-treat chronic rhinosinusitis-when the standard treatment is not effective and biologics are not available]. HNO 2024; 72:231-241. [PMID: 38472346 DOI: 10.1007/s00106-024-01443-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND In recent years, significant improvements have been made in the treatment options for uncontrolled chronic rhinosinusitis (CRS) refractory to standard medical and surgical therapy. This is the result of a better understanding of the pathophysiology and the resulting development of biologicals for CRS with nasal polyps (CRSwNP). However, biologics are not (yet) available for all patients in Europe. OBJECTIVE Based on the session "Difficult-to-treat CRS, when biologics are not available" at the 29th Congress of the European Rhinologic Society (ERS) 2023 in Sofia, Bulgaria, the treatment options for uncontrolled CRS with the exclusion of biologics will be discussed. MATERIALS AND METHODS The content of the presentations "Is there a place for antibiotics?" "Indications for revision surgery," "Novel systemic treatment options," "Novel local treatment options," and "Phototherapy for nasal polyps" are outlined and supported by a review of the literature. RESULTS Various treatment options are available for managing uncontrolled CRS, even if biologic treatments are unavailable. Treatment options for type‑2 (T2) CRS include steroid rinses, repeated short-term oral steroids, steroid-eluting stents, and extended sinus surgery. In the case of nonsteroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (NERD), acetylsalicylic acid (ASA) desensitization can be considered. Non-T2 endotypes or CRS without nasal polyps (CRSsNP) may benefit from several weeks of macrolides and xylitol rinses. CONCLUSION To accurately assess the efficacy of second-line therapies for treatment of difficult-to-treat CRS within an endotype-specific framework, additional controlled clinical trials are needed that take into account the heterogeneity of CRS endotypes.
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Affiliation(s)
- Robert Böscke
- Universitätsklinik für Hals-Nasen-Ohren-Heilkunde, Evangelisches Krankenhaus Oldenburg, Medizinischer Campus der Carl-von-Ossietzky Universität Oldenburg, Steinweg 13-17, 26122, Oldenburg, Deutschland.
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2
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Krüger K, Holzinger F. [Chronic cough in adult patients-evidence-based approach]. HNO 2024; 72:210-220. [PMID: 38319354 DOI: 10.1007/s00106-023-01412-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 02/07/2024]
Abstract
Approximately 10% of the population suffer from a cough lasting longer than 8 weeks. Compared to acute cough, which usually occurs in the context of banal respiratory tract infections, the differential diagnoses of chronic cough require an increased use of diagnostic tests and thus a structured, evidence-based approach according to current international guidelines. A targeted history (smoking status, medication, previous diseases) and ENT status are always followed by chest x‑ray and pulmonary function tests before extended diagnostics. In the case of angiotensin-converting enzyme (ACE) inhibitor use and unremarkable physical examination, a drug discontinuation test can be carried out first. In case of inconspicuous findings, a disease entity that can be treated empirically such as upper airway cough syndrome is most likely. If the cough remains unexplained, cough suppression techniques, physiotherapy or speech therapy should be sought before off-label-use of medication.
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Affiliation(s)
- Karen Krüger
- Institut für Allgemeinmedizin, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - Felix Holzinger
- Institut für Allgemeinmedizin, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
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3
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Huguet-Torres A, Bennasar-Veny M, Castro-Sánchez E, Yáñez AM. [Sociodemographic and environmental factors associated with mask use during the COVID-19 pandemic]. Rev Esp Salud Publica 2024; 98:e202402002. [PMID: 38333919] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/18/2024] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVE During COVID-19 pandemic, prevention measures were implemented to mitigate the community transmission of SARS-CoV-2. Compliance with these measures was influenced by several sociodemographic and environmental factors. However, literature addressing compliance with these prevention measures among the general population remains limited. The study aimed to assess the association of sociodemographic and environmental factors and mask usage during close contact situations. METHODS A cross-sectional study was conducted with a sample of 1,778 individuals identified through close contact tracing of individuals diagnosed with SARS-CoV-2 by the COVID-19 Coordination Center of Mallorca, from February to June 2021. A descriptive analysis was conducted, and a logistic regression model was utilized to evaluate factors associated with mask non-compliance. RESULTS The mean age of the participants was 42.8±17.4 years, with 53.6% being female. Among close contacts, 60.8% (95% CI: 57.8-62.3) did not use masks during their contact. No significant differences were observed between genders or across age groups (p=0.497 and p=0.536, respectively). Factors linked to mask non-compliance included the home setting, indoor spaces without ventilation, and closer physical distances (p<0.001). CONCLUSIONS Our findings indicate that mask adherence was notably lower among close contacts exposed to higher risk. In future public health crises, interventions should be developed to raise awareness about risks and promote adherence to preventive and control measures.
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Affiliation(s)
- Aina Huguet-Torres
- Departamento de Enfermería i Fisioterapia; Universidad de las Islas Baleares. Palma de Mallorca. España
- Research Group on Global Health; Universidad de las Islas Baleares. Palma de Mallorca. España
| | - Miquel Bennasar-Veny
- Departamento de Enfermería i Fisioterapia; Universidad de las Islas Baleares. Palma de Mallorca. España
- Research Group on Global Health; Universidad de las Islas Baleares. Palma de Mallorca. España
- Grupo de investigación en Salud Global y Estilos de Vida; Instituto de Investigación Sanitaria Illes Balears (IdISBa). Palma de Mallorca. España
- Consorcio Centro de Investigación Biomédica en Red (CIBER); Epidemiología y Salud Pública (CIBERESP). Madrid. España
| | - Enrique Castro-Sánchez
- Research Group on Global Health; Universidad de las Islas Baleares. Palma de Mallorca. España
- Brunel University London; College of Business, Arts, and Social Sciences. Uxbridge. Reino Unido
- Imperial College London. Londres. Reino Unido
| | - Aina M Yáñez
- Departamento de Enfermería i Fisioterapia; Universidad de las Islas Baleares. Palma de Mallorca. España
- Research Group on Global Health; Universidad de las Islas Baleares. Palma de Mallorca. España
- Grupo de investigación en Salud Global y Estilos de Vida; Instituto de Investigación Sanitaria Illes Balears (IdISBa). Palma de Mallorca. España
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4
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Zhao X, Zhang N. Global prevalence of infections in newborns with respiratory complications: systematic review and meta-analysis. Iran J Microbiol 2024; 16:19-28. [PMID: 38682067 PMCID: PMC11055449 DOI: 10.18502/ijm.v16i1.14867] [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] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Background and Objectives Newborns as a vulnerable population are exposed to congenital and acquired infections during and after birth. There are several reports of the isolation and reporting of infectious agents (IAs) in early life of newborns with respiratory manifestations, and the present comprehensive study provides a snapshot of the current global situation of the prevalence of IAs in newborns with respiratory symptoms. Materials and Methods A systematic search was conducted in main databases, including PubMed, Scopus, Web of science, and Google scholar. The pooled prevalence of infectious agents (IAs) in newborns was estimated using comprehensive meta-analysis software based on random effects model. Results Out of 44 inclusive studies (50 datasets) for IAs in newborns, the pooled prevalence was estimated to be 12.2% (95% CI: 6.40-22.0%) and the highest and lowest prevalence of IAs was related to the Brazil (78.2%, 95% CI: 31.0-96.6%), and UK (0.01%, 95% CI 0.01-0.01%) respectively. Conclusion The high prevalence of IAs in newborns emphasizes considers the necessary measures to prevent respiratory infections.
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Affiliation(s)
- Xiaoxiao Zhao
- Department of Neonatology, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Nan Zhang
- Department of Neonatology, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
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Park JS, Kim B, Kim Y, Lee SG, Kim TH. Out-of-pocket costs associated with chronic respiratory diseases in Korean adults. Chron Respir Dis 2024; 21:14799731241233301. [PMID: 38385436 PMCID: PMC10893827 DOI: 10.1177/14799731241233301] [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: 07/10/2023] [Accepted: 01/22/2024] [Indexed: 02/23/2024] Open
Abstract
OBJECTIVES Chronic respiratory diseases (CRDs) are a burden on both individuals and society. While previous literature has highlighted the clinical burden and total costs of care, it has not addressed patients' direct payments. This study aimed to estimate the incremental healthcare costs associated with patients with CRDs, specifically out-of-pocket (OOP) costs. METHODS We used survey data from the 2019 Korea Health Panel Survey to estimate the total OOP costs of CRDs by comparing the annual hospitalizations, outpatient visits, emergency room visits, and medications of patients with and without CRDs. Generalized linear regression models controlled for differences in other characteristics between groups. RESULTS We identified 222 patients with CRDs, of whom 166 were aged 65 years and older. Compared with the non-CRD group, CRD patients spent more on OOP costs (238.3 USD on average). Incremental costs were driven by outpatient visits and medications, which are subject to a coinsurance of 30% or more and may include items not covered by public insurance. Moreover, CRD patients aged 50-64 years incurred the highest incremental costs. DISCUSSION The financial burden associated with CRDs is significant, and outpatient visits and medications constitute the largest components of OOP spending. Policymakers should introduce appropriate strategies to reduce CRD-associated burdens.
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Affiliation(s)
- Jun Su Park
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Bomgyeol Kim
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Yejin Kim
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Sang Gyu Lee
- Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Tae Hyun Kim
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
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Alexandre F, Molinier V, Hognon L, Charbonnel L, Calvat A, Castanyer A, Henry T, Marcenac A, Jollive M, Vernet A, Oliver N, Heraud N. Time-Course of Changes in Multidimensional Fatigue and Functional Exercise Capacity and Their Associations during a Short Inpatient Pulmonary Rehabilitation Program. COPD 2023; 20:55-63. [PMID: 36655947 DOI: 10.1080/15412555.2022.2164261] [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] [Indexed: 01/20/2023]
Abstract
This study aimed to assess the time-course of changes in multidimensional fatigue and functional exercise capacity and their associations during an inpatient pulmonary rehabilitation (PR) program. Seventy COPD patients from three centres were enrolled for a four-week PR program and were evaluated before (T0) and at the end of each week (T1, T2, T3, and T4). Weekly change in multidimensional fatigue was assessed by the multidimensional inventory questionnaire (MFI-20) and functional exercise capacity by the 6-minute walking distance (6MWD). Reaction time (RT) and heart rate variability (HRV) were also assessed as complementary markers of fatigue. HRV did not change during the study (all p > 0.05). MFI-20 score and RT decreased during the first part of the program (p < 0.001) and levelled off at T2 (all p > 0.05 compared with each preceding time). While 6MWD improved by almost 70% during the first part of the PR, it continued to increase, albeit at a greatly reduced pace, between T2 and T4 (p < 0.05). In parallel, a negative association was found between MFI-20 score and 6MWD at each evaluation time (r ranged from 0.43 to 0.71), with a significantly stronger T3 correlation compared with the other time periods (all p < 0.05). The strengthening of the association between fatigue and functional exercise capacity at T3, which occurred concomitantly with the slowdown of functional exercise capacity improvement, is consistent with a role for fatigue in the limitation of performance changes during PR. The limitation of fatigue during PR is thus an interesting aspect to improve the magnitude of performance changes.
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Affiliation(s)
- François Alexandre
- Direction de la recherche clinique et de l'innovation en Santé, Korian, Lodève, France
| | - Virginie Molinier
- Direction de la recherche clinique et de l'innovation en Santé, Korian, Lodève, France
| | - Louis Hognon
- Euromov Digital Health in Motion, University of Montpellier, IMT Mines Ales, Montpellier, France
| | | | | | | | - Thomas Henry
- Clinique du Souffle Les Clarines, Korian, Riom-ès-montagne, France
| | | | | | | | - Nicolas Oliver
- Direction de la recherche clinique et de l'innovation en Santé, Korian, Lodève, France.,Clinique du Souffle La Vallonie, Korian, Lodève, France
| | - Nelly Heraud
- Direction de la recherche clinique et de l'innovation en Santé, Korian, Lodève, France
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Kronzer VL, Hayashi K, Crowson CS, Davis JM, McDermott GC, Cui J, Losina E, Juge PA, Cerhan JR, Sparks JA. Gene-respiratory disease interactions for rheumatoid arthritis risk. Semin Arthritis Rheum 2023; 63:152254. [PMID: 37595508 PMCID: PMC10840753 DOI: 10.1016/j.semarthrit.2023.152254] [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: 04/19/2023] [Revised: 06/30/2023] [Accepted: 08/07/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVE We aimed to identify gene by respiratory tract disease interactions that increase RA risk. METHODS In this case-control study using the Mass General Brigham Biobank, we matched incident RA cases, confirmed by ACR/EULAR criteria, to four controls on age, sex, and electronic health record history. Genetic exposures included a validated overall genetic risk score (GRS) for RA, a Human Leukocyte Antigen (HLA) GRS for RA, and the MUC5B promoter variant, an established risk factor for RA-associated interstitial lung disease (ILD). Preceding respiratory tract diseases came from diagnosis codes (positive predictive value 86%). We estimated attributable proportions (AP) and multiplicative odds ratios (OR) with 95% confidence intervals (CI) for RA for each genetic and respiratory exposure using conditional logistic regression models, adjusting for potential confounders. RESULTS We identified 653 incident RA cases and 2,607 matched controls (mean 54 years, 76% female). The highest tertile of the overall GRS and the HLA GRS were both associated with increased RA risk (OR 2.28, 95% CI 1.89,2.74; OR 2.02, 95% CI 1.67-2.45). ILD and the HLA GRS exhibited a synergistic relationship for RA risk (OR for both exposures 4.30, 95% CI 1.28,14.38; AP 0.51, 95% CI-0.16,1.18). Asthma and the MUC5B promoter variant also exhibited a synergistic interaction for seropositive RA (OR for both exposures 2.58, 95% CI 1.10,6.07; AP 0.62, 95% CI 0.24,1.00). CONCLUSION ILD-HLA GRS and asthma-MUC5B promoter variant showed synergistic interactions for RA risk. Such interactions may prove useful for RA prevention and screening.
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Affiliation(s)
| | - Keigo Hayashi
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital; Harvard Medical School, Boston, USA.
| | - Cynthia S Crowson
- Division of Rheumatology, Mayo Clinic, Rochester, MN, USA; Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA.
| | - John M Davis
- Division of Rheumatology, Mayo Clinic, Rochester, MN, USA.
| | - Gregory C McDermott
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital; Harvard Medical School, Boston, USA.
| | - Jing Cui
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
| | - Elena Losina
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, USA.
| | - Pierre-Antoine Juge
- Dept of Rheumatology, DMU Locomotion, INSERM UMR1152, Hôpital Bichat-Claude Bernard, APHP, Université de Paris, Paris, France.
| | - James R Cerhan
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA.
| | - Jeffrey A Sparks
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital; Harvard Medical School, Boston, USA.
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8
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Bergmann ML, Andersen ZJ, Massling A, Kindler PA, Loft S, Amini H, Cole-Hunter T, Guo Y, Maric M, Nordstrøm C, Taghavi M, Tuffier S, So R, Zhang J, Lim YH. Short-term exposure to ultrafine particles and mortality and hospital admissions due to respiratory and cardiovascular diseases in Copenhagen, Denmark. Environ Pollut 2023; 336:122396. [PMID: 37595732 DOI: 10.1016/j.envpol.2023.122396] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 08/20/2023]
Abstract
Ultrafine particles (UFP; particulate matter <0.1 μm in diameter) may be more harmful to human health than larger particles, but epidemiological evidence on their health effects is still limited. In this study, we examined the association between short-term exposure to UFP and mortality and hospital admissions in Copenhagen, Denmark. Daily concentrations of UFP (measured as particle number concentration in a size range 11-700 nm) and meteorological variables were monitored at an urban background station in central Copenhagen during 2002-2018. Daily counts of deaths from all non-accidental causes, as well as deaths and hospital admissions from cardiovascular and respiratory diseases were obtained from Danish registers. Mortality and hospital admissions associated with an interquartile range (IQR) increase in UFP exposure on a concurrent day and up to six preceding days prior to the death or admission were examined in a case-crossover study design. Odds ratios (OR) with 95% confidence intervals (CI) per one IQR increase in UFP were estimated after adjusting for temperature and relative humidity. We observed 140,079 deaths in total, 236,003 respiratory and 342,074 cardiovascular hospital admissions between 2002 and 2018. Hospital admissions due to respiratory and cardiovascular diseases were significantly positively associated with one IQR increase in UFP (OR: 1.04 [95% CI: 1.01, 1.07], lag 0-4, and 1.02 [1.00, 1.04], lag 0-1, respectively). Among the specific causes, the strongest associations were found for chronic obstructive pulmonary disease (COPD) mortality and asthma hospital admissions and two-day means (lag 0-1) of UFP (OR: 1.13 [1.01, 1.26] and 1.08 [1.00, 1.16], respectively, per one IQR increase in UFP). Based on 17 years of UFP monitoring data, we present novel findings showing that short-term exposure to UFP can trigger respiratory and cardiovascular diseases mortality and morbidity in Copenhagen, Denmark. The strongest associations with UFP were observed with COPD mortality and asthma hospital admissions.
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Affiliation(s)
- Marie L Bergmann
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Zorana J Andersen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Massling
- Department of Environmental Science, IClimate, Aarhus University, Denmark
| | | | - Steffen Loft
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Heresh Amini
- Department of Environmental Medicine and Public Health, and Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Thomas Cole-Hunter
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Yuming Guo
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Matija Maric
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Claus Nordstrøm
- Department of Environmental Science, IClimate, Aarhus University, Denmark
| | - Mahmood Taghavi
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Stéphane Tuffier
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Rina So
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jiawei Zhang
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Youn-Hee Lim
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
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Blatt S, Schroth M. [Breathing disorders in children]. Med Klin Intensivmed Notfmed 2023; 118:638-645. [PMID: 37316572 DOI: 10.1007/s00063-023-01029-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/03/2023] [Accepted: 05/03/2023] [Indexed: 06/16/2023]
Abstract
Breathing disorders in children are one of the most common challenges for both parents and physicians. The first step should always consist of the initial clinical assessment concerning the potentially critically ill patient. Using the pediatric assessment triangle (PAT), the rapid evaluation of airway and breathing is crucial. Although the etiology of pediatric breathing disorders is manifold, we would like to focus on common diagnoses. Based on the three leading symptoms stridor, wheeze, and tachypnea, the most important diseases of pediatric patients are presented and initial treatment steps are discussed. We target crucial, life-saving, basic medical procedures that should be mastered and performed in and also outside of specialized centers or pediatric units.
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Affiliation(s)
- Sophie Blatt
- Abteilung Pädiatrie und Neonatologie, Diakoneo Cnopfsche Kinderklinik, St.-Johannis-Mühlgasse 19, 90419, Nürnberg, Deutschland.
| | - Michael Schroth
- Abteilung Pädiatrie und Neonatologie, Diakoneo Cnopfsche Kinderklinik, St.-Johannis-Mühlgasse 19, 90419, Nürnberg, Deutschland
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10
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Valente BCHG, Melo MDCBD, Liu PMF, Gonçalves BAR, Gomes RADS, Martins IG, Oliveira ACPLD, Ferreira ALDCM, Bothrel RG, de Lima Belizário Facury Lasmar LM. High and low-fidelity simulation for respiratory diseases pediatric training: a prospective and randomized study. J Pediatr (Rio J) 2023; 99:521-528. [PMID: 37244290 PMCID: PMC10492141 DOI: 10.1016/j.jped.2023.04.007] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 05/29/2023] Open
Abstract
OBJECTIVE To compare high and low-fidelity simulations for the recognition of respiratory distress and failure in urgency and emergency pediatric scenarios. METHODS 70 fourth-year medical students were randomly distributed in high and low-fidelity groups and simulated different types of respiratory problems. Theory tests, performance checklists, and satisfaction and self-confidence questionnaires were used in the assessment. Face-to-face simulation and memory retention was applied. The statistics were evaluated by averages and quartiles, Kappa, and generalized estimating equations. The p-value was considered 0.05. RESULTS In the theory test there was an increase in scores in both methodologies (p < 0.001); in memory retention (p = 0.043) and at the end of the process the high-fidelity group had better results. The performance in the practical checklists was better after the second simulation (p > 0,05). The high-fidelity group felt more challenged in both phases (p = 0.042; p = 0.018) and showed greater self-confidence to recognize changes in clinical conditions and in memory retention (p = 0.050). The same group, in relation to the hypothetical real patient to be treated in the future, felt better confident to recognize respiratory distress and failure (p = 0.008; p = 0.004), and better prepared to make a systematic clinical evaluation of the patient in memory retention (p = 0.016). CONCLUSION The two levels of simulations enhance diagnostic skills. High fidelity improves knowledge, leads the student to feel more challenged and more self-confident in recognizing the severity of the clinical case, including memory retention, and showed benefits regarding self-confidence in recognizing respiratory distress and failure in pediatric cases.
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Affiliation(s)
| | - Maria do Carmo Barros de Melo
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Departamento de Pediatria, Belo Horizonte, Minas Gerais, Brazil
| | - Priscila Menezes Ferri Liu
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Departamento de Pediatria, Belo Horizonte, Minas Gerais, Brazil
| | | | | | - Isadora Guimarães Martins
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Estudante de Medicina Belo Horizonte, Minas Gerais, Brazil
| | | | | | - Rafaella Garcia Bothrel
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Estudante de Medicina Belo Horizonte, Minas Gerais, Brazil
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Varghese JS, Muhammad T. Prevalence, potential determinants, and treatment-seeking behavior of acute respiratory infection among children under age five in India: Findings from the National Family Health Survey, 2019-21. BMC Pulm Med 2023; 23:195. [PMID: 37280601 DOI: 10.1186/s12890-023-02487-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 01/13/2023] [Accepted: 05/18/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Acute respiratory infections (ARI) are a major cause of mortality and morbidity among under-five children worldwide, particularly in developing countries. Current evidence using nationally representative data on determinants and care-seeking behavior for ARI is limited in the Indian context. Hence, the present study complements the existing literature by examining the prevalence, determinants, and health-care-seeking behavior regarding ARI among Indian children under age five. STUDY DESIGN Cross-sectional study. METHODS The data for the present study were drawn from the fifth round of the National Family Health Survey (NFHS-5) conducted in 28 states and 8 union territories of India in 2019-21. A total of 222,233 children age less than five years were selected to estimate the prevalence and determinants of ARI, and 6198 children having ARI were selected to explore the treatment-seeking behavior. Bivariate analysis and multivariable binary logistic regression analysis were employed. RESULTS Among children under five years, 2.8% suffered from ARI in the two weeks preceding the survey, and 56.1% sought treatment for ARI. Younger age, a recent episode of diarrhea, maternal asthmatic history, and tobacco smoke exposure in the household increase the risk of having ARI. Further, having a separate room as a kitchen in the household reduces the likelihood of having ARI by 14% (AOR: 0.86; CI: 0.79-0.93). Female children (AOR: 0.88; CI: 0.77-1.00) and children belonging to households having difficulty in accessing transport to health facility (AOR: 0.83; CI: 0.69-0.99) are less likely to seek treatment. CONCLUSION The study identified several socio-demographic, maternal, and household characteristics associated with ARI and treatment seeking for ARI. The study also recommends making health centers more accessible to the people in terms of proximity and cost.
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Affiliation(s)
- Jesty Saira Varghese
- Indian Institute of Technology (IIT) Delhi, New Delhi, 110016, India.
- Department of Family & Generations, International Institute for Population Sciences (IIPS), Mumbai, 400088, Maharashtra, India.
| | - T Muhammad
- Indian Institute of Technology (IIT) Delhi, New Delhi, 110016, India
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12
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Chen D, Lawrence KG, Sandler DP. Nontraditional Occupational Exposures to Crude Oil Combustion Disasters and Respiratory Disease Risk: A Narrative Review of Literature. Curr Allergy Asthma Rep 2023:10.1007/s11882-023-01078-x. [PMID: 37166706 PMCID: PMC10330790 DOI: 10.1007/s11882-023-01078-x] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE OF REVIEW Burning of petroleum products has been consistently associated with adverse respiratory health effects. Combustion of crude oil, specifically, produces toxic byproducts, but there have been relatively few studies of health effects. Burning of crude oil is increasingly employed as a means of mitigating environmental disasters despite the potential health risks to workers involved in clean-up efforts. Here, we review epidemiological studies of respiratory effects following unique crude oil burning events to (1) characterize respiratory health effects from this nontraditional occupational exposure and (2) identify approaches used to characterize exposures that could be applied to future disaster-related studies. RECENT FINDINGS We searched PubMed and EMBASE for references from inception to January 30, 2023. We also manually screened references cited in eligible articles. We identified 14 eligible publications. Our review suggests that exposure to crude oil combustion has adverse respiratory effects, including reduced lung function and increased occurrence of respiratory symptoms and disease. However, the evidence is inconsistent, and quality of data varied across studies. While some studies used quantitative, modeled exposure estimates, most used self-reported proxies of exposure. Although disasters involving crude oil combustion are relatively rare, limited evidence suggests that some worker populations may be at risk for respiratory effects from burning exposures in disaster settings. Future studies that use improved exposure assessment methods (e.g., personal monitors, remote sensing data) may help further quantify the respiratory risk from crude oil burning exposures.
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Affiliation(s)
- Dazhe Chen
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Kaitlyn G Lawrence
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA.
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Yao Y, Li Y, Zhu X, Zhao C, Yang L, Huang X, Wang L. The emerging role of the piRNA/PIWI complex in respiratory tract diseases. Respir Res 2023; 24:76. [PMID: 36915129 PMCID: PMC10010017 DOI: 10.1186/s12931-023-02367-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 02/14/2023] [Indexed: 03/16/2023] Open
Abstract
PIWI-interacting RNA (piRNA) is a class of recently discovered small non-coding RNA molecules with a length of 18-33 nt that interacts with the PIWI protein to form the piRNA/PIWI complex. The PIWI family is a subfamily of Argonaute (AGO) proteins that also contain the AGO family which bind to microRNA (miRNA). Recently studies indicate that piRNAs are not specific to in the mammalian germline, they are also expressed in a tissue-specific manner in a variety of human tissues and participated in various of diseases, such as cardiovascular, neurological, and urinary tract diseases, and are especially prevalent in malignant tumors in these systems. However, the functions and abnormal expression of piRNAs in respiratory tract diseases and their underlying mechanisms remain incompletely understood. In this review, we discuss current studies summarizing the biogenetic processes, functions, and emerging roles of piRNAs in respiratory tract diseases, providing a reference value for future piRNA research.
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Affiliation(s)
- Yizhu Yao
- Division of Pulmonary Medicine, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Yaozhe Li
- Division of Pulmonary Medicine, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Xiayan Zhu
- Division of Pulmonary Medicine, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Chengguang Zhao
- Division of Pulmonary Medicine, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China.,School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, 325035, Zhejiang, China
| | - Lehe Yang
- Division of Pulmonary Medicine, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China.
| | - Xiaoying Huang
- Division of Pulmonary Medicine, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China.
| | - Liangxing Wang
- Division of Pulmonary Medicine, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China.
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14
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Barbosa J, Organista D, Rodrigues T, Matos AF, Barardo A, Escoval A, Bárbara C, Rodrigues F. Profile of emergency department overuse in hospitalized patients with pulmonary disease and its impact on mortality. Pulmonology 2023:S2531-0437(23)00012-0. [PMID: 36797150 DOI: 10.1016/j.pulmoe.2023.01.005] [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: 08/29/2022] [Revised: 01/19/2023] [Accepted: 01/23/2023] [Indexed: 02/16/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Portugal is one of the countries with the highest number of visits to the emergency department (ED), 31% classified as "non-urgent" or "avoidable." The objectives of our study were to evaluate the size and characteristics of patients with pulmonary disease who overuse the ED, and identify factors associated with mortality. MATERIALS AND METHODS A retrospective cohort study was conducted, based on the medical records of ED frequent users (ED-FU) with pulmonary disease who attended a university hospital center in the northern inner city of Lisbon from January 1 to December 31, 2019. To evaluate mortality, a follow-up until December 31, 2020 was performed. RESULTS Over 5,567 (4.3%) patients were identified as ED-FU and 174 (0.14%) had pulmonary disease as the main clinical condition, accounting for 1,030 ED visits. 77.2% of ED visits were categorized as "urgent/very urgent." A high mean age (67.8 years), male gender, social and economic vulnerability, high burden of chronic disease and comorbidities, with a high degree of dependency, characterized the profile of these patients. A high proportion (33.9%) of patients did not have a family physician assigned and this was the most important factor associated with mortality (p<0.001; OR: 24.394; CI 95%: 6.777-87.805). Advanced cancer disease and autonomy deficit were other clinical factors that most determined the prognosis. CONCLUSIONS Pulmonary ED-FU are a small group of ED-FU who constitute an aged and heterogeneous group with a high burden of chronic disease and disability. The lack of an assigned family physician was the most important factor associated with mortality, as well as advanced cancer disease and autonomy deficit.
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Affiliation(s)
- J Barbosa
- Pulmonology Unit, Centro Hospitalar Universitário Lisboa Norte (CHULN), Avenida Professor Egas Moniz, MB, 1649-028 Lisbon, Portugal.
| | - D Organista
- Pulmonology Unit, Centro Hospitalar Universitário Lisboa Norte (CHULN), Avenida Professor Egas Moniz, MB, 1649-028 Lisbon, Portugal
| | - T Rodrigues
- Pulmonology Unit, Centro Hospitalar Universitário Lisboa Norte (CHULN), Avenida Professor Egas Moniz, MB, 1649-028 Lisbon, Portugal
| | - A F Matos
- Pulmonology Unit, Centro Hospitalar Universitário Lisboa Norte (CHULN), Avenida Professor Egas Moniz, MB, 1649-028 Lisbon, Portugal
| | - A Barardo
- Hospital Administration, Advisor to the Board of Directors, CHULN, Avenida Professor Egas Moniz, MB, 1649-028 Lisbon, Portugal
| | - A Escoval
- Hospital Administration, Advisor to the Board of Directors, CHULN, Avenida Professor Egas Moniz, MB, 1649-028 Lisbon, Portugal; Center for Research in Public Health (CISP), Center for Integrated Research in Health - Research, Education, and Innovation in Clinical Research and Public Health (CHRC), Escola Nacional de Saúde Pública, Av. Padre Cruz, 1600-560 Lisbon, Portugal
| | - C Bárbara
- Pulmonology Unit, Centro Hospitalar Universitário Lisboa Norte (CHULN), Avenida Professor Egas Moniz, MB, 1649-028 Lisbon, Portugal; Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, Ed. Egas Moniz, Piso 0, Ala C, 1649-028 Lisbon, Portugal
| | - F Rodrigues
- Pulmonology Unit, Centro Hospitalar Universitário Lisboa Norte (CHULN), Avenida Professor Egas Moniz, MB, 1649-028 Lisbon, Portugal; Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, Ed. Egas Moniz, Piso 0, Ala C, 1649-028 Lisbon, Portugal
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15
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Ding J, Li J, Qi J, Fu L. Characterization of dental dust particles and their pathogenicity to respiratory system: a narrative review. Clin Oral Investig 2023; 27:1815-1829. [PMID: 36773127 PMCID: PMC9918839 DOI: 10.1007/s00784-023-04910-w] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 02/03/2023] [Indexed: 02/12/2023]
Abstract
OBJECTIVES Dental professionals are exposed to large amounts of dust particles during routine treatment and denture processing. This article provides a narrative review to investigate the most prevalent dust-related respiratory diseases among dental professionals and to discuss the effects of dental dust on human respiratory health. MATERIALS AND METHODS A literature search was performed in PubMed/Medline, Web of Science, and Embase for articles published between 1990 and 2022. Any articles on the occupational respiratory health effects of dental dust were included. RESULTS The characterization and toxicity evaluation of dental dust show a correlation between dust exposure and respiratory system injury, and the possible pathogenic mechanism of dust is to cause lung injury and abnormal repair processes. The combination use of personal protective equipment and particle removal devices can effectively reduce the adverse health effects of dust exposure. CONCLUSIONS Dental dust should be considered an additional occupational hazard in dental practice. However, clinical data and scientific evidence on this topic are still scarce. Further research is required to quantify dust in the dental work environment and clarify its pathogenicity and potential toxicological pathways. Nonetheless, the prevention of dust exposure should become a consensus among dental practitioners. CLINICAL RELEVANCE This review provides dental practitioners with a comprehensive understanding and preventive advice on respiratory health problems associated with dust exposure.
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Affiliation(s)
- Jiaxin Ding
- grid.64924.3d0000 0004 1760 5735Hospital of Stomatology, Jilin University, Changchun, China
| | - Junxuan Li
- grid.64924.3d0000 0004 1760 5735Hospital of Stomatology, Jilin University, Changchun, China
| | - Junnan Qi
- grid.64924.3d0000 0004 1760 5735Hospital of Stomatology, Jilin University, Changchun, China
| | - Li Fu
- Department of Oral Implantology, Hospital of Stomatology, Jilin University, 1500 Qinghua Road, Chaoyang District, Changchun, 130021, China.
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16
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Lee W, Lim YH, Ha E, Kim Y, Lee WK. Forecasting of non-accidental, cardiovascular, and respiratory mortality with environmental exposures adopting machine learning approaches. Environ Sci Pollut Res Int 2022; 29:88318-88329. [PMID: 35834079 PMCID: PMC9281380 DOI: 10.1007/s11356-022-21768-9] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 06/27/2022] [Indexed: 04/16/2023]
Abstract
Environmental exposure constantly changes with time and various interactions that can affect health outcomes. Machine learning (ML) or deep learning (DL) algorithms have been used to solve complex problems, such as multiple exposures and their interactions. This study developed predictive models for cause-specific mortality using ML and DL algorithms with the daily or hourly measured meteorological and air pollution data. The ML algorithm improved the performance compared to the conventional methods, even though the optimal algorithm depended on the adverse health outcomes. The best algorithms were extreme gradient boosting, ridge, and elastic net, respectively, for non-accidental, cardiovascular, and respiratory mortality with daily measurement; they were superior to the generalized additive model reducing a mean absolute error by 4.7%, 4.9%, and 16.8%, respectively. With hourly measurements, the ML model tended to outperform the conventional models, even though hourly data, instead of daily data, did not enhance the performance in some models. The proposed model allows a better understanding and development of robust predictive models for health outcomes using multiple environmental exposures.
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Affiliation(s)
- Woojoo Lee
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Youn-Hee Lim
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Eunhee Ha
- Department of Occupational and Environmental Medicine, Ewha Medical Research Center, College of Medicine, Ewha Woman's University, Seoul, Republic of Korea
| | - Yoenjin Kim
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Won Kyung Lee
- Department of Prevention and Management, Inha University Hospital, School of Medicine, Inha University, Incheon, Republic of Korea.
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17
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Arabani Nezhad M, Ayatollahi H, Heidari Beigvand H. Development and evaluation of an e-learning course in oxygen therapy. BMC Med Educ 2022; 22:776. [PMID: 36357893 PMCID: PMC9648866 DOI: 10.1186/s12909-022-03838-1] [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] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 10/27/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Respiratory problems are among the most challenging situations in emergency care services. Different oxygen therapy methods are usually used to deal with these problems. In recent years, oxygen therapy has been recognized as one of the most widely used therapeutic processes in emergency departments (ED) mainly due to the Covid-19 pandemic. The aim of this study was to develop and evaluate an e-learning course in oxygen therapy for the ED clinicians. METHODS This was a pre-post study conducted in three phases in 2021. Initially, the educational requirements of clinicians (n = 181) were investigated using a questionnaire, and in the second phase, an interactive e-learning course was developed. In the third phase, the course was assessed in terms of maintaining the principles of developing an e-learning course, affecting participants' knowledge, and supporting usability requirements. RESULTS The findings revealed that training in oxygen therapy was essential for the ED clinicians. Therefore, an e-learning course was developed. The content production experts and the participants evaluated the content and usability of the online course at a good level. In addition, there was a statistically significant difference between the nurses' (p < 0.001) and general practitioners' (p < 0.002) pre- and post-test scores suggesting that the course improved their knowledge. CONCLUSION It seems that the e-learning course developed in the current study can improve health care professionals' knowledge and quality of care. However, more evaluation studies are needed to investigate the effectiveness of the course for other clinicians, such as nurses who work in intensive care units.
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Affiliation(s)
- Maryam Arabani Nezhad
- Present Address: Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Haleh Ayatollahi
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Hazhir Heidari Beigvand
- Family Medicine and Public Health Research Center, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
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18
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Cao N, Peng LJ, Du W. [Meta analysis of rock salt aerosol therapy for respiratory tract diseases]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2022; 40:751-756. [PMID: 36348556 DOI: 10.3760/cma.j.cn121094-20210719-00345] [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] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
Objective: To systematically evaluate the efficacy and safety of rock salt aerosol in the treatment of respiratory tract diseases. Methods: In June 2021, the clinical randomized controlled trial literatures of rock salt aerosol therapy for respiratory tract diseases were searched from CNKI, Wanfang, VIP, Cochrane Library, PubMed database and EMBASE database. Cochrane risk bias evaluation tool was used to evaluate risk bias, Revman 5.4 and Stata16 were used to conduct meta-analysis, TSA 0.9 was used to conduct sequential analysis of trials, and gradepro was used to evaluate evidence quality. Results: A total of 21 literatures were included. According to whether the subjects received rock salt aerosol therapy, they were divided into the experimental group (1125 people) and the control group (973 people) . Compared with the control group, the total clinical effective rate (RR=1.22, 95%CI: 1.15~1.29, P<0.001) , forced expiratory volume in one second (FEV(1)) (WMD=0.20, 95%CI: 0.09~0.31, P<0.001) , percentage of FEV(1) in the predicted value (FEV(1)%) (WMD=5.06, 95%CI: 3.47~6.65, P<0.001) , forced vital capacity (FVC) (WMD=0.22, 95% CI: 0.16~0.27, P<0.001) , maximum expiratory flow (PEF) (WMD=21.312, 95%CI: 9.189~33.435, P=0.004) of experimental group were higher. TSA test shows that the difference conclusions of total effective rate, FEV(1), FEV(1)%, FVC and PEF were reliable, but the conclusion of FEV(1)% needs to be treated with caution; Three literatures reported the adverse reactions in the experimental group; GRADE evidence quality evaluation showed 3 very low-quality evidences and 2 low-quality evidences. Conclusion: Rock salt aerosol therapy combined with conventional therapy has a certain effect on the treatment of respiratory tract diseases, which needs to be further confirmed by high-quality evidence.
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Affiliation(s)
- N Cao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - L J Peng
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - W Du
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
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19
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Sayed ZI, Abdel-Ghany MF, Ahmed SH, Adawy AM, El–Hamid RFA. Streptococcus pseudopneumoniae as an emerging respiratory tract pathogen at Assiut University hospitals. Iran J Microbiol 2022; 14:645-652. [PMID: 36531811 PMCID: PMC9723435 DOI: 10.18502/ijm.v14i5.10957] [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] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
BACKGROUND AND OBJECTIVES Streptococcus pseudopneumoniae is a member of viridans streptococci. It is non-capsulated, bile insoluble and optochin susceptible in ambient air but resistant in 5% CO2. This study aimed to isolate S. pseudopneumoniae from sputum specimens of patients admitted to Chest Department and Chest ICU of Assiut University hospitals, differentiate it from Streptococcus pneumoniae in addition, to evaluate the prevalence of Streptococcus pseudopneumoniae in clinical isolates by phenotypic and genotypic methods, to subject the isolates to antimicrobial susceptibility testing using agar disc diffusion method. MATERIALS AND METHODS Isolation of Streptococcus pseudopneumoniae from sputum sample and doing phenotypic test (optochin susceptibility test,bile susceptibility test and antimicrobial susceptibility test) and genotypic test by polymerase chain reaction (PCR) for five genes: CpsA, LytA, AliB-like ORF2, 16S rRNA and Spn9802 genes. RESULTS Twenty isolates of S. pseudopneumoniae were diagnosed phenotypically by optochin susceptibility and bile solubility tests followed by genotypic characterization by polymerase chain reaction (PCR) for five genes: CpsA, LytA, AliB-like ORF2, 16S rRNA and Spn9802 genes. The prevalence of S. pseudopneumoniae among studied patients was 10% (20/200). CONCLUSION The pure growth of S. pseudopneumoniae from sputum samples together with the great percentage of antibiotic resistance should raise attention to the clinical importance of this organism.
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Affiliation(s)
- Zeinab Ibraheem Sayed
- Department of Medical Microbiology and Immunology, School of Medicine, Assiut University, Assiut, Egypt
| | | | - Shabaan Hashem Ahmed
- Department of Medical Microbiology and Immunology, School of Medicine, Assiut University, Assiut, Egypt
| | - Amany Mohmed Adawy
- Department of Medical Microbiology and Immunology, School of Medicine, Assiut University, Assiut, Egypt
| | - Rawhia Fathy Abd El–Hamid
- Department of Medical Microbiology and Immunology, School of Medicine, Assiut University, Assiut, Egypt
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20
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Kisser U, Pabst F, Bartel S, Schramm D, Glien A, Plontke SK, Ebert D, Wittlinger J. [Case report on traumatic complete laryngotracheal separation with a positive outcome]. HNO 2022. [PMID: 35362726 DOI: 10.1007/s00106-022-01159-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2022] [Indexed: 11/04/2022]
Abstract
HISTORY A 21-year-old female was injured by accidental strangulation. Dyspnea and stridor occurred with delay, and led to emergency intubation. FINDINGS Physical examination showed strangulation marks and neck emphysema. Computed tomography confirmed laryngotracheal separation and revealed misplacement of the ventilation tube. DIAGNOSIS Further surgical exploration revealed complete laryngotracheal (cricotracheal) separation. TREATMENT After initial emergency tracheotomy, cricotracheal reanastomosis was achieved by a two-stage surgical approach. CONCLUSION Laryngotracheal separation is associated with high mortality. In the case presented herein, the patient survived and was discharged from hospital without a tracheostomy tube despite bilateral recurrent laryngeal nerve palsy.
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Fechter-Leggett ED, Fedan KB, Cox-Ganser JM, Meltzer MI, Adhikari BB, Dowell CH. Estimated N95 Respirator Needs for Nonhealthcare Essential Workers in the United States During Communicable Respiratory Infectious Disease Pandemics. Health Secur 2022; 20:127-136. [PMID: 35108104 PMCID: PMC9038697 DOI: 10.1089/hs.2021.0166] [Citation(s) in RCA: 1] [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] [Indexed: 11/13/2022] Open
Abstract
Early in the COVID-19 pandemic, demand for N95 respirators far exceeded the supply, leading to widespread shortages. Initially, the US Centers for Disease Control and Prevention did not recommend N95 respirators in nonhealthcare settings, in order to reserve them for healthcare workers. As N95s became more available, the recommendations were updated in May 2021 to include N95 respirators for nonhealthcare settings. In this study, we estimated the numbers of N95s needed for nonhealthcare essential workers in the United States. This information is valuable for crisis preparedness and planning for future large-scale communicable respiratory infectious disease epidemics or pandemics. We adapted a spreadsheet-based tool originally built to estimate the potential demand for N95 respirators during an influenza pandemic. We defined nonhealthcare essential occupations according to the 2020 US Department of Homeland Security guidance and used US Bureau of Labor Statistics employment numbers and Occupational Information Network data as model parameters. We modeled minimum, intermediate, and maximum N95 provision scenarios (as 1, 2, and 5 N95 respirators, respectively) per week per worker, for pandemic durations of 15 and 40 weeks. For 85.15 million nonhealthcare essential workers during a 15-week pandemic, an estimated 1.3 billion N95 respirators would be needed under minimum provision scenarios, 2.6 billion for intermediate provision, and 6.4 billion for maximum provision. During a 40-week pandemic, these estimates increased to 3.4 billion, 6.8 billion, and 17 billion. Public health authorities and policymakers can use these estimates when considering workplace respirator-wearing practices, including prioritization of allocation, for nonhealthcare essential workers. Our novel spreadsheet-based tool can also be used to quickly generate estimates of other preparedness and response equipment.
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Affiliation(s)
- Ethan D. Fechter-Leggett
- Respiratory Health Division, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Morgantown, WV
| | - Kathleen B. Fedan
- Respiratory Health Division, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Morgantown, WV
| | - Jean M. Cox-Ganser
- Respiratory Health Division, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Morgantown, WV
| | - Martin I. Meltzer
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, GA
| | - Bishwa B. Adhikari
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, GA
| | - Chad H. Dowell
- Emergency Preparedness and Response, NIOSH, CDC, Atlanta, GA
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22
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Prior TS, Wälscher J, Gross B, Bendstrup E, Kreuter M. Clusters of comorbidities in fibrotic hypersensitivity pneumonitis. Respir Res 2022; 23:368. [PMID: 36539821 PMCID: PMC9768944 DOI: 10.1186/s12931-022-02291-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 06/17/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Hypersensitivity pneumonitis (HP) is a type of interstitial lung disease (ILD) with a variable disease course and prognosis ranging from inflammatory and self-limiting to irreversible and progressive pulmonary fibrosis. Comorbidities are common in HP and may have an impact on prognosis. Due to the heterogeneity of HP presentation and progression, the identification of specific phenotypes in relationship to disease course and outcome is essential. The aim of this study was to identify clusters of comorbidities which could represent phenotypes in fibrotic HP and examine their impact on prognosis. METHODS Patients diagnosed with fibrotic HP at a tertiary referral center for ILD were included. Comorbidities were systematically registered and clusters of comorbidities were identified using cluster analyses. Disease progression and survival was estimated for each cluster. RESULTS The cohort comprised 211 patients with 53.6% males, mean age 63.0, baseline FVC 72.7%, DLCO 44.1%. Median follow-up time was 1.8 years (IQR 0.7-3.9). Three clusters with distinct comorbidity profiles and clinical characteristics were identified. One cluster dominated by elder male patients with predominantly cardiovascular diseases was associated with more respiratory hospitalizations and a worse prognosis. Differences in pulmonary function or exercise capacity trajectories between clusters were not observed. CONCLUSIONS Three clusters with distinct comorbidities were identified and could represent phenotypes in fibrotic HP not previously recognized. The worst prognosis was observed in a cluster dominated by elder males with cardiovascular diseases. Increased focus on prevention and treatment of comorbidities could potentially improve the prognosis of patients with fibrotic HP.
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Affiliation(s)
- Thomas Skovhus Prior
- grid.154185.c0000 0004 0512 597XCentre for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Julia Wälscher
- grid.7700.00000 0001 2190 4373Centre for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany ,grid.452624.3German Center for Lung Research (DZL), Heidelberg, Germany ,grid.5718.b0000 0001 2187 5445Centre for Interstitial and Rare Lung Diseases, Pneumology Department, Ruhrlandklinik, University Hospital, University of Essen, Essen, Germany
| | - Benjamin Gross
- grid.7700.00000 0001 2190 4373Centre for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany ,grid.452624.3German Center for Lung Research (DZL), Heidelberg, Germany
| | - Elisabeth Bendstrup
- grid.154185.c0000 0004 0512 597XCentre for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Michael Kreuter
- grid.7700.00000 0001 2190 4373Centre for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany ,grid.452624.3German Center for Lung Research (DZL), Heidelberg, Germany
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Brazeau NF, Verity R, Jenks S, Fu H, Whittaker C, Winskill P, Dorigatti I, Walker PGT, Riley S, Schnekenberg RP, Hoeltgebaum H, Mellan TA, Mishra S, Unwin HJT, Watson OJ, Cucunubá ZM, Baguelin M, Whittles L, Bhatt S, Ghani AC, Ferguson NM, Okell LC. Estimating the COVID-19 infection fatality ratio accounting for seroreversion using statistical modelling. Commun Med (Lond) 2022; 2:54. [PMID: 35603270 PMCID: PMC9120146 DOI: 10.1038/s43856-022-00106-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 03/22/2022] [Indexed: 12/29/2022] Open
Abstract
Background The infection fatality ratio (IFR) is a key statistic for estimating the burden of coronavirus disease 2019 (COVID-19) and has been continuously debated throughout the COVID-19 pandemic. The age-specific IFR can be quantified using antibody surveys to estimate total infections, but requires consideration of delay-distributions from time from infection to seroconversion, time to death, and time to seroreversion (i.e. antibody waning) alongside serologic test sensitivity and specificity. Previous IFR estimates have not fully propagated uncertainty or accounted for these potential biases, particularly seroreversion. Methods We built a Bayesian statistical model that incorporates these factors and applied this model to simulated data and 10 serologic studies from different countries. Results We demonstrate that seroreversion becomes a crucial factor as time accrues but is less important during first-wave, short-term dynamics. We additionally show that disaggregating surveys by regions with higher versus lower disease burden can inform serologic test specificity estimates. The overall IFR in each setting was estimated at 0.49-2.53%. Conclusion We developed a robust statistical framework to account for full uncertainties in the parameters determining IFR. We provide code for others to apply these methods to further datasets and future epidemics.
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Affiliation(s)
- Nicholas F. Brazeau
- grid.7445.20000 0001 2113 8111MRC Centre for Global Infectious Disease Analysis; and the Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London, UK
| | - Robert Verity
- grid.7445.20000 0001 2113 8111MRC Centre for Global Infectious Disease Analysis; and the Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London, UK
| | - Sara Jenks
- grid.418716.d0000 0001 0709 1919Department of Clinical Biochemistry, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Han Fu
- grid.7445.20000 0001 2113 8111MRC Centre for Global Infectious Disease Analysis; and the Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London, UK
| | - Charles Whittaker
- grid.7445.20000 0001 2113 8111MRC Centre for Global Infectious Disease Analysis; and the Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London, UK
| | - Peter Winskill
- grid.7445.20000 0001 2113 8111MRC Centre for Global Infectious Disease Analysis; and the Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London, UK
| | - Ilaria Dorigatti
- grid.7445.20000 0001 2113 8111MRC Centre for Global Infectious Disease Analysis; and the Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London, UK
| | - Patrick G. T. Walker
- grid.7445.20000 0001 2113 8111MRC Centre for Global Infectious Disease Analysis; and the Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London, UK
| | - Steven Riley
- grid.7445.20000 0001 2113 8111MRC Centre for Global Infectious Disease Analysis; and the Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London, UK
| | - Ricardo P. Schnekenberg
- grid.4991.50000 0004 1936 8948Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Henrique Hoeltgebaum
- grid.7445.20000 0001 2113 8111Department of Mathematics, Imperial College, London, UK
| | - Thomas A. Mellan
- grid.7445.20000 0001 2113 8111MRC Centre for Global Infectious Disease Analysis; and the Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London, UK
| | - Swapnil Mishra
- grid.7445.20000 0001 2113 8111MRC Centre for Global Infectious Disease Analysis; and the Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London, UK
| | - H. Juliette T. Unwin
- grid.7445.20000 0001 2113 8111MRC Centre for Global Infectious Disease Analysis; and the Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London, UK
| | - Oliver J. Watson
- grid.7445.20000 0001 2113 8111MRC Centre for Global Infectious Disease Analysis; and the Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London, UK
| | - Zulma M. Cucunubá
- grid.7445.20000 0001 2113 8111MRC Centre for Global Infectious Disease Analysis; and the Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London, UK
| | - Marc Baguelin
- grid.7445.20000 0001 2113 8111MRC Centre for Global Infectious Disease Analysis; and the Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London, UK
| | - Lilith Whittles
- grid.7445.20000 0001 2113 8111MRC Centre for Global Infectious Disease Analysis; and the Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London, UK
| | - Samir Bhatt
- grid.7445.20000 0001 2113 8111MRC Centre for Global Infectious Disease Analysis; and the Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London, UK
| | - Azra C. Ghani
- grid.7445.20000 0001 2113 8111MRC Centre for Global Infectious Disease Analysis; and the Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London, UK
| | - Neil M. Ferguson
- grid.7445.20000 0001 2113 8111MRC Centre for Global Infectious Disease Analysis; and the Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London, UK
| | - Lucy C. Okell
- grid.7445.20000 0001 2113 8111MRC Centre for Global Infectious Disease Analysis; and the Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London, UK
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Rose TC, Daras K, Cloke J, Rodgers S, Farrell P, Ahmed S, Barr B. Impact of local air quality management policies on emergency hospitalisations for respiratory conditions in the North West Coast region of England: a longitudinal controlled ecological study. Int J Equity Health 2021; 20:254. [PMID: 34903229 PMCID: PMC8670133 DOI: 10.1186/s12939-021-01598-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/12/2021] [Accepted: 11/24/2021] [Indexed: 11/17/2022] Open
Abstract
Background Air quality is monitored at a local level in the UK as part of the Local Air Quality Management (LAQM) system. If air quality objectives within an area are not achieved an Air Quality Management Area (AQMA) is declared and action plan developed. The efficacy of this system in reducing air pollution has increasingly come into question, however very little is known about its impact on health or health inequalities. We therefore investigated the effect of declaring an AQMA on emergency hospitalisations for respiratory conditions in the North West Coast region of England, and examined whether the effect differed between more compared to less deprived neighbourhoods. Methods This longitudinal controlled ecological study analysed neighbourhoods located within or touching the boundaries of AQMAs declared in the North West Coast region between 2006 and 2016. Each of these intervention neighbourhoods were matched with five control neighbourhoods which had never been located within/touching an AQMA boundary. Difference-in-differences methods were used to compare the change in hospitalisation rates in the intervention neighbourhoods to the change in hospitalisation rates in the matched control neighbourhoods, before and after the declaration of an AQMA. Results In total, 108 intervention neighbourhoods and 540 control neighbourhoods were analysed over the period 2005–2017, giving a total sample size of 8424 neighbourhood-years. Emergency hospitalisations for respiratory conditions decreased in the intervention neighbourhoods by 158 per 100,000 per year [95% CI 90 to 227] after an AQMA was declared relative to the control neighbourhoods. There was a larger decrease in hospitalisation rates following the declaration of an AQMA in more compared to less income deprived neighbourhoods. Conclusions Our results suggest the LAQM system has contributed to a reduction in emergency hospitalisations for respiratory conditions, and may represent an effective strategy to reduce inequalities in health. These findings highlight the importance of measuring the success of air quality policies not just in terms of air pollution but also in terms of population health. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-021-01598-w.
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Affiliation(s)
- Tanith C Rose
- Institute of Population Health Sciences, University of Liverpool, L69 3GL, Liverpool, UK.
| | - Konstantinos Daras
- Institute of Population Health Sciences, University of Liverpool, L69 3GL, Liverpool, UK
| | - Jane Cloke
- Institute of Population Health Sciences, University of Liverpool, L69 3GL, Liverpool, UK
| | - Sarah Rodgers
- Institute of Population Health Sciences, University of Liverpool, L69 3GL, Liverpool, UK
| | - Paul Farrell
- Environmental Protection & Public Protection Enforcement, Liverpool City Council, Liverpool, UK
| | - Saiqa Ahmed
- Public Advisor NIHR Applied Research Collaboration North West Coast, Liverpool, UK
| | - Benjamin Barr
- Institute of Population Health Sciences, University of Liverpool, L69 3GL, Liverpool, UK
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25
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Lapidot R, Vietri J, Shaff M, Averin A, Lonshteyn A, Weycker D, Wasserman M, Farkouh R, Pelton SI. Community-acquired pneumonia in infants: Not simply an acute event with complete recovery. Respir Med 2021; 191:106671. [PMID: 34864372 DOI: 10.1016/j.rmed.2021.106671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/15/2021] [Accepted: 10/22/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Pneumonia in infancy has been linked to long-term consequences for the rapidly developing lung. We examined the impact of hospitalized community-acquired pneumonia (CAP) on subsequent respiratory health. METHODS We conducted a retrospective matched-cohort study using the Optum® de-identified Electronic Health Record Dataset (2009-2018). Study population comprised healthy infants hospitalized for CAP ("CAP patients"), and matched comparators without pneumonia ("comparison patients"), before age 2 years. Study outcomes included any chronic respiratory disorder, reactive airway disease (asthma, hyperactive airway disease, recurrent wheezing), and CAP hospitalization occurring between age 2-5 years, and were evaluated overall as well as by age and etiology at first CAP hospitalization. RESULTS Study population totaled 1,343 CAP patients and 6,715 comparison patients. Rates per 100 patient-years and relative rates (RR) of study outcomes from age 2-5 years for CAP patients versus comparison patients were: any chronic respiratory disorder, 11.6 vs. 4.9 (RR = 2.4 [95% CI: 2.1-2.6]); reactive airway disease, 6.1 vs 1.9 (RR = 3.2 [2.6-3.8]); and CAP hospitalization, 1.0 vs 0.2 (RR = 6.3 [3.6-10.9]). Rates of study outcomes were highest among CAP patients who had their initial hospitalization in the second year of life. CONCLUSIONS Infant CAP foreshadows an increased risk of subsequent chronic respiratory disorders, which may be elevated when CAP occurs closer to pre-school age (i.e., age 2-5 years). These findings are most consistent with the hypothesis that inflammation persists beyond the acute stage of pneumonia and plays a role in the development of chronic respiratory sequelae.
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Duesberg CB, Valtin C, Fuge J, Logemann F, Fuehner T, Welte T, Gottlieb J. A Before-and-After Study of Evidence-Based Recommendations for On-Call Bronchoscopy. Respiration 2021; 100:600-610. [PMID: 33849036 DOI: 10.1159/000515134] [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: 11/18/2020] [Accepted: 02/05/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Bronchoscopy is widely used and regarded as standard of care in most intensive care units (ICUs). Data concerning recommendations for on-call bronchoscopy are lacking. OBJECTIVES Evaluation of recommendations, complications, and outcome of on-call bronchoscopies. METHOD A retrospective single-centre analysis was conducted in a large university hospital. All on-call bronchoscopies performed outside normal working hours in the year before (period 1) and after (period 2) establishing a catalogue of recommendations for indications of on-call bronchoscopy on November 1, 2016, were included. RESULTS Overall, 924 bronchoscopies in 538 patients were analysed. A relative reduction of 83.6% from 794 bronchoscopies in 432 patients (1.84 per patient) during period 1 to 130 in 107 patients (1.21 per patient) during period 2 was observed. Most bronchoscopies (812/924, 87.9%) were performed in ICUs, and 416 patients (77.3%) were intubated. Bronchoscopies for excessive secretions decreased significantly during period 2. Fifty-three of 130 bronchoscopies (40.8%) fulfilled the specified recommendations during period 2, in comparison with 16.8% in period 1 (p < 0.001). Complications were recorded in 58 of 924 procedures (6.3%) and were more frequent in period 2, especially moderate bleeding. In-hospital mortality of patients undergoing on-call bronchoscopy did not differ between periods and was 28.7 and 30.2% in periods 1 and 2, respectively. CONCLUSION The introduction of recommendations for on-call bronchoscopy led to a significant decline of on-call bronchoscopies without negatively affecting outcome. More evidence is needed in on-call bronchoscopy, especially for ICU patients with intrinsic higher complication rates.
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Affiliation(s)
| | - Christina Valtin
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Jan Fuge
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,German Center for Lung Research (DZL), Hannover, Germany
| | - Frank Logemann
- Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Thomas Fuehner
- German Center for Lung Research (DZL), Hannover, Germany.,Department of Respiratory and Intensive Care Medicine, Hospital Siloah, Hannover, Germany
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,German Center for Lung Research (DZL), Hannover, Germany
| | - Jens Gottlieb
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,German Center for Lung Research (DZL), Hannover, Germany
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Basham CA, Karim ME, Cook VJ, Patrick DM, Johnston JC. Post-tuberculosis airway disease: A population-based cohort study of people immigrating to British Columbia, Canada, 1985-2015. EClinicalMedicine 2021; 33:100752. [PMID: 33718847 PMCID: PMC7933261 DOI: 10.1016/j.eclinm.2021.100752] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/23/2021] [Accepted: 01/26/2021] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Current epidemiological evidence of post-TB airway disease is largely cross-sectional and derived from high-TB-incidence settings. We present the first cohort study of post-TB airway disease in a low-TB-incidence setting. AIMS (1) analyze the risk of airway disease by respiratory TB, (2) assess potential unmeasured confounding between TB and airway disease, and (3) investigate TB effect measure modification. METHODS A population-based cohort study using healthcare claims data for immigrants to British Columbia (BC), Canada, 1985-2015. Airway disease included chronic airway obstruction, asthma, bronchitis, bronchiolitis, and emphysema. Respiratory TB was defined from TB registry data. Cox proportional hazards (PH) regressions were used to analyze time-to-airway disease by respiratory TB. Sensitivity analyses included varying definitions of TB and airway disease. Potential unmeasured confounding by smoking was evaluated by E-value and hybrid least absolute shrinkage and selection operator (LASSO)-high-dimensional propensity score (hdPS). FINDINGS In our cohort (N = 1 005 328; nTB=1141) there were 116 840 incident cases of airway disease during our 30-year study period (10.43 per 1,000 person-years of follow-up), with cumulative incidence of 42·5% among respiratory TB patients compared with 11·6% among non-TB controls. The covariate-adjusted hazard ratio (aHR) for airway disease by respiratory TB was 2·08 (95% CI: 1·91-2·28) with E-value=3·58. The LASSO-hdPS analysis produced aHR=2·26 (95% CI: 2·07-2·47). INTERPRETATION A twofold higher risk of airway disease was observed among immigrants diagnosed with respiratory TB, compared with non-TB controls, in a low-TB-incidence setting. Unmeasured confounding is unlikely to explain this relationship. Models of post-TB care are needed. FUNDING Canadian Institutes of Health Research.
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Affiliation(s)
- C. Andrew Basham
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- British Columbia Centre for Disease Control, Vancouver, Canada
- Corresponding author at: 655W 12th Avenue, Vancouver, British Columbia, V5Z 4R4 Canada.
| | - Mohammad E. Karim
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- Centre for Health Evaluative and Outcome Sciences, University of British Columbia, Vancouver, Canada
| | - Victoria J. Cook
- British Columbia Centre for Disease Control, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - David M. Patrick
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- British Columbia Centre for Disease Control, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - James C. Johnston
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- British Columbia Centre for Disease Control, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
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Affiliation(s)
- Kenneth Jordan Ng Cheong Chung
- Translational and Clinical Research Institute, Faculty of Medical Sciences, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK.
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Casey JA, Kioumourtzoglou MA, Elser H, Walker D, Taylor S, Adams S, Aguilera R, Benmarhnia T, Catalano R. Wildfire particulate matter in Shasta County, California and respiratory and circulatory disease-related emergency department visits and mortality, 2013-2018. Environ Epidemiol 2021; 5:e124. [PMID: 33778357 DOI: 10.1097/EE9.0000000000000124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 11/10/2020] [Indexed: 01/09/2023] Open
Abstract
Supplemental Digital Content is available in the text. Wildfire smoke harms health. We add to this literature by evaluating the health effects of California’s 2018 Carr Fire and preceding wildfire seasons in Shasta County.
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North M, Bourne S, Green B, Chauhan AJ, Brown T, Winter J, Jones T, Neville D, Blythin A, Watson A, Johnson M, Culliford D, Elkes J, Cornelius V, Wilkinson TMA. A randomised controlled feasibility trial of E-health application supported care vs usual care after exacerbation of COPD: the RESCUE trial. NPJ Digit Med 2020; 3:145. [PMID: 33145441 PMCID: PMC7603326 DOI: 10.1038/s41746-020-00347-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 09/17/2020] [Indexed: 01/17/2023] Open
Abstract
Exacerbations of COPD are one of the commonest causes of admission and readmission to hospital. The role of digital interventions to support self-management in improving outcomes is uncertain. We conducted an open, randomised controlled trial of a digital health platform application (app) in 41 COPD patients recruited following hospital admission with an acute exacerbation. Subjects were randomised to either receive usual care, including a written self-management plan (n = 21), or the myCOPD app (n = 20) for 90 days. The primary efficacy outcome was recovery rate of symptoms measured by COPD assessment test (CAT) score. Exacerbations, readmission, inhaler technique quality of life and patient activation (PAM) scores were also captured by a blinded team. The app was acceptable in this care setting and was used by 17 of the 20 patients with sustained use over the study period. The treatment effect on the CAT score was 4.49 (95% CI: -8.41, -0.58) points lower in the myCOPD arm. Patients' inhaler technique improved in the digital intervention arm (101 improving to 20 critical errors) compared to usual care (100 to 72 critical errors). Exacerbations tended to be less frequent in the digital arm compared to usual care; 34 vs 18 events. Hospital readmissions risk was numerically lower in the digital intervention arm: OR for readmission 0.383 (95% CI: 0.074, 1.987; n = 35). In this feasibility study of the digital self-management platform myCOPD, the app has proven acceptable to patients to use and use has improved exacerbation recovery rates, with strong signals of lower re-exacerbation and readmission rates over 90 days. myCOPD reduced the number of critical errors in inhaler technique compared to usual care with written self-management. This provides a strong basis for further exploration of the use of app interventions in the context of recently hospitalised patients with COPD and informs the potential design of a large multi-centre trial.
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Affiliation(s)
| | | | - Ben Green
- Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | | | - Tom Brown
- Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | | | - Tom Jones
- Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Dan Neville
- Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | | | - Alastair Watson
- NIHR ARC Wessex, University of Southampton, Southampton, UK
- University of Southampton Faculty of Medicine, Southampton, UK
| | | | | | | | | | - Tom M. A. Wilkinson
- my mhealth Limited, Bournemouth, UK
- NIHR ARC Wessex, University of Southampton, Southampton, UK
- University of Southampton Faculty of Medicine, Southampton, UK
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Pishgar E, Mohammadi A, Bagheri N, Kiani B. A spatio-temporal geodatabase of mortalities due to respiratory tract diseases in Tehran, Iran between 2008 and 2018: a data note. BMC Res Notes 2020; 13:469. [PMID: 33028414 PMCID: PMC7539274 DOI: 10.1186/s13104-020-05319-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 09/30/2020] [Indexed: 12/25/2022] Open
Abstract
Objectives Respiratory tract diseases (RTDs) are among the top five leading causes of death worldwide. Mortality rates due to respiratory tract diseases (MRRTDs) follow a spatial pattern and this may suggest a potential link between environmental risk factors and MRRTDs. Spatial analysis of RTDs mortality data in an urban setting can provide new knowledge on spatial variation of potential risk factors for RTDs. This will enable health professionals and urban planners to design tailored interventions. We aim to release the datasets of MRRTDs in the city of Tehran, Iran, between 2008 and 2018. Data description The Research data include four datasets; (a) mortality dataset which includes records of deaths and their attributes (age, gender, date of death and district name where death occurred), (b) population data for 22 districts (age groups with 5 years interval and gender by each district). Furthermore, two spatial datasets about the city are introduced; (c) the digital boundaries of districts and (d) urban suburbs of Tehran.
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Affiliation(s)
- Elahe Pishgar
- Department of Human Geography and Logistics, Faculty of Earth Science, Shahid Beheshti University, Tehran, Iran
| | - Alireza Mohammadi
- Department of Geography & Planning, Faculty of Social Sciences, University of Mohaghegh Ardabili, Ardabil, Iran
| | - Nasser Bagheri
- Visualization and Decision Analytics (VIDEA) Lab, Centre for Mental Health Research, Research School of Population Health, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Behzad Kiani
- Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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Pishgar E, Fanni Z, Tavakkolinia J, Mohammadi A, Kiani B, Bergquist R. Mortality rates due to respiratory tract diseases in Tehran, Iran during 2008-2018: a spatiotemporal, cross-sectional study. BMC Public Health 2020; 20:1414. [PMID: 32943045 PMCID: PMC7495408 DOI: 10.1186/s12889-020-09495-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/03/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Tehran, the 22nd most populous city in the world, has the highest mortality rate due to respiratory system diseases (RSDs) in Iran. This study aimed to investigate spatiotemporal patterns of mortality due to these diseases in Tehran between 2008 and 2018. METHODS We used a dataset available from Tehran Municipality including all cases deceased due RSDs in this city between 2008 and 2018. Global Moran's I was performed to test whether the age-adjusted mortality rates were randomly distributed or had a spatial pattern. Furthermore, Anselin Local Moran's I was conducted to identify potential clusters and outliers. RESULTS During the 10-year study, 519,312 people died in Tehran, 43,177 because of RSDs, which corresponds to 831.1 per 10,000 deaths and 5.0 per 10,000 population. The death rate was much higher in men (56.8%) than in women (43.2%) and the highest occurred in the > 65 age group (71.2%). Overall, three diseases dominated the mortality data: respiratory failure (44.2%), pneumonia (15.9%) and lung cancer (10.2%). The rates were significantly higher in the central and southeastern parts of the city and lower in the western areas. It increased during the period 2008-2018 and showed a clustered spatial pattern between 2008 and 2013 but presented a random geographical pattern afterwards. CONCLUSIONS This study provides a first report of the spatial distribution of mortality due to RSDs in Tehran and shows a significant increase in respiratory disease mortality in the last ten years. Effective control of the excess fatality rates would warrant a combination of urban prevention and treatment strategies including environmental health plans.
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Affiliation(s)
- Elahe Pishgar
- Department of Human Geography and Logistics, Faculty of Earth Science, Shahid Beheshti University, Tehran, Iran
| | - Zohre Fanni
- Department of Human Geography and Logistics, Faculty of Earth Science, Shahid Beheshti University, Tehran, Iran.
| | - Jamileh Tavakkolinia
- Department of Human Geography and Logistics, Faculty of Earth Science, Shahid Beheshti University, Tehran, Iran
| | - Alireza Mohammadi
- Department of Geography and Urban Planning, Faculty of Social Sciences, University of Mohaghegh Ardabili, Ardabil, Iran
| | - Behzad Kiani
- Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Robert Bergquist
- Ingerod, Brastad, Sweden (formerly with the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases, World Health Organization), Geneva, Switzerland
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Iranpour S, Khodakarim S, Shahsavani A, Khosravi A, Etemad K. Modification of the effect of ambient air temperature on cardiovascular and respiratory mortality by air pollution in Ahvaz, Iran. Epidemiol Health 2020; 42:e2020053. [PMID: 32777886 PMCID: PMC7871149 DOI: 10.4178/epih.e2020053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/02/2020] [Accepted: 07/18/2020] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES This study investigated the modification of temperature effects on cardiovascular and respiratory mortality by air pollutants (particulate matter less than 2.5 and 10 µm in diameter [respectively], ozone, nitrogen dioxide, carbon monoxide, and sulfur dioxide). METHODS Poisson additive models with a penalized distributed lag non-linear model were used to assess the association of air temperature with the daily number of deaths from cardiovascular and respiratory diseases in Ahvaz, Iran from March 21, 2014 to March 20, 2018, controlling for day of the week, holidays, relative humidity, wind speed, air pollutants, and seasonal and long-term trends. Subgroup analyses were conducted to evaluate the effect modification for sex and age group. To assess the modification of air pollutants on temperature effects, the level of each pollutant was categorized as either greater than the median value or less than/equal to the median value. RESULTS We found no significant associations between temperature and cardiovascular and respiratory mortality. In the subgroup analyses, however, high temperatures were significantly associated with an increased risk of cardiovascular mortality among those 75 years old and older, with the strongest effect observed on day 0 relative to exposure. The results revealed a lack of interactive effects between temperature and air pollutants on cardiovascular and respiratory mortality. CONCLUSIONS A weak but significant association was found between high temperature and cardiovascular mortality, but only in elderly people. Air pollution did not significantly modify the effect of ambient temperature on cardiovascular and respiratory mortality.
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Affiliation(s)
- Sohrab Iranpour
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soheila Khodakarim
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Shahsavani
- Department of Environmental Health Engineering, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Environmental and Occupational Hazards Control Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Koorosh Etemad
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Schneider LP, Sartori LG, Machado FVC, Dala Pola D, Rugila DF, Hirata RP, Bertoche MP, Camillo CA, Hernandes NA, Furlanetto KC, Pitta F. Physical activity and inactivity among different body composition phenotypes in individuals with moderate to very severe chronic obstructive pulmonary disease. Braz J Phys Ther 2020; 25:296-302. [PMID: 32792230 DOI: 10.1016/j.bjpt.2020.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 03/30/2020] [Revised: 05/28/2020] [Accepted: 07/20/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The phenotype profiling of individuals with chronic obstructive pulmonary disease (COPD) according to impairments in body composition and level of physical activity in daily life (PADL) needs to be determined. OBJECTIVE To verify if individuals with COPD classified as physically active/inactive present different characteristics within different body composition phenotypes. METHODS Individuals with COPD were cross-sectionally stratified into four groups according to fat-free and fat mass indexes: Normal Body Composition (NBC), Obese (Ob), Sarcopenic (Sarc), and Sarcopenic/Obese (Sarc/Ob). Additionally, individuals had their PADL level objectively assessed through activity monitoring during two weekdays for at least 10h/day, and then were classified as physically active (Act) or inactive (Inact) according to international recommendations. Lung function (spirometry), exercise capacity (6-minute walking test [6MWT]) and peripheral muscle strength (1-repetition maximum [1RM]) were also assessed. RESULTS 176 individuals with COPD (mean±standard deviation age: 67±8 years, body mass index 26±6kg/m2, FEV1 47±16%predicted) were classified as: NBC+Act (17%), NBC+Inact (22%), Ob+Act (6%), Ob+Inact (10%), Sarc+Act (12%), Sarc+Inact (9%), Sarc/Ob+Act (8%) and Sarc/Ob+Inact (16%). The Sarc/Ob+Inact group presented lower 6MWT and 1RM for knee extension compared to NBC+Act, NBC+Inact, and Ob+Act groups (p<0.05). The Sarc/Ob+Inact group also presented lower FEV1% predicted, 1RM for elbow flexion and elbow extension compared to the NBC+Act and NBC+Inact groups and lower 1RM for elbow extension compared to Ob+Inact group (p<0.05). CONCLUSION The combination of sarcopenia, obesity, and physical inactivity was shown to be detrimental in individuals with COPD. Therefore, this profile is a main therapeutic target for improving PADL level and/or body composition.
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Affiliation(s)
- Lorena P Schneider
- Department of Physical Therapy, Laboratory of Research in Respiratory Physical Therapy (LFIP), Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil
| | - Larissa G Sartori
- Department of Physical Therapy, Laboratory of Research in Respiratory Physical Therapy (LFIP), Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil
| | - Felipe V C Machado
- Department of Research and Education, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, Netherlands
| | - Daniele Dala Pola
- Department of Physical Therapy, Laboratory of Research in Respiratory Physical Therapy (LFIP), Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil
| | - Diery Fernandes Rugila
- Department of Physical Therapy, Laboratory of Research in Respiratory Physical Therapy (LFIP), Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil; Research Centre in Health Sciences, University Pitágoras UNOPAR, Londrina, PR, Brazil
| | - Raquel P Hirata
- Department of Physical Therapy, Laboratory of Research in Respiratory Physical Therapy (LFIP), Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil
| | - Mariana P Bertoche
- Department of Physical Therapy, Laboratory of Research in Respiratory Physical Therapy (LFIP), Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil
| | - Carlos A Camillo
- Department of Physical Therapy, Laboratory of Research in Respiratory Physical Therapy (LFIP), Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil; Research Centre in Health Sciences, University Pitágoras UNOPAR, Londrina, PR, Brazil
| | - Nidia A Hernandes
- Department of Physical Therapy, Laboratory of Research in Respiratory Physical Therapy (LFIP), Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil
| | - Karina C Furlanetto
- Department of Physical Therapy, Laboratory of Research in Respiratory Physical Therapy (LFIP), Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil; Research Centre in Health Sciences, University Pitágoras UNOPAR, Londrina, PR, Brazil
| | - Fabio Pitta
- Department of Physical Therapy, Laboratory of Research in Respiratory Physical Therapy (LFIP), Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil.
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Masaki K, Tateno H, Nomura A, Muto T, Suzuki S, Satake K, Hida E, Fukunaga K. A randomized controlled trial of a smoking cessation smartphone application with a carbon monoxide checker. NPJ Digit Med 2020; 3:35. [PMID: 32195370 PMCID: PMC7067789 DOI: 10.1038/s41746-020-0243-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [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: 10/25/2019] [Accepted: 02/18/2020] [Indexed: 11/09/2022] Open
Abstract
Evidence of the long-term efficacy of digital therapies for smoking cessation that include a smartphone application (app) is limited. In this multi-center randomized controlled trial, we tested the efficacy of a novel digital therapy for smoking cessation: the "CureApp Smoking Cessation (CASC)" system, including a CASC smartphone app, a web-based patient management PC software for primary physicians, and a mobile exhaled carbon monoxide (CO) checker. A total of 584 participants with nicotine dependence were recruited from October 2017 to January 2018, and allocated 1:1 to the CASC intervention group or the control group. Both groups received a standard smoking cessation treatment with pharmacotherapy and counseling for 12 weeks. Meanwhile, the intervention group used the CASC system, and the control group used a control-app without a mobile CO checker, each for 24 weeks. The primary outcome was the biochemically validated continuous abstinence rate (CAR) from weeks 9 to 24. The main secondary outcome was an extended CAR from weeks 9 to 52. Except for 12 participants who did not download or use the apps, 285 participants were assigned to the intervention group, and 287, to the control. CAR from weeks 9 to 24 in the intervention group was significantly higher than that in the control group (63.9% vs. 50.5%; odds ratio [OR], 1.73; 95% confidence interval [CI], 1.24 to 2.42; P = 0.001). The CAR from weeks 9 to 52 was also higher in the intervention group than that in the control group (52.3% vs. 41.5%; OR, 1.55; 95% CI, 1.11 to 2.16; P = 0.010). No specific adverse events caused by the CASC system were reported. Augmenting standard face-to-face counseling and pharmacotherapy with a novel smartphone app, the CASC system significantly improved long-term CARs compared to standard treatment and a minimally supportive control app.
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Affiliation(s)
- Katsunori Masaki
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hiroki Tateno
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
- Department of Internal Medicine, Saitama City Hospital, Saitama, Japan
| | - Akihiro Nomura
- CureApp Institute, Karuizawa, Nagano, Japan
- Innovative Clinical Research Center, Kanazawa University (iCREK), Kanazawa, Ishikawa, Japan
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan
| | - Tomoyasu Muto
- CureApp Institute, Karuizawa, Nagano, Japan
- CureApp, Inc, Tokyo, Japan
| | | | - Kohta Satake
- CureApp Institute, Karuizawa, Nagano, Japan
- CureApp, Inc, Tokyo, Japan
| | - Eisuke Hida
- Department of Biostatistics and Data Science, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Koichi Fukunaga
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
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Orimo K, Saito H, Matsumoto K, Morita H. Innate Lymphoid Cells in the Airways: Their Functions and Regulators. Allergy Asthma Immunol Res 2020; 12:381-398. [PMID: 32141254 PMCID: PMC7061164 DOI: 10.4168/aair.2020.12.3.381] [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] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/28/2019] [Accepted: 11/11/2019] [Indexed: 12/17/2022]
Abstract
Since the airways are constantly exposed to various pathogens and foreign antigens, various kinds of cells in the airways—including structural cells and immune cells—interact to form a precise defense system against pathogens and antigens that involve both innate immunity and acquired immunity. Accumulating evidence suggests that innate lymphoid cells (ILCs) play critical roles in the maintenance of tissue homeostasis, defense against pathogens and the pathogenesis of inflammatory diseases, especially at body surface mucosal sites such as the airways. ILCs are activated mainly by cytokines, lipid mediators and neuropeptides that are produced by surrounding cells, and they produce large amounts of cytokines that result in inflammation. In addition, ILCs can change their phenotype in response to stimuli from surrounding cells, which enables them to respond promptly to microenvironmental changes. ILCs exhibit substantial heterogeneity, with different phenotypes and functions depending on the organ and type of inflammation, presumably because of differences in microenvironments. Thus, ILCs may be a sensitive detector of microenvironmental changes, and analysis of their phenotype and function at local sites may enable us to better understand the microenvironment in airway diseases. In this review, we aimed to identify molecules that either positively or negatively influence the function and/or plasticity of ILCs and the sources of the molecules in the airways in order to examine the pathophysiology of airway inflammatory diseases and facilitate the issues to be solved.
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Affiliation(s)
- Keisuke Orimo
- Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Hirohisa Saito
- Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Kenji Matsumoto
- Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Hideaki Morita
- Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development, Tokyo, Japan.
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Pacifico J, Geerlings MAJ, Reijnierse EM, Phassouliotis C, Lim WK, Maier AB. Prevalence of sarcopenia as a comorbid disease: A systematic review and meta-analysis. Exp Gerontol 2019; 131:110801. [PMID: 31887347 DOI: 10.1016/j.exger.2019.110801] [Citation(s) in RCA: 153] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/28/2019] [Accepted: 11/28/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Sarcopenia shares risk factors with various other age-related diseases. This meta-analysis aimed to determine the prevalence of sarcopenia as a comorbid disease. METHODS Medline, EMBASE and Cochrane databases were searched for articles from inception to 8th June 2018, reporting the prevalence of sarcopenia in individuals with a diagnosis of cardiovascular disease (CVD), dementia, diabetes mellitus or respiratory disease and, if applicable their controls. No exclusion criteria were applied with regards to definition of sarcopenia, individuals' age, study design and setting. Meta-analyses were stratified by disease, definition of sarcopenia and continent. RESULTS The 63 included articles described 17,206 diseased individuals (mean age: 65.3 ± 1.6 years, 49.9% females) and 22,375 non-diseased controls (mean age: 54.6 ± 16.2 years, 53.8% females). The prevalence of sarcopenia in individuals with CVD was 31.4% (95% CI: 22.4-42.1%), no controls were available. The prevalence of sarcopenia was 26.4% (95% CI: 13.6-44.8%) in individuals with dementia compared to 8.3% (95% CI: 2.8-21.9%) in their controls; 31.1% (95% CI: 19.8-45.2%) in individuals with diabetes mellitus compared to 16.2% (95% CI: 9.5-26.2%) in controls; and 26.8% (95% CI: 17.8-38.1%) in individuals with respiratory diseases compared to 13.3% (95% CI: 8.3-20.7%) in controls. CONCLUSIONS Sarcopenia is highly prevalent in individuals with CVD, dementia, diabetes mellitus and respiratory disease.
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Affiliation(s)
- Jacob Pacifico
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia
| | - Milou A J Geerlings
- Department of Clinical Physical Therapy, VieCuri Medical Center, Venlo, the Netherlands; Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit, Amsterdam, the Netherlands
| | - Esmee M Reijnierse
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia
| | - Christina Phassouliotis
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia
| | - Wen Kwang Lim
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia
| | - Andrea B Maier
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia; Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit, Amsterdam, the Netherlands.
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Sugizaki T, Tanaka KI, Asano T, Kobayashi D, Hino Y, Takafuji A, Shimoda M, Mogushi K, Kawahara M, Mizushima T. Idebenone has preventative and therapeutic effects on pulmonary fibrosis via preferential suppression of fibroblast activity. Cell Death Discov 2019; 5:146. [PMID: 31754474 PMCID: PMC6861265 DOI: 10.1038/s41420-019-0226-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 09/10/2019] [Revised: 09/24/2019] [Accepted: 09/27/2019] [Indexed: 01/03/2023] Open
Abstract
Alveolar epithelial injury induced by reactive oxygen species (ROS) and abnormal collagen production by activated fibroblasts (myofibroblasts) is involved in the onset and exacerbation of idiopathic pulmonary fibrosis (IPF). Compared with alveolar epithelial cells, lung fibroblasts, especially myofibroblasts, exhibit an apoptosis-resistance phenotype (apoptosis paradox) that appears to be involved in IPF pathogenesis. Thus, we screened for chemicals eliciting preferential cytotoxicity of LL29 cells (lung fibroblasts from an IPF patient) compared with A549 cells (human lung alveolar epithelial cell line) from medicines already in clinical use. We identified idebenone, a synthetic analogue of coenzyme Q10 (CoQ10, an antioxidant) that has been used clinically as a brain metabolic stimulant. Idebenone induced cell growth inhibition and cell death in LL29 cells at a lower concentration than in A549 cells, a feature that was not observed for other antioxidant molecules (such as CoQ10) and two IPF drugs (pirfenidone and nintedanib). Administration of idebenone prevented bleomycin-induced pulmonary fibrosis and increased pulmonary ROS levels. Importantly, idebenone also improved pulmonary fibrosis and lung function when administered after the development of fibrosis, whereas administration of CoQ10 similarly prevented bleomycin-induced pulmonary fibrosis, but had no effect after its development. Administration of idebenone, but not CoQ10, suppressed bleomycin-induced increases in lung myofibroblasts. In vitro, treatment of LL29 cells with idebenone, but not CoQ10, suppressed TGF-β–induced collagen production. These results suggest that in addition to antioxidant activity, idebenone exerts inhibitory activity on the function of lung fibroblasts, with the former activity being preventative and the latter therapeutic for bleomycin-induced fibrosis. Thus, we propose that idebenone may be more therapeutically beneficial for IPF patients than current treatments.
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Affiliation(s)
- Toshifumi Sugizaki
- 1Department of System Chemotherapy and Molecular Sciences, Division of Bioinformatics and Chemical Genomics, Graduate School of Pharmaceutical Sciences, Kyoto University, Kyoto, Japan
| | - Ken-Ichiro Tanaka
- 2Laboratory of Bio-Analytical Chemistry, Research Institute of Pharmaceutical Sciences, Faculty of Pharmacy, Musashino University, 1-1-20 Shinmachi, Nishi-Tokyo, 202-8585 Japan
| | - Teita Asano
- 3Institute of Medical Science, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki 216-8512 Japan
| | - Daisuke Kobayashi
- 2Laboratory of Bio-Analytical Chemistry, Research Institute of Pharmaceutical Sciences, Faculty of Pharmacy, Musashino University, 1-1-20 Shinmachi, Nishi-Tokyo, 202-8585 Japan
| | - Yuuki Hino
- 2Laboratory of Bio-Analytical Chemistry, Research Institute of Pharmaceutical Sciences, Faculty of Pharmacy, Musashino University, 1-1-20 Shinmachi, Nishi-Tokyo, 202-8585 Japan
| | - Ayaka Takafuji
- 2Laboratory of Bio-Analytical Chemistry, Research Institute of Pharmaceutical Sciences, Faculty of Pharmacy, Musashino University, 1-1-20 Shinmachi, Nishi-Tokyo, 202-8585 Japan
| | - Mikako Shimoda
- 2Laboratory of Bio-Analytical Chemistry, Research Institute of Pharmaceutical Sciences, Faculty of Pharmacy, Musashino University, 1-1-20 Shinmachi, Nishi-Tokyo, 202-8585 Japan
| | - Kaoru Mogushi
- 4Intractable Disease Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Masahiro Kawahara
- 2Laboratory of Bio-Analytical Chemistry, Research Institute of Pharmaceutical Sciences, Faculty of Pharmacy, Musashino University, 1-1-20 Shinmachi, Nishi-Tokyo, 202-8585 Japan
| | - Tohru Mizushima
- 5LTT Bio-Pharma Co., Ltd, Shiodome Building 3F, 1-2-20 Kaigan, Minato-ku, Tokyo 105-0022 Japan
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Li Y, Yin Z, Fan J, Zhang S, Yang W. The roles of exosomal miRNAs and lncRNAs in lung diseases. Signal Transduct Target Ther 2019; 4:47. [PMID: 31728212 PMCID: PMC6851157 DOI: 10.1038/s41392-019-0080-7] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/15/2019] [Accepted: 09/15/2019] [Indexed: 12/11/2022] Open
Abstract
An increasing number of studies have reported that exosomes released from various cells can serve as mediators of information exchange between different cells. With further exploration of exosome content, a more accurate molecular mechanism involved in the process of cell-to-cell communication has been revealed; specifically, microRNAs (miRNAs) and long noncoding RNAs (lncRNAs) are shuttled by exosomes. In addition, exosomal miRNAs and lncRNAs may play vital roles in the pathogenesis of several respiratory diseases, such as chronic obstructive pulmonary disease (COPD), lung cancer, and asthma. Consequently, exosomal miRNAs and lncRNAs show promise as diagnostic biomarkers and therapeutic targets in several lung diseases. This review will summarize recent knowledge about the roles of exosomal miRNAs and lncRNAs in lung diseases, which has shed light on the discovery of novel diagnostic methods and treatments for these disorders. Because there is almost no published literature about exosomal lncRNAs in COPD, asthma, interstitial lung disease, or tuberculosis, we summarize the roles of exosomal lncRNAs only in lung cancer in the second section. This may inspire some new ideas for researchers who are interested in whether lncRNAs shuttled by exosomes may play roles in other lung diseases.
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Affiliation(s)
- Yang Li
- Key Laboratory of Respiratory Diseases of the Ministry of Health, Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, 430022 Wuhan, China
| | - Zhengrong Yin
- Key Laboratory of Respiratory Diseases of the Ministry of Health, Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, 430022 Wuhan, China
| | - Jinshuo Fan
- Key Laboratory of Respiratory Diseases of the Ministry of Health, Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, 430022 Wuhan, China
| | - Siyu Zhang
- Key Laboratory of Respiratory Diseases of the Ministry of Health, Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, 430022 Wuhan, China
| | - Weibing Yang
- Key Laboratory of Respiratory Diseases of the Ministry of Health, Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, 430022 Wuhan, China
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Modak D, Sotomayor M. Identification of an adhesive interface for the non-clustered δ1 protocadherin-1 involved in respiratory diseases. Commun Biol 2019; 2:354. [PMID: 31583286 PMCID: PMC6769022 DOI: 10.1038/s42003-019-0586-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 05/10/2019] [Accepted: 08/21/2019] [Indexed: 12/29/2022] Open
Abstract
Cadherins form a large family of calcium-dependent adhesive proteins involved in morphogenesis, cell differentiation, and neuronal connectivity. Non-clustered δ1 protocadherins form a cadherin subgroup of proteins with seven extracellular cadherin (EC) repeats and cytoplasmic domains distinct from those of classical cadherins. Non-clustered δ1 protocadherins mediate homophilic adhesion and have been implicated in various diseases including asthma, autism, and cancer. Here we present X-ray crystal structures of human Protocadherin-1 (PCDH1), a δ1-protocadherin member essential for New World Hantavirus infection that is typically expressed in the brain, airway epithelium, skin keratinocytes, and lungs. The structures suggest a binding mode that involves antiparallel overlap of repeats EC1 to EC4. Mutagenesis combined with binding assays and biochemical experiments validated this mode of adhesion. Overall, these results reveal the molecular mechanism underlying adhesiveness of PCDH1 and δ1-protocadherins, also shedding light on PCDH1's role in maintaining airway epithelial integrity, the loss of which causes respiratory diseases.
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Affiliation(s)
- Debadrita Modak
- Department of Chemistry and Biochemistry, The Ohio State University, 484 W 12th Avenue, Columbus, OH 43210 USA
| | - Marcos Sotomayor
- Department of Chemistry and Biochemistry, The Ohio State University, 484 W 12th Avenue, Columbus, OH 43210 USA
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Zhang Y, Chen W, Ji JF, Wang ZY, Wu MH, Cheng Y, Jiang MJ, Wang QP, Chen RJ. [The significance of eosinophils in the correlation of upper and lower airway inflammation in patients with chronic rhinitis]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2019; 54:450-455. [PMID: 31262111 DOI: 10.3760/cma.j.issn.1673-0860.2019.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the predictor of lower airway inflammation among the index of nasal inflammation by investigating the expression and association of eosinophils (EOS) in the upper-lower airways and blood of patients with chronic rhinitis. Methods: A total of 162 patients with allergic rhinitis (AR), 117 patients with non-allergic rhinitis (NAR) and 104 controls were enrolled from June 2010 to December 2013 from General Hospital of Eastern Theater Command, People's Liberation Army. All subjects were required detailed medical history collection and nasal resistance measurement. Skin prick test (SPT), blood total immunoglobin E (tIgE) and blood EOS, nasal lavage and induced sputum EOS, nasal provocation and bronchial provocation test (NPT, BPT), nasal and forced exhaled nitric oxide (NNO, FeNO) were performed in all patients. One-way analysis of variance was used for comparison between groups. LSD t test or Mann-Whitney U test was used for comparison between the two groups. Pearson or Spearman related parameter test was used for correlation analysis. Results: The nasal lavage EOS, NNO, induced sputum EOS, FeNO, blood EOS and tIgE were higher in the AR group than that in the NAR group (3.70[1.20, 14.23]/200 HP vs 1.40[0.20, 3.40]/200 HP, 673.50[466.80, 936.00] ppb vs 455.80[248.10, 705.60] ppb, 2.97[0.00, 10.63]% vs 1.00[0.23, 2.00]%, (49.28±26.37)ppb vs (34.07±19.11)ppb, 4.00[2.00, 7.00]% vs 2.00[1.00, 5.00]%, 208.01[61.70, 387.50] IU/ml vs 43.30[19.00, 122.00] IU/ml, F or χ(2) value was 11.442, 19.440, 70.727, 69.449, 47.453, 46.525, respectively, all P<0.05). But there was no significant difference in nasal resistance, NPT and BPT between the two groups. Nasal lavage EOS in AR group and NAR group was correlated with induced sputum EOS, FeNO, tIgE and blood EOS (r value of AR group was 0.448, 0.202, 0.159, 0.321, r value of NAR group was 0.442, 0.268, 0.268, 0.334, respectively, all P<0.05), but not with BPT. After adjustment for gender, age, height and weight, nasal EOS was positively correlated with sputum EOS. Multiple linear regression analysis showed that nasal EOS, blood EOS and SPT were factors affecting sputum EOS levels. The optimal threshold for nasal EOS to determine induced sputum EOS was 3.30/200 HP by (receiver operating characteristic,ROC) analysis. Conclusion: The nasal EOS is correlated with multiple lower airway and systemic inflammatory markers, and is a risk factor for the induced sputum EOS, which can be used as an inflammation biomarker to predict the lower air inflammation.
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Affiliation(s)
- Y Zhang
- Department of Otorhinolaryngology, Second Affiliated Hospital, Nanjing Medical University, Nanjing 200031, China; Department of Otorhinolaryngology, General Hospital of Eastern Theater Command, People's Liberation Army, Nanjing 210002, China
| | - W Chen
- Department of Otorhinolaryngology, General Hospital of Eastern Theater Command, People's Liberation Army, Nanjing 210002, China
| | - J F Ji
- Department of Otorhinolaryngology, General Hospital of Eastern Theater Command, People's Liberation Army, Nanjing 210002, China
| | - Z Y Wang
- Department of Otorhinolaryngology, General Hospital of Eastern Theater Command, People's Liberation Army, Nanjing 210002, China
| | - M H Wu
- Department of Otorhinolaryngology, General Hospital of Eastern Theater Command, People's Liberation Army, Nanjing 210002, China
| | - Y Cheng
- Department of Otorhinolaryngology, General Hospital of Eastern Theater Command, People's Liberation Army, Nanjing 210002, China
| | - M J Jiang
- Department of Otorhinolaryngology, General Hospital of Eastern Theater Command, People's Liberation Army, Nanjing 210002, China
| | - Q P Wang
- Department of Otorhinolaryngology, General Hospital of Eastern Theater Command, People's Liberation Army, Nanjing 210002, China
| | - R J Chen
- Department of Otorhinolaryngology, Second Affiliated Hospital, Nanjing Medical University, Nanjing 200031, China
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Continente X, Arechavala T, Fernàndez E, Pérez-Ríos M, Schiaffino A, Soriano JB, Carreras G, López-Nicolás Á, Gorini G, López MJ. Burden of respiratory disease attributable to secondhand smoke exposure at home in children in Spain (2015). Prev Med 2019; 123:34-40. [PMID: 30817956 DOI: 10.1016/j.ypmed.2019.02.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 10/18/2018] [Revised: 02/12/2019] [Accepted: 02/23/2019] [Indexed: 10/27/2022]
Abstract
This study aimed to estimate the number of incident cases and hospital admissions attributable to secondhand smoke (SHS) exposure at home for asthma, otitis media (OM), and lower respiratory infections (LRI) in children in Spain. The burden of respiratory disease caused by SHS exposure was estimated in terms of incident cases and hospitalized cases for asthma, OM, and LRI. Estimates were calculated using the population attributable fraction. The age-specific (0-1 year, 0-4 years, 5-11 years, and 0-11 years) prevalence of SHS exposure in children was estimated through a telephone survey performed in a representative sample of Spanish households with children in 2016. The risk estimates for all diseases were selected from international meta-analyses. The number of hospitalized cases was obtained for each disease from the Hospital Minimum Data Set provided by the Ministry of Health of Spain. Incident cases were obtained from the Global Health Data Exchange. In 2015, SHS exposure caused an estimated total of 136,403 incident cases of the following respiratory diseases: 9058 (8.5%) cases of asthma, 120,248 (8.5%) of OM, and 7097 (13.5%) of LRI in children aged 0-14 years old in Spain. Likewise, SHS exposure caused a total of 3028 hospitalized cases, with 379 (8.5%) for asthma and 167 (8.5%) for OM in children 0-11 years old, and 2482 (11.6%) for LRI in children <2 years old. The high burden of respiratory disease attributed to SHS exposure supports the need to improve protection of children against SHS exposure by extending smoke-free regulations to homes and cars.
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Affiliation(s)
- Xavier Continente
- Agència de Salut Pública de Barcelona (Public Health Agency, Barcelona), Pl. Lesseps, 1, PC 08023 Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP) (Biomedical Research Centre Network for Epidemiology and Public Health), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, PC 28029 Madrid, Spain; Institut d'Investigació Biomèdica de Sant Pau (IIB Sant Pau) (Institute of Biomedical Research, Barcelona), Sant Antoni Maria Claret, 167, PC 08025 Barcelona, Spain
| | - Teresa Arechavala
- Agència de Salut Pública de Barcelona (Public Health Agency, Barcelona), Pl. Lesseps, 1, PC 08023 Barcelona, Spain; Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra (UPF) (Experimental and Health Sciences Department, Pompeu Fabra University), Dr. Aiguader, 88, PC 08003 Barcelona, Spain
| | - Esteve Fernàndez
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'Oncologia (ICO), Granvia de L'Hospitalet, 199-203, PC 08908 L'Hospitalet de Llobregat, Spain; Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Granvia de L'Hospitalet, 199, PC 08908 L'Hospitalet de Llobregat, Spain; Department of Clinical Sciences, Campus de Bellvitge, School of Medicine and Health Sciences, Universitat de Barcelona, Feixa Llarga, s/n, PC 08907 L'Hospitalet de Llobregat, Spain
| | - Mónica Pérez-Ríos
- Epidemiology Unit, Galician Directorate for Public Health, Galician Health Authority, Xunta de Galicia, San Caetano, s/n, PC 15704 Santiago de Compostela, Spain; Department of Preventive Medicine and Public Health, School of Medicine, University of Santiago de Compostela, Praza do Obradoiro, s/n, PC 15782 Santiago de Compostela, Spain
| | - Anna Schiaffino
- Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Granvia de L'Hospitalet, 199, PC 08908 L'Hospitalet de Llobregat, Spain; Direcció General de Planificació en Salut, Departament de Salut, Generalitat de Catalunya, Travessera de les Corts, 131-159 (Pavelló Ave Maria), PC 08028 Barcelona, Spain
| | - Joan B Soriano
- Fundación para la Investigación Biomédica del Hospital Universitario La Princesa (IISP) (The Biomedical Research Foundation of University Hospital La Princesa), Diego de León, 62 1st floor, PC 28006 Madrid, Spain
| | - Giulia Carreras
- Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO) (Oncological Network, Prevention & Research Institute), Via Cosimo Il Vecchio, 2, PC 50139 Firenze, Italy
| | - Ángel López-Nicolás
- Universidad Politécnica de Cartagena (UPCT) (Polytechnic University of Cartagena), Plaza Cronista Isidoro Valverde, s/n, PC 30202 Cartagena, Spain
| | - Giuseppe Gorini
- Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO) (Oncological Network, Prevention & Research Institute), Via Cosimo Il Vecchio, 2, PC 50139 Firenze, Italy
| | - Maria José López
- Agència de Salut Pública de Barcelona (Public Health Agency, Barcelona), Pl. Lesseps, 1, PC 08023 Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP) (Biomedical Research Centre Network for Epidemiology and Public Health), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, PC 28029 Madrid, Spain; Institut d'Investigació Biomèdica de Sant Pau (IIB Sant Pau) (Institute of Biomedical Research, Barcelona), Sant Antoni Maria Claret, 167, PC 08025 Barcelona, Spain; Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra (UPF) (Experimental and Health Sciences Department, Pompeu Fabra University), Dr. Aiguader, 88, PC 08003 Barcelona, Spain.
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Ye R, Cui L, Peng X, Yu K, Cheng F, Zhu Y, Jia C. Effect and threshold of PM 2.5 on population mortality in a highly polluted area: a study on applicability of standards. Environ Sci Pollut Res Int 2019; 26:18876-18885. [PMID: 31065985 DOI: 10.1007/s11356-019-04999-1] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 03/26/2019] [Indexed: 06/09/2023]
Abstract
For assessing the effect and threshold of PM2.5 on mortality in highly polluted areas and further studying the standard applicability, daily data on meteorological factors, air pollutants, and mortality were obtained in Jinan, China, from 2011 to 2017. A generalized additive model (GAM) and a distributed lag non-linear model (DLNM) were employed to assess the nonlinearity and the hysteresis of associations. We further explored the breakpoints to evaluate the existence of the threshold. The correlation between mortality and PM2.5 was nonlinear. The impact of average PM2.5 on non-accidental mortality (RR = 1.11; 95% CI = 1.06, 1.16), cardiovascular disease (CVD) mortality (RR = 1.17; 95% CI = 1.10, 1.24), and respiratory disease (RD) mortality (RR = 1.17; 95% CI = 1.10, 1.24) reached the highest in the current day (lag 0). The excess risks of PM2.5 at secondary standard level to non-accidental, CVD, and RD mortality are 8.79% (95% CI = 3.84, 13.98), 14.41% (95% CI = 7.79, 21.43), 15.35% (95% CI = 1.76, 30.74), respectively. The saturation points exist in highly polluted areas. Above the saturation points of 247 μg/m3 for non-accidental mortality, 245 μg/m3 for CVD mortality, and 250 μg/m3 for RD mortality, the model of all three relationships presented a harvesting effect. This study underscores the necessity of the ongoing efforts of reducing particulate air pollution and the adjustment of the standards in seriously polluted areas to adapt to regional conditions. At the same time, for highly polluted areas, it is advocated to strengthen personal protection to decrease the saturation point and control the concentration of pollutants as much as possible, which will substantially save more cost that benefits the public.
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Affiliation(s)
- Runze Ye
- Department of Epidemiology, School of Public Health, Shandong University, No. 44 Wenhuaxi Road, Jinan, 250012, People's Republic of China
| | - Liangliang Cui
- Department of Environmental Health, Jinan Municipal Center for Disease Control and Prevention, No. 2 Weiliu Road, Jinan, 250012, People's Republic of China
| | - Xiumiao Peng
- Department of Environmental Health, Jinan Municipal Center for Disease Control and Prevention, No. 2 Weiliu Road, Jinan, 250012, People's Republic of China
| | - Kunkun Yu
- Department of Environmental Health, Jinan Municipal Center for Disease Control and Prevention, No. 2 Weiliu Road, Jinan, 250012, People's Republic of China
| | - Fang Cheng
- Department of Epidemiology, School of Public Health, Shandong University, No. 44 Wenhuaxi Road, Jinan, 250012, People's Republic of China
| | - Yakun Zhu
- Department of Epidemiology, School of Public Health, Shandong University, No. 44 Wenhuaxi Road, Jinan, 250012, People's Republic of China
| | - Chongqi Jia
- Department of Epidemiology, School of Public Health, Shandong University, No. 44 Wenhuaxi Road, Jinan, 250012, People's Republic of China.
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Pennington AF, Sircar K, Hsu J, Zahran HS, Damon SA, Mirabelli MC. Communication channels for air quality alerts in the United States. Prev Med Rep 2019; 14:100860. [PMID: 30989035 PMCID: PMC6449704 DOI: 10.1016/j.pmedr.2019.100860] [Citation(s) in RCA: 5] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/04/2019] [Accepted: 03/28/2019] [Indexed: 12/18/2022] Open
Abstract
Short-term exposure to air pollution can result in acute health effects, particularly for individuals with respiratory and cardiovascular disease. Air quality alert programs that notify the public about high air pollution days are critical for susceptible populations. We assessed how U.S. adults receive air quality alerts and whether it varies by demographic or health characteristics. We analyzed data from the summer 2014 wave of ConsumerStyles, a nationally representative survey of U.S. adults (n = 4269). We calculated the weighted proportion of individuals who received air quality alerts from seven communication channels, combining all individuals and stratifying by demographics. To assess whether the reach of communication channels varied by respiratory and cardiovascular disease status, we computed weighted prevalence ratios adjusted for sex, age, race, and education. Forty-eight percent of U.S. adults had heard about air quality alerts. Within every demographic category, television was the most common communication channel (76% among individuals aware of air quality alerts). Other common communication modes were radio (30%), newspaper (24%), and internet (20%). Less common communication modes were friend or family member, mobile phone or device app, and electronic highway sign. The reach of communication channels varied by demographic factors, such as age, but not by respiratory or cardiovascular disease status. Television is the most common communication channel for receiving air quality alerts. Expanding use of other communication channels might increase awareness of air quality alerts. These results can help decision-makers target communication channels that reach susceptible populations and will achieve the greatest impact.
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Affiliation(s)
- Audrey F. Pennington
- Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop V-24, Atlanta, GA 30333, USA
- Asthma and Community Health Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Highway, Mailstop F-60, Atlanta, GA 30341, USA
| | - Kanta Sircar
- Asthma and Community Health Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Highway, Mailstop F-60, Atlanta, GA 30341, USA
| | - Joy Hsu
- Asthma and Community Health Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Highway, Mailstop F-60, Atlanta, GA 30341, USA
| | - Hatice S. Zahran
- Asthma and Community Health Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Highway, Mailstop F-60, Atlanta, GA 30341, USA
| | - Scott A. Damon
- Asthma and Community Health Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Highway, Mailstop F-60, Atlanta, GA 30341, USA
| | - Maria C. Mirabelli
- Asthma and Community Health Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Highway, Mailstop F-60, Atlanta, GA 30341, USA
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Li X, Sun Y, An Y, Wang R, Lin H, Liu M, Li S, Ma M, Xiao C. Air pollution during the winter period and respiratory tract microbial imbalance in a healthy young population in Northeastern China. Environ Pollut 2019; 246:972-979. [PMID: 31126003 DOI: 10.1016/j.envpol.2018.12.083] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 12/26/2018] [Accepted: 12/27/2018] [Indexed: 05/03/2023]
Abstract
In order to investigate the relationship between air pollution and the respiratory tract microbiota, 114 healthy volunteers aged 18-21 years were selected during the winter heating period in Northeast China; 35 from a lightly polluted region (group A), 40 from a moderately polluted region (group B) and 39 from a heavily polluted region (group C). Microbial genome DNA was extracted from throat swab samples to study the oral flora composition of the volunteers by amplifying and sequencing the V3 regions of prokaryotic 16S rRNA. Lung function tests were also performed. The relative abundance of Bacteroidetes and Fusobacteria were significantly lower and Firmicutes Proteonacteria and Actinobacteria higher in participants from polluted regions. Within bacteria classes, Bacterioida abundance was lower and Clostridia abundance higher in polluted areas, which was also reflected in the order of abundance. In samples from region C, the abundance of Prevotellaceae, Veillonellaceae, Porphyromonadaceae, Fusobacteriaceae Paraprevollaceae and Flavobacteriaceae were lowest among the 3 regions studied, whereas the abundance of Lachnospiraceae and Ruminococcaceae were the highest. From group A to group C, the relative class abundances of Prevotella, Veillonella, Fusobacterium, Camphylobacter and Capnocytophaga Porphyromonas, Peptostreptococcus and Moraxella became lower in polluted areas. Pulmonary function correlated with air pollution and the oropharyngeal microbiota differed within regions of high, medium and low air pollution. Thus, during the winter heating period in Northeast China, the imbalance of the oropharyngeal microbiota might be caused by air pollution and is likely associated with impairment of lung function in young people.
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Affiliation(s)
- Xinming Li
- Key Laboratory of Environmental Pollution and Microecology of Liaoning Province, Shenyang Medical College, No.146, North Huanghe Street, Yuhong District, Shenyang, Liaoning, 110034, China
| | - Ye Sun
- Key Laboratory of Environmental Pollution and Microecology of Liaoning Province, Shenyang Medical College, No.146, North Huanghe Street, Yuhong District, Shenyang, Liaoning, 110034, China
| | - Yunhe An
- Department of Biotechnology, Beijing Center for Physical and Chemical Analysis, No. 27, West Sanhuan North Road, Haidian District, Beijing, 100089, China
| | - Ran Wang
- Department of Respiratory Medicine, Central Hospital affiliated to Shenyang Medical College, No. 5 South Seven West Road, Tiexi District, Shenyang, Liaoning, 110024, China
| | - Hong Lin
- Department of Environmental Forecasting, Shenyang Environmental Monitoring Center, No.98 Quanyun Third Road, Hunnan District, Shenyang, 110000, China
| | - Min Liu
- Department of Environmental Forecasting, Shenyang Environmental Monitoring Center, No.98 Quanyun Third Road, Hunnan District, Shenyang, 110000, China
| | - Shuyin Li
- Key Laboratory of Environmental Pollution and Microecology of Liaoning Province, Shenyang Medical College, No.146, North Huanghe Street, Yuhong District, Shenyang, Liaoning, 110034, China
| | - Mingyue Ma
- Key Laboratory of Environmental Pollution and Microecology of Liaoning Province, Shenyang Medical College, No.146, North Huanghe Street, Yuhong District, Shenyang, Liaoning, 110034, China
| | - Chunling Xiao
- Key Laboratory of Environmental Pollution and Microecology of Liaoning Province, Shenyang Medical College, No.146, North Huanghe Street, Yuhong District, Shenyang, Liaoning, 110034, China.
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Klassing HM, Ruisinger JF, Prohaska ES, Melton BL. Evaluation of Pharmacist-Initiated Interventions on Vaccination Rates in Patients with Asthma or COPD. J Community Health 2019; 43:297-303. [PMID: 28852915 DOI: 10.1007/s10900-017-0421-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To determine if pharmacy-initiated interventions improved the rate of influenza and pneumococcal vaccinations in adult patients with asthma and/or chronic obstructive pulmonary disease (COPD). Adult patients who filled prescriptions at one of three community pharmacies, who had a dispensing history indicative of an asthma and/or COPD diagnosis were randomized to receive a personal phone call or standardized mailed letter recommending influenza and pneumococcal vaccinations, or control with no vaccination information. The rate of influenza and pneumococcal vaccinations was measured for each group and measured using Chi square. Of 831 eligible participants, 210 patients completed the study, and self-reported a diagnosis of asthma and/or COPD. The influenza vaccine was administered to 56 (72.7%), 55 (87.3%), and 62 (88.6%) patients (p = 0.019); pneumococcal vaccine was administered to 46 (59.7%), 39 (61.9%), and 39 (55.7%) patients in the phone call, letter, and control groups, respectively. While the control group had significantly more influenza vaccinations, between the interventions the letter showed a higher rate of influenza vaccination over the phone call. Reviewing patients under age 65, the letter had a significantly higher rate of influenza vaccination than the phone call (p = 0.021). No significant improvement was found for the pneumococcal vaccination. Patients under age 65 who received a mailed letter had a significantly higher rate of influenza vaccination than those who received a phone call, and had a higher rate of pneumococcal vaccination. A standardized, mailed letter may help community pharmacists improve vaccination rates in patients with asthma and/or COPD.
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Affiliation(s)
| | | | - Emily S Prohaska
- Balls Food Stores Hen House Pharmacy, Olathe, KS, USA
- Adjunct Faculty, University of Kansas School of Pharmacy, Lawrence, KS, USA
| | - Brittany L Melton
- University of Kansas School of Pharmacy, Lawrence, KS, USA.
- University of Kansas Medical Center, 3901 Rainbow Blvd, Mailstop 4047, Kansas City, KS, USA.
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Zhang XX, Wang J, Xiao Y, Ma LJ. [Analysis of long-term effect of juvenile-onset recurrent respiratory papillomatosis]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2018; 53:825-829. [PMID: 30453401 DOI: 10.3760/cma.j.issn.1673-0860.2018.11.006] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To observe the clinical course of children with juvenile-onset recurrent respiratory papillomatosis (JORRP) until 14 years old. Methods: The clinical data of one hundred and twenty cases treated between Januray 1, 2002 and September 30, 2017 in Beijing Tongren Hospital were analyzed retrospectively. Excluding the deaths and the lost, patients who could be ≥ 5 years without recurrence, were defined as the cured group, and < 5 years with recurrence defined as the recurrent group. Furthermore, using statistical methods to analyze the differences of the age of initial operation, total number of operations, invasive lesion, HPV infection, tracheotomy, airway dissemination after tracheotomy and time of tube wear between the two groups. Results: One hundred and three cases were followed up, except for the six deaths.Numbers of operations in eight cases were ≤2, and ≥3 in eighty nine cases.Peak of the primary surgical age were about 4.5 years old, while the self-healing trend occurred at nine years old. In the cured group, forty three cases were cured, with a curative rate of 41.7% (43/103), and there were all fifty four survivors in the recurrent group.The total number of operations, invasive cases, HPV positive cases and the G score of hoarseness in the recurrent group were higher than those in the cured group (F=13.02, χ(2)=13.04, χ(2)=17.37, Z=-4.59, P<0.05). The number of tracheal dissemination caused by tracheotomy in the recurrent group (66.7%, 27.8%)was more than that in the cured group (χ(2)=16.01, P<0.05). Compared with the time of wearing a tracheostomy tube in cured group, the recurrent group was longer ((3.4±3.1) years vs (8.3±6.7) years, χ(2)=7.19, P<0.05). Conclusions: 41.7% of the patients had no relapse for at least five years.There exsisted differences between the cured and recurrent group in the following aspects: the total numbers of surgery, the agression of the lesions, tracheal intratracheal dissemination after tracheotomy, the time of tracheotomy, the HPV typing and the G grading of hoarseness.
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Affiliation(s)
- X X Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - J Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Y Xiao
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - L J Ma
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
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Park JY, Park SY, Haam S, Jung J, Koh YW. Pulmonary Nodular Lymphoid Hyperplasia in a 33-Year-Old Woman. Korean J Thorac Cardiovasc Surg 2018; 51:133-137. [PMID: 29662812 PMCID: PMC5894578 DOI: 10.5090/kjtcs.2018.51.2.133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 11/14/2017] [Accepted: 11/14/2017] [Indexed: 11/16/2022]
Abstract
Pulmonary nodular lymphoid hyperplasia is a reactive lymphoproliferative disease. It is very rare, which means that many aspects of the disease are unknown or have not been proven. Pulmonary nodular lymphoid hyperplasia can be symptomatic or asymptomatic, progressive or not, and solitary or multiple, and a surgical approach is the current treatment of choice. We present a case of pulmonary nodular lymphoid hyperplasia that was visualized as multiple ground glass opacities on a computed tomography (CT) scan, and observed for 1 year because the patient was pregnant. Over this period, the number and extent of the opacities progressed, but no symptoms were reported. A surgical biopsy was done and some remaining lesions regressed on follow-up CT scans, while others progressed, without any appearance of symptoms.
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Affiliation(s)
- Ji Ye Park
- Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine
| | - Seong Yong Park
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine
| | - Seokjin Haam
- Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine
| | - Joonho Jung
- Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine
| | - Young Wha Koh
- Department of Pathology, Ajou University School of Medicine
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Barnes SR, Wansaula Z, Herrick K, Oren E, Ernst K, Olsen SJ, Casal MG. Mortality estimates among adult patients with severe acute respiratory infections from two sentinel hospitals in southern Arizona, United States, 2010-2014. BMC Infect Dis 2018; 18:78. [PMID: 29433471 PMCID: PMC5809880 DOI: 10.1186/s12879-018-2984-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 01/31/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND From October 2010 through February 2016, Arizona conducted surveillance for severe acute respiratory infections (SARI) among adults hospitalized in the Arizona-Mexico border region. There are few accurate mortality estimates in SARI patients, particularly in adults ≥ 65 years old. The purpose of this study was to generate mortality estimates among SARI patients that include deaths occurring shortly after hospital discharge and identify risk factors for mortality. METHODS Patients admitted to two sentinel hospitals between 2010 and 2014 who met the SARI case definition were enrolled. Demographic data were used to link SARI patients to Arizona death certificates. Mortality within 30 days after the date of admission was calculated and risk factors were identified using logistic regression models. RESULTS Among 258 SARI patients, 47% were females, 51% were white, non-Hispanic and 39% were Hispanic. The median age was 63 years (range, 19 to 97 years) and 80% had one or more pre-existing health condition; 9% died in hospital. Mortality increased to 12% (30/258, 30% increase) when electronic vital records and a 30-day post-hospitalization time frame were used. Being age ≥ 65 years (OR = 4.0; 95% CI: 1.6-9.9) and having an intensive care unit admission (OR = 7.4; 95% CI: 3.0-17.9) were independently associated with mortality. CONCLUSION The use of electronic vital records increased SARI-associated mortality estimates by 30%. These findings may help guide prevention and treatment measures, particularly in high-risk persons in this highly fluid border population.
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Affiliation(s)
- Steve R. Barnes
- Arizona Department of Health Services, Border Infectious Disease Surveillance Program, 400 West Congress, Suite 116, Tucson, AZ 85701 USA
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave, Tucson, AZ 85724 USA
| | - Zimy Wansaula
- Arizona Department of Health Services, Border Infectious Disease Surveillance Program, 400 West Congress, Suite 116, Tucson, AZ 85701 USA
| | - Kristen Herrick
- Arizona Department of Health Services, Office of Infectious Disease Services, 150 N 18th Ave Phoenix, Phoenix, AZ 85007 USA
| | - Eyal Oren
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave, Tucson, AZ 85724 USA
| | - Kacey Ernst
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave, Tucson, AZ 85724 USA
| | - Sonja J. Olsen
- Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329-4027 USA
| | - Mariana G. Casal
- Arizona Department of Health Services, Border Infectious Disease Surveillance Program, 400 West Congress, Suite 116, Tucson, AZ 85701 USA
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Abstract
How can health systems make good use of digital medicine? For healthcare infrastructure, the answer is population measurement, monitoring people to compute status for clustering cohorts. In chronic care, most effective is measuring all the time, to track health status as it gradually changes. Passive monitors run in the background, without additional tasks to activate monitors, especially on mobile phones. At its core, a health system is a "sorting problem". Each patient entering the system must be effectively sorted into treatment cohorts. Health systems have three primary problems: Case Finding (which persons have which diagnoses), Risk Stratification (which persons are which status), and Care Routing (which persons need which treatments). The issue is then which measures can be continuously monitored at appropriate periodicity. The solutions of population measurement measure vital signs with passive monitors. These are input to predictive analytics to detect clinical values for providing care within health systems. For chronic care, complex vitals must be measured for overall status, such as oxygen saturation or gait speed. This enables healthcare infrastructure to support stratification, with persons placed into current levels of health status. Practical considerations for health systems influence implementation of new infrastructure. Case finding is more likely to be useful in urban settings, with barriers to entry based upon lower incomes. Care routing is more likely to be useful in rural settings, with barriers to entry based upon isolated geographies. Viable healthcare at acceptable quality and affordable cost is now possible for the range of geographies and incomes.
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Affiliation(s)
- Bruce R Schatz
- Department of Medical Information Science, Carl R. Woese Institute for Genomic Biology, University of Illinois, Urbana, IL 61801 USA
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