ORCID Profile
0000-0002-8976-8053
Current Organisations
Australian Institute of Company Directors
,
Australasian Faculty of Public Health Medicine
,
Ingham Institute
,
Woolcock Institute of Medical Research
,
UNSW Sydney
,
University of Sydney
,
Royal College of Physicians
,
University of New South Wales
,
Liverpool Hospital
,
Royal Australasian College of Physicians
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Publications
Correction: Completion of Treatment for Latent Tuberculosis Infection with Monthly Drug Dispensation Directly through the Tuberculosis Clinic
Publisher: Public Library of Science (PLoS)
Date: 09-12-2013
DOI: 10.1371/ANNOTATION/4498FD07-ACAE-49BB-ABF2-D2E914A249D0
Traffic-related air pollution exposure is associated with allergic sensitization, asthma, and poor lung function in middle age
Publisher: Elsevier BV
Date: 2017
DOI: 10.1016/J.JACI.2016.05.008
Abstract: Traffic-related air pollution (TRAP) exposure is associated with allergic airway diseases and reduced lung function in children, but evidence concerning adults, especially in low-pollution settings, is scarce and inconsistent. We sought to determine whether exposure to TRAP in middle age is associated with allergic sensitization, current asthma, and reduced lung function in adults, and whether these associations are modified by variants in Glutathione S-Transferase genes. The study s le comprised the proband 2002 laboratory study of the Tasmanian Longitudinal Health Study. Mean annual residential nitrogen dioxide (NO Increased mean annual NO Even relatively low TRAP exposures confer an increased risk of adverse respiratory and allergic outcomes in genetically susceptible in iduals.
Contact Tracing of Tuberculosis: A Systematic Review of Transmission Modelling Studies
Publisher: Public Library of Science (PLoS)
Date: 04-09-2013
Tobacco control
Publisher: International Union Against Tuberculosis and Lung Disease
Date: 03-2020
A multinational Delphi consensus to end the COVID-19 public health threat
Publisher: Springer Science and Business Media LLC
Date: 03-11-2022
DOI: 10.1038/S41586-022-05398-2
Abstract: Despite notable scientific and medical advances, broader political, socioeconomic and behavioural factors continue to undercut the response to the COVID-19 pandemic 1,2 . Here we convened, as part of this Delphi study, a erse, multidisciplinary panel of 386 academic, health, non-governmental organization, government and other experts in COVID-19 response from 112 countries and territories to recommend specific actions to end this persistent global threat to public health. The panel developed a set of 41 consensus statements and 57 recommendations to governments, health systems, industry and other key stakeholders across six domains: communication health systems vaccination prevention treatment and care and inequities. In the wake of nearly three years of fragmented global and national responses, it is instructive to note that three of the highest-ranked recommendations call for the adoption of whole-of-society and whole-of-government approaches 1 , while maintaining proven prevention measures using a vaccines-plus approach 2 that employs a range of public health and financial support measures to complement vaccination. Other recommendations with at least 99% combined agreement advise governments and other stakeholders to improve communication, rebuild public trust and engage communities 3 in the management of pandemic responses. The findings of the study, which have been further endorsed by 184 organizations globally, include points of unanimous agreement, as well as six recommendations with % disagreement, that provide health and social policy actions to address inadequacies in the pandemic response and help to bring this public health threat to an end.
Predictive markers of asthma exacerbation during stepwise dose reduction of inhaled corticosteroids.
Publisher: American Thoracic Society
Date: 02-2001
DOI: 10.1164/AJRCCM.163.2.9912091
Abstract: To determine predictors for failed reduction of inhaled corticosteroids (ICS), in 50 subjects with well-controlled asthma (age 43.7 [18-69] 22 males) taking a median dose of 1,000 microg ICS/d (100-3,600 microg/d), ICS were halved every 8 wk. Airway hyperresponsiveness (AHR) to a bronchial provocation test (BPT) with histamine was measured at baseline. AHR to BPT with mannitol, spirometry, exhaled nitric oxide (eNO), and, in 31 subjects, sputum inflammatory cells were measured at baseline and at monthly intervals. Thirty-nine subjects suffered an asthma exacerbation. Seven subjects were successfully weaned off ICS. Using a Kaplan- Meier survival analysis, the significant predictors of a failure of ICS reduction were being hyperresponsive to both histamine and mannitol at baseline (p = 0.039), and being hyperresponsive to mannitol during the dose-reduction phase of the study (p = 0.02). Subjects older than 40 yr of age tended to be at greater risk of ICS reduction failure (p = 0.059). Response to mannitol and percentage sputum eosinophils were significantly greater before a failed ICS reduction than before the last successful ICS reduction, whereas there were no significant differences in symptoms, spirometry, or eNO. These findings suggest that documentation of patient's AHR or sputum eosinophils may be useful in guiding the reduction of ICS doses.
Experimentally determined deposition of ambient urban ultrafine particles in the respiratory tract of children
Publisher: Elsevier BV
Date: 12-2020
Ultrafine particles from traffic emissions and children’s health (UPTECH) in Brisbane, Queensland (Australia): Study design and implementation
Publisher: MDPI AG
Date: 02-02-2015
Presence and timing of cat ownership by age 18 and the effect on atopy and asthma at age 28
Publisher: Elsevier BV
Date: 03-2004
Does a Patient-Directed Financial Incentive Affect Patient Choices About Controller Medicines for Asthma? A Discrete Choice Experiment and Financial Impact Analysis
Publisher: Springer Science and Business Media LLC
Date: 27-10-2019
DOI: 10.1007/S40273-018-0731-5
Abstract: In Australia, many patients who are initiated on asthma controller inhalers receive combination inhaled corticosteroid/long-acting beta We conducted a discrete choice experiment (DCE) in a nationally representative s le of adults (n = 792) and parents of children (n = 609) with asthma. Mixed multinomial models were estimated and calibrated to reflect the estimated market shares of ICS-alone, ICS/LABA and no controller. We then simulated the impact of varying patient co-payment on demand and the financial impact on government pharmaceutical expenditure. Preference for inhaler decreased with increasing costs to the patient or government, increasing chance of a repeat visit to the doctor, and if fewer symptoms were present. Adults preferred high-strength controllers, but parents preferred low-strength inhalers for children (general beneficiaries only). The DCE predicted a higher proportion choosing controller treatment (89%) compared to current levels (57%) at the current co-payment level, with proportionately higher uptake of ICS-alone and a lower average cost per patient [32.73 Australian dollars (AU$) c.f. AU$38.54]. Reducing the co-payment on ICS-alone by 50% would increase its market share to 50%, whilst completely removing the co-payment would only have a small marginal impact on market share, but increased average cost of treatment to the government to AU$41.04 per person. Patient-directed financial incentives are unlikely to encourage much switching of medicines, and current levels of under-treatment are not explained by patient preferences. Interventions directed at prescribers are more likely to promote better use of asthma medicines.
Impact of obstructive sleep apnoea on post‐operative outcomes
Publisher: Wiley
Date: 10-2018
DOI: 10.1111/JSR.45_12765
Dairy consumption and diet quality in a sample of australian children
Publisher: Informa UK Limited
Date: 06-2012
DOI: 10.1080/07315724.2012.10720026
Abstract: To examine the association between intake of dairy products and indicators of diet quality among a s le of Australian children. Three 24-hour recalls were collected from 222 children aged 8-10 years living in western Sydney. Analysis of covariance was used to examine differences in mean intakes of foods and nutrients among 3 dairy consumption groups (<1 serve, 1-2 serves, ≥2 serves per day). The percentage of children meeting healthy eating guidelines for foods and estimated average requirements (EAR) for nutrients was also assessed. Higher dairy consumption was associated with higher intakes of energy, protein, calcium, phosphorus, magnesium, potassium, zinc, vitamin A, riboflavin, and niacin as well as foods from the bread and cereal group but lower intakes of mono- and polyunsaturated fats, foods from the meat and alternatives group, and energy-dense, nutrient-poor foods. Children who consumed ≥2 serves of dairy products per day (38%) were more likely to meet food and nutrient recommendations. Body mass index z-score and waist circumference were not associated with dairy consumption. Milk intake was inversely associated with the intake of sugar-sweetened beverages, and children who did not meet their minimum dairy serve recommendations consumed higher quantities of sugar-sweetened beverages than milk. Adequate dairy consumption was associated with diets of higher nutritional quality but also higher intakes of energy, suggesting a potential benefit from shifting consumption from regular-fat to reduced-fat dairy products in line with current national recommendations.
The cost-effectiveness of azithromycin in reducing exacerbations in uncontrolled asthma
Publisher: European Respiratory Society (ERS)
Date: 02-10-2021
DOI: 10.1183/13993003.02436-2020
Abstract: Add-on azithromycin (AZM) results in a significant reduction in exacerbations among adults with persistent uncontrolled asthma. The aim of this study was to assess the cost-effectiveness of add-on AZM in terms of healthcare and societal costs. The AMAZES trial randomly assigned 420 participants to AZM or placebo. Healthcare use and asthma exacerbations were measured during the treatment period. Healthcare use included all prescribed medicine and healthcare contacts. Costs of antimicrobial resistance (AMR) were estimated based on overall consumption and published estimates of costs. The value of an avoided exacerbation was based on published references. Differences in cost between the two groups were related to differences in exacerbations in a series of net monetary benefit estimates. Societal costs included lost productivity, over the counter medicines, steroid induced morbidity and AMR costs. Add-on AZM resulted in a reduction in healthcare costs (mean (95% CI)) including nights in hospital (AUD 433.70 (AUD 48.59–818.81) or EUR 260.22 (EUR 29.15–491.29)), unplanned healthcare visits (AUD 20.25 (AUD 5.23–35.27) or EUR 12.15 (EUR 3.14–21.16)), antibiotic costs (AUD 14.88 (AUD 7.55–22.21) or EUR 8.93 (EUR 4.53–13.33)) and oral corticosteroid costs (AUD 4.73 (AUD 0.82–8.64) or EUR 2.84 (EUR 0.49–5.18)) all p .05. Overall healthcare and societal costs were lower (AUD 77.30 (EUR 46.38) and AUD 256.22 (EUR 153.73) respectively) albeit not statistically significant. The net monetary benefit of add-on AZM was estimated to be AUD 2072.30 (95% CI AUD 1348.55–2805.23) or (EUR 1243.38 (EUR 809.13–1683.14) assuming a willingness to pay per exacerbation avoided of AUD 2651 (EUR 1590.60). Irrespective of the sensitivity analysis applied, the net monetary benefit for total, moderate and severe exacerbations remained positive and significant. Add-on AZM therapy in poorly controlled asthma was a cost-effective therapy. Costs associated with AMR did not influence estimated cost-effectiveness.
Identification of treatable traits in a severe asthma registry: prevalence and exacerbation predictors
Publisher: European Respiratory Society
Date: 15-09-2018
Assessing the performance of two lung age equations on the Australian population: using data from the cross-sectional BOLD-Australia study
Publisher: Oxford University Press (OUP)
Date: 18-08-2014
DOI: 10.1093/NTR/NTU123
Abstract: Lung age, a simple concept for patients to grasp, is frequently used as an aid in smoking cessation programs. Lung age equations should be continuously updated and should be made relevant for target populations. We observed how new lung age equations developed for Australian populations performed when utilizing the Burden of Obstructive Lung Disease (BOLD)-Australia dataset compared to more commonly used equations. Data from a cross-sectional population study of noninstitutionalized Australians aged ≥40 years with analysis restricted to Caucasians <75 years. Lung age calculated using equations developed by Newbury et al. and Morris and Temple was compared with chronological age by smoking status and within smoking status. There were 2,793 participants with a mean age of 57 (±10 SD) years. More than half (52%) ever smoked, and 10.4% were current smokers. Prevalence of chronic obstructive pulmonary disease stage I or higher was 13.4% (95% confidence interval = 12.2, 14.7). For both genders, newer Newbury equations estimated lung ages significantly higher than actual age across all smoking groups (p < .05). Morris and Temple equations resulted in lung age estimates significantly lower than chronological age for nonsmokers (p < .05) but no difference among current smokers. Both equations showed exposure to smoking had lung ages higher than never-smokers (p < .001). Lung age also increased with increased pack-years. This supports the use of updated equations suited to the population of interest. The Australian Newbury equations performed well in the BOLD-Australia dataset, providing more meaningful lung age profile compared to chronological age among smokers. Using equations not developed or ideally suited for our population is likely to produce misleading results.
Worldwide trends in the burden of asthma symptoms in school-aged children: Global Asthma Network Phase I cross-sectional study
Publisher: Elsevier BV
Date: 10-2021
Domestic control of house dust mite allergen in children’s beds
Publisher: Elsevier BV
Date: 06-2000
Abstract: House dust mite allergen levels in humid coastal regions of Australia are high, particularly in beds. Because high allergen levels in beds are associated with more severe asthma, reduction of levels may be important for asthma control. We tested the effectiveness of an acaricidal treatment of bedding in combination with occlusive mattress and pillow encasings in reducing allergen levels in children's beds in a community setting. A total of 14 beds of children were selected for the active intervention. In each home the bed of a sibling of nearest age was selected as the control. Dust was vacuumed from beds by using a standard protocol, and Der p 1 levels were measured by using ELISA. Adjacent settling dust was collected by using opened Petri dishes. The intervention consisted of encasing mattresses and pillows in occlusive covers and washing all bedding with Acaril, an acaricidal additive. The acaricidal wash was repeated twice in 7 households at 2-month intervals. Control beds were not treated. The mean Der p 1 concentration at baseline was 27.9 microg/g in the active beds and 18.1 microg/g in the control beds. At 4 days after intervention, Der p 1 decreased to 3.2 microg/g and 15.7 microg/g in active and control beds, respectively. The average difference (active minus control) over the first 8-week cycle was 78.5% (P <.0001), and the difference over 3 washing cycles was 125.1% (P <.05). The mean rate of settling Der p 1 adjacent to the actively treated beds decreased from 24.4 ng.m(-2).d(-1) at baseline to 10.0 ng.m(-2).d(-1) after intervention (P <.01). A substantial reduction in Der p 1 levels in beds and in airborne dust in a humid region with naturally high house dust mite allergen levels can be achieved and sustained in a community setting with use of occlusive covers and a rigorous washing routine.
World Asthma Day, 5 May 2015
Publisher: International Union Against Tuberculosis and Lung Disease
Date: 05-2015
General practitioners' views on the influence of cost on the prescribing of asthma preventer medicines: A qualitative study
Publisher: CSIRO Publishing
Date: 2019
DOI: 10.1071/AH17030
Abstract: Objective Out-of-pocket costs strongly affect patient adherence with medicines. For asthma, guidelines recommend that most patients should be prescribed regular low-dose inhaled corticosteroids (ICS) alone, but in Australia most are prescribed combination ICS–long-acting β2-agonists (LABA), which cost more to patients and government. The present qualitative study among general practitioners (GPs) explored the acceptability, and likely effect on prescribing, of lower patient copayments for ICS alone. Methods Semistructured telephone interviews were conducted with 15 GPs from the greater Sydney area the interviews were transcribed and thematically analysed. Results GPs reported that their main criteria for selecting medicines were appropriateness and effectiveness. They did not usually discuss costs with patients, had low awareness of out-of-pocket costs and considered that these were seldom prohibitive for asthma patients. GPs strongly believed that patient care should not be compromised to reduce cost to government. They favoured ICS–LABA combinations over ICS alone because they perceived that ICS–LABA combinations enhanced adherence and reduced costs for patients. GPs did not consider that lower patient copayments for ICS alone would affect their prescribing. Conclusion The results suggest that financial incentives, such as lower patient copayments, would be unlikely to encourage GPs to preferentially prescribe ICS alone, unless accompanied by other strategies, including evidence for clinical effectiveness. GPs should be encouraged to discuss cost barriers to treatment with patients when considering treatment choices. What is known about the topic? Australian guidelines recommend that most patients with asthma should be treated with low-dose ICS alone to minimise symptom burden and risk of flare ups. However, most patients in Australian general practice are instead prescribed combination ICS–LABA preventers, which are indicated if asthma remains uncontrolled despite treatment with ICS alone. It is not known whether GPs are aware that the combination preventers have a higher patient copayment and a higher cost to government. What does this paper add? This qualitative study found that GPs favoured combination ICS–LABA inhalers over ICS alone because they perceived ICS–LABA combinations to have greater effectiveness and promote patient adherence. This aligned with GPs’ views that their primary responsibility was patient care rather than generating cost savings for government. However, it emerged that GPs rarely discussed medicine costs with patients, had low knowledge of medicine costs to patients and the health system and reported that patients rarely volunteered cost concerns. GPs believed that lower patient copayments for asthma preventer medicines would have little effect on their prescribing practices. What are the implications for practitioners? This study suggests that, when considering asthma treatment choices, GPs should empathically explore with the patient whether cost-related medication underuse is an issue, and should be aware of the option of lower out-of-pocket costs with guideline-recommended ICS alone treatment. Policy makers must be aware that differential patient copayments for ICS preventer medicines are unlikely to act as an incentive for GPs to preferentially prescribe ICS alone preventers, unless the position of these preventers in guidelines and evidence for their clinical effectiveness are also reiterated.
Treating sleep apnoea is cost effective
Publisher: BMJ
Date: 2002
Meteorological conditions, climate change, new emerging factors, and asthma and related allergic disorders. A statement of the World Allergy Organization
Publisher: Elsevier BV
Date: 2015
Towards Optimum Reporting of Pulmonary Effectiveness Databases and Outcomes (TORPEDO): identifying a core dataset for asthma and COPD studies
Publisher: Cold Spring Harbor Laboratory
Date: 22-10-2021
DOI: 10.1101/2021.10.14.21264843
Abstract: There remains a need for a standardized dataset for respiratory studies to accelerate data collection, improve research efficiency and aid the sharing, merging and comparison of datasets. This TORPEDO (Towards Optimum Reporting of Pulmonary Effectiveness Databases and Outcomes) project aimed to develop a checklist of optimum and minimum variables for asthma and chronic obstructive pulmonary disease (COPD) research. A 3-phase modified Delphi survey was conducted: in phase 1, an expert panel generated a list of variables, in phase 2 a Delphi panel selected the minimum variables ( % agreement) for any design and in phase 3 they were asked to select a minimum set for specific study designs. In phase 1 the expert panel (n=22) proposed 224 variables. In phase 2, voting by 64 participants resulted in consensus ( % agreement) for 18 variables and partial agreement (50-66%) for 44 variables, following this, 5 technical variables (e.g. date of test) were removed. In phase 3, 34 members of the Delphi panel completed voting consensus was reached for 13 variables for retrospective asthma studies and 34 for prospective asthma studies. For COPD, there were 16 variables for retrospective studies and 37 for prospective studies. Gender, asthma/COPD exacerbations and patient-reported outcomes were the only variables with 100% agreement for both asthma and COPD studies. The proposed list of minimally required variables will allow the assessment of current data sources for their utility in asthma and COPD studies, facilitate the merging of datasets, aid standardization of data collection and improve research efficiency.
Continuing the debate about measuring asthma in population studies
Publisher: BMJ
Date: 05-2001
Abstract: The reasons for measuring atopy and airway hyperresponsiveness (AHR) and the methods of validating measurements of asthma in population studies continue to be debated. The debate has centred around standards against which to validate asthma measurements but the absence of a "gold standard" makes the criterion validation of measurements difficult. Questionnaires will always be useful but cannot be validated against a doctor diagnosis because of self-selection and recall biases. In practice, measurements should be selected on the merits of what they measure rather than being regarded as validated or non-validated alternatives. The measurement of AHR is invaluable because it is reliable, not influenced by variations in symptom perception or diagnostic trends, and is closely related to the underlying mechanisms of asthma. The value of AHR lies in its high specificity (rate of true negatives) and low sensitivity (rate of false positives) against asthma symptoms which gives additional information about symptomatic subjects. Atopy is also a useful test and, in quantifying its association with asthma, we should not place any currency on ecological evidence. Atopy is a strong risk factor for asthma in the presence of regionally specific allergens and ecological analyses that ignore these effects are ersionary rather than productive. For preventing asthma, we need to identify the group at greatest risk of developing it, measure the risk factors with precision, and develop interventions that are effective in changing environmental exposures and homogeneous outcomes. This is the only approach that has the potential to lead to significant public health benefits.
Comparison of model estimates from an intra-city land use regression model with a national satellite-LUR and a regional Bayesian Maximum Entropy model, in estimating NO2 for a birth cohort in Sydney,
Publisher: Elsevier BV
Date: 07-2019
DOI: 10.1016/J.ENVRES.2019.03.068
Abstract: Methods for estimating air pollutant exposures for epidemiological studies are becoming more complex in an effort to minimise exposure error and its associated bias. While land use regression (LUR) modelling is now an established method, there has been little comparison between LUR and other recent, more complex estimation methods. Our aim was to develop a LUR model to estimate intra-city exposures to nitrogen dioxide (NO Satellite-based LUR and BME estimates were obtained using existing models. We used methods consistent with the European Study of Cohorts for Air Pollution Effects (ESCAPE) methodology to develop LUR models for NO The NO Our LUR models explained a high degree of spatial variability in annual mean NO
Asthma in the global NCD agenda: a neglected epidemic
Publisher: Elsevier BV
Date: 04-2013
Atopy in people aged 40 years and over: Relation to airflow limitation
Publisher: Wiley
Date: 02-11-2017
DOI: 10.1111/CEA.13038
Abstract: Previous studies have reached conflicting conclusions about the role of atopy as a risk factor for COPD. In part, this is attributable to variation in the definitions of airflow limitation and the treatment of people with asthma. To establish whether there is any independent association between atopy and post-bronchodilator airflow limitation in the general population aged 40 years and over. A cross-sectional survey was conducted in a general population s le of 2415 people aged 40 years and over in Australia. A history of ever being diagnosed with asthma was elicited by questionnaire. Atopy was defined as any skin prick test weal to common aeroallergens ≥4 mm. Airflow limitation was defined as post-bronchodilator spirometric (FEV The prevalence of atopy, ever diagnosed asthma and post-bronchodilator airflow obstruction was 44.8%, 19.3% and 7.5%, respectively. In the population as a whole, atopy was associated with lower FEV₁ (adjusted difference -0.068L, 95% confidence interval (CI) -0.104 to -0.032), FVC (adj. difference -0.043L, 95% CI -0.086 to -0.0009) and post-bronchodilator FEV₁/FVC ratio (adj. difference -0.011, 95% CI -0.017 to -0.0055). The effect of atopy on lung function was no longer apparent when participants who reported ever diagnosed asthma were excluded (FEV₁ -0.011L, [95% CI -0.05 to 0.028L], FVC -0.012L [95% CI -0.060 to 0.036] and FEV₁/FVC ratio -0.0012 [95% CI -0.0072 to 0.0047L]). The apparent association between atopy and post-bronchodilator airflow limitation in the general population appears to be explained by the association between atopy and having ever diagnosed asthma and the effect of asthma on lung function.
Household contact investigation for the detection of tuberculosis in Vietnam: economic evaluation of a cluster-randomised trial
Publisher: Elsevier BV
Date: 03-2019
The role of the Journal in fulfilling The Union's mission and pursuing its vision [Editorial]
Publisher: International Union Against Tuberculosis and Lung Disease
Date: 2012
Ambient temperature and lung function in children with asthma in Australia
Publisher: European Respiratory Society (ERS)
Date: 05-12-2013
DOI: 10.1183/09031936.00079313
Abstract: The association between ambient temperature and lung function in children with asthma is still uncertain. A panel of 270 children (aged 7-12 years) with asthma was recruited from six Australian cities. They performed three successive forced expiratory manoeuvres twice daily for 4 weeks. The highest peak expiratory flow rate (PEF) and forced expiratory volume in 1 s (FEV1) were stored for each session. During the same period, data were obtained daily on ambient temperature, relative humidity and air pollution. Mixed models were used to examine the effects of temperature on lung function, controlling for in idual characteristics and environmental factors. Ambient temperature was negatively related to both morning and evening PEF and FEV1 for 0-3 days lag. In general, the effects of temperature were stronger in males than in females for evening PEF, while the effects were stronger in females for evening FEV1. Children with asthma living in southern cities were more sensitive to high temperature than those in the northernmost city. Higher ambient temperature is associated with lower lung function in children with asthma. Preventive health policies will be required to protect children with asthma from increasingly frequent high temperatures.
Snoring is not associated with adverse effects on blood pressure, arterial structure or function in 8-year-old children: The Childhood Asthma Prevention Study (CAPS)
Publisher: Wiley
Date: 29-04-2011
DOI: 10.1111/J.1440-1754.2011.02014.X
Abstract: To study the association between childhood snoring and cardiovascular risk factors. Cross-sectional analyses of a population-based birth cohort, who had been participants in a randomised controlled trial of interventions to prevent asthma and who were assessed at age 8 years. The presence and frequency of snoring were assessed by parent-completed questionnaire. We measured a wide range of cardiovascular function markers including non-fasting serum lipoproteins, blood pressure, high-sensitivity C-reactive protein, carotid artery intima media thickness (by ultrasound), brachial pulse wave velocity and augmentation index (by applanation tonometry). Of 409 children whose snoring status was assessed at age 8 years, 321 had lipid and 386 had arterial structure and function measurements. Snoring was not independently associated with blood pressure, carotid artery intima media thickness or measures of arterial stiffness (all P > 0.05). Increasing snoring frequency was independently associated with lower high-density lipoprotein cholesterol (-0.032 g/dL per step, 95% confidence interval -0.060 to -0.003), although the difference in high-density lipoprotein between snorers and non-snorers was not significant (P = 0.052). An association of snoring frequency with brachial pulse wave velocity differed according to body mass index (P = 0.03) and was the reverse of that expected. Parentally reported snoring was not independently associated with adverse measurements of metabolic markers, vascular structure or function in 8-year-old children. Parental reports of snoring may be below the treatment threshold without additional diagnosis via sleep studies.
Childhood fish oil supplementation modifies associations between traffic related air pollution and allergic sensitisation
Publisher: Springer Science and Business Media LLC
Date: 27-03-2018
Adhesive tapes as capturing surfaces in Burkard sampling
Publisher: Informa UK Limited
Date: 1998
Asthma in older adults
Publisher: Elsevier BV
Date: 09-2010
Particle sizes of talc for pleurodesis available in Australia
Publisher: Wiley
Date: 04-2010
CHARACTERISING SMOKING BEHAVIOUR AMONG ADULT PATIENTS PRESENTING TO HEALTH FACILITIES IN FOUR PROVINCES OF VIETNAM
Publisher: Wiley
Date: 11-2019
Severity of Airflow Obstruction in Chronic Obstructive Pulmonary Disease (COPD): Proposal for a New Classification
Publisher: Informa UK Limited
Date: 11-08-2017
DOI: 10.1080/15412555.2017.1339681
Abstract: Current classifications of Chronic Obstructive Pulmonary Disease (COPD) severity are complex and do not grade levels of obstruction. Obstruction is a simpler construct and independent of ethnicity. We constructed an index of obstruction severity based on the FEV
Sero-Prevalence of SARS-CoV-2 in High-Risk Populations in Vietnam
Publisher: Elsevier BV
Date: 2021
DOI: 10.2139/SSRN.3781699
Early and late childhood telomere length predict subclinical atherosclerosis at age 14 yrs. – The CardioCAPS study
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.IJCARD.2018.12.065
Abstract: Carotid Intima Media Thickness (CIMT) is a marker of subclinical atherosclerosis, associated with cardiovascular risk in adults. Telomere length (TL) is a marker of cellular ageing. We sought to determine whether telomere length in early childhood and/or at 14-years is associated with CIMT in adolescence, in a community-based cohort study. 118 children had TL measured at mean age 3.6-years and 165 children had TL and CIMT, measured at 14-years, from the community-based Childhood Asthma Prevention Study. TL in early childhood was significantly inversely associated with CIMT at 14 years, p = 0.04. TL in teenage life was also significantly inversely associated with CIMT at 14 years, p = 0.03. This latter association was no longer significant, however, after adjusting for early life TL. TL measured in early childhood and adolescence is significantly associated with CIMT at 14-years, suggesting that telomere length is a biological marker or even early determinant of late cardiovascular risk.
Guiding policy to reduce the burden of COPD: the role of epidemiological research
Publisher: BMJ
Date: 14-02-2018
Risk Factors for Tuberculosis (TB) Among Household Contacts of Patients With Smear-Positive TB in 8 Provinces of Vietnam: A Nested Case-Control Study
Publisher: Oxford University Press (OUP)
Date: 30-07-2020
DOI: 10.1093/CID/CIAA1742
Abstract: Tuberculosis (TB) continues to account for significant morbidity and mortality annually. Household contacts (HHCs) of persons with TB are a key population for targeting prevention and control interventions. We aimed to identify risk factors associated with developing TB among HHCs. We conducted a nested case-control study among HHCs in 8 provinces in Vietnam enrolled in a randomized controlled trial of active case finding for TB. Cases were any HHCs diagnosed and registered with TB within the Vietnam National TB Program during 2 years of follow-up. Controls were selected by simple random s ling from the remaining HHCs. Risk factor data were collected at enrollment and during follow-up. A logistic regression model was developed to determine predictors of TB among HHCs. We selected 1254 HHCs for the analysis: 214 cases and 1040 controls. Underlying characteristics varied between both groups cases were older, more likely to be male, with a higher proportion of reported previous TB and diabetes. Risk factors associated with a TB diagnosis included being male (adjusted odds ratio [aOR], 1.4 95% confidence interval [CI], 1.03–2.0), residing in an urban setting (aOR, 1.8 1.3–2.5), prior TB (aOR, 4.6 2.5–8.7), history of diabetes (aOR, 3.1 1.7–5.8), current smoking (aOR, 3.1 2.2–4.4), and prolonged history of coughing in the index case at enrollment (OR , 1.6 1.1–2.3). Household contacts remain an important key population for TB prevention and control. TB programs should ensure effective contact investigations are implemented for household contacts, particularly those with additional risk factors for developing TB.
Asthma in older adults: a holistic, person‐centred and problem‐oriented approach
Publisher: Wiley
Date: 08-2009
DOI: 10.5694/J.1326-5377.2009.TB02751.X
Abstract: Regardless of how obstructive lung disease is labelled, targeting treatment to components of the problem is the best solution.
Questionnaire Items That Predict Asthma and Other Respiratory Conditions in Adults
Publisher: Elsevier BV
Date: 11-1998
Abstract: The International Union Against Tuberculosis and Lung Disease questionnaire is widely used in epidemiologic studies of adult asthma. We examined whether the symptom questions could be classified into groups that represent different "syndromes," and whether some questions are better for predicting asthma than others. We analyzed questionnaire data from a population s le of 1,527 adults aged 18 to 55 years using factor analyses to classify the 17 respiratory symptom questions into four different groups that we termed asthma, cough, breathlessness, and urgent medical visit. The urgent medical visit was a subset of asthma. These four "syndromes" had good validity when measured against airway responsiveness to histamine, atopy to common allergens, lung function, smoking status, and body mass index. Questions that predicted asthma syndrome were those that asked about wheeze at rest or following exercise, asthma attack, chest tightness, and shortness of breath at rest. Questions about cough identified a different group of subjects who apparently did not have asthma. Questions of breathlessness did not aggregate with "asthma" or with "cough syndrome." The identification of particular questions that measure different respiratory conditions is important for epidemiologic studies when short questionnaires or more precise definitions are required.
Systematic review and meta-analysis investigating breast feeding and childhood wheezing illness
Publisher: Wiley
Date: 25-08-2011
Rare variant analysis in eczema identifies exonic variants in DUSP1, NOTCH4 and SLC9A4
Publisher: Springer Science and Business Media LLC
Date: 16-11-2021
DOI: 10.1038/S41467-021-26783-X
Abstract: Previous genome-wide association studies revealed multiple common variants involved in eczema but the role of rare variants remains to be elucidated. Here, we investigate the role of rare variants in eczema susceptibility. We meta-analyze 21 study populations including 20,016 eczema cases and 380,433 controls. Rare variants are imputed with high accuracy using large population-based reference panels. We identify rare exonic variants in DUSP1 , NOTCH4 , and SLC9A4 to be associated with eczema. In DUSP1 and NOTCH4 missense variants are predicted to impact conserved functional domains. In addition, five novel common variants at SATB1-AS1 / KCNH8 , TRIB1 / LINC00861 , ZBTB1 , TBX21 / OSBPL7 , and CSF2RB are discovered. While genes prioritized based on rare variants are significantly up-regulated in the skin, common variants point to immune cell function. Over 20% of the single nucleotide variant-based heritability is attributable to rare and low-frequency variants. The identified rare/low-frequency variants located in functional protein domains point to promising targets for novel therapeutic approaches to eczema.
Risk of tuberculosis among people with diabetes mellitus
Publisher: BMJ
Date: 2012
Lessons Learned from the Australian Bushfires
Publisher: American Medical Association (AMA)
Date: 05-2020
Working while unwell: Workplace impairment in people with severe asthma
Publisher: Wiley
Date: 17-05-2018
DOI: 10.1111/CEA.13153
Abstract: Severe asthma affects quality of life however, its impact on workplace productivity is poorly understood. To compare workplace productivity-absenteeism and presenteeism-and impairment in daily activities in severe and non-severe asthma over time and identify characteristics associated with presenteeism in severe asthma. The Severe Asthma Web-based Database is an ongoing observational registry from Australia, New Zealand and Singapore. At April 2017, 434 patients with severe asthma and 102 with non-severe asthma were enrolled (18-88 years 59% female). Participants provided comprehensive clinical and questionnaire data at baseline and were followed-up every 6 months for 24 months. Absenteeism (percentage of time not at work), presenteeism (self-reported impairment at work) and impairment in daily activities outside work due to health problems in the last week were calculated. At baseline, 61.4% of participants with severe asthma and 66.2% with non-severe asthma under 65 years were employed. At younger ages (30-50 years), fewer severe asthma participants were employed (69% vs 100%). Presenteeism and impairment in daily activity were more frequently reported in severe asthma and in participants with poorer asthma control, poorer lung function and more past-year exacerbations (P < .01). Over time, deteriorating asthma control was associated with increasing presenteeism. Although absenteeism was not different between severe and non-severe asthma, worse asthma control was associated with absenteeism (P < .001). In participants with severe asthma, presenteeism was reported more frequently in those with poorer asthma control, poorer asthma-related quality of life and symptoms of depression or anxiety (P < .01). Severe asthma was associated with impairment at work and outside the workplace. Improving asthma control and mental health may be important targets for optimizing workplace productivity in severe asthma. Presenteeism and absenteeism may represent key metrics for assessing intervention efficacy in people with severe asthma of working age.
Incidence of Tuberculosis among a Cohort of Tuberculin-Positive Refugees in Australia
Publisher: American Thoracic Society
Date: 11-2000
DOI: 10.1164/AJRCCM.162.5.2004154
Abstract: Estimates of the lifetime risk of tuberculosis have varied widely and may not be applicable in all current settings. The aim of this study was to measure the incidence of reactivation of latent tuberculosis in a cohort of 15,489 predominantly Southeast Asian refugees aged 12 yr and over who arrived in Sydney, Australia during the period 1984 to 1994 and who had a clear chest X-ray on arrival. Tuberculin skin test (TST) reaction size and the presence of a BCG scar were recorded at entry. Incident cases of tuberculosis, occurring before June 1998, were identified by record linkage analysis with confirmatory review of case notes. There were 122 cases of tuberculosis over an average 10.3 yr of follow-up (crude annual incidence, 76.2/100,000). There was a linear increase in risk with increasing TST reaction size above 10 mm. The risk, and the relation of risk to TST reaction size, were unrelated to BCG scar status. Among those whose initial TST reaction was >/= 15 mm, the annual incidence rate in the first 3 yr was 213 (95% CI, 150 to 300) per 100,000 person-years and in the subsequent 10 yr the rate averaged 122 (95% CI, 90 to 165) per 100,000 person-years. The observed rates are similar to those estimated in the general population of the United States in the 1950s and 1960s. Further data on the prognosis of tuberculosis and the effects of isoniazid preventive therapy in Southeast Asian migrants to Western countries are required to inform policy and practice for the prevention of tuberculosis in this population.
Diagnosing acute myocardial infarction
Publisher: Wiley
Date: 08-1992
DOI: 10.1111/J.1445-5994.1992.TB02156.X
Abstract: Microgram quantities of bovine serum albumin (BSA) and hen egg albumin (OA) associate spontaneously with living BCG in aqueous suspension. The association is stable insofar as bound protein cannot be readily dissociated from the organism by repeated washing. Association of BSA or OA is dependent upon the concentration of specific protein or competing protein in the incubation mixture, pH and the amount of protein already bound to the organisms. Washed BCG "complexes" containing either BSA or OA are potent inducers of delayed-type hypersensitivity (DTH). The same soluble proteins are far less effective inducers of DTH, even when injected with BCG. The capacity of OA-BCG complexes to provoke a cell-mediated response seems to be related, at least in part, to "stabilization" of the antigen on an appropriate carrier and its concentration at the site of BCG injection.
Pregnancy and birth outcomes in families with asthma.
Publisher: Informa UK Limited
Date: 2003
Abstract: Studies of maternal asthma in pregnancy have shown an increased risk of adverse neonatal and maternal outcomes such as preecl sia, hypertension, cesarean delivery, prematurity, low birth weight, and perinatal/neonatal mortality. However, results are not consistent between studies. We studied the association between maternal asthma and various adverse neonatal and maternal outcomes and explored whether there is any evidence that pregnancy exacerbates maternal asthma. The data were collected as part of the Childhood Asthma Prevention Study. Pregnant women with asthma or women whose partners or other children had current symptoms of asthma were recruited at six Sydney hospitals. All women recruited were post 36 weeks gestation and were living within 30 km of the study recruitment center. Information about family history of asthma was collected using a questionnaire at 36 weeks gestation and subsequent information about antenatal and perinatal events was obtained from hospital records. Data from 611 pregnant women were available for analysis, 340 of whom had asthma. Hypertension was significantly more common in asthmatics than in nonasthmatics [OR = 2.16 (1.02-4.6), p < 0.043]. The prevalence of gestational diabetes, labor complications, delivery complications, and adverse neonatal outcomes did not differ significantly between the groups. We also found that the course of maternal asthma usually remains unchanged during pregnancy, but that more severe asthma is likely to get worse. We have confirmed previous observations that women with asthma are at increased risk of hypertension in pregnancy, which is consistent with studies that show that pregnant asthmatic women have a slightly increased risk of preecl sia. However, we did not find evidence of an increased risk of adverse perinatal outcomes.
Prehospital management of exacerbations of asthma: Relation to patient and disease characteristics
Publisher: Wiley
Date: 03-2000
DOI: 10.1046/J.1440-1843.2000.00225.X
Abstract: Admission to hospital due to an exacerbation of asthma may represent a failure of prehospital management to prevent an attack or bring about its remission. We aim to describe the steps taken prior to hospital attendance in patients with asthma and to identify patient or disease characteristics that were associated with failure to take appropriate actions. Patients aged over 15 years who were discharged from hospital or the Emergency Department with a primary diagnosis of asthma completed a questionnaire about the impact of asthma and its management prior to the onset of the recent exacerbation. The impact of asthma on quality of life was measured using our Asthma Quality of Life Questionnaire (AQLQ). Seventy-eight subjects completed the questionnaire including 49 who had been inpatients and 29 who had been discharged from the Emergency Department. They included many subjects with severe asthma: 41% had nocturnal symptoms three or more times per week and 41% had been admitted to hospital with asthma in the 12 months prior to this episode. Their AQLQ scores were high (severe) (mean 4.5+/-2.2). Most subjects described their presenting exacerbation as slow in onset and moderate or severe in intensity. During this exacerbation and prior to hospital attendance, only 27% of subjects had measured their peak expiratory flow rate, 19% had commenced or increased the dose of inhaled steroids, and 22% had commenced oral steroids. These actions were not related to the self-perceived speed of onset of the attack. Patients with lower levels of asthma-related concerns for health and more severe mood disturbance associated with asthma were less likely to take these appropriate self-management steps. This study shows that the failure of prehospital management to prevent the necessity of hospital attendance in most cases stems from a failure to implement currently recommended actions or treatments for exacerbations. Addressing this problem should result in a reduction in rates of hospitalization for asthma.
COVID-19 hospital admissions and deaths after BNT162b2 and ChAdOx1 nCoV-19 vaccinations in 2·57 million people in Scotland (EAVE II): a prospective cohort study
Publisher: Elsevier BV
Date: 12-2021
Folic Acid Supplementation of Female Mice, with or without Vitamin B-12, before and during Pregnancy and Lactation Programs Adiposity and Vascular Health in Adult Male Offspring
Publisher: Elsevier BV
Date: 04-2016
Abstract: The developmental origins of health and disease theory suggest that disturbances in the fetal and early postnatal environment contribute to chronic adulthood diseases, such as type 2 diabetes and cardiovascular disease. Greater adiposity and insulin resistance have been reported in children of women with high erythrocyte folate but poor vitamin B-12 status during pregnancy. The mechanisms underlying this relation are not known. The objective of this study was to investigate the effects of maternal supplemental folic acid, with or without vitamin B-12, on adiposity, glucose homeostasis, and vascular health in adult male offspring mice. Female C57BL/6J mice were fed a control diet (M-CON, 2 mg folic acid/kg, 50 μg vitamin B-12/kg) or a folic acid-supplemented diet with [10 mg folic acid/kg, 50 μg vitamin B-12/kg (SFA+B12)] or without [10 mg folic acid/kg, no vitamin B-12 (SFA-B12)] vitamin B-12 for 6 wk before mating and during pregnancy and lactation. The offspring were weaned onto a control diet (16% energy from fat) or a western diet (45% energy from fat) until 23 wk of age. The effects of maternal diet on adiposity, vascular function, and glucose tolerance were assessed in 6 groups of adult male offspring: control diet-fed M-CON, SFA+B12, and SFA-B12 and western diet-fed M-CON, SFA+B12, and SFA-B12. Control and western diet-fed SFA-B12 and SFA+B12 offspring had smaller visceral and subcutaneous adipose tissue than M-CON offspring (P < 0.05). Control SFA-B12 and SFA+B12 offspring had lower serum total adiponectin and vitamin B-12 concentrations and lower NADPH oxidase 2 expression in aorta compared with M-CON offspring (P < 0.05). These effects were not observed in western diet-fed offspring. Folic acid supplementation of female mice before and during pregnancy and lactation, with or without dietary vitamin B-12, affects adult male offspring adiposity, vascular function, and one-carbon metabolism in those fed a control diet but not a western diet.
A Comparison of the Health Effects of Ambient Particulate Matter Air Pollution from Five Emission Sources
Publisher: MDPI AG
Date: 08-06-2018
Hospital readmissions for asthma: a feasibility study comparing strategies for linking hospital morbidity data
Publisher: Elsevier BV
Date: 10-2006
DOI: 10.1111/J.1467-842X.2006.TB00459.X
Abstract: To investigate whether the variables in the National Hospital Morbidity Database (NHMD) provide sufficient information to validly link hospital admission records for the same person so that persons admitted and re-admissions for a specified disease can be enumerated. Records of hospital admissions where asthma was the principal diagnosis were extracted from the New South Wales Inpatient Statistics Collection for the period July 2000 to June 2003 and linked using several strategies. The optimal' strategy applied probabilistic record linkage, using many demographic and administrative variables. A range of restricted strategies, using only those variables that were available with the NHMD (sex, date of birth, and either postcode or statistical local area of residence) and linking them deterministically, were evaluated and their validity for quantifying readmission for asthma within 28 days was assessed relative to the optimal strategy. The optimal and restricted linkage strategies obtained similar estimates of readmissions. Approximately 95% of readmissions within 28 days identified using the optimal strategy were also identified using the restricted strategies. Linking hospital records where asthma was the principal diagnosis using only those variables available in the NHMD enabled reliable identification of hospital readmissions tor asthma. This methodology may have useful applications for monitoring the rate of readmissions for asthma and other chronic diseases nationally.
Willingness to receive vaccination against COVID-19: results from a large nationally representative Australian population survey
Publisher: Cold Spring Harbor Laboratory
Date: 25-07-2021
DOI: 10.1101/2021.07.22.21260551
Abstract: We surveyed 10,024 Australians regarding COVID-19 vaccine willingness. Overall, 59.9% indicated yes, 13.9% no and 26.3% unsure/don’t know. Vaccine willingness was higher in males, and increased with increasing education and socioeconomic advantage. Results contrast with earlier, smaller Australian surveys regarding vaccination willingness and confirm the need for targeted vaccination information.
LATE PRETERM INFANTS AND THERAPEUTIC HYPOTHERMIA
Publisher: Wiley
Date: 2012
Clustered randomised trial of an intervention to improve the management of asthma: Greenwich asthma study
Publisher: BMJ
Date: 08-05-1999
DOI: 10.1136/BMJ.318.7193.1251
Abstract: To evaluate the effectiveness of an asthma resource centre in improving treatment and quality of life for asthmatic patients. Community based randomised controlled trial. 41 general practices in Greenwich with a practice nurse. All registered patients aged 15-50 years. Nurse specialists in asthma who educated and supported practice nurses, who in turn educated patients in the management of asthma according to the British Thoracic Society's guidelines. Quality of life of asthmatic patients, attendance at accident and emergency departments, admissions to local hospitals, and steroid prescribing by general practitioners. Of 24 400 patients randomly selected and surveyed in 1993, 12 238 replied 1621 were asthmatic of whom 1291 were sent a repeat questionnaire in 1996 and 780 replied. Of 24 400 patients newly surveyed in 1996, 10 783 (1616 asthmatic) replied. No evidence was found for an improvement in asthma related quality of life among newly surveyed patients in intervention practices compared with control practices. Neither was there evidence of an improvement in other measures of the quality of asthma care. Weak evidence was found for an improvement in quality of life in intervention practices among asthmatics registered with study practices in 1993 and followed up in 1996. Neither attendances at accident and emergency departments nor admissions for asthma showed any tendency to erge in intervention and control practices over the study period. Steroid prescribing rates rose steadily during the study period. The average annual increase in steroid prescribing was 3% per year higher in intervention than control practices (95% confidence interval -1% to 6%, P=0.10). This model of service delivery is not effective in improving the outcome of asthma in the community. Further development is required if cost effective management of asthma is to be introduced.
Inhaled corticosteroid dosage in asthma [3] (multiple letters)
Publisher: BMJ
Date: 09-2002
Commentary: Geographical heterogeneity of asthma
Publisher: Oxford University Press (OUP)
Date: 02-2001
DOI: 10.1093/IJE/30.1.179
Early intervention for chronic obstructive pulmonary disease by practice nurse and GP teams: A cluster randomized trial
Publisher: Oxford University Press (OUP)
Date: 17-08-2016
Abstract: Early detection and intervention for chronic obstructive pulmonary disease (COPD) could potentially slow disease progress and minimize harm. To assess the effectiveness of early intervention by a practice nurse-GP team on quality of life (QoL) and process of care in patients with newly diagnosed COPD, compared with usual care. Nurses and GPs in intervention practices were educated to develop and implement disease management plans for COPD. A 12-month, multicentre, pragmatic randomized controlled trial with blinded outcome assessment was conducted. Participants were current and former smokers aged 40 to 85 years newly identified as having COPD on post-bronchodilator spirometry. The primary outcome was health-related QoL, assessed with the St George's Respiratory Questionnaire (SGRQ). Secondary outcome measures were other QoL measures, lung function, disease knowledge, smoking and immunization status, inhaler technique and health service use. Of the 10 234 patients from 36 practices in Sydney invited to a case-finding appointment, 1641 (16%) attended and 287 (18%) were diagnosed with COPD. Nineteen practices (144 patients) were randomized to the intervention group and 17 practices (110 patients) to the control group. Only 15.3% (n = 22) patients in the intervention group saw the nurse for COPD care following case finding. There was no between-group difference in SGRQ score at follow-up (mean difference -0.21 P = 0.86). Influenza vaccination was higher in the intervention group (OR 2.31: P = 0.035), but there were no other significant between-group differences in outcomes. Intervention uptake was low and had no additional beneficial effect, over usual care, on participants' health-related QoL.
Using NSW Health Survey data to monitor asthma prevalence and management in NSW
Publisher: The Sax Institute
Date: 2001
DOI: 10.1071/NB01072
Summarising published results from spirometric surveys of COPD: the problem of inconsistent definitions
Publisher: International Union Against Tuberculosis and Lung Disease
Date: 08-2014
Prevalence of asthma and allergy in schoolchildren in Belmont, Australia
Publisher: BMJ
Date: 12-02-2004
Airway responsiveness to hypertonic saline: dose-response slope or PD15?
Publisher: European Respiratory Society (ERS)
Date: 2005
DOI: 10.1183/09031936.04.00008004
Abstract: The result of airway challenge test with hypertonic saline (HS) is expressed as the dose causing a 15% fall in forced expiratory volume in one second (FEV1 PD15). A noncensored measure, such as the dose-response slope (DRS), allows the evaluation of the risk of asthma for subjects with a fall in FEV1 or =15%, and the DRS was calculated for all tests. Graphs were constructed to visualise relationships with current wheeze, blood eosinophils and serum ECP. Odds ratios and Spearman's correlation coefficients were calculated to quantify these relationships. Children with features of asthma had lower PD15 and higher DRS, and separation was most pronounced for DRS. Prevalence of current wheeze increased continuously over the entire range of DRS values. Blood eosinophils were significantly higher only for the highest values of DRS. In conclusion, the continuous relationship between airway responsiveness and asthma symptoms is in favour of a noncensored measure of airway responsiveness, such as the dose-response slope.
After asthma: redefining airways diseases
Publisher: Elsevier BV
Date: 2018
Prevalence and burden of breathlessness in Australian adults: The National Breathlessness Survey—a cross‐sectional web‐based population survey
Publisher: Wiley
Date: 10-05-2021
DOI: 10.1111/RESP.14070
Abstract: Chronic respiratory symptoms (in particular, breathlessness and cough) can cause physical, social and emotional distress, and may indicate the presence of an underlying disease that presages future poor health outcomes. Our aim was to investigate the burden of breathlessness in Australian adults, including breathlessness that may be undiagnosed, unlabelled or untreated. The National Breathlessness Survey was a cross‐sectional, web‐based survey conducted in October 2019. Australian adults were randomly selected from a large web‐based survey panel with recruitment stratified by age‐group, gender and state of residence according to national population data. The main outcome measures were modified Medical Research Council (mMRC) dyspnoea scale, EuroQol visual analog scale, Dyspnoea‐12 score and 4‐item Patient Health Questionnaire (PHQ‐4). Among all respondents ( n = 10,072 51.1% female median age group 40–49 years), 9.5% reported clinically important breathlessness (mMRC dyspnoea grade ≥ 2, 2 = ‘ I walk slower than people of the same age on the level because of breathlessness or have to stop for breath when walking at my own pace on the level ’). Among those with clinically important breathlessness, 49.1% rated their general health as fair or poor and 44.2% had at least moderate depression or anxiety symptoms (PHQ ≥ 6) but over half (50.8%) did not report a current respiratory or heart condition diagnosis. Breathlessness is common among Australian adults, and is associated with a substantial burden of ill health, including among people without a diagnosed respiratory or heart condition. The extent of underdiagnosis of these conditions or alternative causes of breathlessness requires further investigation.
Carotid extra-medial thickness in childhood: Early life effects on the arterial adventitia
Publisher: Elsevier BV
Date: 06-2012
DOI: 10.1016/J.ATHEROSCLEROSIS.2012.03.032
Abstract: Structural modification of the arterial adventitia may be an early event in atherosclerosis. Carotid extra-medial thickness is a new measure of arterial adventitial thickness. We examined the association of cardiovascular risk factors with extra-medial thickness, in childhood. Carotid extra-medial thickness was assessed by high-resolution ultrasound in 389 non-diabetic children aged 8-years. A non-fasting blood s le was collected from 314 participants. Associations of gender, age, lipoproteins, blood pressure, BMI z-score, waist:height ratio and parental history of early vascular disease, with extra-medial thickness were examined. Carotid extra-medial thickness was lower in girls (r=-.163, P=.001) and directly associated with systolic (r=.128, P=.009), diastolic blood pressure (r=.130, P=.009), and height (r=.170, P=.0006). These associations remained after adjustment for carotid intima-media thickness. In multivariable analysis including carotid intima-media thickness, only gender and height were significantly associated with carotid extra-medial thickness. In gender-stratified analysis, the strongest associations with extra-medial thickness were BMI z-score (r=.181, P=.01), height (r=.210, P=.003) and diastolic blood pressure (r=.167, P=.02) for boys and systolic blood pressure (r=.153, P=.03) and parental history of premature cardiovascular disease (r=.139, P=.05) for girls. The association of BMI z-score with extra-medial thickness differed by gender (P-interaction=.04). Carotid extra-medial thickness is independently associated with gender and height in childhood. Extra-medial thickness may provide important information concerning early arterial health, particularly related to the arterial adventitia.
Serial correlation and confounders in time‐series air pollution studies
Publisher: AMPCo
Date: 10-2002
Relationship between life-time exposure to ambient fine particulate matter and carotid artery intima-media thickness in Australian children aged 11–12 years
Publisher: Elsevier BV
Date: 12-2021
Causes of hypercapnic respiratory failure and associated in‐hospital mortality
Publisher: Wiley
Date: 09-10-2023
DOI: 10.1111/RESP.14388
Abstract: Hypercapnic respiratory failure (HRF) can occur due to severe respiratory disease but also because of multiple coexistent causes. There are few data on the prevalence of antecedent causes for HRF and the effect of these causes on prognosis, especially where study inclusion has not been biased with respect to primary diagnosis, interventions received or clinical outcome. We sought to determine the prevalence of pre‐specified conditions among patients with HRF and to determine the effect of these causes on in‐hospital mortality. Cross‐sectional study of patients with HRF from 2013 to 2017. Inclusion criteria were PaCO 2 mm Hg and pH ≤7.45. Causes of interest were identified using diagnosis codes from hospital records. We used directed acyclic graphs to inform logistic regression models for the outcome of in‐hospital death. We identified 873 persons with HRF in the study period. Mean (SD) age was 69 years and 50.4% were males. Acidosis (pH .35) was present in 488 (55%) cases. Most (83%) had one or more of the following: obstructive lung disease, lower respiratory tract infection, congestive cardiac failure, sleep disordered breathing, neuromuscular disease, opioid or benzodiazepine use. In‐hospital mortality was 12.8%. Obstructive lung disease and cardiac failure were associated with a lower risk of death, whereas respiratory tract infection and neuromuscular disease were associated with increased risk of death. HRF is associated with a range of potentially causative conditions, which significantly impact hospital survival. Systematic evaluation of patients with HRF may increase detection of treatable comorbidities.
Adherence to allergy prevention recommendations in children with a family history of asthma.
Publisher: Wiley
Date: 18-04-2008
DOI: 10.1111/J.1399-3038.2007.00645.X
Abstract: Allergen avoidance has been a major component of most programs for primary prevention of asthma and allergic diseases in childhood. As a part of the Childhood Asthma Prevention Study, families were provided with written and oral information on measures considered to be helpful in the primary prevention of allergic disease in high-risk infants. Dietary measures included advice to breastfeed for 6 months or longer, to delay the introduction of solid foods until after the infant turned 6 months of age, and to delay giving allergenic foods (egg and peanut butter) until after 12 months of age. In the active group of the randomized controlled trial aimed at reducing house dust mite (HDM) allergen levels, parents were advised to use an HDM-impermeable study mattress cover and an acaricide, to avoid sheep skins, and not to use a pillow before 12 months of age. Families received regular visits from the research nurses at 1, 3, 6, 9 and 12 months and phone calls every 6 wk. Only 43.4% of mothers were breastfeeding by 6 months and less than 20% by 12 months. The introduction of solid foods before 6 months was common, 26% by 3 months and 96% by 6 months. Adherence to infant-feeding recommendations was significantly greater in women over 30 yr of age, women who did not smoke during pregnancy, and women who had a tertiary education. Adherence to HDM reduction measures was greater than to those for infant feeding. The presence of symptoms in the form of an itchy rash by 4 wk did not significantly increase adherence. Complete adherence to infant-feeding recommendations in this intervention study of high-risk infants was low despite the provision of written information and reinforcement at home visits. In considering allergy prevention advice offered during clinical care, the likelihood of adherence is a factor which needs to be evaluated in assessing any potential benefits of allergy prevention regimens.
Erratum: Measuring progress and projecting attainment on the basis of past trends of the health-related Sustainable Development Goals in 188 countries: an analysis from the Global Burden of Disease Study 2016 (The Lancet (2017) 390(10100) (1423–1459) (S014067361732336X) (10.1016/S0140-6736(17)32336-X))
Publisher: Elsevier BV
Date: 10-2017
Ending tuberculosis by 2030-Pipe dream or reality?
Publisher: Elsevier BV
Date: 03-2020
Dietary supplementation with n-3 polyunsaturated fatty acids in early childhood
Publisher: Elsevier BV
Date: 08-2009
Abstract: n-3 Fatty acid supplementation in adults results in cardiovascular benefits. However, the cardiovascular effects of n-3 supplementation in early childhood are unknown. The objective was to evaluate blood pressure (BP) and arterial structure and function in 8-y-old children who had participated in a randomized controlled trial of dietary n-3 and n-6 modification over the first 5 y of life. The children (n = 616 49% girls) were randomly assigned antenatally to active (n = 312 increase in n-3 intake and decrease in n-6 intake) or control (n = 304) diet interventions implemented from the time of weaning or introduction of solids until 5 y of age. At age 8.0 +/- 0.1 y, BP, carotid intima-media thickness, carotid artery distensibility, augmentation index, and brachial pulse wave velocity were measured in 405 of these children. Venous blood was collected for measurement of plasma fatty acids, lipoproteins, high-sensitivity C-reactive protein, and asymmetric dimethylarginine. Plasma fatty acid concentrations were also assessed during the intervention. Plasma concentrations of n-3 fatty acids were higher and of n-6 were lower in the active than in the control diet group at 18 mo and 3 and 5 y (P < 0.0001). Concentrations of n-3 and n-6 fatty acids were similar at 8 y. At 8 y of age, no significant differences were found in BP, carotid intima-media thickness, carotid artery distensibility, augmentation index, asymmetric dimethylarginine, high-sensitivity C-reactive protein, or lipoproteins between diet groups. A dietary supplement intervention to increase n-3 and decrease n-6 intakes from infancy until 5 y does not result in significant improvements in arterial structure and function at age 8 y. This trial was registered at the Australian Clinical Trials Registry as ACTRN012605000042640.
A scale for the measurement of quality of life in adults with asthma
Publisher: Elsevier BV
Date: 05-1992
DOI: 10.1016/0895-4356(92)90095-5
Abstract: A 20-item self-administered questionnaire with Likert scale responses was developed to measure quality of life in adult subjects with asthma. A total scale score together with subscale scores for breathlessness, mood disturbance, social disruption and concerns for health were calculated by addition of item scores. Items for the scale were selected by principal components analysis of the responses of 283 subjects to a preliminary pool of 69 items. In 58 subjects with stable asthma, good short term test-retest reliability was demonstrated with the intraclass correlation coefficient for the total scale being 0.80. The questionnaire was internally consistent in a s le of outpatients (Cronbach's alpha 0.92 in 77 subjects) and in a community s le with asthma (Cronbach's alpha 0.94 in 87 subjects). Weak correlations in the expected direction were seen with three medical markers of asthma severity. This supports the construct validity of the questionnaire and emphasizes that quality of life represents a separate dimension of asthma.
Household-contact investigation for detection of tuberculosis in Vietnam
Publisher: Massachusetts Medical Society
Date: 18-01-2018
POST‐TREATMENT MORTALITY AMONG PATIENTS TREATED FOR TUBERCULOSIS IN VIETNAM
Publisher: Wiley
Date: 11-2017
Case-finding options for COPD: results from the Burden of Obstructive Lung Disease Study
Publisher: European Respiratory Society (ERS)
Date: 27-06-2012
Chronic respiratory disease: the forgotten NCD?
Publisher: International Union Against Tuberculosis and Lung Disease
Date: 11-2014
The pesticide health risk index - An application to the world's countries
Publisher: Elsevier BV
Date: 12-2021
Health outcomes of continuous positive airway pressure versus oral appliance treatment for obstructive sleep apnea: A randomized controlled trial
Publisher: American Thoracic Society
Date: 15-04-2013
Liquid versus solid energy intake in relation to body composition among Australian children
Publisher: Wiley
Date: 18-02-2014
DOI: 10.1111/JHN.12223
Abstract: The debate about whether energy consumed in liquid form is more obesogenic than energy consumed in solid form remains equivocal. We aimed to evaluate the effects of liquid versus solid energy intake and different beverage types on changes in childhood adiposity. Our analyses included 8-year-old Australian children (n = 158) participating in the Childhood Asthma Prevention Study. Dietary information was collected using three 24-h recalls at age 9 years. Multivariate linear regression was used to evaluate the effects of liquid versus solid energy intake and different beverage types on changes in body mass index (BMI) Z-score from ages 8 to 11.5 years (△BMIz(8-11.5y)) and percentage body fat (%BF) at age 11.5 years (%BF(11.5y)). Substitution models were used to evaluate the effects of substituting other beverage types for sugar-sweetened beverages (SSB). Liquid energy intake (1 MJ day(-1)) was more closely associated with both △BMIz(8-11.5y) (β = 0.23, P = 0.02) and %BF(11.5y) (β = 2.31%, P = 0.01) than solid energy intake (△BMIz(8-11.5y): β = 0.12, P = 0.01 and %BF(11.5y): β = 0.80%, P = 0.07). SSB consumption (100 g day(-1)) was directly associated with △BMIz(8-11.5y) (β = 0.08, P = 0.02) and %BF(11.5y) (β = 0.92%, P = 0.004),whereas diet drinks (100 g day(-1) ) were inversely associated with △BMIz(8-11.5y) (β = 0.18, P = 0.02). Substitution of 100 g of SSB by 100 g of water or diet drink, but not other beverages, was inversely associated with both △BMIz(8-11.5y) and %BF(11.5y) (P < 0.01). Our findings indicate that liquid energy is more obesogenic than solid energy. In particular, SSB, but not other beverage types, are a significant predictor of childhood adiposity and replacing SSB with water can have long-term beneficial effects on childhood adiposity.
Inappropriate prescribing of inhaled corticosteroids: are they being prescribed for respiratory tract infections? A retrospective cohort study
Publisher: Springer Science and Business Media LLC
Date: 25-04-2013
Indices of bronchial reactivity and sensitivity
Publisher: BMJ
Date: 27-10-2011
Predictors of treatment outcomes among patients with multidrug-resistant tuberculosis in Vietnam: a retrospective cohort study
Publisher: Springer Science and Business Media LLC
Date: 20-01-1919
DOI: 10.1186/S12879-021-06992-X
Abstract: Improving treatment outcomes for multidrug-resistant tuberculosis (MDR-TB) is a leading priority for global TB control. This retrospective cohort study evaluated the factors associated with treatment success among patients treated for MDR-TB in two provinces in Vietnam. Treatment outcomes were evaluated for adult patients treated in Hanoi and Thanh Hoa provinces between 2014 and 2016. The primary outcome was the proportion of patients with treatment success, defined as cure or treatment completion. Logistic regression analysis was used to evaluate the relationship between patient clinical and microbiological characteristics and treatment success. Treatment outcomes were reported in 612 of 662 patients of these, 401 (65.5)% were successfully treated. The odds of treatment success were lower for male patients (aOR 0.56, 95% CI 0.34–0.90), for people living with HIV (aOR 0.44, 95% CI 0.20–1.00), and for patients treated for extensive antibiotic resistance (pre-XDR-/XDT-TB) (aOR 0.53, 95% CI 0.29–0.97), compared with others. Patients who achieved culture conversion in the first 4 months of treatment had increased odds (aOR 2.93, 95% CI 1.33–6.45) of treatment success. In addition, loss to follow-up was less common among patients covered by social health insurance compared to those who paid for treatment out-of-pocket (aOR 0.55, 95% CI 0.32–0.95). Among patients with MDR-TB, males, people living with HIV, and those with more extensive antibiotic resistance at diagnosis are at greatest risk of an unsuccessful treatment outcome. Efforts to optimise the management of co-morbidities (such as HIV), ensure rapid bacteriological conversion, and provide financial support for patients promise to improve treatment outcomes.
Contact investigation for tuberculosis: A systematic review and meta-analysis
Publisher: European Respiratory Society (ERS)
Date: 30-08-2013
Allergens and occlusive bedding covers
Publisher: Elsevier BV
Date: 07-1993
Liquid Iron Wetting of Calcium Aluminates
Publisher: Iron and Steel Institute of Japan
Date: 2010
Community-wide Screening for Tuberculosis
Publisher: Massachusetts Medical Society
Date: 19-03-2020
DOI: 10.1056/NEJMC1916666
Associations between long-term exposure to ambient air pollution and Parkinson's disease prevalence: A cross-sectional study
Publisher: Elsevier BV
Date: 02-2020
DOI: 10.1016/J.NEUINT.2019.104615
Abstract: Epidemiological studies have reported contradictory results regarding the effects of ambient air pollution on Parkinson's disease (PD). This study investigated the associations between long-term exposure to particulate matter <2.5 μm in diameter (PM We conducted a cross-sectional analysis of long-term exposure to PM Among the 236,390 participants with complete data, 1,428 (0.6%) reported physician-diagnosed PD. Annual mean PM Overall, we found limited evidence of associations between long-term exposure to NO
Lung health in LMICs: tackling challenges ahead – Authors' reply
Publisher: Elsevier BV
Date: 08-2021
Effectiveness of First Dose of COVID-19 Vaccines Against Hospital Admissions in Scotland: National Prospective Cohort Study of 5.4 Million People
Publisher: Elsevier BV
Date: 2021
DOI: 10.2139/SSRN.3789264
The effect of insecticide aerosols on lung function, airway responsiveness and symptoms in asthmatic subjects
Publisher: European Respiratory Society (ERS)
Date: 07-2000
DOI: 10.1034/J.1399-3003.2000.16A07.X
Abstract: The object of this study was to compare the effect of standard and "low irritant" insecticide aerosols on lung function, airway hyperresponsiveness (AHR) and symptoms in asthmatic subjects. A double blind randomized, crossover study was conducted in 25 asthmatic subjects who reported sensitivity to insecticide aerosols. All subjects were exposed for 30 min, on separate occasions, to two standard insecticide formulations (A and B), one low irritant formulation (C) and a negative control aerosol. Spirometric function and chest, nose and eye symptoms were recorded during, and for 90 min after, the exposure. AHR to methacholine was measured 90 min after the exposure. Compared to the negative control, the maximum fall in forced expiratory volume in one second (FEV1) was slightly greater after standard insecticides (mean differences from control +/-95% confidence interval: aerosol A, 3.3+/-3.6%, p=0.08 aerosol B, 5.1+/-4.7%, p=0.04), AHR was significantly more severe (mean difference from control: aerosol A, 0.35+/-0.29 doubling doses, p=0.028 aerosol B, 0.52+/-0.43 doubling doses, p=0.028), and symptoms were more severe. The low irritant test aerosol (C) did not differ significantly from the negative control with respect to FEV1, AHR or symptoms. It is concluded that some insecticide aerosols trigger symptoms and falls in lung function in some people with asthma. Furthermore, these aerosols may also increase airway hyperresponsiveness, although the mechanism of this effect has not been determined. The low irritant formulation did not appear to have the same effects.
Effect of azithromycin on asthma exacerbations and quality of life in adults with persistent uncontrolled asthma (AMAZES): a randomised, double-blind, placebo-controlled trial
Publisher: Elsevier BV
Date: 08-2017
Identifying asthma in population studies: from single entity to a multi-component approach
Publisher: European Respiratory Society (ERS)
Date: 07-2005
Community-wide Screening for Tuberculosis in a High-Prevalence Setting
Publisher: Massachusetts Medical Society
Date: 03-10-2019
Treatment of mild asthma
Publisher: Elsevier BV
Date: 03-1997
DOI: 10.1016/S0140-6736(05)61745-X
Abstract: Splenic cysts are infrequent and most of them are related to parasitic diseases. Splenic epithelial cyst (SEC) is the most common type of primary non-parasitic splenic cysts. Its pathogenesis is not yet clear. Splenic cysts are usually asymptomatic and are detected incidentally during imaging exams or an exploratory laparotomy. Our case is about a primary SEC discovered incidentally. An 18-year-old male patient without any personal and family medical history, presented with symptoms of upper urinary tract infection. Renal ultrasound was performed and found incidentally a solitary cystic lesion in the spleen. A laparoscopic partial splenectomy was made then. The specimen was sent for pathological examination and a diagnosis of primary (epidermoid) epithelial splenic cyst was given. SEC is a rare pathology that could mimic other splenic cysts like hydatid cyst. The preoperative diagnosis of SEC can be suspected by ultrasonography, computed tomography or magnetic resonance imaging. However, histopathological examination is mandatory to confirm the diagnosis. A wide range of differential diagnoses is considered when we suspect clinically SEC because of its lower incidence. Actually, spleen-preserving surgery with minimally invasive methods such as laparoscopy is the gold standard for the treatment of SEC despite the risk of recurrence encountered with these techniques. However, different surgical modalities are discussed depending on the size and the location of the cyst and the patient's age.
Harnessing new mHealth technologies to Strengthen the Management of Multidrug-Resistant Tuberculosis in Vietnam (V-SMART trial): a protocol for a randomised controlled trial
Publisher: BMJ
Date: 06-2022
DOI: 10.1136/BMJOPEN-2021-052633
Abstract: Multidrug-resistant tuberculosis (MDR-TB) remains a major public health problem globally. Long, complex treatment regimens coupled with frequent adverse events have resulted in poor treatment adherence and patient outcomes. Smartphone-based mobile health (mHealth) technologies offer national TB programmes an appealing platform to improve patient care and management however, clinical trial evidence to support their use is lacking. This trial will test the hypothesis that an mHealth intervention can improve treatment success among patients with MDR-TB and is cost-effective compared with standard practice. A community-based, open-label, parallel-group randomised controlled trial will be conducted among patients treated for MDR-TB in seven provinces of Vietnam. Patients commencing therapy for microbiologically confirmed rif icin-resistant or multidrug-resistant tuberculosis within the past 30 days will be recruited to the study. Participants will be in idually randomised to an intervention arm, comprising use of an mHealth application for treatment support, or a ‘standard care’ arm. In both arms, patients will be managed by the national TB programme according to current national treatment guidelines. The primary outcome measure of effectiveness will be the proportion of patients with treatment success (defined as treatment completion and/or bacteriological cure) after 24 months. A marginal Poisson regression model estimated via a generalised estimating equation will be used to test the effect of the intervention on treatment success. A prospective microcosting of the intervention and within-trial cost-effectiveness analysis will also be undertaken from a societal perspective. Cost-effectiveness will be presented as an incremental cost per patient successfully treated and an incremental cost per quality-adjusted life-year gained. Ethical approval for the study was granted by The University of Sydney Human Research Ethics Committee (2019/676). Study findings will be disseminated to participants and published in peer-reviewed journals and conference proceedings. ACTRN12620000681954.
“Contact investigation for tuberculosis: a systematic review and meta-analysis.” Gregory J. Fox, Simone E. Barry, Warwick J. Britton and Guy B. Marks. Eur Respir J 2013; 41: 140–156.
Publisher: European Respiratory Society (ERS)
Date: 31-07-2015
Development of Population and Bayesian Models for Applied Use in Patients Receiving Cefepime
Publisher: Springer Science and Business Media LLC
Date: 05-03-2020
Care of patients with a diagnosis of chronic obstructive pulmonary disease
Publisher: AMPCo
Date: 10-2012
DOI: 10.5694/MJA12.10813
Abstract: To evaluate a partnership model of care for patients with a diagnosis of chronic obstructive pulmonary disease (COPD). Cluster randomised controlled trial with blinded outcome assessment of 44 general practices in south-western Sydney comprising 451 people with a diagnosis of COPD, conducted between 2006 and 2009. Participants from intervention group practices were visited at their home by a registered nurse with specific training in COPD care who worked with the general practitioner, the patient and other health professionals to develop and implement an in idualised care plan based on best-practice guidelines. Participants from control group practices received usual care. The primary outcome was disease-related quality of life measured using the St George's Respiratory Questionnaire (SGRQ) at 12-month follow-up. Other outcomes were overall quality of life, lung function, smoking status, immunisation status, patient knowledge of COPD, and health service use. Of the 451 participants, 257 (57.8%) were confirmed as having COPD on post-bronchodilator spirometry. Follow-up was completed for 330 patients (73.2%). At 12 months, there was no statistically significant difference in the mean SGRQ scores between intervention and control groups (38.7 v 37.6 difference, 1.1 95% CI, - 1.53-3.74 P = 0.41) or in measures of quality of life, lung function and smoking status. Compared with the control group, in the intervention group, attendance at pulmonary rehabilitation was more frequent (31.1% v 9.6% OR, 5.16 95% CI, 2.40-11.10 P = 0.002) and the mean COPD knowledge score was higher (10.5 v 9.8 difference, 0.70 CI, 0.10-1.21 P = 0.02). The nurse-GP partnership intervention did not have an impact on disease-related quality of life at 12-month follow-up. However, there was evidence of improved quality of care, in particular, in attendance at pulmonary rehabilitation and patient knowledge of COPD. Australian Clinical Trials Registry ACTRN012606000304538.
Procedures to improve the repeatability of forced oscillation measurements in school-aged children
Publisher: Elsevier BV
Date: 07-2011
DOI: 10.1016/J.RESP.2011.02.004
Abstract: Forced oscillation technique (FOT) parameters are less repeatable than spirometry, and the impact of technical factors, such as data acquisition and data filtering, are unknown. FOT was performed, in triplicate, on 48 children (8-11 years) and repeated two weeks later. We examined the separate effects of monitoring tidal volume (V(T)) prior to measurement and length of data acquisition on measurement repeatability. We compared the effects on repeatability of a filtering technique in which complete breaths containing respiratory artefact were rejected and statistical filters in which outlying data points were rejected. Within- and between-session repeatability of respiratory system resistance (Rrs) and reactance (Xrs) were assessed using coefficient of variation (CV) and intra-class correlation coefficient (ICC). Longer data acquisition reduced CV of Rrs and Xrs (60s vs. shorter durations, p ≤ 0.001). Monitoring V(T) reduced CV of Rrs (p = 0.05). Complete breath filtering improved CV and ICC for both Rrs and Xrs. The repeatability of FOT measurements can be improved by optimising data acquisition and filtering.
Cost-effectiveness of current and optimal treatment for adult asthma
Publisher: Wiley
Date: 09-03-2006
DOI: 10.1111/J.1445-5994.2006.01054.X
Abstract: This article is part of a project to determine the cost-effectiveness of averting the burden of disease. We used population data to investigate the costs and benefits of allocating resources to optimal treatment for asthma in adults, using a burden of disease framework. We calculated the population burden of asthma in the absence of any treatment as years lived with disability (YLD), ignoring the years of life lost. We then estimated the proportion of burden averted with current interventions, the proportion that could be averted with optimally implemented current evidence-based guidelines and the direct treatment cost-effectiveness ratio in dollarA per YLD averted for both current and optimal treatment. The direct treatment cost of current treatment of adult asthma in Australia was dollar A452 million and averted 25% of the burden with a cost-effectiveness ratio of dollar A14 000/YLD averted. Optimal treatment and optimal compliance would cost dollar A627 million and avert 69% of the burden with a cost-effectiveness ratio of dollar A7000/YLD averted. Implementation of optimal treatment for asthma is affordable, will be more cost-effective and will significantly decrease disability.
Risk factors for and origins of COPD
Publisher: Elsevier BV
Date: 05-2015
Predictors of high house dust mite allergen concentrations in residential homes in Sydney.
Publisher: Wiley
Date: 02-2002
DOI: 10.1034/J.1398-9995.2002.5720999.X
Abstract: In parts of coastal Australia, house dust mite allergen concentrations in homes are often very high with at least 80% of homes in Sydney exceeding concentrations of 10 microg of allergen per gram of fine dust. In this study, we report the relation between characteristics of the home environment and house dust mite allergen concentrations at three sites in Sydney homes. A total of 616 families were recruited as part of the Childhood Asthma Prevention Study (CAPS). Information about the home environment and structural aspects of the home was collected using a questionnaire. S les of dust were collected from the parents' bed, the bedroom floor and the living room floor and assayed for Der p 1. A total of 68% of participants' beds, 65% of bedroom floors and 56% of living room floors had Der p 1 concentrations above 10 microg/g, with the highest concentrations of allergen in the bed. The most significant predictor of high Der p 1 concentrations in the bed and floors was the age of the home. We also found that beds with mattresses over two years old and with woollen or synthetic blankets or synthetic quilts had higher Der p 1 concentrations. Carpeted floors had higher Der p 1 concentrations than hard floors. The finding that high Der p 1 allergen concentrations in homes with carpets and older mattresses indicates that control strategies directed at these sources are likely to be effective in reducing exposure. Alternatives such as the use of house dust mite impermeable mattress encasings on older mattresses may also be effective in reducing exposure.
A nationwide perspective on asthma in older Australians
Publisher: AMPCo
Date: 07-2005
DOI: 10.5694/J.1326-5377.2005.TB06908.X
Abstract: WHAT WE NEED TO KNOW: What is the prevalence of impaired lung function among older people in Australia? How can we differentiate between asthma and other causes of breathlessness in population-based health surveys of older people? What are the effects of ageing on people with asthma? WHAT WE NEED TO DO: Improve existing survey measures and accuracy of diagnosis. Incorporate measures of spirometric function into health surveys of representative s les of the general population. Use spirometry in the diagnostic work-up of older patients with dyspnoea.
Effect of nitrogen dioxide and other combustion products on asthmatic subjects in a home-like environment
Publisher: European Respiratory Society (ERS)
Date: 05-1996
DOI: 10.1183/09031936.96.09050910
Abstract: Nitrogen dioxide (NO2) is one of a number of nitrogen compounds that are by-products of combustion and occur in domestic environments following the use of gas or other fuels for heating and cooking. In this study, we examined the effect of two levels of NO2 on symptoms, lung function and airway hyperresponsiveness (AHR) in asthmatic adults and children. In addition, in the same subjects, we examined the effects of the same levels of NO2 mixed with combustion by-products from a gas space heater. The subjects were nine adults, aged 19-65 yrs, and 11 children, aged 7-15 yrs, with diagnosed asthma which was severe enough to require daily medication. All subjects had demonstrable AHR to histamine. Exposures were for 1 h on five separate occasions, 1 week apart, to: 1) ambient air, drawn from outside the building 2) 0.3 parts per million (ppm) NO2 in ambient air 3) 0.6 ppm NO2 in ambient air 4) ambient air+combustion by-products+NO2 to give a total of 0.3 ppm and 5) ambient air+combustion by-products+NO2 to give a total of 0.6 ppm. Effects were measured as changes in lung function and symptoms during and 1 h after exposure, in AHR 1 h and 1 week after exposure, and in lung function and symptoms during the week following exposure. Exposure to NO2 either in ambient air or mixed with combustion by-products from a gas heater, had no significant effect on symptoms or lung function in adults or in children. There was a small, but statistically significant, increase in AHR after exposure to 0.6 ppm NO2 in ambient air. However, there was no effect of 0.6 ppm NO2 on AHR when the combustion by-products were included in the test atmosphere nor of 0.3 ppm NO2 under either exposure condition. We conclude that a 1 h exposure to 0.3 or 0.6 ppm NO2 has no clinically important effect on the airways of asthmatic adults or children, but that 0.6 ppm may cause a slight increase in airway hyperresponsiveness.
When can personal best peak flow be determined for asthma action plans?
Publisher: BMJ
Date: 11-2004
Allergen-specific IL-5 responses in early childhood predict asthma at age eight
Publisher: Public Library of Science (PLoS)
Date: 29-05-2014
Bed Covers and Dust Mites
Publisher: Massachusetts Medical Society
Date: 23-10-2003
A personalised mobile-based home monitoring system for heart failure: The SUPPORT-HF Study
Publisher: Elsevier BV
Date: 10-2015
DOI: 10.1016/J.IJMEDINF.2015.05.003
Abstract: Despite their potential for improving health outcomes, mobile-based home monitoring systems for heart failure have not yet been taken up widely by the patients and providers. To design and iteratively move towards a personalised mobile health monitoring system for patients living with heart failure, according to their health care and usability needs. We present an iterative approach to refining a remote health monitoring system that is based on interactions between different actors (patients, clinicians, social scientists and engineers) and supports the collection of quantitative and qualitative information about user experience and engagement. Patients were provided with tablet computers and commercially available sensing devices (a blood pressure monitor, a set of weighing scales, and a pulse oximeter) in order to complete physiological measurements at home, answer symptom-specific questionnaires, review their personal readings, view educational material on heart failure self-management, and communicate with their health professionals. The system supported unobtrusive remote software upgrades via an application distribution channel and the activation or deactivation of functional components by health professionals during run-time operation. We report early findings from the application of this approach in a cohort of 26 heart failure patients (mean age 72±15 years), their caregivers and healthcare professionals who participated in the SUPPORT-HF (Seamless User-centred Proactive Provision Of Risk-stratified Treatment for Heart Failure) study over a one-year study period (mean patient follow-up duration=270±62 days). The approach employed in this study led to several system upgrades dealing in particular with patient requirements for better communication with the development team and personalised self-monitoring interfaces. Engagement with the system was constantly high throughout the study and during the last week of the evaluation, 23 patients (88%) used the system at least once and 16 patients (62%) at least three times. Designers of future mobile-based home monitoring systems for heart failure and other chronic conditions could leverage the described approach as a means of meeting patients' needs during system use within the home environment and facilitating successful uptake.
Degradation of ronidazole by electrochemically simultaneously generated persulfate and ferrous ions
Publisher: Elsevier BV
Date: 2020
DOI: 10.1016/J.CHEMOSPHERE.2019.124579
Abstract: Nitroimidazoles are found in pharmaceuticals and personal care products (PPCPs) and, when discharged into the environment, have adverse effects on human health and survival. Advanced oxidation technologies (AOTs) based on persulfate (PS) can rapidly and efficiently degrade organic pollutants via strong oxidizing radicals under activation conditions. This study investigated the degradation of ronidazole (RNZ) by indirect electrolytic generation of PS and its activator, ferrous ion (Fe
Evaluation of patients with symptoms of chronic lung disease in primary care
Publisher: Springer Science and Business Media LLC
Date: 24-05-2013
Diagnosing asthma in adults in primary care: A qualitative study of Australian GPs' experiences
Publisher: Springer Science and Business Media LLC
Date: 21-07-2010
Estimating the contribution of subclinical tuberculosis disease to transmission – an individual patient data analysis from prevalence surveys
Publisher: Cold Spring Harbor Laboratory
Date: 14-06-2022
DOI: 10.1101/2022.06.09.22276188
Abstract: In iduals with bacteriologically confirmed pulmonary tuberculosis disease (TB) that do not report symptoms (subclinical TB) represent around half of all prevalent cases of TB, yet their contribution to Mycobacterium tuberculosis ( Mtb ) transmission is unknown, especially compared to in iduals who report symptoms at time of diagnosis (clinical TB). Relative infectiousness can be approximated by cumulative infections in household contacts, but such data are rare. We reviewed the literature to identify studies where surveys of Mtb infection were linked to population surveys of TB disease. We collated in idual population data for analysis and used literature on the relative durations of subclinical and clinical TB to estimate relative infectiousness through a cumulative hazard model, accounting for sputum-smear status. Relative prevalence of subclinical and clinical disease in high burden settings was used to estimate the contribution of subclinical TB to global Mtb transmission. We collated data on 414 index cases and 789 household contacts from three prevalence surveys (Bangladesh, Philippines, Viet Nam) and one case-finding trial in Viet Nam. The odds ratio of household infection prevalence was 1.2 (0.6-2.3, 95% Confidence Interval). Adjusting for duration of disease, we found a per-unit-time infectiousness of subclinical TB relative to clinical TB of 1.93 (0.62-6.18, 95% Prediction Interval (PrI)). 14 countries across Asia and Africa provided data on relative prevalence of subclinical and clinical TB, suggesting an estimated 68% (27-92%, 95% PrI) of global transmission is from subclinical TB. Our results suggest that subclinical TB contributes substantially to transmission and needs to be diagnosed and treated for effective progress towards TB elimination.
Inhaled corticosteroid dosage in asthma.
Publisher: BMJ
Date: 09-2002
Nonlinear relationship of mite allergen exposure to mite sensitization and asthma in a birth cohort
Publisher: Elsevier BV
Date: 07-2008
DOI: 10.1016/J.JACI.2008.05.010
Abstract: There is uncertainty about the nature of the relationship between mite allergen exposure during infancy and the expression of allergic diseases in childhood. We sought to explore the relationships between repeated measurements of mite allergen exposure during the first 5 years of life and clinical allergic disease outcomes at age 5 years. In a birth cohort of 516 at-risk children, 13 bed dust s les were collected between birth and 5 years of age and analyzed for mite allergen. At age 5 years, the presence of mite atopy was assessed based on skin prick test results, and clinical assessments for asthma, eczema, and wheeze were conducted. The association of allergen exposure with each clinical outcome was examined by means of logistic regression, with adjustments for potential confounders. The lowest and highest mite exposure quintiles, expressed as mean allergen concentration averaged over 0 to 5 years, were associated with a lower prevalence of mite atopy and of asthma compared with intermediate levels of exposure. These relationships, when determined by using average allergen concentration over 0 to 18 months, were weaker. This study demonstrates a nonlinear relationship between mite allergen exposure and clinical outcomes in this generally high mite allergen environment.
Diagnoses among patients with hypercapnic respiratory failure and effect on in‐hospital mortality
Publisher: Wiley
Date: 10-2018
DOI: 10.1111/JSR.43_12765
Randomised controlled trial of home based care of patients with chronic obstructive pulmonary disease
Publisher: BMJ
Date: 26-10-2002
Abstract: To evaluate usefulness of limited community based care for patients with chronic obstructive pulmonary disease after discharge from hospital. Randomised controlled trial. Liverpool Health Service and Macarthur Health Service in outer metropolitan Sydney between September 1999 and July 2000. 177 patients randomised into an intervention group (84 patients) and a control group (93 patients) which received current usual care. Home visits by community nurse at one and four weeks after discharge and preventive general practitioner care. Frequency of patients' presentation and admission to hospital changes in patients' disease-specific quality of life, measured with St George's respiratory questionnaire, over three months after discharge patients' knowledge of illness, self management, and satisfaction with care at discharge and three months later frequency of general practitioner and nurse visits and their satisfaction with care. Intervention and control groups showed no differences in presentation or admission to hospital or in overall functional status. However, the intervention group improved their activity scores and the control group worsened their symptom scores. While intervention group patients received more visits from community nurses and were more satisfied with their care, involvement of general practitioners was much less (with only 31% (22) remembering receiving a care plan). Patients in the intervention group had higher knowledge scores and were more satisfied. There were no differences in general practitioner visits or management. This brief intervention after acute care improved patients' knowledge and some aspects of quality of life. However, it failed to prevent presentation and readmission to hospital.
Towards an understanding of sexual risk behavior in people living with HIV: a review of social, psychological, and medical findings
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2002
Weighted Road Density and Allergic Disease in Children at High Risk of Developing Asthma
Publisher: Public Library of Science (PLoS)
Date: 20-06-2014
Thunderstorm outflows preceding epidemics of asthma during spring and summer
Publisher: BMJ
Date: 06-2001
Abstract: A study was undertaken to assess the importance of thunderstorms as a cause of epidemics of asthma exacerbations and to investigate the underlying mechanism. A case control study was performed in six towns in south eastern Australia. Epidemic case days (n = 48) and a random s le of control days (n = 191) were identified by reference to the difference between the observed and expected number of emergency department attendances for asthma. The occurrence of thunderstorms, their associated outflows and cold fronts were ascertained, blind to case status, for each of these days. In addition, the relation of hourly pollen counts to automatic weather station data was examined in detail for the period around one severe epidemic of asthma exacerbations. The main outcome measure was the number of epidemics of asthma exacerbations. Thunderstorm outflows were detected on 33% of epidemic days and only 3% of control days (odds ratio 15.0, 95% confidence interval 6.0 to 37.6). The association was strongest in late spring and summer. Detailed examination of one severe epidemic showed that its onset coincided with the arrival of the thunderstorm outflow and a 4-12 fold increase in the ambient concentration of grass pollen grains. These findings are consistent with the hypothesis that some epidemics of exacerbations of asthma are caused by high concentrations of allergenic particles produced by an outflow of colder air, associated with the downdraught from a thunderstorm, sweeping up pollen grains and particles and then concentrating them in a shallow band of air at ground level. This is a common cause of exacerbations of asthma during the pollen season.
Exploring Tuberculosis Riskscapes in a Papua New Guinean ‘Hotspot’
Publisher: SAGE Publications
Date: 04-08-2022
DOI: 10.1177/10497323221111912
Abstract: This article explores socio-spatial dimensions of risk and how they can enhance understanding of a high burden tuberculosis (TB) context in the South Fly District of Papua New Guinea. We report on select findings from a qualitative study that included 128 semi-structured in-depth interviews and 10 focus group discussions with a wide range of South Fly District community members. Using the conceptual framework of ‘riskscapes’ to examine emic perspectives on risk, space and practice, we map key elements of TB riskscapes on Daru Island, South Fly District, along with solutions for navigating through these riskscapes. Overcrowding, lack of water, sanitation and hygiene, as well as food insecurity and undernutrition, were identified as common elements within participants’ riskscapes, that compounded upon each other to create the perception of an assemblage of risk favourable to TB transmission.
The burden of asthma, hay fever and eczema in adults in 17 countries: GAN Phase I study
Publisher: European Respiratory Society (ERS)
Date: 24-02-2022
DOI: 10.1183/13993003.02865-2021
Abstract: Asthma, hay fever and eczema are three common chronic conditions. There have been no recent multi-country data on the burden of these three conditions in adults the aims of this study are to fill this evidence gap. The Global Asthma Network Phase I is a multi-country cross-sectional population-based study using the same core methodology as the International Study of Asthma and Allergies in Childhood Phase III. It provides data on the burden of asthma, hay fever and eczema in children and adolescents, and, for the first time, in their parents/guardians. Data were available from 193 912 adults (104 061 female mean± sd age 38±7.5 years) in 43 centres in 17 countries. The overall prevalence (range) of symptoms was 6.6% (0.9–32.7%) for current wheeze, 4.4% (0.9–29.0%) for asthma ever, 14.4% (2.8–45.7%) for hay fever ever and 9.9% (1.6–29.5%) for eczema ever. Centre prevalence varied considerably both between countries and within countries. There was a moderate correlation between hay fever ever and asthma ever, and between eczema ever and hay fever ever at the centre level. There were moderate to strong correlations between indicators of the burden of disease reported in adults and the two younger age groups. We found evidence for a substantial burden of asthma, hay fever ever and eczema ever in the countries examined, highlighting the major public health importance of these diseases. Prevention strategies and equitable access to effective and affordable treatments for these three conditions would help mitigate the avoidable morbidity they cause.
Asthma management and control in children, adolescents, and adults in 25 countries: a Global Asthma Network Phase I cross-sectional study
Publisher: Elsevier BV
Date: 02-2023
Effectiveness of an intervention to reduce house dust mite allergen levels in children's beds.
Publisher: Wiley
Date: 10-07-2003
DOI: 10.1034/J.1398-9995.2003.00194.X
Abstract: In temperate climates, exposure to house dust mite (HDM) allergens is the strongest environmental risk factor for childhood asthma. Environmental modifications to limit exposure have the potential to reduce the prevalence of asthma. The aim of this study was to reduce allergen exposure for children at high risk of developing asthma. A total of 616 pregnant women were randomized to HDM intervention and control groups. The control group had no special recommendations whereas the intervention group was given allergen impermeable mattress covers and an acaricidal washing detergent for bedding. Children were visited regularly until 18 months of age to have dust collected from their bed. Der p 1 concentrations in the control group increased from 5.20 microg/g at 1 month to 22.18 microg/g at 18 months but remained low in the intervention group, ranging from 3.27 microg/g at 1 month to 6.12 microg/g at 18 months. In a high HDM allergen environment, a combined approach using physical barriers and an acaricidal wash, is effective in reducing HDM allergen concentrations in bedding. However, even with these control measures in place, HDM allergen levels remained high by international standards.
Parental smoking and respiratory tract infections in children
Publisher: Elsevier BV
Date: 09-2001
Abstract: The adverse health consequences of exposing children to tobacco smoke have been well documented. Re-calculation of the data available from cohort and cross-sectional studies worldwide shows that between 500-2500 excess hospitalisations and between 1000 to 5000 excess diagnoses per 100 000 young children as result from respiratory infections can be directly attributed to parental smoking. Results of published meta-analyses support these figures, which are probably under-estimated because of the effects of non-differential misclassification bias. These excess infections are a source of preventable morbidity and have a high cost to the community. They also have important long-term consequences because children who have respiratory infections in early life are at an increased risk of developing asthma in later childhood. More effective strategies that prevent smoking in young people before they become parents have the potential to lead to reductions in these high rates of unnecessary morbidity in the next generation of children.
Atopy phenotypes in the Childhood Asthma Prevention Study (CAPS ) cohort and the relationship with allergic disease
Publisher: Wiley
Date: 28-05-2013
DOI: 10.1111/CEA.12095
Abstract: Atopy in early life is heterogeneous in timing of onset, remission and persistence and in the nature of specific sensitization to allergens. However, this heterogeneity is not well characterized. Our aim was to define longitudinal phenotypes of atopy between ages 1.5 and 8 years, and to assess the relationship of the atopy phenotypes to the risk of asthma, eczema and rhinitis at 8 years of age. We used latent class analysis (LCA) to define atopy phenotypes using data from skin prick tests that were performed at 1.5, 3, 5 and 8 years in participants in the Childhood Asthma Prevention Study (CAPS). Four phenotypes were defined: late mixed inhalant sensitization mixed food and inhalant sensitization house dust mite (HDM) monosensitized and no atopy. All three atopic phenotypes were associated with asthma, eczema and rhinitis, but the strongest association, particularly for asthma, was with the mixed food and inhalant sensitization phenotype. We have used a LCA model to define atopy phenotypes empirically. The finding of a strong association between the mixed food and inhalant sensitization class and the presence of asthma and poor asthma control at age 8 years implies that food sensitization in early life may be of greater significance for subsequent risk of asthma than previously thought.
Tuberculosis: an old world disease providing new world challenges in NSW
Publisher: The Sax Institute
Date: 2013
DOI: 10.1071/NB13007
Pneumonia: a disease for all ages [Editorial]
Publisher: International Union Against Tuberculosis and Lung Disease
Date: 11-2013
Trends in eczema prevalence in children and adolescents: A Global Asthma Network Phase I Study
Publisher: Wiley
Date: 08-02-2023
DOI: 10.1111/CEA.14276
Abstract: Eczema (atopic dermatitis) is a major global public health issue with high prevalence and morbidity. Our goal was to evaluate eczema prevalence over time, using standardized methodology. The Global Asthma Network (GAN) Phase I study is an international collaborative study arising from the International Study of Asthma and Allergies in Children (ISAAC). Using surveys, we assessed eczema prevalence, severity, and lifetime prevalence, in global centres participating in GAN Phase I (2015–2020) and one/ both of ISAAC Phase I (1993–1995) and Phase III (2001–2003). We fitted linear mixed models to estimate 10‐yearly prevalence trends, by age group, income, and region. We analysed GAN Phase I data from 27 centres in 14 countries involving 74,361 adolescents aged 13–14 and 47,907 children aged 6–7 (response rate 90%, 79%). A median of 6% of children and adolescents had symptoms of current eczema, with 1.1% and 0.6% in adolescents and children, respectively, reporting symptoms of severe eczema. Over 27 years, after adjusting for world region and income, we estimated small overall 10‐year increases in current eczema prevalence (adolescents: 0.98%, 95% CI 0.04%–1.92% children: 1.21%, 95% CI 0.18%–2.24%), and severe eczema (adolescents: 0.26%, 95% CI 0.06%–0.46% children: 0.23%, 95% CI 0.02%–0.45%) with larger increases in lifetime prevalence (adolescents: 2.71%, 95% CI 1.10%–4.32% children: 3.91%, 95% CI 2.07%–5.75%). There was substantial heterogeneity in 10‐year change between centres (standard deviations 2.40%, 0.58%, and 3.04%), and strong evidence that some of this heterogeneity was explained by region and income level, with increases in some outcomes in high‐income children and middle‐income adolescents. There is substantial variation in changes in eczema prevalence over time by income and region. Understanding reasons for increases in some regions and decreases in others will help inform prevention strategies.
Independent Validation of National Satellite-Based Land-Use Regression Models for Nitrogen Dioxide Using Passive Samplers
Publisher: American Chemical Society (ACS)
Date: 04-11-2016
Abstract: Including satellite observations of nitrogen dioxide (NO
Smoking behaviour among adult patients presenting to health facilities in four provinces of Vietnam
Publisher: Springer Science and Business Media LLC
Date: 05-2021
DOI: 10.1186/S12889-021-10880-Z
Abstract: Attendance at healthcare facilities provides an opportunity for smoking cessation interventions. However, the smoking behaviours of patients seeking healthcare in Vietnam are not well-understood. We aimed to evaluate behaviours related to smoking among patients presenting to health facilities in Vietnam. We conducted a cross-sectional study in 4 provinces of Vietnam. Consecutive patients aged ≥15 years presenting to 46 health facilities were assessed. Current smokers were randomly selected to complete a full survey about smoking behaviour, quit attempts, and preparedness to quit. Among 11,245 patients who sought healthcare, the prevalence of current smoking was 18.6% (95% CI: 17.8–19.4%) overall, 34.6% (95% CI: 33.2–36.0%) among men and 1.1% (95% CI: 0.8–1.3%) among women. Current smokers who were asked about smoking by healthcare providers in the last 12 months were more likely to make quit attempts than those not asked (40.6% vs 31.8%, p = 0.017). Current smokers who attempted to quit in the past 12 months made limited use of cessation aids: counselling (1.9%) and nicotine replacement therapy (10%). A higher proportion of patients wanted to quit in the next month at national rovincial hospitals (30.3%) than those visiting district hospitals (11.3%, p 0.001) and commune health centres (11.1%, p = 0.004). Smoking is common among male patients presenting to healthcare facilities in Vietnam. Formal smoking cessation supports are generally not used or offered. This population is likely to benefit from routine smoking cessation interventions that are integrated within the routine healthcare delivery system.
Therapeutic potential of pharmacologically targeting arteriolar myogenic tone
Publisher: Elsevier BV
Date: 07-2009
DOI: 10.1016/J.TIPS.2009.04.008
Abstract: The arteriolar myogenic response, which is defined as vasoconstriction to increases in intraluminal pressure and, conversely, dilation to a reduction in pressure, is key in the setting of vascular resistance, local control of microvascular blood flow through autoregulation, and in the control of capillary hydrostatic pressure. Although considerable progress has been made in the quest for understanding the underlying sensory apparatus and cellular mechanisms, fundamental questions remain - particularly if this pathway is to be considered as a target for novel strategies of pharmacological intervention. We propose that an ability to 're-set' myogenic tone would enable modification of systemic vascular resistance and pressure while at the same time preserving existing interactions with neurohumoral regulatory mechanisms. The challenge, therefore, is to identify steps unique to the myogenic signaling pathway to enable specific pharmacological targeting.
Four methods of sampling for dust mite allergen: differences in ‘dust’
Publisher: Wiley
Date: 10-07-2003
DOI: 10.1034/J.1398-9995.2003.00228.X
Abstract: Measurement of exposure to the dust mite allergen Der p 1 is important in asthma research and is potentially useful in managing asthma. As no single measure can capture all characteristics of an exposure, it is important to recognize differences in the available methods of measuring exposure to Der p 1. Fourteen bedrooms and living rooms were s led using four methods for 1 week. Airborne allergen was s led by static Institute of Occupational Medicine s lers. Settling dust was collected on Petri dishes and an adhesive-membrane system (A-book). Vacuumed reservoir dust s les were collected from floors at the end of 1 week. Der p 1 was measured in all s les by enzyme-linked immunosorbent assay, except A-books, in which it was measured by Halogen immunoassay. All four methods intercorrelated moderately (r range = 0.40-0.64, P = 0.04), except between allergen in reservoir dust (as microg/m2 and microg/g dust) and settling dust by Petri dishes (P = 0.2). Reservoir allergen, expressed as microg/m2, did not correlate with any measure, except reservoir allergen expressed as microg/g (r = 0.39, P = 0.04). No differences in these associations occurred between bedrooms and living rooms. While the four methods examined correlated moderately, all have practical advantages and difficulties. No method can be considered as ideal for measuring in idual exposure. For practicality, use of vacuum cleaner and Petri dish methods are recommended.
Are non‐allergenic environmental factors important in asthma?
Publisher: Wiley
Date: 11-1995
DOI: 10.5694/J.1326-5377.1995.TB124724.X
Abstract: To review the roles of viral respiratory tract infections, environmental tobacco smoke and air pollution in asthma. MEDLINE (1992-1995) searches were conducted for publications on asthma, environmental tobacco smoke, ozone, nitrogen dioxide and particulates. Representative original experimental and epidemiological studies and reviews of viral infections in asthma. Respiratory virus infections are the most common and important trigger of asthma attacks in children and probably also in adults. Their role in promoting development of asthma is not so clear. Exposure to environmental tobacco smoke is almost certainly responsible for some cases of childhood asthma, and can also trigger symptoms of bronchoconstriction in adults with asthma. Exposure to ozone or nitrogen dioxide is associated with symptoms, impaired lung function, bronchial hyperresponsiveness and hospital presentations for asthma. These pollutants may also act as cofactors in the development of allergen-specific bronchial hyperresponsiveness. Research on preventing upper respiratory viral infections may reduce asthma morbidity. The move to non-smoking workplaces is welcome, but new interventions are needed to prevent young women taking up smoking and subsequently exposing their children. The ambient air quality guideline for ozone should be revised and a health-based guideline for respirable particulates introduced.
Are you busy for the next 5 years? Recruitment in the Childhood Asthma Prevention Study (CAPS).
Publisher: Wiley
Date: 02-05-2002
DOI: 10.1046/J.1440-1843.2002.00384.X
Abstract: The process of recruitment into randomized controlled trials is not often reported. In the present paper, the methods used for recruitment into the Childhood Asthma Prevention Study are reported and the reasons why eligible subjects chose not to participate or withdrew from the trial are examined. Recruitment was conducted at the antenatal clinics of six hospitals in Sydney (NSW, Australia). Pregnant women with a family history of asthma who consented to participate were randomized into one of four groups and were asked to follow a set of interventions. The study will continue until the infants are 5 years old. Of 7171 women screened, 2095 (29.2%) were eligible, of whom only 616 (29.4% of eligible women) were recruited. The main reasons for not taking part in the study were a lack of interest, ineligibility (on further questioning), inability to be contacted and 'too busy'. During the first 21/2 years of the trial, 10% of participants withdrew. The most common reasons for withdrawal from the study were loss of contact, family moving interstate or overseas and medical reasons. In families that withdrew from the trial or who were eligible but did not participate, the parents were significantly younger, mothers were less educated and fathers were less likely to be in full-time employment. By collecting demographic data on people who withdrew from the study and chose not to participate, we gained a better understanding of why our recruitment rate was low. The preferential recruitment of some sectors of the community has important implications for the ways in which future studies will be planned.
Benefit of treatment of latent tuberculosis infection in individual patients
Publisher: European Respiratory Society (ERS)
Date: 24-09-2015
DOI: 10.1183/13993003.00577-2015
Abstract: We aimed to develop a decision aid that estimates whether treatment of latent tuberculosis infection (LTBI) is likely to have a net gain in quality-adjusted life-years for an in idual. A Markov model was developed which incorporated personalised estimates for risk of tuberculosis (TB) reactivation, TB death, quality-of-life impairments and treatment side-effects. The net effect of LTBI treatment was quantified in terms of quality-adjusted life-years gained or lost. Analyses were conducted for a representative set of hypothetical patients. LTBI treatment was estimated to be beneficial when the annual risk of TB reactivation exceeded 13/100 000 to 93/100 000 for females aged 10–75 years and 15/100 000 to 119/100 000 for males aged 10–75 years the numbers needed to treat to avoid one case of TB were 93, 77, 85 and 72, respectively, at these threshold levels. LTBI treatment was estimated to confer a positive net benefit across a broad range of patients with characteristics typically seen in a low incidence setting for TB. Use of the decision aid has the potential to facilitate and increase confidence with LTBI treatment decisions by providing clinicians and patients with personalised estimates of likely net benefit.
Bug Breakfast in the Bulletin: Diagnosis, investigation and management of tuberculosis at an Australian zoo
Publisher: The Sax Institute
Date: 2013
DOI: 10.1071/NB13003
Prevalence and burden of chronic bronchitis symptoms: results from the BOLD study
Publisher: European Respiratory Society (ERS)
Date: 11-2017
DOI: 10.1183/13993003.00621-2017
Abstract: We studied the prevalence, burden and potential risk factors for chronic bronchitis symptoms in the Burden of Obstructive Lung Disease study. Representative population-based s les of adults aged ≥40 years were selected in participating sites. Participants completed questionnaires and spirometry. Chronic bronchitis symptoms were defined as chronic cough and phlegm on most days for ≥3 months each year for ≥2 years. Data from 24 855 subjects from 33 sites in 29 countries were analysed. There were significant differences in the prevalence of self-reported symptoms meeting our definition of chronic bronchitis across sites, from 10.8% in Lexington (KY, USA), to 0% in Ile-Ife (Nigeria) and Blantyre (Malawi). Older age, less education, current smoking, occupational exposure to fumes, self-reported diagnosis of asthma or lung cancer and family history of chronic lung disease were all associated with increased risk of chronic bronchitis. Chronic bronchitis symptoms were associated with worse lung function, more dyspnoea, increased risk of respiratory exacerbations and reduced quality of life, independent of the presence of other lung diseases. The prevalence of chronic bronchitis symptoms varied widely across the studied sites. Chronic bronchitis symptoms were associated with significant burden both in in iduals with chronic airflow obstruction and those with normal lung function.
Risk factors for onset and remission of atopy, wheeze and airway hyperresponsiveness
Publisher: BMJ
Date: 02-2002
Abstract: Although many children with asthma may have a remission as they grow and other children who did not have asthma may develop asthma in adult life, knowledge about the factors that influence the onset and prognosis of asthma during adolescence and young adulthood is very limited. A cohort of 8-10 year old children (n=718) living in Belmont, New South Wales, Australia were surveyed six times at 2 yearly intervals from 1982 to 1992, and then again 5 years later in 1997. From this cohort, 498 subjects had between three and seven assessments and were included in the analysis. Atopy, airway hyperresponsiveness (AHR), and wheeze in the last 12 months were measured at each survey. Late onset, remission, and persistence were defined based on characteristics at the initial survey and the changes in characteristics at the follow up surveys. The proportion of subjects with late onset atopy (13.7%) and wheeze (12.4%) was greater than the proportion with remission of atopy (3.2%) and wheeze (5.6%). Having atopy at age 8-12 years (OR 2.8, 95% CI 1.5 to 5.1) and having a parental history of asthma (OR 2.0, 95% CI 1.02 to 4.13) were significant risk factors for the onset of wheeze. Having AHR at age 8-12 years was a significant risk factor for the persistence of wheeze (OR 4.3, 95% CI 1.3 to 15.0). Female sex (OR 1.9, 95% CI 1.01 to 3.60) was a significant risk factor for late onset AHR whereas male sex (OR 1.9, 95% CI 1.1 to 2.8) was a significant risk factor for late onset atopy. The onset of AHR is uncommon during adolescence, but the risk of acquiring atopy and recent wheeze for the first time continues during this period. Atopy, particularly present at the age of 8-10 years, predicts the subsequent onset of wheeze.
Weighted road density: A simple way of assigning traffic-related air pollution exposure
Publisher: Elsevier BV
Date: 10-2009
Clinical characteristics of adults with self-reported diagnosed asthma and/or COPD: data from the BOLD Australia Study
Publisher: European Respiratory Society (ERS)
Date: 23-06-2023
DOI: 10.1183/23120541.00098-2023
Abstract: Diagnosis of asthma and chronic obstructive pulmonary disease (COPD) in the community is variable, often without spirometry. Some studies report that adults with both diagnostic labels (asthma+COPD) have worse health outcomes than those with asthma or COPD only, but data for Australian adults are limited. We investigated the relationship between clinical characteristics and self-reported diagnoses of asthma, COPD and both. We used data from the BOLD Australia study, which included randomly selected adults aged ≥40 years from six study sites. The BOLD questionnaires and spirometry test were used in all sites. Participants were grouped by self-reported diagnosis. Demographic and clinical characteristics and lung function were compared between groups. Of the study s le (n=3522), 336 reported asthma only, 172 reported COPD only, 77 reported asthma+COPD and 2937 reported neither. Fewer than half of participants with a COPD diagnosis (with or without asthma) had airflow limitation. Participants with asthma+COPD had more respiratory symptoms and greater airflow limitation than those with either diagnosis alone. Having asthma+COPD was independently associated with a higher probability of having clinically important breathlessness (modified Medical Research Council score ≥2) than asthma only (adjusted OR 3.44, 95% CI 1.86–6.33) or COPD only (adjusted OR 3.28, 95% CI 1.69–6.39). Airflow limitation (Global Initiative for Chronic Obstructive Lung Disease 2 or higher, using post-bronchodilator forced expiratory volume in 1 s/forced vital capacity ratio .7) was similar between asthma only and COPD only, but twice as prevalent in asthma+COPD (adjusted OR 2.18 and 2.58, respectively). Adults with diagnoses of asthma+COPD have a higher symptom and disease burden than those with diagnoses of asthma only or COPD only. These patients should receive regular comprehensive reviews because of the substantially increased burden of having both diagnoses.
Evaluation of Loopamp Assay for the Diagnosis of Pulmonary Tuberculosis in Cambodia
Publisher: Hindawi Limited
Date: 02-06-2020
DOI: 10.1155/2020/6828043
Abstract: The Loop ™ MTBC kit (TB-LAMP) is recommended by WHO for Mycobacterium tuberculosis complex detection in low-income countries with a still low drug-resistant tuberculosis (TB) rate. This study is aimed at testing its feasibility in Cambodia on sputa collected from presumptive tuberculosis patients. 499 s les were tested at a smear microscopy center and 200 at a central-level mycobacteriology laboratory. Using mycobacterial cultures as reference, TB-LAMP results were compared with those of LED fluorescent microscopy (LED-FM) and Xpert® MTB/RIF. At the microscopy center, TB-LAMP sensitivity was higher than that of LED-FM (81.5% [95% CI, 74.5-87.6] versus 69.4% [95% CI, 62.2-76.6]), but lower than that of the Xpert assay (95.5% [95% CI 92.3-98.8]). At the central-level laboratory, TB-LAMP sensitivity (92.8% [95% CI, 87.6-97.9]) was comparable to that of Xpert (90.7% [95% CI, 85.0-96.5]) using stored s le. No significant difference in terms of specificity between TB-LAMP and Xpert assays was observed in both study sites. In conclusion, our data demonstrate that TB-LAMP could be implemented at microscopy centers in Cambodia to detect TB patients. In addition, TB-LAMP can be a better choice to replace smear microscopy for rapid TB diagnosis of new presumptive TB patients, in settings with relative low prevalence of drug-resistant TB and difficulties to implement Xpert assay.
“Safe air” to breathe: Time for action?
Publisher: Wiley
Date: 07-02-2023
DOI: 10.1111/RESP.14469
Abstract: See related article
The Utility of Single-Channel Nasal Airflow Pressure Transducer in the Diagnosis Of OSA at Home
Publisher: Oxford University Press (OUP)
Date: 08-2010
Department of Error
Publisher: Elsevier BV
Date: 09-2017
Investigating health effects in a community surrounding a road tunnel stack – a cross sectional study
Publisher: Springer Science and Business Media LLC
Date: 26-09-2008
Key messages and partnerships to raise awareness and improve outcomes for people with asthma and COPD in low- and middle-income countries
Publisher: International Union Against Tuberculosis and Lung Disease
Date: 12-2022
Sahaja yoga in the management of moderate to severe asthma: a randomised controlled trial
Publisher: BMJ
Date: 02-2002
Abstract: Sahaja Yoga is a traditional system of meditation based on yogic principles which may be used for therapeutic purposes. A study was undertaken to assess the effectiveness of this therapy as an adjunctive tool in the management of asthma in adult patients who remained symptomatic on moderate to high doses of inhaled steroids. A parallel group, double blind, randomised controlled trial was conducted. Subjects were randomly allocated to Sahaja yoga and control intervention groups. Both the yoga and the control interventions required the subjects to attend a 2 hour session once a week for 4 months. Asthma related quality of life (AQLQ, range 0-4), Profile of Mood States (POMS), level of airway hyperresponsiveness to methacholine (AHR), and a diary card based combined asthma score (CAS, range 0-12) reflecting symptoms, bronchodilator usage, and peak expiratory flow rates were measured at the end of the treatment period and again 2 months later. Twenty one of 30 subjects randomised to the yoga intervention and 26 of 29 subjects randomised to the control group were available for assessment at the end of treatment. The improvement in AHR at the end of treatment was 1.5 doubling doses (95% confidence interval (CI) 0.0 to 2.9, p=0.047) greater in the yoga intervention group than in the control group. Differences in AQLQ score (0.41, 95% CI -0.04 to 0.86) and CAS (0.9, 95% CI -0.9 to 2.7) were not significant (p>0.05). The AQLQ mood subscale did improve more in the yoga group than in the control group (difference 0.63, 95% CI 0.06 to 1.20), as did the summary POMS score (difference 18.4, 95% CI 0.2 to 36.5, p=0.05). There were no significant differences between the two groups at the 2 month follow up assessment. This randomised controlled trial has shown that the practice of Sahaja yoga does have limited beneficial effects on some objective and subjective measures of the impact of asthma. Further work is required to understand the mechanism underlying the observed effects and to establish whether elements of this intervention may be clinically valuable in patients with severe asthma.
Azole-resistant Aspergillus fumigatus is highly prevalent in the environment of Vietnam, with marked variability by land use type
Publisher: Wiley
Date: 16-07-2021
Abstract: Azole‐resistant environmental Aspergillus fumigatus presents a threat to public health but the extent of this threat in Southeast Asia is poorly described. We conducted environmental surveillance in the Mekong Delta region of Vietnam, collecting air and ground s les across key land‐use types, and determined antifungal susceptibilities of Aspergillus section Fumigati (ASF) isolates and azole concentrations in soils. Of 119 ASF isolates, 55% were resistant (or non‐wild type) to itraconazole, 65% to posaconazole and 50% to voriconazole. Azole resistance was more frequent in A. fumigatus sensu stricto isolates (95%) than other ASF species (32%). Resistant isolates and agricultural azole residues were overrepresented in s les from cultivated land. cyp51A gene sequence analysis showed 38/56 resistant A. fumigatus sensu stricto isolates carried known resistance mutations, with TR 34 /L98H most frequent (34/38).
Prevalence and genetic basis of first-line drug resistance of Mycobacterium tuberculosis in Ca Mau, Vietnam
Publisher: European Respiratory Society (ERS)
Date: 16-09-2022
DOI: 10.1183/23120541.00122-2022
Abstract: Data on the prevalence of anti-tuberculous drug resistance and its association with genetic mutations in Mycobacterium tuberculosis are limited. Our study explores the genomics of tuberculosis in Ca Mau, Vietnam. Patients ≥15 years in Ca Mau Province, Vietnam, were screened annually for tuberculosis between 2014 and 2017. Isolates underwent drug susceptibility testing (DST) using the breakpoint method. DNA was extracted and whole genome sequencing (WGS) was performed. We identified 365 positive sputum cultures for M. tuberculosis and processed 237 for DST and 265 for WGS. Resistance to isoniazid was present in 19.8% (95% CI 14.7 to 24.9%), rif icin in 3.5% (1.1 to 5.7%) and ethambutol in 2.5% (0.9 to 5.4%) of isolates. Relevant mutations in rpoB gene were detected in 3.8% (1.8 to 6.8%). katG, inhA or fabG1 mutations were found in 19.6% (15.0 to 24.9%) with KatG being most common at 12.8% (9.1–17.5%). We found 38.4% of isolates were of Beijing lineage, 49.4% East-African-Indian lineage and 8.4% European-American lineage. There were no associations between resistance profiles and clinical features. The high burden of isoniazid resistance and the katG mutation highlights the challenges facing Vietnam in its efforts to achieve its EndTB goals.
Interim findings from first-dose mass COVID-19 vaccination roll-out and COVID-19 hospital admissions in Scotland: a national prospective cohort study
Publisher: Elsevier BV
Date: 05-2021
Worldwide time trends in prevalence of symptoms of rhinoconjunctivitis in children: Global Asthma Network Phase I
Publisher: Wiley
Date: 21-09-2021
DOI: 10.1111/PAI.13656
Abstract: The Global Asthma Network (GAN), by using the International Study of Asthma and Allergies in Childhood (ISAAC) methodology, has updated trends in prevalence of symptoms of childhood allergic diseases, including non‐infective rhinitis and conjunctivitis (‘rhinoconjunctivitis’), which is reported here. Prevalence and severity of rhinoconjunctivitis were assessed by questionnaire among schoolchildren in GAN Phase I and ISAAC Phase I and III surveys 15–23 years apart. Absolute rates of change in prevalence were estimated for each centre and modelled by multi‐level linear regression to compare trends by age group, time period and per capita national income. Twenty‐seven GAN centres in 14 countries surveyed 74,361 13‐ to 14‐year‐olds (‘adolescents’) and 45,434 6‐ to 7‐year‐olds (‘children’), with average response proportions of 90% and 79%, respectively. Many centres showed highly significant ( p .001) changes in prevalence of rhinoconjunctivitis in the past year (‘current rhinoconjunctivitis’) compared with ISAAC. The direction and magnitude of centre‐level trends varied significantly ( p .001) both within and between countries. Overall, current rhinoconjunctivitis prevalence decreased slightly from ISAAC Phase III to GAN: −1.32% per 10 years, 95% CI [−2.93%, +0.30%] among adolescents and −0.44% [−1.29%, +0.42%] among children. Together, these differed significantly ( p .001) from the upward trend within ISAAC. Among adolescents, centre‐level trends in current rhinoconjunctivitis were highly correlated with those for eczema symptoms (rho = 0.72, p .0001) but not with centre‐level trends in asthma symptoms (rho = 0.15, p = .48). Among children, these correlations were positive but not significant. Symptoms of non‐infective rhinoconjunctivitis among schoolchildren may no longer be on the increase globally, although trends vary substantially within and between countries.
Psychological and Medical Characteristics Associated with Non-Adherence to Prescribed Daily Inhaled Corticosteroid
Publisher: MDPI AG
Date: 14-09-2020
DOI: 10.3390/JPM10030126
Abstract: Medication non-adherence is associated with sub-optimal asthma control. Identification of medical and psychological characteristics associated with non-adherence is important to enable a targeted and personalized approach when working with patients and for the development of interventions to improve patient outcomes by improving medication adherence. We enrolled adults who had diagnosed asthma and who were prescribed daily inhaled corticosteroid medication. We used published and validated instruments to measure medical characteristics including asthma features, practical asthma knowledge and perceived involvement in care and psychological characteristics including anxiety, depression, optimism, and personality traits, to assess the relationship with medication non-adherence. A total of 126 participants provided data, with 64 (50.8%) of the participants identified as non-adherent. Multivariate analyses showed that younger age, high neuroticism scores and a previous asthma hospital admission were associated with non-adherence. Interestingly, depression was associated with a lower risk of non-adherence. This study showed that a personalized medicine approach would include interventions targeting those who are younger, who have been in hospital for asthma and who rate high on the neuroticism personality trait. Given the availability of effective medications for asthma, better understanding of the characteristics associated with non-adherence is important to enhance optimal self-management.
Telomere length in early childhood: Early life risk factors and association with carotid intima-media thickness in later childhood
Publisher: Oxford University Press (OUP)
Date: 24-09-2016
Abstract: Reduced telomere length is a measure of biological aging that is predictive of cardiac events in adults, and has been mechanistically implicated in the onset and progression of atherosclerosis. We sought to describe the early life factors associated with leukocyte telomere length in early childhood, and to determine whether telomere length measured during early childhood is associated with arterial wall thickening later in childhood. A longitudinal birth cohort recruited antenatally in Sydney from 1997 to 1999. Leukocyte telomere length was measured in 331 children at age 3.6 years (SD 1.0) of whom 268 children without diabetes had carotid intima-media thickness assessed by ultrasound at age 8 years. Male sex, younger paternal age and higher maternal body mass index were associated with shorter telomere length in early childhood, which in turn was associated with greater carotid intima-media thickness at age 8 years (standardised β = -0.159, P = 0.01). There was a graded association across quartiles of telomere length (Ptrend = 0.001) with the highest odds of elevated intima-media thickness (>75th percentile) being in children with the shortest telomeres (odds ratio 4.00 (95% confidence interval 1.58 to 10.14) relative to those with the longest telomeres, P = 0.003). This association remained after adjustment for early life risk factors (Ptrend = 0.001). Reduced telomere length in early childhood is independently associated with arterial wall thickness in later childhood, suggesting that reduced telomere length during early childhood may be a marker of vascular disease risk.
Prevalence Of Tuberculosis Among Household Contacts Of Smear Positive Tuberculosis Patients In Four Districts In Ha Noi, Viet Nam
Publisher: American Thoracic Society
Date: 05-2011
DOI: 10.1164/AJRCCM-CONFERENCE.2011.183.1_MEETINGABSTRACTS.A1843
Asthma in Indigenous Australians: so much yet to do for Indigenous lung health
Publisher: AMPCo
Date: 05-2009
Severe Asthma Toolkit: An online resource for multidisciplinary health professionals - Needs assessment, development process and user analytics with survey feedback
Publisher: BMJ
Date: 03-2020
DOI: 10.1136/BMJOPEN-2019-032877
Abstract: Severe asthma imposes a significant burden on in iduals, families and the healthcare system. New treatment and management approaches are emerging as effective options for severe asthma. Translating new knowledge to multidisciplinary healthcare professionals is a priority. We developed ‘The Severe Asthma Toolkit’ (toolkit.severeasthma.org.au ) to increase awareness of severe asthma, provide evidence-based resources and support decisionmaking by healthcare providers. Roundtable discussions and a survey of Australians clinicians were conducted to determine clinician preferences, format and content for a severe asthma resource. A reference group from stakeholder and consumer bodies and severe asthma experts provided advice and feedback. A multidisciplinary team of international experts was engaged to develop content. Written content was based on up-to-date literature. Peer and editorial review were performed to finalise content and inform web design. Website design focused on user experience, navigation, engagement, interactivity and tailoring of content for a clinical audience. A web-based resource was developed. Roundtable discussions and a needs assessment survey identified the need for dedicated severe asthma management resources to support skills training. The end-product, which launched 26 March 2018, includes an overview of severe asthma, diagnosis and assessment, management, medications, comorbidities, living with severe asthma, establishing a clinic, paediatrics/adolescents and clinical resources. Analytics indicate access by users worldwide (32 169 users from 169 countries). User survey results (n=394) confirm access by the target audience (72% health professionals), who agreed the toolkit increased their knowledge (73%) and confidence in managing severe asthma (66%), and 75% are likely to use the resource in clinic. The Severe Asthma Toolkit is a unique, evidence-based internet resource to support healthcare professionals providing optimal care for people with severe asthma. It is a comprehensive, accessible and independent resource developed by leading severe asthma experts to improve clinician knowledge and skills in severe asthma management.
Multi-city study on air pollution and hospital outpatient visits for asthma in China
Publisher: Elsevier BV
Date: 02-2020
DOI: 10.1016/J.ENVPOL.2019.113638
Abstract: The proportion of asthma patients with mild to moderate exacerbations is far greater than the number who experience episodes that are severe enough to require emergency room visits or hospital admission. However the routinely collected data from hospitals is absent in the past. To evaluate associations between short-term exposures to air pollutants and hospital outpatient visits for asthma in China. We obtained data for 143,057 asthma outpatient visits from the largest hospitals in 17 Chinese cities, between Jan 01 2013 and Dec 31 2015. We used daily concentrations of air pollutants measured by the China National Environmental Monitoring Centre. We used a time-stratified case-crossover design, and fitted conditional logistic regression models to determine the associations. Particulate matter ≤10μm in diameter (PM10) and nitrogen dioxide (NO2) were associated with increased risks of hospital outpatient visits for asthma on the same day, while the effects were delayed for particulate matter ≤2.5μm in diameter (PM2.5) and sulphur dioxide (SO2). For the cumulative effect model at lag05 days, 10 μg/m3 increase in air pollutants concentrations were correlated with hospital outpatient visits for asthma with odds ratios (ORs) and 95% confidence intervals 1.004 (1.000-1.008) for PM2.5, 1.005 (1.002-1.008) for PM10, 1.030 (1.021-1.040) for NO2, and 1.015 (1.008-1.021) for SO2. Almost one in nine (10.9% 7.7, 13.9%) hospital outpatient visits for asthma were attributable to NO2. Short-term exposures to PM2.5, PM10, NO2 and SO2 were associated with hospital outpatient visits for asthma in China.
Risk of tuberculosis among contacts in a low-incidence setting
Publisher: European Respiratory Society (ERS)
Date: 31-05-2013
How can airborne transmission of COVID-19 indoors be minimised?
Publisher: Elsevier BV
Date: 09-2020
Personal exposure to allergenic pollen and mould spores in inland New South Wales, Australia
Publisher: Wiley
Date: 12-2000
DOI: 10.1046/J.1365-2222.2000.00966.X
Abstract: In inland NSW, Australia, allergic sensitization to the fungi Alternaria and Cladosporium and to pollen is common and an important risk factor for asthma. We report the results of a series of experiments designed to assess the nature of personal exposure to these airborne allergenic particles. We have tested the effect of exposure conditions and level of activity on measurements of the personal exposure. Personal Air S lers (PAS) and Nasal Air S lers (NAS) were employed. NAS are fitted just inside the nose and collect inhaled particles by impaction, while the PAS use a pump-operated filter with constant air flow (2 L/min). Thirty-three subjects (adults and children) used both NAS and PAS simultaneously for four one hour periods during which they performed activities or rested, both inside and outside their homes. S les were analysed by light microscopy. Alternaria spores, Cladosporium spores, grass pollen and nongrass pollen were counted. Both s lers detected substantial variation in exposure between subjects. Between members of the same household, the intrahouse correlation coefficient ranged from < 0 - 0.38. Levels of pollen grains and fungal spores inhaled were higher during periods of activity than during rest, and higher while subjects were outdoors than indoors. During the active outdoor period, the number of Alternaria spores inhaled ranged from 4 to 794 (median 11) spores/hr, Cladosporium from 0 to 396 (median 4) spores/hr, grass pollen from 0 to 81 (median 1) grains/hr and nongrass pollen from 0 to 72 (median 5) grains/hr. This is the first study to quantify in idual inhaled levels of allergenic fungal spores and pollen under normal domestic circumstances. Exposure can be substantial and highly variable between in iduals. The amount of particles inhaled relates both to location of the in idual and activity being performed, independent of age group.
Predictors of accuracy of diagnosis of chronic obstructive pulmonary disease in general practice
Publisher: AMPCo
Date: 08-2011
DOI: 10.5694/J.1326-5377.2011.TB03271.X
Abstract: To compare the clinical diagnosis of chronic obstructive pulmonary disease (COPD) with results of post-bronchodilator spirometry in general practice, and examine practitioner, practice and patient characteristics associated with agreement between clinical and spirometric diagnoses. General practitioners from practices in Sydney identified eligible patients aged 40-80 years seen in the past year and prescribed respiratory medications whom they regarded as having COPD. Between November 2006 and April 2008, we collected information on the GPs and their practices, and demographic information, smoking status, comorbidities, respiratory medicines use, vaccination status, quality of life and spirometry results for participating patients. Frequency of COPD diagnosis on spirometry odds ratios for characteristics associated with agreement between clinical and spirometric diagnoses. 56 GPs from 44 practices participated in the study. Of 1144 eligible patients, 445 were recruited (mean age, 65 years 49% male). Of these, 257 (57.8%) had post-bronchodilator spirometry consistent with COPD ± asthma, 16 (3.6%) had asthma only, 82 (18.4%) had normal spirometry, and 90 (20.2%) had other spirometric diagnoses. Having a spirometer in the practice was not predictive of agreement between clinical and spirometric diagnoses. Older patient age was significantly associated with correct diagnosis, while higher numbers of comorbidities were associated with misdiagnosis. A substantial proportion of patients clinically identified as having COPD in general practice do not have the condition according to spirometric criteria, with inaccurate diagnosis more common in patients with comorbidities. Policy and practice change is needed to support the use of spirometry in primary care.
Long-Term Azithromycin Reduces
Publisher: American Thoracic Society
Date: 08-2019
Effects of ambient PM 1 air pollution on daily emergency hospital visits in China: an epidemiological study
Publisher: Elsevier BV
Date: 09-2017
Respiratory Health Effects of Exposure to Low-NOx Unflued Gas Heaters in the Classroom: A Double-Blind, Cluster-Randomized, Crossover Study
Publisher: Environmental Health Perspectives
Date: 10-2010
DOI: 10.1289/EHP.1002186
Do immune responses to inhaled skin flakes modulate the expression of allergic disease?
Publisher: Wiley
Date: 03-07-2007
Validation of a Spatiotemporal Land Use Regression Model Incorporating Fixed Site Monitors
Publisher: American Chemical Society (ACS)
Date: 06-12-2010
DOI: 10.1021/ES100683T
Abstract: Land use regression (LUR) has been widely adopted as a method of describing spatial variation in air pollutants however, traditional LUR methods are not suitable for characterizing short-term or time-variable exposures. Our aim was to develop and validate a spatiotemporal LUR model for use in epidemiological studies examining health effects attributable to time-variable air pollution exposures. A network of 42 NO(2) passive s lers was deployed for 12 two week periods over three years. A mixed effects model was tested using a combination of spatial predictors, and readings from fixed site continuous monitors, in order to predict NO(2) values for any two week period over three years in the defined study area. The final model, including terms based on traffic density at 50 and 150 m, population density within 500 m, commercial land use area within 750 m, and NO(2) concentrations at a central fixed site monitor, explained over 80% of the overall variation in NO(2) concentrations. We suggest that such a model can be used to study the association between variable air pollutant exposures and health effects in epidemiological studies.
Prevalence of anaemia, syphilis and hepatitis B in pregnant women in Nausori, Fiji
Publisher: International Union Against Tuberculosis and Lung Disease
Date: 21-03-2013
DOI: 10.5588/PHA.12.0069
The burden of asthma in children
Publisher: Elsevier BV
Date: 03-2005
DOI: 10.1016/J.PRRV.2004.11.004
Abstract: The burden of asthma among children is high in Australia compared with many other countries. Recent data show that 14-16% of children report a diagnosis of asthma that remains a problem. Boys, children under the age of 5 years and urban indigenous children experience a greater burden of asthma than other children. More than one-third of children with asthma have sleep disturbance due to the illness and 60% have missed school and/or experienced other restrictions in their activities due to the disease. Despite this, there is continuing evidence of under-utilisation of effective treatment for the disease. Asthma is a major cause of healthcare utilisation among children. Since the early 1990s, there has been a decline in both hospitalisation rates and general practitioner consultation rates for asthma among children. It remains to be seen whether this favourable trend will continue and extend into the adult age range.
Pertussis vaccination and allergic illness in Australian children
Publisher: Wiley
Date: 20-07-2020
DOI: 10.1111/PAI.13300
Comparison of Methods for Estimation of Exposure to Traffic Related NO2
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2009
Maternal asthma in Australian indigenous women and perinatal outcomes: A whole population–linked study
Publisher: Wiley
Date: 08-08-2023
DOI: 10.1002/IJGO.14363
Abstract: To assess the association between maternal asthma and adverse perinatal outcomes in an Australian Indigenous population. This prospective cohort study included all Indigenous mother and baby dyads for births from 2001 to 2013 in Western Australia ( n = 25 484). Data were linked from Western Australia Births, Deaths, Midwives, Hospital, and Emergency Department collections. Maternal asthma was defined as a self‐reported diagnosis at an antenatal visit or hospitalization or emergency visit for asthma during pregnancy or less than 3 years before pregnancy. Associations with birth, labor, and pregnancy outcomes were assessed using generalized estimating equations. Asthma exacerbation during pregnancy and stratification by remoteness was also assessed. Maternal asthma was associated with placental abruption (adjusted odds ratio [aOR], 1.59 [95% confidence interval (CI), 1.07–2.35]), threatened preterm labor (aOR, 1.58 [95% CI, 1.39–1.79]), and emergency cesarean sections (aOR, 1.27 [95% CI, 1.13–1.44]). These risks increased further with an asthma exacerbation during pregnancy or if the mother was from a remote area. No associations were found for low birth weight, preterm birth, small for gestational age, or perinatal mortality. Maternal asthma in Indigenous women is associated with an increased risk of emergency cesarean sections, placental abruption, and threatened preterm labor. These risks may be mitigated by improved management of asthma exacerbations during pregnancy.
Prevalence of chronic obstructive pulmonary disease with breathlessness in Australia: weighted using the 2016 Australian census
Publisher: Wiley
Date: 05-2021
DOI: 10.1111/IMJ.15325
Abstract: Access to up‐to‐date Australian disease prevalence estimates assists health services and consumer organisations to plan and allocate resources. The Burden of Obstructive Lung Disease study was conducted between 2006 and 2012 and provided chronic obstructive pulmonary disease (COPD) (post‐bronchodilator airflow limitation) prevalence estimates weighted to the 2006 Australian census. Using the 2016 Australian census, an updated prevalence estimate of all COPD is 8.30% (95% confidence interval = 6.59%–10.01%) for adults aged 40 or more years in Australia and includes 2.52% with mild breathlessness, 0.99% with moderate breathlessness and 0.91% with severe breathlessness.
A syndromic approach to assess diagnosis and management of patients presenting with respiratory symptoms to healthcare facilities in Vietnam
Publisher: European Respiratory Society (ERS)
Date: 26-11-2020
DOI: 10.1183/23120541.00572-2020
Abstract: The aim of the study was to establish syndromic diagnoses in patients presenting with respiratory symptoms to healthcare facilities in Vietnam and to compare the diagnoses with facility-level clinical diagnoses and treatment decisions. A representative s le of patients aged ≥5 years, presenting with dyspnoea, cough, wheezing, and/or chest tightness to healthcare facilities in four provinces of Vietnam were systematically evaluated. Eight common syndromes were defined using data obtained. We enrolled 977 subjects at 39 facilities. We identified fixed airflow limitation (FAL) in 198 (20.3%) patients and reversible airflow limitation (RAL) in 26 (2.7%) patients. Patients meeting the criteria for upper respiratory tract infection (URTI) alone constituted 160 (16.4%) patients and 470 (48.1%) did not meet the criteria for any of the syndromes. Less than half of patients with FAL were given long-acting bronchodilators. A minority of patients with either RAL or FAL with eosinophilia were prescribed inhaled corticosteroids. Antibiotics were given to more than half of all patients, even among those with URTI alone. This study identified a substantial discordance between prescribed treatment, clinician diagnosis and a standardised syndromic diagnosis among patients presenting with respiratory symptoms. Increased access to spirometry and implementation of locally relevant syndromic approaches to management may help to improve patient care in resource-limited settings.
The bell tolls for the relationship between house dust mite exposure and asthma in childhood
Publisher: European Respiratory Society (ERS)
Date: 06-2008
Causal inference studies: improving the quality of evidence
Publisher: International Union Against Tuberculosis and Lung Disease
Date: 12-2018
Development and validation of a model for diagnosis of obstructive sleep apnoea in primary care
Publisher: Wiley
Date: 02-08-2021
DOI: 10.1111/RESP.14122
Abstract: Use of in‐laboratory polysomnography (PSG) to diagnose obstructive sleep apnoea (OSA) is cost and resource intensive. Questionnaires, physical measurements and home monitors have been studied as potential simpler alternatives. This study aimed to develop a diagnostic model for OSA for use in primary care. Primary care practitioners were trained to recognize symptoms of sleep apnoea and recruited patients based on the clinical need to investigate OSA. Assessment was by symptom questionnaires, anthropomorphic measurements, digital facial photography, and a single‐channel nasal flow monitor (Flow Wizard©, DiagnoseIT, Sydney, Australia) worn at home for 3 nights. The in‐laboratory PSG was the reference test, with OSA defined as apnoea–hypopnoea index (AHI) ≥10 events/h. In the model development phase, 25 primary care practitioners studied 315 patients in whom they suspected OSA, of which 57% had AHI≥10 and 22% had AHI≥30. Published OSA questionnaires provided low to moderate prediction of OSA (area under the curve [AUC] 0.53–0.73). The nasal flow monitor alone yielded high accuracy for predicting OSA with AUC of 0.87. Sensitivity was 0.87 and specificity 0.77 at a threshold respiratory event index (REI) of 18 events/h. A model adding age, gender, symptoms and BMI to the nasal flow monitor REI only modestly improved OSA prediction (AUC 0.89), with similar AUC (0.88) confirmed in the validation population of 114 patients. Sleep apnoea can be diagnosed in the primary care setting with a combination of clinical judgement and portable monitor test outcomes.
Normal limits for oscillometric bronchodilator responses and relationships with clinical factors
Publisher: European Respiratory Society (ERS)
Date: 09-09-2021
DOI: 10.1183/23120541.00439-2021
Abstract: We aimed to determine normal thresholds for positive bronchodilator responses for oscillometry in an Australian general population s le aged ≥40 years, to guide clinical interpretation. We also examined relationships between bronchodilator responses and respiratory symptoms, asthma diagnosis, smoking and baseline lung function. Subjects recruited from Sydney, Melbourne and Busselton, Australia, underwent measurements of spirometry, resistance ( R rs 6 ) and reactance ( X rs 6 ) at 6 Hz, before and after inhalation of salbutamol 200 μg. Respiratory symptoms and/or medication use, asthma diagnosis, and smoking were recorded. Threshold bronchodilator responses were defined as the fifth percentile of decrease in R rs 6 and 95th percentile increase in X rs 6 in a healthy subgroup. Of 1318 participants, 1145 (570 female) were analysed. The lower threshold for Δ R rs 6 was −1.38 cmH 2 O·s·L −1 (−30.0% or −1.42 Z-scores) and upper threshold for Δ X rs 6 was 0.57 cmH 2 O·s·L −1 (1.36 Z-scores). Respiratory symptoms and/or medication use, asthma diagnosis, and smoking all predicted bronchodilator response, as did baseline oscillometry and spirometry. When categorised into clinically relevant groups according to those predictors, Δ X rs 6 was more sensitive than spirometry in smokers without current asthma or chronic obstructive pulmonary disease (COPD), ∼20% having a positive response. Using absolute or Z-score change provided similar prevalences of responsiveness, except in COPD, in which responsiveness measured by absolute change was twice that for Z-score. This study describes normative thresholds for bronchodilator responses in oscillometry parameters, including intra-breath parameters, as determined by absolute, relative and Z-score changes. Positive bronchodilator response by oscillometry correlated with clinical factors and baseline function, which may inform the clinical interpretation of oscillometry.
The challenge of delivering effective care for asthma [Editorial]
Publisher: International Union Against Tuberculosis and Lung Disease
Date: 21-09-2012
DOI: 10.5588/PHA.12.0057
A comparison of digital chest radiography and Xpert® MTB/RIF in active case finding for tuberculosis
Publisher: International Union Against Tuberculosis and Lung Disease
Date: 09-2020
Abstract: OBJECTIVE: To compare two community screening tests for TB: sputum examination using Xpert ® MTB/RIF and chest radiography (CXR). METHOD: Men aged ≥15 years and women aged years living in 96 sub-communes in Ca Mau, Viet Nam, were invited to provide a single sputum specimen that was tested using Xpert. Participants were also invited to attend a nearby location for digital radiography. Participants whose sputum was Xpert MTB-positive or whose CXR was reported as ‘consistent with TB´ were requested to provide two further sputum specimens for culture. The sensitivities of the two tests for detecting TB (defined as sputum culture-positive for Mycobacterium tuberculosis ) were compared. RESULTS: There were 72 985 eligible participants, of whom 57 597 (78.9%) participated in Xpert screening, 12 752 (17.5%) had CXR and 11 235 (15.4%) had both tests. We estimated that there were 59 cases of TB, of whom 20 were Xpert MTB-positive (programmatic sensitivity 34.0%) and 47 had CXR reported as ‘consistent with TB´ (sensitivity 80.0%, P 0.0001). CONCLUSION: In community-wide screening for TB, CXR is more sensitive than a single spontaneously expectorated sputum s le tested using Xpert, but it has a substantially lower participation rate.
Mycobacterium tuberculosis lineages and anti-tuberculosis drug resistance in reference hospitals across Viet Nam
Publisher: Springer Science and Business Media LLC
Date: 28-07-2016
Priorities for the treatment of latent tuberculosis [3] (multiple letters)
Publisher: Massachusetts Medical Society
Date: 19-08-2004
Unprecedented Prevalence of Azole-Resistant Aspergillus fumigatus Identified in the Environment of Vietnam, with Marked Variability by Land Use Type
Publisher: Elsevier BV
Date: 2020
DOI: 10.2139/SSRN.3692480
Effects of exposure to ambient ultrafine particles on respiratory health and systemic inflammation in children
Publisher: Elsevier BV
Date: 05-2018
DOI: 10.1016/J.ENVINT.2018.02.019
Abstract: It is known that ultrafine particles (UFP, particles smaller than 0.1 μm) can penetrate deep into the lungs and potentially have adverse health effects. However, epidemiological data on the health effects of UFP is limited. Therefore, our objective was to test the hypothesis that exposure to UFPs is associated with respiratory health status and systemic inflammation among children aged 8 to 11 years. We conducted a cross-sectional study among 655 children (43.3% male) attending 25 primary (elementary) schools in the Brisbane Metropolitan Area, Australia. Ultrafine particle number concentration (PNC) was measured at each school and modelled at homes using Land Use Regression to derive exposure estimates. Health outcomes were respiratory symptoms and diagnoses, measured by parent-completed questionnaire, spirometric lung function, exhaled nitric oxide (FeNO), and serum C reactive protein (CRP). Exposure-response models, adjusted for potential personal and environmental confounders measured at the in idual, home and school level, were fitted using Bayesian methods. PNC was not independently associated with respiratory symptoms, asthma diagnosis or spirometric lung function. However, PNC was positively associated with an increase in CRP (1.188-fold change per 1000 UFP cm
ENVIRONMENTAL FACTORS AND GENE–ENVIRONMENT INTERACTIONS IN THE AETIOLOGY OF ASTHMA
Publisher: Wiley
Date: 14-02-2006
DOI: 10.1111/J.1440-1681.2006.04360.X
Abstract: The importance of early life environmental influences on the aetiology of asthma is implied by the observed geographic and temporal variation in the prevalence of the disease among children. 2. There is evidence pointing to the role of exposure to allergen, various aspects of diet and hygiene-related factors in the aetiology of asthma. 3. There is also evidence that heritable factors influence the impact of hygiene-related exposures on the risk of having asthma. Polymorphism within genes coding for the toll-like receptor-lipopolysaccharide (TLR-LPS) signalling pathway may underlie variations in effects of hygiene-related exposures, including specifically endotoxin, on the risk of developing allergic sensitization and allergic disease. 4. At present there is no unifying theory to explain the childhood origins of asthma and, hence, no solid basis for developing preventative interventions. Progress towards this goal requires better understanding of the heterogeneous nature of the disease in early childhood, improved characterization of relevant environmental exposures and long-term follow up of birth cohorts with reliable and valid measures of allergy and asthma outcomes.
β-Lactam pharmacodynamics in Gram-negative bloodstream infections in the critically ill
Publisher: Oxford University Press (OUP)
Date: 26-10-2019
DOI: 10.1093/JAC/DKZ437
Abstract: To determine the β-lactam exposure associated with positive clinical outcomes for Gram-negative blood stream infection (BSI) in critically ill patients. Pooled data of critically ill patients with mono-microbial Gram-negative BSI treated with β-lactams were collected from two databases. Free minimum concentrations (fCmin) of aztreonam, cefepime, ceftazidime, ceftriaxone, piperacillin (co-administered with tazobactam) and meropenem were interpreted in relation to the measured MIC for targeted bacteria (fCmin/MIC). A positive clinical outcome was defined as completion of the treatment course or de-escalation, without other change of antibiotic therapy, and with no additional antibiotics commenced within 48 h of cessation. Drug exposure breakpoints associated with positive clinical outcome were determined by classification and regression tree (CART) analysis. Data from 98 patients were included. Meropenem (46.9%) and piperacillin/tazobactam (36.7%) were the most commonly prescribed antibiotics. The most common pathogens were Escherichia coli (28.6%), Pseudomonas aeruginosa (19.4%) and Klebsiella pneumoniae (13.3%). In all patients, 87.8% and 71.4% achieved fCmin/MIC ≥1 and fCmin/MIC , respectively. Seventy-eight patients (79.6%) achieved positive clinical outcome. Two drug exposure breakpoints were identified: fCmin/MIC .3 for all β-lactams (predicted difference in positive outcome 84.5% versus 15.5%, P 0.05) and fCmin/MIC .95 for meropenem, aztreonam or ceftriaxone (predicted difference in positive outcome 97.7% versus 2.3%, P 0.05). A β-lactam fCmin/MIC .3 was a significant predictor of a positive clinical outcome in critically ill patients with Gram-negative BSI and could be considered an antibiotic dosing target.
Prevalence of COPD and its risk factors in the Australian Bold study
Publisher: American Thoracic Society
Date: 05-2011
DOI: 10.1164/AJRCCM-CONFERENCE.2011.183.1_MEETINGABSTRACTS.A1747
Effect of two alternative methods of pooling sputum prior to testing for tuberculosis with genexpert MTB/RIF
Publisher: Springer Science and Business Media LLC
Date: 27-04-2019
Calling time on asthma deaths in tropical regions—how much longer must people wait for essential medicines?
Publisher: Elsevier BV
Date: 2019
Bridgesampling: An R package for estimating normalizing constants
Publisher: Foundation for Open Access Statistic
Date: 2020
Recurrence of tuberculosis among patients following treatment completion in eight provinces of Vietnam: A nested case-control study
Publisher: Elsevier BV
Date: 09-2018
DOI: 10.1016/J.IJID.2018.06.013
Abstract: Patients completing treatment for tuberculosis (TB) in high-prevalence settings face a risk of developing recurrent disease. This has important consequences for public health, given its association with drug resistance and a poor prognosis. Previous research has implicated in idual factors such as smoking, alcohol use, HIV, poor treatment adherence, and drug resistant disease as risk factors for recurrence. However, little is known about how these factors co-act to produce recurrent disease. Furthermore, perhaps factors related to the index disease means higher burden/low resource settings may be more prone to recurrent disease that could be preventable. We conducted a case-control study nested within a cohort of consecutively enrolled adults who were being treated for smear positive pulmonary TB in 70 randomly selected district clinics in Vietnam. Cases were patients with recurrent TB, identified by follow-up from the parent cohort study. Controls were selected from the cohort by random s ling. Information on demographic, clinical and disease-related characteristics was obtained by interview. Treatment information was extracted from clinic registries. Logistic regression, with stepwise selection, was used to develop a fully adjusted model for the odds of recurrence of TB. We recruited 10,964 patients between October 2010 and July 2013. Median follow-up was 988 days. At the end of follow-up, 505 patients (4.7%) with recurrence were identified as cases and 630 other patients were randomly selected as controls. Predictors of recurrence included multidrug-resistant (MDR)-TB (adjusted odds ratio 79.6 95% CI: 25.1-252.0), self-reported prior TB therapy (aOR=2.5 95% CI: 1.7-3.5), and incomplete adherence (aOR=1.9 95% CI 1.1-3.1). Index disease treatment history is a leading determinant of relapse among patients with TB in Vietnam. Further research is required to identify interventions that will reduce the risk of recurrent disease and enhance its early detection within high-risk populations.
Perception of airway narrowing during reduction of inhaled corticosteroids and asthma exacerbation
Publisher: BMJ
Date: 12-2003
DOI: 10.1136/THORAX.58.12.1042
Abstract: The perception of airway narrowing is reduced in subjects with severe asthma and may be related to the severity of airway inflammation. A study was undertaken to determine if the perception of airway narrowing changes during the reduction of inhaled corticosteroid (ICS) dose or during an asthma exacerbation. Forty two asthmatic subjects with well controlled asthma had their daily ICS dose halved every 2 months until they were weaned off ICS or they developed an exacerbation. Perception was measured at baseline and at monthly intervals during bronchial challenge with mannitol as the slope and intercept of the regression of the Borg score and percentage fall in forced expiratory volume in 1 second (FEV(1)), and as the Borg score at 20% fall in FEV(1) (PS(20)FEV(1)). Sputum was collected for measurement of inflammatory cell numbers. In 33 subjects who successfully halved their ICS dose without exacerbation there were significant reductions in slope (p = 0.01), intercept (p = 0.01), and PS(20)FEV(1) (p = 0.003). Sputum eosinophils and airway hyperresponsiveness increased significantly but, in 14 subjects from whom sputum was obtained, changes in eosinophils were not correlated with changes in perception. Change in airway hyperresponsiveness correlated with change in PS(20)FEV(1) (r = -0.40, p = 0.025). In 27 subjects who developed an exacerbation, slope decreased (p = 0.02) and intercept increased (p = 0.01) compared with the visit before the exacerbation. Changes in intercept correlated with changes in resting FEV(1) (r = -0.57, p = 0.002). Perception of airway narrowing decreases during ICS dose reduction and decreases further during a mild asthma exacerbation. These changes are related to concurrent changes in airway hyperresponsiveness and resting lung function. The effect of changes in airway inflammation on perception is unclear.
Treatable traits can be identified in a severe asthma registry and predict future exacerbations
Publisher: Wiley
Date: 19-09-2019
DOI: 10.1111/RESP.13389
Abstract: A new taxonomic and management approach, termed treatable traits, has been proposed for airway diseases including severe asthma. This study examined whether treatable traits could be identified using registry data and whether particular treatable traits were associated with future exacerbation risk. The Australasian Severe Asthma Web-Based Database (SAWD) enrolled 434 participants with severe asthma and a comparison group of 102 participants with non-severe asthma. Published treatable traits were mapped to registry data fields and their prevalence was described. Participants were characterized at baseline and every 6 months for 24 months. In SAWD, 24 treatable traits were identified in three domains: pulmonary, extrapulmonary and behavioural/risk factors. Patients with severe asthma expressed more pulmonary and extrapulmonary treatable traits than non-severe asthma. Allergic sensitization, upper-airway disease, airflow limitation, eosinophilic inflammation and frequent exacerbations were common in severe asthma. Ten traits predicted exacerbation risk among the strongest were being prone to exacerbations, depression, inhaler device polypharmacy, vocal cord dysfunction and obstructive sleep apnoea. Treatable traits can be assessed using a severe asthma registry. In severe asthma, patients express more treatable traits than non-severe asthma. Traits may be associated with future asthma exacerbation risk demonstrating the clinical utility of assessing treatable traits.
Asthma Symptoms and Rhinovirus In A Longitudinal Children's Cohort
Publisher: Elsevier BV
Date: 02-2014
Machine and Deep Learning for Tuberculosis Detection on Chest X-Rays: Systematic Literature Review
Publisher: JMIR Publications Inc.
Date: 03-07-2023
DOI: 10.2196/43154
Abstract: Tuberculosis (TB) was the leading infectious cause of mortality globally prior to COVID-19 and chest radiography has an important role in the detection, and subsequent diagnosis, of patients with this disease. The conventional experts reading has substantial within- and between-observer variability, indicating poor reliability of human readers. Substantial efforts have been made in utilizing various artificial intelligence–based algorithms to address the limitations of human reading of chest radiographs for diagnosing TB. This systematic literature review (SLR) aims to assess the performance of machine learning (ML) and deep learning (DL) in the detection of TB using chest radiography (chest x-ray [CXR]). In conducting and reporting the SLR, we followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 309 records were identified from Scopus, PubMed, and IEEE (Institute of Electrical and Electronics Engineers) databases. We independently screened, reviewed, and assessed all available records and included 47 studies that met the inclusion criteria in this SLR. We also performed the risk of bias assessment using Quality Assessment of Diagnostic Accuracy Studies version 2 (QUADAS-2) and meta-analysis of 10 included studies that provided confusion matrix results. Various CXR data sets have been used in the included studies, with 2 of the most popular ones being Montgomery County (n=29) and Shenzhen (n=36) data sets. DL (n=34) was more commonly used than ML (n=7) in the included studies. Most studies used human radiologist’s report as the reference standard. Support vector machine (n=5), k-nearest neighbors (n=3), and random forest (n=2) were the most popular ML approaches. Meanwhile, convolutional neural networks were the most commonly used DL techniques, with the 4 most popular applications being ResNet-50 (n=11), VGG-16 (n=8), VGG-19 (n=7), and AlexNet (n=6). Four performance metrics were popularly used, namely, accuracy (n=35), area under the curve (AUC n=34), sensitivity (n=27), and specificity (n=23). In terms of the performance results, ML showed higher accuracy (mean ~93.71%) and sensitivity (mean ~92.55%), while on average DL models achieved better AUC (mean ~92.12%) and specificity (mean ~91.54%). Based on data from 10 studies that provided confusion matrix results, we estimated the pooled sensitivity and specificity of ML and DL methods to be 0.9857 (95% CI 0.9477-1.00) and 0.9805 (95% CI 0.9255-1.00), respectively. From the risk of bias assessment, 17 studies were regarded as having unclear risks for the reference standard aspect and 6 studies were regarded as having unclear risks for the flow and timing aspect. Only 2 included studies had built applications based on the proposed solutions. Findings from this SLR confirm the high potential of both ML and DL for TB detection using CXR. Future studies need to pay a close attention on 2 aspects of risk of bias, namely, the reference standard and the flow and timing aspects. PROSPERO CRD42021277155 www.crd.york.ac.uk rospero/display_record.php?RecordID=277155
All-cause mortality and long-term exposure to low level air pollution in the ‘45 and up study’ cohort, Sydney, Australia, 2006–2015
Publisher: Elsevier BV
Date: 05-2019
DOI: 10.1016/J.ENVINT.2019.02.044
Abstract: Epidemiological studies show that long-term exposure to ambient air pollution reduces life expectancy. Most studies have been in environments with relatively high concentrations such as North America, Europe and Asia. Associations at the lower end of the concentration-response function are not well defined. We assessed associations between all-cause mortality and exposure to annual average particulate matter <2.5 μm (PM The '45 and Up Study' comprises a prospective longitudinal cohort from the state of New South Wales, Australia with 266,969 participants linked to death registry data. We analyzed data for the participants who resided in Sydney at baseline questionnaire (n = 75,268). Exposures to long-term pollution were estimated using annual averages from a chemical transport model (PM In our cohort mean annual PM We found evidence that low-level air pollution exposure was associated with increased risk of mortality in this cohort of adults aged 45 years and over, even at the relatively low concentrations seen in Sydney. However, a clear determination of the association with mortality is difficult because the results were sensitive to some covariates. Our findings are supportive of emerging evidence that exposure to low levels of air pollution reduces life expectancy.
Prediction of airborne pollen and sub-pollen particles for thunderstorm asthma outbreaks assessment
Publisher: Elsevier BV
Date: 03-2023
An Australian national panel study of diurnal temperature range and children's respiratory health
Publisher: Elsevier BV
Date: 04-2014
DOI: 10.1016/J.ANAI.2014.01.007
Abstract: It is still uncertain whether diurnal temperature range (DTR) affects children's respiratory function. To examine the effects of DTR on lung function and respiratory symptoms for school children with asthma in Australia. A panel of 270 children (ages 7-12 years) with asthma living in 6 Australian cities was recruited. They were asked to perform 3 successive forced expiratory maneuvers using a portable electronic peak flow meter twice daily for 4 weeks. The highest values for peak expiratory flow (PEF) were stored for each session. At the same time, they were asked to record their respiratory symptoms (eg, cough and/or phlegm and wheeze and/or chest tightness) every day in the morning (for nighttime symptoms) and evening (for daytime symptoms). Daily data on different metrics of ambient temperature and air pollution were obtained from fixed monitors nearby. Relative humidity data were downloaded from the Weather Underground website. Mixed models, adjusting for children's in idual characteristics and air pollution, were used to examine the effects of DTR on PEF and respiratory symptoms. DTR had linear effects on PEF and respiratory symptoms. An increase in DTR induced a reduction in PEF and increased the occurrence of respiratory symptoms. In general, the effects lasted for 3 days (lag, 0-2 days). The effects occurred for both boys and girls. Our findings provide evidence that DTR had significant effects on lung function and respiratory symptoms for children with asthma. These results indicate that it is important and necessary to protect children with asthma from the effect of unstable weather.
Eighteen-month outcomes of house dust mite avoidance and dietary fatty acid modification in the Childhood Asthma Prevention Study (CAPS).
Publisher: Elsevier BV
Date: 2003
DOI: 10.1067/MAI.2003.36
Abstract: Observational studies have linked house dust mite (HDM) exposure and dietary fatty acid intake with asthma in childhood. However, definitive evidence of their role in the etiology of asthma requires a randomized controlled trial. We hypothesized that the incidence of asthma and allergy in high-risk children would be reduced by avoidance of HDM allergens, supplementation with omega-3 fatty acids, or the combination of these strategies. We present the results of an interim analysis reporting outcomes assessed at 18 months. A total of 616 pregnant women were randomized to an HDM avoidance intervention, comprising the use of impermeable mattress covers and an acaricide or control and the use of an oil supplement, margarines, and cooking oils containing high levels of omega-3 fatty acids or control. Atopic status was measured by skin prick testing. Symptoms, diagnoses, and medication histories were elicited by means of parental interviews. The diet intervention resulted in a 9.8% absolute reduction (95% CI, 1.5-18.1 P =.02) in the prevalence of any wheeze and a 7.8% absolute reduction (95% CI, 0.5-15.1, P =.04) in prevalence of wheeze of >1 week, but it had no effect on serum IgE, atopy, or doctors' diagnosis of asthma. The HDM avoidance intervention did not affect these outcomes but was associated with a lower use of oral steroids. Increasing dietary omega-3 fatty acids might have a beneficial effect on the prevalence of wheeze during the first 18 months of life. Follow-up to age 5 years, when the effect of the interventions on asthma risk will be assessed, is underway.
Congenital Rubella Syndrome in Fiji, 1995–2010
Publisher: Hindawi Limited
Date: 2013
DOI: 10.1155/2013/956234
Abstract: Setting . A nationwide study in Fiji. Objective . To describe the incidence of congenital rubella syndrome (CRS) and its relationship to the incidence of notified cases of rubella in Fiji from 1995 to 2010. Design . Descriptive, retrospective review of all recorded congenital abnormalities associated with live births in Fiji over 16 years. Results . There were 294 infants who met the criteria for CRS. Of these, 95% were classified as “suspected” cases, 5% were “clinically confirmed,” and none were “laboratory confirmed cases”. There was a significant linear increase over the study period in the incidence of CRS (odds ratio 1.045 per year, 95% CI 1.019 to 1.071, P ≤ 0.001 ). There was no significant association between the incidence of CRS and the reported incidence of rubella ( P = 0.3 ). Conclusion . There is a rising trend in reports of suspected CRS cases in Fiji. This highlights the need to strengthen surveillance for CRS through improvements in clinical and laboratory diagnosis to confirm or exclude suspected cases. It is also important to ensure high coverage of rubella vaccination in Fiji.
Associations Between Ambient Particulate Air Pollution and Cognitive Function in Indonesian Children Living in Forest Fire–Prone Provinces
Publisher: SAGE Publications
Date: 09-07-2021
DOI: 10.1177/10105395211031735
Abstract: Smoke from forest fires can reach hazardous levels for extended periods of time. We aimed to determine if there is an association between particulate matter ≤2.5 µm in aerodynamic diameter (PM 2.5 ) and living in a forest fire–prone province and cognitive function. We used data from the Indonesian Family and Life Survey. Cognitive function was assessed by the Ravens Colored Progressive Matrices (RCPM). We used regression models to estimate associations between PM 2.5 and living in a forest fire–prone province and cognitive function. In multivariable models, we found very small positive relationships between PM 2.5 levels and RCPM scores (PM 2.5 level at year of survey: β = 0.1% 95% confidence interval (CI) [0.01, 0.19%]). There were no differences in RCPM scores for children living in forest fire–prone provinces compared with children living in non-forest fire–prone provinces (mean difference = −1.16%, 95% CI [–2.53, 0.21]). RCPM scores were lower for children who had lived in a forest fire–prone province all their lives compared with children who lived in a non-forest fire–prone province all their life (β = −1.50% 95% CI [–2.94, –0.07]). Living in a forest fire–prone province for a prolonged period of time negatively affected cognitive scores after adjusting for in idual factors.
Supine awake oximetry as a screening tool for daytime hypercapnia in super‐obese patients
Publisher: Wiley
Date: 10-2017
DOI: 10.1111/IMJ.13496
Abstract: Evidence‐based screening tools are required for detection of daytime hypercapnia in high‐risk patient populations. To determine the validity of supine awake oximetry as a test for daytime hypercapnia and severe sleep disordered breathing ( SDB ) in super‐obese patients. This was a cross‐sectional diagnostic test evaluation of super‐obese adults (body mass index kg/m 2 ) presenting to Liverpool Hospital, Australia, between 2009 and 2015 for diagnostic polysomnography ( PSG ) and arterial blood gas measurement. Supine awake oxygen saturation ( SpO 2 ) was determined using oximetry measurements from the first three awake epochs of raw PSG data. Sensitivity and specificity of SpO 2 for detecting patients with daytime hypercapnia ( PaCO 2 mmHg ) and severe SDB (respiratory disturbance index ( RDI ) events/h) were assessed at various cut‐off points and displayed using a receiver operating characteristic ( ROC ) curve. Area under the ROC curve and positive and negative predictive values ( PPV and NPV ) in the present patient population were derived. Of 52 patients, 23 (44%) had daytime hypercapnia. SpO 2 measured awake in the supine position was associated with the presence of daytime hypercapnia but not with the presence of severe SDB . Overall, awake supine SpO 2 .2% had 34.8% sensitivity, 96.6% specificity and 88.8% PPV , and SpO 2 .7% had 87.0% sensitivity, 20.7% specificity and 66.7% NPV for the presence of daytime hypercapnia. Awake supine oximetry is an easily performed test that may have novel use in identifying patients at high risk of respiratory failure. Future studies are required to evaluate prospectively its role in screening patients at risk of daytime hypercapnia.
Effects of long-term ambient air pollution exposure on township-level pulmonary tuberculosis notification rates during 2005–2017 in Ningxia, China
Publisher: Elsevier BV
Date: 2023
DOI: 10.1016/J.ENVPOL.2022.120718
Abstract: Studies examining long-term effects of ambient air pollution exposure, measured as annual averages, on pulmonary tuberculosis (TB) incidence are scarce, particularly in endemic, rural settings. We performed a small-area study in Ningxia Hui Autonomous Region (NHAR), a high TB-burden area in rural China, using township-level (n = 358 non-overlapping townships) annual TB notification data (2005-2017). We aimed to determine if annual average concentrations of ambient air pollution (particulate matter <2·5 μm [PM
Omega-3 and omega-6 fatty acid exposure from early life does not affect atopy and asthma at age 5 years.
Publisher: Elsevier BV
Date: 06-2007
DOI: 10.1016/J.JACI.2007.01.046
Abstract: The Childhood Asthma Prevention Study was a randomized controlled trial conducted in children with a family history of asthma in whom omega-3 fatty acid supplementation and restriction of dietary omega-6 fatty acids did not prevent asthma, eczema, or atopy at age 5 years. We sought to examine the relation of all measures of omega-3 and omega-6 polyunsaturated fatty acids with outcomes at age 5 years in the whole birth cohort, regardless of randomization group. Plasma fatty acids were measured at 18 months, 3 years, and 5 years. Compliance with the fatty acid supplements was estimated every 6 months. Dietary intake was assessed at 18 months by means of weighed-food record and at 3 years by means of food-frequency questionnaire. At age 5 years, 516 children were examined for wheeze and eczema (questionnaire) and atopy (skin prick tests, n = 488). Multiple logistic regression was used to evaluate associations between exposures and outcomes. Plasma levels of omega-3 or omega-6 fatty acids were not associated with wheeze, eczema, or atopy at age 5 years (P = .11-.96). Overall, fatty acid exposure, measured as plasma levels, dietary intake, and compliance with supplements, was not associated with any respiratory or allergic outcomes (P = .35-.59). This observational analysis of the cohort, using the full range of observed variation in omega-3 and omega-6 fatty acid exposure, supports the negative findings of the randomized controlled trial. Modification of dietary polyunsaturated fatty acids in early childhood is not helpful in preventing atopy and asthma.
A paradigm shift to combat indoor respiratory infection
Publisher: American Association for the Advancement of Science (AAAS)
Date: 14-05-2021
Abstract: Building ventilation systems must get much better
COPD in the Australian Burden Of Lung Disease (BOLD) study
Publisher: American Thoracic Society
Date: 05-2011
DOI: 10.1164/AJRCCM-CONFERENCE.2011.183.1_MEETINGABSTRACTS.A1733
Prevalence of respiratory symptoms, illnesses and spirometric diagnoses by age group and sex
Publisher: American Thoracic Society
Date: 05-2011
DOI: 10.1164/AJRCCM-CONFERENCE.2011.183.1_MEETINGABSTRACTS.A1734
An empirical study of interest-based negotiation
Publisher: ACM
Date: 19-08-2007
Tuberculosis and chronic respiratory disease: A systematic review
Publisher: Elsevier BV
Date: 03-2015
DOI: 10.1016/J.IJID.2014.12.016
Abstract: Chronic respiratory disease causes substantial global morbidity and mortality. The contribution of pulmonary tuberculosis to the aetiology of chronic respiratory disease is rarely considered, but may be important in tuberculosis-endemic areas. We performed a systematic literature review to assess the association between a history of tuberculosis and the presence of chronic obstructive pulmonary disease (COPD) or chronic suppurative lung disease (bronchiectasis). Study quality was evaluated using the National Heart Lung and Blood Institute quality assessment tool. Meta-analysis was performed using the DerSimonian and Laird random effects model. We identified 9 eligible studies for COPD and 2 for bronchiectasis. Overall, there was a significant association between a history of tuberculosis and the presence of COPD in adults aged over 40 years (pooled odds ratio 3.05 (95% confidence interval 2.42, 3.85). Among in idual COPD studies the strongest associations were found in countries with a high incidence of tuberculosis, as well as among never smokers and younger people. In tuberculosis endemic areas, tuberculosis is strongly associated with the presence of chronic respiratory disease in adults. Efforts to improve long-term lung health should be part of tuberculosis care.
Validation of the inhaler adherence questionnaire
Publisher: Springer Science and Business Media LLC
Date: 03-09-2020
DOI: 10.1186/S40359-020-00461-X
Abstract: Although electronic monitoring is the “gold standard” for adherence monitoring, the range of inhaler devices on the market exceeds the availability of appropriate monitoring devices. Simple tools, applicable across a range of inhalers, are needed to assess patients’ adherence to prescribed inhaled medication. This study reports on the validation of an Inhaler Adherence Questionnaire (IAQ). Seventy-four adults who self-reported doctor diagnosed asthma and who were prescribed daily inhaled corticosteroids (ICS) for asthma contributed data for these analyses. These participants were part of a larger study, investigating factors associated with non-adherence to prescribed daily inhaled corticosteroid medication. Participants were informed the research was investigating asthma management without explicit mention that medication adherence was being monitored. Inhaled corticosteroid medication adherence was measured in two ways. Firstly, participants completed the 6-item IAQ at enrolment. Secondly, ICS via pressurised Metered Dose Inhaler (pMDI) use was monitored electronically using the DoserCT which recorded daily use over 6 weeks. During the 6 weeks of prospective medication monitoring via the DoserCT we did not have contact with participants so that the adherence measure would reflect usual self-management behaviour. Two of the six questions in the IAQ had poor face validity and their exclusion from the questionnaire resulted in improved internal consistency. Mean days adherent were 37.1, 29.2 and 33.2% for subjects with IAQ scores of 0, 1 and 2 respectively. Higher IAQ scores of 3 and 4 were associated with greater mean days adherent of 73.7 and 67.4% respectively. A cut-point of 2 or less had a sensitivity of 73% and a specificity of 80% for detecting non-adherence. The area under the ROC curve was 0.764 ( p 0.001). The modified 4-item IAQ is simple, quick to complete and useful for measuring adherence with prescribed daily inhaled medication. This validation of the IAQ provides evidence for its utility in research and it will be important to validate this simple, inexpensive tool for use in clinical practice.
Resistance Band Exercise: An Effective Strategy to Reverse Cardiometabolic Disorders in Women With Osteosarcopenic Obesity
Publisher: Human Kinetics
Date: 08-2023
Abstract: We designed to evaluate the effects of resistance elastic band exercises (REBEs) on cardiometabolic/obesity-related biomarkers in older females with osteosarcopenic obesity. Sixty-three patients (aged 65–80 years) with osteosarcopenic obesity and a body mass index exceeding 30 kg/m 2 were enrolled in the study. The participants were randomly assigned to either an experimental group (REBE, n = 32) or a usual care group ( n = 31). The experimental group completed a 12-week REBE program, three times a week and 60 min per session. There were decreases in lipid accumulation product ( p = .033), visceral adipose index ( p = .001), triglyceride-glucose-body mass index ( p = .034), and atherogenic index of plasma ( p = .028) in the experimental group compared with the usual care group. Our findings highlight the importance of an REBE program in improving combined cardiometabolic/obesity-related indices in older women with osteosarcopenic obesity. The incorporation of an REBE program may benefit in iduals who are unable to tolerate or participate in more strenuous exercise programs.
Risk Of Tuberculosis Among People On Renal Replacement Therapy : A National Cohort Study
Publisher: American Thoracic Society
Date: 05-2010
DOI: 10.1164/AJRCCM-CONFERENCE.2010.181.1_MEETINGABSTRACTS.A5375
Control of Confounding and Reporting of Results in Causal Inference Studies. Guidance for Authors from Editors of Respiratory, Sleep, and Critical Care Journals.
Publisher: American Thoracic Society
Date: 2019
Risk Of Tuberculosis Among People With Diabetes: A National Cohort Study
Publisher: American Thoracic Society
Date: 05-2010
DOI: 10.1164/AJRCCM-CONFERENCE.2010.181.1_MEETINGABSTRACTS.A5376
Transmission ofMycobacterium tuberculosisfrom an Asian elephant (Elephas maximus) to a chimpanzee (Pan troglodytes) and humans in an Australian zoo
Publisher: Cambridge University Press (CUP)
Date: 28-03-2013
DOI: 10.1017/S095026881300068X
Abstract: Mycobacterium tuberculosis is primarily a pathogen of humans. Infections have been reported in animal species and it is emerging as a significant disease of elephants in the care of humans. With the close association between humans and animals, transmission can occur. In November 2010, a clinically healthy Asian elephant in an Australian zoo was found to be shedding M. tuberculosis in September 2011, a sick chimpanzee at the same zoo was diagnosed with tuberculosis caused by an indistinguishable strain of M. tuberculosis. Investigations included staff and animal screening. Four staff had tuberculin skin test conversions associated with spending at least 10 hours within the elephant enclosure none had disease. Six chimpanzees had suspected infection. A pathway of transmission between the animals could not be confirmed. Tuberculosis in an elephant can be transmissible to people in close contact and to other animals more remotely. The mechanism for transmission from elephants requires further investigation.
Essential Medicines at the National Level: The Global Asthma Network’s Essential Asthma Medicines Survey 2014
Publisher: MDPI AG
Date: 19-02-2019
Abstract: Patients with asthma need uninterrupted supplies of affordable, quality-assured essential medicines. However, access in many low- and middle-income countries (LMICs) is limited. The World Health Organization (WHO) Non-Communicable Disease (NCD) Global Action Plan 2013–2020 sets an 80% target for essential NCD medicines’ availability. Poor access is partly due to medicines not being included on the national Essential Medicines Lists (EML) and/or National Reimbursement Lists (NRL) which guide the provision of free/subsidised medicines. We aimed to determine how many countries have essential asthma medicines on their EML and NRL, which essential asthma medicines, and whether surveys might monitor progress. A cross-sectional survey in 2013–2015 of Global Asthma Network principal investigators generated 111/120 (93%) responses—41 high-income countries and territories (HICs) 70 LMICs. Patients in HICs with NRL are best served (91% HICs included ICS (inhaled corticosteroids) and salbutamol). Patients in the 24 (34%) LMICs with no NRL and the 14 (30%) LMICs with an NRL, however no ICS are likely to have very poor access to affordable, quality-assured ICS. Many LMICs do not have essential asthma medicines on their EML or NRL. Technical guidance and advocacy for policy change is required. Improving access to these medicines will improve the health system’s capacity to address NCDs.
The effects of in utero and post-natal tobacco smoke exposures on airway mechanics at age 8 years
Publisher: American Thoracic Society
Date: 05-2011
DOI: 10.1164/AJRCCM-CONFERENCE.2011.183.1_MEETINGABSTRACTS.A1771
A polymorphism in the P2X7 gene increases susceptibility to extrapulmonary tuberculosis
Publisher: American Thoracic Society
Date: 15-02-2007
Exhaled Nitric Oxide Measurements in a Population Sample of Young Adults
Publisher: American Thoracic Society
Date: 03-1999
DOI: 10.1164/AJRCCM.159.3.9802108
Abstract: In epidemiologic studies of asthma there is a group with recent wheeze, but with no airway hyperresponsiveness (AHR), in whom it is unclear whether any significant airway abnormality exists. Exhaled nitric oxide (NO) has been proposed as a measure of airway inflammation. We measured exhaled NO in a population s le of 306 young adults who also underwent bronchial challenge with histamine or a bronchodilator test. Subjects blew into a 3-L Tedlar bag against a 2-mm-diameter resistance to close the soft palate and exclude nasal air. The NO content of expired gas from a single breath was analyzed by chemiluminescent analyzer. Exhaled NO was log-normally distributed in the population s le and duplicate measurements were highly reproducible (intraclass correlation coefficient = 0.98). Exhaled NO correlated significantly with airway responsiveness, measured as the dose-response ratio to histamine (r = 0.39, p < 0.001) and with peripheral blood eosinophils (r = 0.35, p < 0.001). Exhaled NO was significantly greater in asthmatic subjects (geometric mean, 22.2 95% confidence intervals, 16.1 to 30. 7 ppb) than in normal subjects (7.8, 7.1 to 8.4, p < 0.001) or in subjects with wheeze but no AHR (8.8, 7.5 to 10.3, p < 0.001). We conclude that exhaled NO is log-normally distributed, is highly reproducible and discriminates well among subjects, suggesting that it is both a feasible and useful measurement for epidemiologic studies of asthma. The findings suggest that wheeze in the absence of AHR is unlikely to be associated with airway inflammation.
Damp housing, gas stoves, and the burden of childhood asthma in Australia
Publisher: Wiley
Date: 04-2018
DOI: 10.5694/MJA17.00469
Abstract: To determine the proportion of the national childhood asthma burden associated with exposure to d ness and gas stoves in Australian homes. Comparative risk assessment modelling study. Setting, participants: Australian children aged 14 years or less, 2011. The population attributable fractions (PAFs) and number of disability-adjusted life years (DALYs) for childhood asthma associated with exposure to d housing and gas stoves. 26.1% of Australian homes have d ness problems and 38.2% have natural gas as the main energy source for cooktop stoves. The PAF for childhood asthma attributable to d housing was 7.9% (95% CI, 3.2-12.6%), causing 1760 disability-adjusted life years (DALYs 95% CI, 416-3104 DALYs), or 42 DALYs/100 000 children. The PAF associated with gas stoves was 12.3% (95% CI, 8.9-15.8%), corresponding to 2756 DALYs (95% CI, 1271-4242), or 67 DALYs/100 000 children. If all homes with gas stoves were fitted with high efficiency range hoods to vent gas combustion products outdoors, the PAF and burden estimates were reduced to 3.4% (95% CI, 2.2-4.6%) and 761 DALYs (95% CI, 322-1199). Exposure to d housing and gas stoves is common in Australia, and is associated with a considerable proportion of the childhood asthma burden. Strategies for reducing exposure to indoor d ness and gas combustion products should be communicated to parents of children with or at risk of asthma.
Treatable traits: a new paradigm for 21st century management of chronic airway diseases: Treatable Traits Down Under International Workshop report
Publisher: European Respiratory Society (ERS)
Date: 07-03-2019
DOI: 10.1183/13993003.02058-2018
Abstract: “Treatable traits” have been proposed as a new paradigm for the management of airway diseases, particularly complex disease, which aims to apply personalised medicine to each in idual to improve outcomes. Moving new treatment approaches from concepts to practice is challenging, but necessary. In an effort to accelerate progress in research and practice relating to the treatable traits approach, the Treatable Traits Down Under International Workshop was convened in Melbourne, Australia in May 2018. Here, we report the key concepts and research questions that emerged in discussions during the meeting. We propose a programme of research that involves gaining international consensus on candidate traits, recognising the prevalence of traits, and identifying a potential hierarchy of traits based on their clinical impact and responsiveness to treatment. We also reflect on research methods and designs that can generate new knowledge related to efficacy of the treatable traits approach and consider multidisciplinary models of care that may aid its implementation into practice.
EFFECTIVENESS AND RESPONSE PREDICTORS OF OMALIZUMAB IN A SEVERE ALLERGIC ASTHMA POPULATION WITH A HIGH PREVALENCE OF COMORBIDITIES: THE AUSTRALIAN XOLAIR REGISTRY
Publisher: Wiley
Date: 09-2016
DOI: 10.1111/IMJ.13166
Abstract: Severe asthma is a high impact disease. Omalizumab targets the allergic inflammatory pathway however, effectiveness data in a population with significant comorbidities are limited. To describe severe allergic asthma, omalizumab treatment outcomes and predictors of response among the Australian Xolair Registry participants. A web-based post-marketing surveillance registry was established to characterise the use, effectiveness and adverse effects of omalizumab (Xolair) for severe allergic asthma. Participants (n = 192) (mean age 51 years, 118 female) with severe allergic asthma from 21 clinics in Australia were assessed, and 180 received omalizumab therapy. They had poor asthma control (Asthma Control Questionnaire, ACQ-5, mean score 3.56) and significant quality of life impairment (Asthma-related Quality of Life Questionnaire score 3.57), and 52% were using daily oral corticosteroid (OCS). Overall, 95% had one or more comorbidities (rhinitis 48%, obesity 45%, cardiovascular disease 23%). The omalizumab responder rate, assessed by an improvement of at least 0.5 in ACQ-5, was high at 83%. OCS use was significantly reduced. The response in participants with comorbid obesity and cardiovascular disease was similar to those without these conditions. Baseline ACQ-5 ≥ 2.0 (P = 0.002) and older age (P = 0.05) predicted the magnitude of change in ACQ-5 in response to omalizumab. Drug-related adverse events included anaphylactoid reactions (n = 4), headache (n = 2) and chest pains (n = 1). Australian patients with severe allergic asthma report a high disease burden and have extensive comorbidity. Symptomatic response to omalizumab was high despite significant comorbid disease. Omalizumab is an effective targeted therapy for severe allergic asthma with comorbidity in a real-life setting.
Undiagnosed and Misdiagnosed Chronic Obstructive Pulmonary Disease
Publisher: Informa UK Limited
Date: 02-2021
DOI: 10.2147/COPD.S287172
Impact of asthma on self-reported health status and quality of life: a population based study of Australians aged 18-64
Publisher: BMJ
Date: 09-2005
First-dose ChAdOx1 and BNT162b2 COVID-19 vaccines and thrombocytopenic, thromboembolic and hemorrhagic events in Scotland
Publisher: Springer Science and Business Media LLC
Date: 09-06-2021
DOI: 10.1038/S41591-021-01408-4
Abstract: Reports of ChAdOx1 vaccine–associated thrombocytopenia and vascular adverse events have led to some countries restricting its use. Using a national prospective cohort, we estimated associations between exposure to first-dose ChAdOx1 or BNT162b2 vaccination and hematological and vascular adverse events using a nested incident-matched case-control study and a confirmatory self-controlled case series (SCCS) analysis. An association was found between ChAdOx1 vaccination and idiopathic thrombocytopenic purpura (ITP) (0–27 d after vaccination adjusted rate ratio (aRR) = 5.77, 95% confidence interval (CI), 2.41–13.83), with an estimated incidence of 1.13 (0.62–1.63) cases per 100,000 doses. An SCCS analysis confirmed that this was unlikely due to bias (RR = 1.98 (1.29–3.02)). There was also an increased risk for arterial thromboembolic events (aRR = 1.22, 1.12–1.34) 0–27 d after vaccination, with an SCCS RR of 0.97 (0.93–1.02). For hemorrhagic events 0–27 d after vaccination, the aRR was 1.48 (1.12–1.96), with an SCCS RR of 0.95 (0.82–1.11). A first dose of ChAdOx1 was found to be associated with small increased risks of ITP, with suggestive evidence of an increased risk of arterial thromboembolic and hemorrhagic events. The attenuation of effect found in the SCCS analysis means that there is the potential for overestimation of the reported results, which might indicate the presence of some residual confounding or confounding by indication. Public health authorities should inform their jurisdictions of these relatively small increased risks associated with ChAdOx1. No positive associations were seen between BNT162b2 and thrombocytopenic, thromboembolic and hemorrhagic events.
Thunderstorm-associated asthma in an inland town in south-eastern Australia. Who is at risk?
Publisher: European Respiratory Society (ERS)
Date: 07-2000
DOI: 10.1034/J.1399-3003.2000.16A02.X
Abstract: The aim of the study was to characterize patients at risk of asthma exacerbation during spring thunderstorms and identify potential measures to ameliorate the impact of those events. A case-control study was conducted among patients aged 7-60 yrs, who attended Wagga Hospital (NSW, Australia) for asthma during the period of 1 June 1997 to 31 October 1997. One hundred and eighty-three patients who attended on 30 and 31 October 1997 were the cases and the remaining 121 patients were the controls. Questionnaire data were obtained from 148 (81%) cases and 91 (75%) controls. One hundred and thirty-eight (95%) cases who attended during the thunderstorm gave a history of hayfever prior to the event compared to 66 (74%) controls who attended at other times (odds ratio (OR) 6.01, 95% confidence interval (CI) 2.55-14.15) 111 (96%) cases were allergic to rye grass pollen compared to 47 (64%) controls (OR 23.6, 95% CI 6.6-84.3). Among subjects with a prior diagnosis of asthma (64% cases and 82% controls), controls (56%) were more likely to be taking inhaled steroids at time of the thunderstorm than cases (27%, OR 0.3, 95% CI 0.16-0.57). History of hayfever and allergy to rye grass are strong predictors for asthma exacerbation during thunderstorms in spring. The lower rate of inhaled steroid use in thunderstorm cases suggests that this treatment may be effective in preventing severe attacks during thunderstorms.
A new approach for modeling researcher community based on scientific article metadata using natural language processing
Publisher: IEEE
Date: 04-2017
Pooling sputum samples to improve the feasibility of Xpert (R) MTB/RIF in systematic screening for tuberculosis
Publisher: International Union Against Tuberculosis and Lung Disease
Date: 05-2017
Abstract: Systematic screening for tuberculosis (TB) using Xpert® MTB/RIF. To determine whether pooling sputum s les for Xpert testing may improve the feasibility and cost-effectiveness of Xpert by reducing the number of Xpert tests required. Mycobacterium tuberculosis-spiked sputum s les at low organism concentrations were used to mimic s les that are more likely to be found in the screening, compared to the diagnostic, setting. Using Xpert, pooled sputum s les were tested from a pooling ratio of 1 in 2 to 1 in 12. A linear relationship between the pooling ratio and the Xpert MTB cycle threshold (Ct) value was found. As the sputum pooling ratio increased, the Ct value also increased. However, the slope of this increase was relatively small. In the majority of the s les pooled (75/96, 78.1%), Xpert was able to detect M. tuberculosis. These findings suggest that sputum pooling may be a viable method of improving the feasibility and cost-effectiveness of large-scale sputum testing using Xpert in the TB screening setting.
Principles for setting air quality guidelines to protect human health in Australia
Publisher: AMPCo
Date: 07-03-2021
DOI: 10.5694/MJA2.50964
Coagulopathy of Dengue and COVID-19: Clinical Considerations
Publisher: MDPI AG
Date: 25-08-2022
DOI: 10.3390/TROPICALMED7090210
Abstract: Thrombocytopenia and platelet dysfunction commonly occur in both dengue and COVID-19 and are related to clinical outcomes. Coagulation and fibrinolytic pathways are activated during an acute dengue infection, and endothelial dysfunction is observed in severe dengue. On the other hand, COVID-19 is characterised by a high prevalence of thrombotic complications, where bleeding is rare and occurs only in advanced stages of critical illness here thrombin is the central mediator that activates endothelial cells, and elicits a pro-inflammatory reaction followed by platelet aggregation. Serological cross-reactivity may occur between COVID-19 and dengue infection. An important management aspect of COVID-19-induced immunothrombosis associated with thrombocytopenia is anticoagulation with or without aspirin. In contrast, the use of aspirin, nonsteroidal anti-inflammatory drugs and anticoagulants is contraindicated in dengue. Mild to moderate dengue infections are treated with supportive therapy and paracetamol for fever. Severe infection such as dengue haemorrhagic fever and dengue shock syndrome often require escalation to higher levels of support in a critical care facility. The role of therapeutic platelet transfusion is equivocal and should not be routinely used in patients with dengue with thrombocytopaenia and mild bleeding. The use of prophylactic platelet transfusion in dengue fever has strained financial and healthcare systems in endemic areas, together with risks of transfusion-transmitted infections in low- and middle-income countries. There is a clear research gap in the management of dengue with significant bleeding.
The effect of neonatal BCG vaccination on atopy and asthma at age 7 to 14 years: An historical cohort study in a community with a very low prevalence of tuberculosis infection and a high prevalence of atopic disease
Publisher: Elsevier BV
Date: 03-2003
DOI: 10.1067/MAI.2003.171
Abstract: There are conflicting reports on the effect of BCG vaccination on the subsequent development of atopy and asthma. There are no data on the effects of neonatal BCG vaccination on cytokine responses of lymphocytes that are exposed in vitro to allergens. We sought to test the hypothesis that neonatal BCG vaccination or, alternatively, evidence of an immunologic memory of this vaccination is associated with a reduced prevalence of allergic sensitization, asthma, eczema, and hay fever during childhood. An historical cohort study was conducted among 7- to 14-year-old children who were born in 2 districts in Sydney, Australia, and whose mothers were born in southeast Asia. One district had routinely administered BCG vaccination to infants born to overseas-born mothers and the other had not. Eligible subjects were identified from birth registers. Consenting subjects completed questionnaires, performed spirometric and airway hyperresponsiveness testing, and had allergen skin prick testing and tuberculin skin testing. Blood was collected to measure total serum IgE levels and for in vitro lymphocyte culture in the presence of an extract of house dust mite, the dominant allergen in this region, and purified protein derivative of Mycobacterium tuberculosis (tuberculin). IL-4, IL-5, IL-10, and IFN-gamma were measured in the culture supernatant. The cohort included 309 BCG-vaccinated subjects and 442 non-BCG-vaccinated subjects. BCG-vaccinated subjects did not have a lower rate of allergic sensitization than nonvaccinated subjects. However, among the subgroup of subjects with a family history of rhinitis or eczema, BCG vaccination was associated with a lower prevalence of current asthma (defined as recent wheezing plus airway hyperresponsiveness relative risk, 0.46 95% CI, 0.22-0.95). BCG vaccination was also associated with lower levels of allergen-stimulated IL-10 production in vitro. Among the BCG-vaccinated subjects, the 44 (14.3%) who had tuberculin skin test reaction sizes of 5 mm or greater and the 31 (18.3%) who demonstrated an in vitro IFN-gamma response to purified protein derivative of M tuberculosis did not have lower rates of allergic sensitization and, overall, did not have a lower prevalence of allergic disease than tuberculin skin test or IFN-gamma nonreactors. We conclude that neonatal BCG vaccination has an effect on T-cell allergen responsiveness 7 to 14 years after vaccination and that among a subgroup of subjects with an inherited predisposition to allergic disease, this is associated with clinically relevant beneficial effects. The findings of this study encourage the view that external influences on the immune system in the neonatal period have consequences that extend into later childhood and influence the expression of asthma. Genetic factors are likely to modify the effect of those external factors.
Prevalence of airflow obstruction and reduced forced vital capacity in an Aboriginal Australian population: The cross-sectional BOLD study
Publisher: Wiley
Date: 22-02-2015
DOI: 10.1111/RESP.12482
Abstract: Mortality and hospital separation data suggest a higher burden of chronic obstructive pulmonary disease (COPD) in indigenous than non-indigenous subpopulations of high-income countries. This study sought to accurately measure the true prevalence of post-bronchodilator airflow obstruction and forced vital capacity reduction in representative s les of Indigenous and non-Indigenous Australians. This study applies cross-sectional population-based survey of Aboriginal and non-Indigenous residents of the Kimberley region of Western Australia aged 40 years or older, following the international Burden Of Lung Disease (BOLD) protocol. Quality-controlled spirometry was conducted before and after bronchodilator. COPD was defined as Global initiative for chronic Obstructive Lung Disease (GOLD) Stage 2 and above (post-bronchodilator forced expiratory volume in 1 s/forced vital capacity (FEV1 /FVC) ratio <0.7 and FEV1 < 80% predicted). Complete data were available for 704 participants. The prevalence of COPD, adjusted for age, gender and body weight in Aboriginal participants (7.2%, 95% confidence interval (CI) 3.9 to 10.4) was similar to that seen in non-Indigenous Kimberley participants (8.2%, 95% CI 5.7 to 10.7) and non-Indigenous residents of the remainder of Australia (7.1%, 95% CI 6.1 to 8.0). The prevalence of low FVC (<80% predicted) was substantially higher in Aboriginal compared with non-Indigenous participants (74.0%, 95% CI 69.1 to 78.8, vs 9.7%, 95% CI 7.1 to 12.4). Low FVC, rather than airflow obstruction, characterizes the impact of chronic lung disease previously attributed to COPD in this population subject to significant social and economic disadvantage. Environmental risk factors other than smoking as well as developmental factors must be considered. These findings require further investigation and have implications for future prevention of chronic lung disease in similar populations.
Standardization of ambulatory peak flow monitoring: The importance of recent β2 -agonist inhalation
Publisher: European Respiratory Society (ERS)
Date: 08-1998
DOI: 10.1183/09031936.98.12020309
Abstract: Standardization of conditions for peak expiratory flow (PEF) monitoring is much more difficult in practice than for laboratory spirometry. Patients are usually asked to record PEF before medication. The aim of this study was to determine the effect of prior bronchodilator use on PEF outcome measures in a clinical trial. Electronic PEF records from 43 subjects with poorly controlled asthma were examined to determine the frequency with which beta2-agonist was inhaled h before PEF measurement, as such PEF are potentially "postbronchodilator". The effect of inclusion of such PEF values on improvement in PEF outcome measures after 8 weeks of inhaled budesonide was calculated. Subjects were asked to record PEF before medication. During run-in, the median frequency of postbronchodilator PEF was 29%, falling to 0% after 8 weeks of budesonide. Inclusion of postbronchodilator PEF led to an overestimation of average morning, evening and daily PEF during run-in (p .001). Improvement in these indices with treatment was, therefore, underestimated. Minimum morning PEF expressed as per cent personal best was unaffected. Subjects may not be able to withhold beta2-agonist for 4 h before every peak flow reading. This may change as the level of asthma control changes, leading to a systematic bias in clinical trial end-points or inaccuracy in in idual treatment decisions. Simple changes to peak expiratory flow instructions and analysis are proposed.
Population-wide active case finding and prevention for tuberculosis and leprosy elimination in Kiribati: the PEARL study protocol
Publisher: BMJ
Date: 04-2022
DOI: 10.1136/BMJOPEN-2021-055295
Abstract: Population-wide interventions offer a pathway to tuberculosis (TB) and leprosy elimination, but ‘real-world’ implementation in a high-burden setting using a combined approach has not been demonstrated. This implementation study aims to demonstrate the feasibility and evaluate the effect of population-wide screening, treatment and prevention on TB and leprosy incidence rates, as well as TB transmission. A non-randomised ‘screen-and-treat’ intervention conducted in the Pacific atoll of South Tarawa, Kiribati. Households are enumerated and all residents ≥3 years, as well as children years with recent household exposure to TB or leprosy, invited for screening. Participants are screened using tuberculin skin testing, signs and symptoms of TB or leprosy, digital chest X-ray with computer-aided detection and sputum testing (Xpert MTB/RIF Ultra). Those diagnosed with disease are referred to the National TB and Leprosy Programme for management. Participants with TB infection are offered TB preventive treatment and those without TB disease or infection, or leprosy, are offered leprosy prophylaxis. The primary study outcome is the difference in the annual TB case notification rate before and after the intervention a similar outcome is included for leprosy. The effect on TB transmission will be measured by comparing the estimated annual risk of TB infection in primary school children before and after the intervention, as a co-primary outcome used for power calculations. Comparison of TB and leprosy case notification rates in South Tarawa (the intervention group) and the rest of Kiribati (the control group) before, during and after the intervention is a secondary outcome. Approval was obtained from the University of Sydney Human Research Ethics Committee (project no. 2021/127) and the Kiribati Ministry of Health and Medical Services (MHMS). Findings will be shared with the MHMS and local communities, published in peer-reviewed journals and presented at international conferences.
Repeatability of peak nasal inspiratory flow measurements and utility for assessing the severity of rhinitis
Publisher: Wiley
Date: 06-05-2005
DOI: 10.1111/J.1398-9995.2005.00779.X
Abstract: The measurement of peak nasal inspiratory flow (PNIF) provides a simple, cheap, fast and readily available tool for determining the extent of nasal airway patency. However, there are questions regarding its repeatability when used to assess the degree of nasal obstruction in large populations. Therefore, this study aimed to evaluate the repeatability of PNIF measurements and to assess their association with the signs and symptoms of rhinitis. The PNIF, rhinitis symptoms, judged by Meltzer questionnaire and rhinitis signs, as determined by anterior rhinoscopy, were assessed in 283 adults representative of the general population. One training and two test PNIF measurements were recorded during the same session. The PNIF was highly reproducible (ICC = 0.92 95% limits of agreement: +/-36 l/min). The PNIF was strongly correlated with rhinitis signs, measured by anterior rhinoscopy (rs= -0.38, P < 0.0001) but was not correlated with rhinitis symptoms, measured by questionnaire (rs= -0.11, P = 0.057). Differences in PNIF for subjects categorized as asymptomatic, mild or moderate/severe on the basis of rhinitis signs, were highly significant (P < 0.0001), but less significant on the basis of rhinitis symptoms (P = 0.04). A PNIF cut-off of 115 l/min had moderately high specificity (72%) and sensitivity (65%) and a high negative predictive value (90%) for moderate/severe signs of rhinitis. In a large general population-based s le of young adults, PNIF was highly reproducible and closely related to the signs of rhinitis, as determined by clinical examination. The PNIF provides information that is qualitatively different to that provided by symptom scores and may be useful to measure the extent of nasal obstruction.
Trends In The Prevalence Of Asthma In Australia
Publisher: American Thoracic Society
Date: 05-2012
DOI: 10.1164/AJRCCM-CONFERENCE.2012.185.1_MEETINGABSTRACTS.A3241
The incidence of tuberculosis in a cohort of South-East Asian refugees arriving in Australia 1984-94
Publisher: Wiley
Date: 03-2001
DOI: 10.1046/J.1440-1843.2001.00300.X
Abstract: We have used record linkage analysis to describe the incidence of tuberculosis in a cohort of 24 652 predominantly south-east Asian refugees who arrived in Sydney, Australia during the period 1984 to 1994. Cases that had been registered with the State Department of Health were confirmed by examination of case records. After an average follow-up interval of 10.3 years there were 189 cases of tuberculosis, equivalent to an average incidence rate of 74.9 cases per 100 000 person-years. The highest incidence rate was in 40-49 year olds and 47% of cases were in women. One hundred and twenty seven cases (67%) were pulmonary and, of these, 64 (50%) were direct smear positive. The incidence of tuberculosis in this cohort is similar to that observed among Vietnamese migrants to Australia and the USA and substantially higher than the incidence among people born in Australia. It is important to maintain awareness of the diagnosis of tuberculosis, especially in countries such as Australia, where the incidence in the general population is low but where there are large populations of migrants and refugees in whom a higher incidence is expected.
Mortality benefits of reduction fine particulate matter in Vietnam, 2019
Publisher: Frontiers Media SA
Date: 18-11-2022
DOI: 10.3389/FPUBH.2022.1056370
Abstract: Studies assessing the health benefits of air pollution reduction in Vietnam are scarce. This study quantified the annual mortality burden due to PM 2.5 pollution in Vietnam above the World Health Organization recommendation for community health (AQG: 5 μg/m 3 ) and the proposed National Technical Regulation on Ambient Air Quality ( proposed QCVN: 15 μg/m 3 ). This study applied a health impact assessment methodology with the hazard risk function for non-communicable diseases (NCDs) and lower respiratory infections (LRIs) in the Global Exposure Mortality Model (GEMM) to calculate attributable deaths, Years of Life lost, and Loss of Life expectancy at birth due to air pollution in the Vietnamese population above 25 years of age in 11 provinces. We obtained annual average PM 2.5 concentrations for Vietnam in 2019 at a 3x3 km grid modeled using Mixed Linear regression and multi-data sources. Population and baseline mortality data were obtained from administrative data system in Vietnam. We reported the findings at both the provincial and smaller district levels. Annual PM 2.5 concentrations in all studied provinces exceeded both the AQG and the proposed QCVN . The maximum annual number of attributable deaths in the studied provinces if they had complied with WHO air quality guidelines was in Ha Noi City, with 5,090 (95%CI: 4,253–5,888) attributable deaths. At the district level, the highest annual rate of attributable deaths if the WHO recommendation for community health had been met was 104.6 (95%CI: 87.0–121.5) attributable deaths per 100,000 population in Ly Nhan (Ha Nam province). A much larger number of premature deaths in Vietnam could potentially be avoided by lowering the recommended air quality standard. These results highlight the need for effective clean air action plans by local authorities to reduce air pollution and improve community health.
A critical appraisal of the evidence for adverse respiratory effects due to exposure to environmental ozone and particulate pollution: relevance to air quality guidelines
Publisher: Wiley
Date: 04-1994
Time-Based Measurement of Personal Mite Allergen Bioaerosol Exposure over 24 Hour Periods
Publisher: Public Library of Science (PLoS)
Date: 18-05-2016
Are children׳s asthmatic symptoms related to ambient temperature? A panel study in Australia
Publisher: Elsevier BV
Date: 08-2014
DOI: 10.1016/J.ENVRES.2014.05.032
Abstract: To examine the short-term effects of ambient temperature on respiratory symptoms for school children with asthma across Australia. A panel of 270 children (7-12 years) with asthma was recruited from six Australian cities. They were asked to record their respiratory symptoms every day in the morning (for night-time symptoms) and evening (for daytime symptoms) for four weeks. Daily ambient temperature, relative humidity and air pollution data were obtained from fixed monitors nearby. A mixed logistic regression model was used to examine the effects of ambient temperature on respiratory symptoms adjusted for children's sex, age, standing height, weight and air pollution. Subjects were specified as random effects. The relationships between ambient temperature and respiratory symptoms were linear. Increasing temperatures induced the risks of children's asthmatic symptoms, especially for "wheeze/chest tightness" and to a lesser extent for "cough hlegm". The effects were acute and lasted for four days (lag 0-3) in general. With increasing ambient temperature, boys were more at risk than girls. High ambient temperature is a risk factor for respiratory symptoms in children with asthma. As ambient temperature increases, policies and strategies for rising temperatures will be necessary to protect asthmatic children.
Outcomes Of Contact Investigation For Tuberculosis: A Systematic Review And Meta-Analysis
Publisher: American Thoracic Society
Date: 05-2012
DOI: 10.1164/AJRCCM-CONFERENCE.2012.185.1_MEETINGABSTRACTS.A3247
Description of a randomised controlled trial of inhaled corticosteroid/fast-onset LABA reliever therapy in mild asthma
Publisher: European Respiratory Society (ERS)
Date: 04-02-2016
Effects of early cat or dog ownership on sensitisation and asthma in a high-risk cohort without disease-related modification of exposure
Publisher: Wiley
Date: 03-2010
DOI: 10.1111/J.1365-3016.2010.01095.X
Abstract: Variation in the observed association between pet ownership and allergic disease may be attributable to selection bias and confounding. The aim of this study was to suggest a method to assess disease-related modification of exposure and second to examine how cat acquisition or dog ownership in early life affects atopy and asthma at 5 years. Information on sociodemographic factors and cat and dog ownership was collected longitudinally in an initially cat-free Australian birth cohort based on children with a family history of asthma. At age 5 years, 516 children were assessed for wheezing, and 488 for sensitisation. Data showed that by age 5 years, 82 children had acquired a cat. Early manifestations of allergic disease did not foreshadow a reduced rate of subsequent acquisition of a cat. Independent risk factors for acquiring a cat were exposure to tobacco smoke at home odds ratio (OR) 1.92 [95% confidence interval (CI) 1.13, 3.26], maternal education < or =12 years OR 1.95 [1.08, 3.51] and dog ownership OR 2.23 [1.23, 4.05]. Cat or dog exposure in the first 5 years was associated with a decreased risk of any allergen sensitisation, OR 0.50 [0.28, 0.88] but no association with wheeze OR 0.96 [0.57, 1.61]. This risk was not affected by age at which the cat was acquired or whether the pet was kept in- or outdoors. In conclusion, cat or dog ownership reduced the risk of subsequent atopy in this high-risk birth cohort. This cannot be explained by disease-related modification of exposure. Public health recommendations on the effect of cat and dog ownership should be based on birth cohort studies where possible selection bias has been taken into account.
Measures of asthma control and quality of life: Longitudinal data provide practical insights into their relative usefulness in different research contexts
Publisher: Springer Science and Business Media LLC
Date: 19-02-2009
DOI: 10.1007/S11136-009-9448-4
Abstract: To further our understanding of the relationships between asthma control and health-related quality of life (HRQOL) and provide insights into the relative usefulness of various measures in different research contexts. We present a conceptual model and test it with longitudinal survey data. Participants recruited via population s ling and hospital Emergency Departments completed questionnaires every 6 months for up to 3 years. Measures included: sleep disturbance, use of short-acting beta agonists (SABA), activity limitation, urgent medical visits, hospital use, Marks' Asthma Quality of Life Questionnaire (AQLQ-M) and the SF-36 Health Survey. Correlation analysis and multi-level models tested predictions from the conceptual model. A total of 213 people with asthma aged 16-75 years provided 967 observations. Correlations between asthma control and asthma-specific HRQOL were stronger than those between asthma control and generic HRQOL. The asthma control variables explained 54-58% of the variance in asthma-specific HRQOL and 8-25% of the variance in generic HRQOL. Activity limitation was the main contributor to between-person variation, while sleep disturbance and SABA use were the main contributors to within-person variation. Sleep disturbance and SABA use may be most useful in evaluating treatment effectiveness, while activity limitation may be better when monitoring the impact of asthma in populations.
Commemorating World Tuberculosis Day 2022: recent
Publisher: European Respiratory Society (ERS)
Date: 03-2022
Impaired Fetal Growth and Arterial Wall Thickening: A Randomized Trial of Omega-3 Supplementation
Publisher: American Academy of Pediatrics (AAP)
Date: 03-2012
Abstract: Impaired fetal growth is an independent cardiovascular risk factor and is associated with arterial wall thickening in children. No preventive strategy has been identified. We sought to determine whether dietary omega-3 fatty acid supplementation during early childhood prevents the association between impaired fetal growth and carotid arterial wall thickening. The Childhood Asthma Prevention Study was a randomized, controlled single-blind trial in 616 children born at term, recruited antenatally from maternity hospitals in Sydney. Participants were randomized to either a 500-mg-daily fish oil supplement and canola-based margarines and cooking oil (omega-3 group), or a 500-mg-daily sunflower oil supplement and omega-6 fatty acid–rich margarines and cooking oil (control group), from the start of bottle-feeding or 6 months of age until 5 years of age. Carotid intima-media thickness (IMT), a noninvasive measure of subclinical atherosclerosis, was the primary endpoint of a cardiovascular substudy (CardioCAPS) at age 8 years. We examined the association of fetal growth with carotid IMT in children with birth weight & th percentile (omega-3 group [n = 187], control group [n = 176]). In the control group, fetal growth was inversely associated with carotid IMT, but this was prevented in the omega-3 group (difference between groups of 0.041 mm [95% confidence interval 0.006, 0.075] per kg birth weight, adjusted for gestational age and gender, Pheterogeneity = .02). The inverse association of fetal growth with arterial wall thickness in childhood can be prevented by dietary omega-3 fatty acid supplementation over the first 5 years of life.
Specificity of notification for tuberculosis among screened refugees in NSW
Publisher: Elsevier BV
Date: 08-1999
DOI: 10.1111/J.1467-842X.1999.TB01284.X
Abstract: Epidemiological surveillance of tuberculosis (TB) in Australia is dependent on the accuracy of the notification data. We have investigated the specificity of TB notification for the diagnosis of this disease. We used data from notifications to the NSW Department of Health to identify members of a cohort of refugees who were screened between 1984 and 1993 and subsequently developed TB during that period. We reviewed notification data and, in most instances, case notes and x-ray films, to independently confirm or refute the diagnosis of TB. Two hundred and fifty members of the cohort were identified in the notification database. After excluding refugees on treatment prior to arrival in Australia, and those who were notified as 'quiescent' and 'atypical' cases, there were 189 cases notified as active TB. There was evidence to support the diagnosis of active TB in 125 cases (66%) and evidence that subjects did not have active disease in 60 cases (32%). We could not determine the status of the remaining four notified cases. This study has shown that, in a population of refugees subject to screening, nearly one-third of cases notified as active tuberculosis from the study population were actually not active tuberculosis cases. The use of the TB notification database may result in overestimation of the incidence of TB in population groups who are subject to active screening.
Long term follow up of obstructive sleep apnoea in primary care ‐ a pilot study
Publisher: Wiley
Date: 10-2018
Nosocomial Pulmonary Tuberculosis Contact Investigation in a Neonatal Intensive Care Unit
Publisher: Cambridge University Press (CUP)
Date: 07-2013
DOI: 10.1086/670995
Abstract: The diagnosis of smear-positive pulmonary tuberculosis in a medical officer working in a metropolitan Australian neonatal intensive care unit led to a contact investigation involving 125 neonates, 165 relatives, and 122 healthcare workers with varying degrees of exposure. There was no evidence of nosocomial tuberculosis transmission from the index case.
Three-year outcomes of dietary fatty acid modification and house dust mite reduction in the Childhood Asthma Prevention Study.
Publisher: Elsevier BV
Date: 10-2004
DOI: 10.1016/J.JACI.2004.06.057
Abstract: Two factors thought to influence the risk of asthma are the promoting effect of sensitization to house dust mites and the preventive effect of increased omega-3 fatty acids. Although house dust mite allergen avoidance has been used as a preventive strategy in several trials, the effect of omega-3 fatty acid supplementation in the primary prevention of asthma and allergic disease is not known. To measure the effects of dietary supplementation with omega-3 fatty acids and house dust mite allergen avoidance in children with a family history of asthma. A total of 616 children at high risk of asthma were enrolled antenatally in a randomized controlled trial, and 526 children remained in the trial at age 3 years. The outcomes were symptoms of allergic disease and allergen sensitization. There was a significant 10.0% (95% CI, 3.7-16.4) reduction in the prevalence of cough in atopic children in the active diet group ( P=.003 number needed to treat, 10) but a negligible 1.1% (95% CI, -7.1 to 9.5) reduction cough among nonatopic children. There was a 7.2% (95% CI, 10.11-14.3) reduction in sensitization to house dust mite in the active allergen avoidance group ( P=.05 number needed to treat, 14). No significant differences in wheeze were found with either intervention. These results suggest that our interventions, designed to be used in simple public health c aigns, may have a role in preventing the development of allergic sensitization and airways disease in early childhood. This offers the prospect of reducing allergic disease in later life.
The impact of sputum quality on tuberculosis diagnosis: a systematic review
Publisher: International Union Against Tuberculosis and Lung Disease
Date: 05-2015
Abstract: To perform a systematic review to evaluate the impact of sputum quality on the yield of tuberculosis (TB) diagnostic tests. We searched PubMed, EMBASE, LILACS and the Cochrane Database to identify studies that addressed 1) the impact of sputum quality on the proportion of sputum s les with Mycobacterium tuberculosis detected using smear, culture or polymerase chain reaction (PCR) and 2) the impact of pre-sputum collection interventions on sputum quality and M. tuberculosis detection. Ten studies met the eligibility criteria for review inclusion. Five studies assessed macroscopic and/or microscopic sputum quality characteristics and M. tuberculosis detection. The other five studies assessed the impact of pre-sputum collection interventions on sputum quality and M. tuberculosis detection. No studies assessed the impact of sputum quality on PCR-based diagnostic tests. Definitive conclusions about the utility of sputum quality assessments are limited by the paucity of, and heterogeneity within, the available data. Given the potential for sputum quality assessments to enhance diagnostic yield and prevent wasteful laboratory testing, further research into this field is urgently needed.
The health impacts of waste-to-energy emissions: a systematic review of the literature
Publisher: IOP Publishing
Date: 12-2020
Abstract: Waste-to-energy (WtE) processes, or the combustion of refuse-derived fuel (RDF) for energy generation, has the potential to reduce landfill volume while providing a renewable energy source. We aimed to systematically review and summarise current evidence on the potential health effects (benefits and risks) of exposure to WtE/RDF-related combustion emissions. We searched PubMed and Google Scholar using terms related to health and WtE/RDF combustion emissions, following PRISMA guidelines. Two authors independently screened titles, abstracts and then full-texts of original, peer-reviewed research articles published until 20th March 2020, plus their relevant references. Overall quality of included epidemiological studies were rated using an amended Navigation framework. We found 19 articles from 269 search results that met our inclusion criteria, including two epidemiological studies, five environmental monitoring studies, seven health impact or risk assessments (HIA/HRA), and five life-cycle assessments. We found a dearth of health studies related to the impacts of exposure to WtE emissions. The limited evidence suggests that well-designed and operated WtE facilities using sorted feedstock (RDF) are critical to reduce potential adverse health (cancer and non-cancer) impacts, due to lower hazardous combustion-related emissions, compared to landfill or unsorted incineration. Poorly fed WtE facilities may emit concentrated toxins with serious potential health risks, such as dioxins/furans and heavy metals these toxins may remain problematic in bottom ash as a combustion by-product. Most modelling studies estimate that electricity (per unit) generated from WtE generally emits less health-relevant air pollutants (also less greenhouse gases) than from combustion of fossil fuels (e.g. coal). Some modelled estimates vary due to model sensitivity for type of waste processed, model inputs used, and facility operational conditions. We conclude that rigorous assessment (e.g. HRA including sensitivity analyses) of WtE facility/technological characteristics and refuse type used is necessary when planning roposing facilities to protect human health as the technology is adopted worldwide.
MITE ALLERGEN (DER-P-1) CONCENTRATION IN HOUSES AND ITS RELATION TO THE PRESENCE AND SEVERITY OF ASTHMA IN A POPULATION OF SYDNEY SCHOOLCHILDREN
Publisher: Elsevier BV
Date: 10-1995
DOI: 10.1016/S0091-6749(95)70285-7
Abstract: House dust mite (HDM) allergen exposure and its relation to HDM allergy and asthma was assessed in a case-control study conducted over three seasons in 74 Sydney schoolchildren, 33 of whom were allergic to HDM and 12 of whom had current asthma. In each season histamine inhalation tests and skin prick tests were performed, symptom questionnaires were administered, and dust s les were collected. The mean concentrations of HDM allergen (in micrograms of Der p 1 per gram of fine dust) were: bed, 38.9 (95% confidence interval [CI], 31.8 to 47.5) bedroom floor, 22.4 (95% CI, 18.3 to 27.5) and lounge room floor, 13.7 (95% CI, 10.7 to 17.6). The mean of the highest allergen concentration in each house was 51.0 (95% CI, 43.2 to 60.1). All but two subjects had at least one site in all seasons with an HDM allergen concentration greater than 10 micrograms/gm, the proposed threshold for asthma symptoms. Subjects with allergy to HDM, symptoms of asthma, or airway hyperresponsiveness did not have higher HDM allergen concentrations in their house. In this study we were unable to test hypotheses concerning proposed thresholds for risk of sensitization and for risk of asthma symptoms because virtually all subjects were exposed to HDM allergen levels above the proposed thresholds.
Reattendance at hospital for asthma in two Australian states, 2000–2003
Publisher: Wiley
Date: 13-02-2007
DOI: 10.1111/J.1440-1843.2006.01039.X
Abstract: Reattendance rates at hospitals and emergency departments (ED) can provide a valuable marker of the quality and effectiveness of clinical care. Linked hospital and ED data from New South Wales and Victoria, Australia, were used to examine reattendances for asthma. Hospital and ED data were linked to identify in iduals who reattended hospital or ED for asthma within 28 days of an initial attendance. The sociodemographic characteristics that predicted reattendance were examined using logistic regression. There were 139,043 attendances for asthma between July 2000 and June 2003 attributed to 95,042 people. Overall, 7.1% of people reattended for asthma within 28 days. There was a significantly higher risk of reattendance among females (odds ratio (OR) 1.09, 95% confidence interval (CI) 1.03-1.14), people who lived in areas of greater socioeconomic disadvantage (OR 1.20, 95% CI 1.12-1.29) and Indigenous people (OR 1.15, 95% CI 1.00-1.32). Reattendance rates differed among age groups (P < 0.001), with the lowest rate being in 5- to 14-year-olds. The availability of linked hospital and ED data has provided a rare opportunity to investigate predictors of reattendance for asthma. Surveillance of trends in reattendances for asthma can be used to monitor the effectiveness of interventions to improve asthma control across the continuum of care, particularly in higher-risk groups such as Indigenous people, young children and those with greater socioeconomic disadvantage.
Effect of Burkholderia cepacia infection in the clinical course of patients with cystic fibrosis: A pilot study in a Sydney clinic
Publisher: Wiley
Date: 31-07-2002
DOI: 10.1046/J.1440-1843.2002.00387.X
Abstract: Colonisation with Burkholderia cepacia complex in patients with cystic fibrosis (CF) has been associated with adverse outcomes. The aim of the present study was to determine the actuarial survival of CF patients colonized with B. cepacia and to evaluate the efficacy of the Royal Prince Alfred Hospital segregation policy. A secondary aim was to characterize the specific genomovars and strains of B. cepacia isolated in an Australian clinic. Retrospective review of spirometric and microbiological data on all patients colonized with B. cepacia. Each B. cepacia-colonized subject was matched with three case-control subjects. Phenotype and genomovar typing, random lified polymorphic DNA strain type and B. cepacia epidemic strain marker analyses were performed. The effect of B. cepacia colonization on transplant-free survival was estimated by Cox's proportional hazards regression using the entire clinic population. Fifteen patients were colonized with B. cepacia, of whom six (40%) had died from CF-related disease by August 1998, compared with 30 of 173 (17.3%) of the entire clinic population. Cepacia status had a significant adverse effect on survival, with a hazard ratio of 2.16 (95% confidence interval 1.0-4.69 P = 0.05). The outcome was variable in subgroups of B. cepacia. Colonization with B. cepacia had a significant adverse effect on survival within the study population. Genomovar and strain typing contributed usefully in accessing the effectiveness of the hospital's segregation policy in preventing cross-colonization.
Evaluation of Loopamp™MTBC detection kit for diagnosis of pulmonary tuberculosis at a peripheral laboratory in a high burden setting
Publisher: Elsevier BV
Date: 03-2018
DOI: 10.1016/J.DIAGMICROBIO.2017.11.009
Abstract: The Loop ™MTBC detection kit (TB-LAMP) was designed to replace the sputum smear microscopy for the diagnosis of pulmonary tuberculosis. We evaluated its performance at a peripheral laboratory in Vietnam. The sensitivity of TB-LAMP was 45.5% (28.1%-63.6%), which was equal to 3-sputum smear microscopy but lower than that of Xpert MTB/RIF (87.8% [71.8%-96.6%]). In patients with culture-confirmed TB, sensitivity was 80% (51.9%-95.7%) in smear-positive and 16.7% (3.5%-41.4%) in smear-negative cases. The specificity of TB-LAMP was 95.1% (92.7%-96.9%), which was lower than that of smear microscopy (98.9% [97.5%-99.7%]) and Xpert MTB/RIF (99.3% [98.1%-99.9%]) (P<0.05). The probability of TB detection by TB-LAMP was more influenced by s le quality and viscosity than were smear microscopy, Xpert MTB/RIF, and culture. The present data do not support the use of TB-LAMP as a replacement test for smear microscopy in peripheral laboratories.
Improving lung health in low-income and middle-income countries: from challenges to solutions
Publisher: Elsevier BV
Date: 03-2021
Misuse of Pollution Reference Standards: No Safe Level of Air Pollution
Publisher: American Thoracic Society
Date: 05-2022
Adapting a TB contact investigation strategy for COVID-19
Publisher: International Union Against Tuberculosis and Lung Disease
Date: 05-2020
Weight gain in infancy is associated with carotid extra-medial thickness in later childhood
Publisher: Elsevier BV
Date: 04-2014
DOI: 10.1016/J.ATHEROSCLEROSIS.2014.01.020
Abstract: Early life is an important period for determining future risk of cardiovascular disease. Carotid extra-medial thickness is a novel noninvasive measure that estimates arterial adventitial thickness, information concerning vascular health not captured by assessment of arterial intima-media thickness alone. We sought to determine whether fetal growth and early postnatal growth are associated with carotid extra-medial thickness in 8 year old children. Carotid extra-medial thickness was assessed by high-resolution ultrasound in 379 non-diabetic children aged 8-years, with complete data for birth weight, gestational age, early postnatal weight gain and carotid extra-medial thickness. Weight gain during infancy, from birth to 18 months of age, was significantly and positively associated with carotid EMT (11 μm per kg length-adjusted weight gain [95% CI 3, 18], P=0.007). This association was significantly stronger in boys than girls (Pheterogeneity=0.005). By contrast, there was no significant association between birth weight and carotid EMT (6 μm/kg birth weight [95% CI -12, 24], P=0.51). Excessive weight gain during infancy is associated with increased carotid extra-medial thickness, indicating that the alterations to the vasculature associated with excessive early postnatal growth likely include arterial adventitial thickening.
Tuberculosis and mental health in the Asia-Pacific
Publisher: SAGE Publications
Date: 10-07-2016
Abstract: This opinion piece encourages mental health researchers and clinicians to engage with mental health issues among tuberculosis patients in the Asia-Pacific region in a culturally appropriate and ethical manner. The ersity of cultural contexts and the high burden of tuberculosis throughout the Asia-Pacific presents significant challenges. Research into tuberculosis and mental illness in this region is an opportunity to develop more nuanced models of mental illness and treatment, while simultaneously contributing meaningfully to regional tuberculosis care and prevention. We overview key issues in tuberculosis and mental illness co-morbidity, highlight ethical concerns and advocate for a regional approach to tuberculosis and mental health that is consistent with the transnational challenges presented by this airborne infectious disease. Integrating tuberculosis and mental health services will go a long way to addressing the needs of vulnerable populations and stopping the transmission of one of the world’s biggest infectious killers.
House dust mite allergen avoidance: a randomized controlled trial of surface chemical treatment and encasement of bedding
Publisher: Wiley
Date: 11-1994
DOI: 10.1111/J.1365-2222.1994.TB02746.X
Abstract: To test the effectiveness of a house dust mite (HDM) allergen avoidance strategy we conducted a randomized controlled trial in 35 atopic subjects with asthma, aged 13 to 60 living in Sydney - a high HDM allergen environment. After a 3 month run-in period, subjects were randomized to active allergen avoidance treatment (n = 17) or placebo (n = 18) groups and followed for 6 months. The active treatment involved placing impermeable covers over the mattress, pillows and duvet and spraying the remaining bedding, as well as the carpets and furniture, with a tannic acid/acaricidal spray. Subjects kept a daily record of symptoms and peak expiratory flow rates and had 3 monthly assessments of lung function and airway hyperresponsiveness (AHR). Dust s les were collected from the bed, the bedroom floor and the living room floor at 3 monthly intervals and 2 weeks after the treatment. Mean HDM allergen levels at baseline at these sites were, in the active group, 15.5, 9.6 and 10.2 micrograms Der p I/g of fine dust, and, in the placebo group 25.7, 11.8 and 6.3 micrograms/g. Two weeks after the allergen avoidance treatment the HDM allergen level in the beds was reduced to 29% of baseline (95% CI 16-50%, P = 0.038 compared with placebo), but was not significantly different at 3 or 6 months. There was also no significant effect of the allergen avoidance treatment on symptom scores, peak flow variability, lung function or AHR P > 0.1).(ABSTRACT TRUNCATED AT 250 WORDS)
Cost-Related Underuse of Medicines for Asthma—Opportunities for Improving Adherence
Publisher: Elsevier BV
Date: 09-2019
DOI: 10.1016/J.JAIP.2019.03.024
Abstract: In asthma, underuse of cost-effective preventive treatments increases morbidity and mortality. The cost of medicines contributes to underuse ("nonadherence"), but the extent to which people with asthma skip or reduce doses or let prescriptions go unfilled when faced with cost pressures is unknown. To estimate the extent of cost-related underuse behaviors and associated factors. Using previously validated summary indicators, we conducted an online cross-sectional survey of adults and parents of children 5 to 17 years with asthma in Australia (a high-income country) and developed logistic regression models for adults and children with asthma, controlling for key clinical and demographic factors. The survey was completed by n = 792 adults (mean age, 47 [standard deviation, 17] years, male 47%, concession 60%) and n = 609 parents of children (5-10 years 51%, male 60%, concession 59%) with asthma. Cost-related underuse was reported by 52.9% adults and 34.3% parents, predominantly decreasing or skipping doses to make medicines last longer. Higher odds of cost-related underuse were observed with younger adults (adults: odds ratio [OR]: 1.19 95% confidence interval [CI]: 1.12, 1.27), males (adults: OR: 1.49 95% CI: 1.06, 2.08), having concerns about medicines (adults: OR: 3.12 95% CI: 2.17, 4.35 parents: OR: 2.63 95% CI: 1.56, 4.55), less comfortable talking to prescribers about cost (parents: OR: 1.22 95% CI: 1.12, 1.33) or changing medicines (adults: OR: 1.12 95% CI: 1.03, 1.22), feeling less engaged with prescribers about medicine decisions (parents: OR: 1.11 95% CI: 1.01, 1.23), and with poorer asthma control (adults, poor control: OR: 1.87 95% CI: 1.13, 3.09 parents, poor control: OR: 3.87 95% CI: 1.99, 7.54), and requiring specialist (parents: OR: 1.83 95% CI: 1.16, 2.87) or urgent health care visits (adults: OR: 1.54 95% CI: 1.06, 2.23). Income and concession card status were not associated with cost-related underuse. Adults and parents of children with asthma indicate high rates of cost-related underuse of asthma medicines, even in the context of national medicines subsidies. Urgent targeting of interventions to promote discussion of medicines and costs between doctor and patients, particularly young adult males, is needed.
Breastfeeding and snoring: a birth cohort study
Publisher: Public Library of Science (PLoS)
Date: 08-01-2014
Cost is a major barrier to the use of inhaled corticosteroids for obstructive lung disease
Publisher: AMPCo
Date: 09-2009
DOI: 10.5694/J.1326-5377.2009.TB02815.X
Abstract: To examine the effect of the level of patient copayment on the rate of purchase of inhaled corticosteroids (ICS) by patients with obstructive lung disease. Cross-sectional study of records of all prescriptions for ICS dispensed to general and concessional beneficiaries aged 15 years or over in the period January 2003 to December 2006. Data were obtained from the Pharmaceutical Benefits Scheme, which subsidises medication costs for all Australians. The number of prescriptions for ICS dispensed to government concession card holders compared with the number dispensed to general beneficiaries, expressed as a rate ratio. ICS prescriptions were dispensed to over 1.6 million people during the study period. Concession card holders were dispensed ICS prescriptions at a higher rate than general beneficiaries, both overall (43.7 v 9.1 ICS prescriptions per 100 person-years) and in all population subgroups. After adjusting for age, sex, remoteness category and socioeconomic status, people holding a concession card were dispensed over 2.5 times the number of ICS prescriptions (alone or in combination with a long-acting beta(2)-agonist) compared with general beneficiaries. Similar patterns were seen after adjusting for differences between the two groups in the prevalence of obstructive lung disease. As the patient copayment for general beneficiaries is over six times higher than for concession card holders, our findings imply that cost is a barrier to the purchase of ICS prescriptions for obstructive lung disease, independent of socioeconomic status.
Levofloxacin versus placebo for the treatment of latent tuberculosis among contacts of patients with multidrug-resistant tuberculosis (the VQUIN MDR trial): A protocol for a randomised controlled trial
Publisher: BMJ
Date: 2020
DOI: 10.1136/BMJOPEN-2019-033945
Abstract: Treatment of latent tuberculosis infection (LTBI) plays a substantial role in the prevention of drug-susceptible tuberculosis (TB). However, clinical trials to evaluate the efficacy of preventive therapy for presumed multidrug-resistant (MDR) LTBI are lacking. This trial aims to evaluate the efficacy of the antibiotic levofloxacin in preventing the development of active TB among latently infected contacts of index patients with MDR-TB. A double-blind placebo-controlled parallel group randomised controlled trial will be conducted in 10 provinces of Vietnam. Household contacts living with patients with bacteriologically confirmed rif icin-resistant or MDR-TB will be eligible for recruitment if they have a positive tuberculin skin test or are known to be immunosuppressed, and do not have active TB. Participants will be randomised to receive either levofloxacin or placebo tablets once per day for 6 months. Screening for incident TB will be performed at 6 months intervals. The primary study outcome is the incidence of bacteriologically confirmed TB within 30 months after randomisation. Analysis will be by intention to treat, using Poisson regression. Ethical approval from the University of Sydney Human Research Ethics Committee was obtained on 29 April 2015 (2014/929), and from the Vietnam Ministry of Health Institutional Review Board on 30 September 2015 (4040/QD-BYT). Findings of the study will be published in peer-reviewed publications and conference presentations. ACTRN12616000215426.
Development and Validation of a Sub-National, Satellite-Based Land-Use Regression Model for Annual Nitrogen Dioxide Concentrations in North-Western China
Publisher: MDPI AG
Date: 07-12-2021
Abstract: Existing national- or continental-scale models of nitrogen dioxide (NO2) exposure have a limited capacity to capture subnational spatial variability in sparsely-populated parts of the world where NO2 sources may vary. To test and validate our approach, we developed a land-use regression (LUR) model for NO2 for Ningxia Hui Autonomous Region (NHAR) and surrounding areas, a small rural province in north-western China. Using hourly NO2 measurements from 105 continuous monitoring sites in 2019, a supervised, forward addition, linear regression approach was adopted to develop the model, assessing 270 potential predictor variables, including tropospheric NO2, optically measured by the Aura satellite. The final model was cross-validated (5-fold cross validation), and its historical performance (back to 2014) assessed using 41 independent monitoring sites not used for model development. The final model captured 63% of annual NO2 in NHAR (RMSE: 6 ppb (21% of the mean of all monitoring sites)) and contiguous parts of Inner Mongolia, Gansu, and Shaanxi Provinces. Cross-validation and independent evaluation against historical data yielded adjusted R2 values that were 1% and 10% lower than the model development values, respectively, with comparable RMSE. The findings suggest that a parsimonious, satellite-based LUR model is robust and can be used to capture spatial contrasts in annual NO2 in the relatively sparsely-populated areas in NHAR and neighbouring provinces.
Variability Of Respiratory System Impedance In School-Aged Children With Asthma
Publisher: American Thoracic Society
Date: 05-2010
DOI: 10.1164/AJRCCM-CONFERENCE.2010.181.1_MEETINGABSTRACTS.A3295
Over the limit: tuberculosis and excessive alcohol use
Publisher: International Union Against Tuberculosis and Lung Disease
Date: 2020
Asthma in preschool children: prevalence and risk factors
Publisher: BMJ
Date: 08-2001
Abstract: The prevalence of asthma in children has increased in many countries over recent years. To plan effective interventions to reverse this trend we need a better understanding of the risk factors for asthma in early life. This study was undertaken to measure the prevalence of, and risk factors for, asthma in preschool children. Parents of children aged 3-5 years living in two cities (Lismore, n=383 Wagga Wagga, n=591) in New South Wales, Australia were surveyed by questionnaire to ascertain the presence of asthma and various proposed risk factors for asthma in their children. Recent asthma was defined as ever having been diagnosed with asthma and having cough or wheeze in the last 12 months and having used an asthma medication in the last 12 months. Atopy was measured by skin prick tests to six common allergens. The prevalence of recent asthma was 22% in Lismore and 18% in Wagga Wagga. Factors which increased the risk of recent asthma were: atopy (odds ratio (OR) 2.35, 95% CI 1.49 to 3.72), having a parent with a history of asthma (OR 2.05, 95% CI 1.34 to 3.16), having had a serious respiratory infection in the first 2 years of life (OR 1.93, 95% CI 1.25 to 2.99), and a high dietary intake of polyunsaturated fats (OR 2.03, 95% CI 1.15 to 3.60). Breast feeding (OR 0.41, 95% CI 0.22 to 0.74) and having three or more older siblings (OR 0.16, 95% CI 0.04 to 0.71) decreased the risk of recent asthma. Of the factors tested, those that have the greatest potential to be modified to reduce the risk of asthma are breast feeding and consumption of polyunsaturated fats.
What should we tell allergic families about pets?
Publisher: Elsevier BV
Date: 10-2001
Respiratory sensation during bronchial challenge testing with methacholine, sodium metabisulphite, and adenosine monophosphate.
Publisher: BMJ
Date: 08-1996
DOI: 10.1136/THX.51.8.793
Abstract: There is some evidence that the perception of bronchoconstriction may very according to the nature of the provoking stimulus. The aims of this study were, firstly, to develop a method for measuring dyspnoea during induced bronchoconstriction in patients with asthma and, secondly, to apply this method to testing differences between directly and indirectly acting bronchoconstricting stimuli. Descriptive terms suitable for quantifying respiratory discomfort due to bronchoconstriction in patients with asthma were identified in a preliminary investigation. The relation between reduction in forced expiratory volume in one second (FEV1) and respiratory discomfort, measured using a visual analogue scale (VAS), was then studied during challenges with three different inhaled stimuli: methacholine (MCH), sodium metabisulphite (MBS), and adenosine monophosphate (AMP). Three indices were calculated to describe the relation: the VAS value associated with a 20% fall in FEV1 (FEV20 VAS) the ratio of the final VAS value to the final percentage fall in FEV1 (VAS-FEV1 ratio) and the regression coefficient for predicting VAS from the percentage fall in FEV1 within each challenge (beta VAS FEV1). "Difficulty in breathing" and "chest tightness" were selected as suitable terms for quantifying respiratory discomfort. There were no differences between the three agonists in the qualitative aspects of the respiratory sensation. In paired challenges with the same agonist the three indices were all found to be reproducible for both sensations measured. MCH induced less intense difficulty in breathing and chest tightness for a given fall in FEV1 than did AMP. There was a trend in the same direction for the comparison between MCH and MBS. There were no differences between AMP and MBS. FEV20 VAS was less powerful in discriminating between agonists than the two slope indices. The relation between induced reduction in FEV1 and the intensity of respiratory discomfort can be measured reliably. The indirectly acting bronchoconstricting agonists AMP and MBS induced more intense respiratory discomfort for a given fall in FEV1 than the direct agonist MCH. This may be due to differences in unmeasured mechanical changes in the lungs or to an additional action on airway sensory nerves.
A CLUSTER RANDOMISED CONTROLLED TRIAL OF CONTACT INVESTIGATION FOR THE DETECTION OF TUBERCULOSIS: THE ACT2 TRIAL
Publisher: Wiley
Date: 11-2017
The persuasiveness of metaphor in advertising
Publisher: Wiley
Date: 28-12-2022
DOI: 10.1002/MAR.21633
Abstract: Metaphor—drawing a comparison between two seemingly incompatible concepts in an effort to create symbolism—is frequently used in advertising. This study investigates the persuasiveness of metaphor in advertising and the conditions under which the effectiveness of metaphorical advertisements can be leveraged. Across three experimental studies, the results show that mixed emotional appeals (happiness and sadness) versus positive emotional appeals (happiness) can increase the persuasiveness of an advertising metaphor. Furthermore, cognitive flexibility mediates this effect. This study contributes to the literature on metaphor in advertising by showing the benefits of using mixed emotional appeals and establishing the underlying process. Moreover, the findings can be beneficial for marketers in designing effective marketing communication strategies combining mixed emotions with a metaphor.
An Update on COVID-19 Vaccine Induced Thrombotic Thrombocytopenia Syndrome and Some Management Recommendations
Publisher: MDPI AG
Date: 18-08-2021
DOI: 10.3390/MOLECULES26165004
Abstract: The thrombotic thrombocytopenia syndrome (TTS), a complication of COVID-19 vaccines, involves thrombosis (often cerebral venous sinus thrombosis) and thrombocytopenia with occasional pulmonary embolism and arterial ischemia. TTS appears to mostly affect females aged between 20 and 50 years old, with no predisposing risk factors conclusively identified so far. Cases are characterized by thrombocytopenia, higher levels of D-dimers than commonly observed in venous thromboembolic events, inexplicably low fibrinogen levels and worsening thrombosis. Hyper fibrinolysis associated with bleeding can also occur. Antibodies that bind platelet factor 4, similar to those associated with heparin-induced thrombocytopenia, have also been identified but in the absence of patient exposure to heparin treatment. A number of countries have now suspended the use of adenovirus-vectored vaccines for younger in iduals. The prevailing opinion of most experts is that the risk of developing COVID-19 disease, including thrombosis, far exceeds the extremely low risk of TTS associated with highly efficacious vaccines. Mass vaccination should continue but with caution. Vaccines that are more likely to cause TTS (e.g., Vaxzevria manufactured by AstraZeneca) should be avoided in younger patients for whom an alternative vaccine is available.
RELAPSE OF TUBERCULOSIS AMONG PATIENTS COMPLETING TREATMENT IN VIETNAM: A NESTED CASE‐CONTROL STUDY
Publisher: Wiley
Date: 11-2017
Sputum TNF markers are increased in neutrophilic and severe asthma and are reduced by azithromycin treatment
Publisher: Wiley
Date: 02-03-2021
DOI: 10.1111/ALL.14768
Abstract: The AMAZES randomized controlled trial demonstrated that long‐term low‐dose azithromycin treatment reduces exacerbations of poorly controlled asthma, but the therapeutic mechanisms remain unclear. Dysregulation of the inflammatory tumour necrosis factor (TNF) pathway is implicated in asthma and could be suppressed by azithromycin. We aimed to determine the inflammatory and clinical associations of soluble TNF signalling proteins (TNF receptors [TNFR] 1 and 2, TNF) in sputum and serum, and to test the effect of 48 weeks of azithromycin vs placebo on TNF markers. Sputum supernatant and serum TNFR1, TNFR2 (n = 142 75 azithromycin‐treated, 67 placebo‐treated) and TNF (n = 48 22 azithromycin‐treated, 26 placebo‐treated) were measured by ELISA in an AMAZES trial sub‐population at baseline and end of treatment. Baseline levels were compared between sputum inflammatory phenotypes, severe/non‐severe asthma and frequent/non‐frequent exacerbators. Effect of azithromycin on markers was tested using linear mixed models. Baseline sputum TNFR1 and TNFR2 were significantly increased in neutrophilic vs non‐neutrophilic asthma phenotypes, while serum markers did not differ. Sputum TNFR1 and TNFR2 were increased in severe asthma and correlated with poorer lung function, worse asthma control and increasing age. Serum TNFR1 was also increased in severe asthma. Sputum and serum TNFR2 were increased in frequent exacerbators. Azithromycin treatment significantly reduced sputum TNFR2 and TNF relative to placebo, specifically in non‐eosinophilic participants. We demonstrate dysregulation of TNF markers, particularly in the airways, that relates to clinically important phenotypes of asthma including neutrophilic and severe asthma. Suppression of dysregulated TNF signalling by azithromycin could contribute to its therapeutic mechanism.
Feasibility and yield of screening for non-communicable diseases among treated tuberculosis patients in Peru
Publisher: International Union Against Tuberculosis and Lung Disease
Date: 2018
Abstract: The increasing prevalence of non-communicable diseases (NCDs) poses a major challenge to low- and middle-income countries. Patients' engagement with health services for anti-tuberculosis treatment provides an opportunity for screening for NCDs and for linkage to care. We explored the feasibility and yield of screening for NCDs in patients treated for tuberculosis (TB) in Lima, Peru, as part of a study focused on chronic respiratory sequelae. A representative s le of community controls was recruited from the same geographical area. Screening entailed taking a medical history and performing ambulatory blood pressure measurement and urinalysis. A total of 177 participants with previous TB (33 with multidrug-resistant TB) and 161 community controls were evaluated. There was an almost four-fold increased prevalence of self-reported diabetes mellitus (DM) in the TB group (adjusted prevalence ratio 3.66, 95%CI 1.68-8.01). Among those without self-reported DM, 3.3% had glycosuria, with a number needed to screen (NNS) of 31. The NNS to find one (new) case of hypertension or proteinuria in the TB group was respectively 24 and 5. Patient-centred care that includes pragmatic NCD screening is feasible in TB patients, and the treatment period provides a good opportunity to link patients to ongoing care.
Recurrence of tuberculosis at a Sydney chest clinic between 1994 and 2006
Publisher: AMPCo
Date: 02-2008
DOI: 10.5694/J.1326-5377.2008.TB01558.X
Abstract: To estimate the incidence of recurrence of culture-positive tuberculosis (TB) and the relative contributions of reinfection and reactivation (based on DNA fingerprinting). Retrospective analysis of all culture-positive TB notifications between 1994 and 2006 from Liverpool Chest Clinic in the south-west of Sydney. Patients with more than one notification of culture-positive TB during this period were identified. Genotyping of Mycobacterium tuberculosis was used to determine whether recurrence was due to reinfection or reactivation. Estimation of the incidence of recurrence of culture-positive TB (cases per 100 000 person-years of follow-up), and the proportions of reinfection and reactivation. Three cases of recurrent culture-positive disease were identified (incidence of recurrence: 57.7 per 100 000 person-years of follow-up). All three patients were treated with directly observed therapy. Two of these patients had evidence of reinfection with different strains both were natives of a country with a high incidence of TB and had returned to that country after the initial episode. The other patient had evidence of reactivation of the initial strain, indicating secondary failure of treatment. This patient had poor adherence to treatment. Our observations suggest there is a very low rate of reactivation of tuberculosis. The low incidence of recurrence due to reinfection reflects the low incidence of tuberculosis in Australia. When reinfection does occur, this probably has been sustained during residence in a country with a high incidence of tuberculosis.
Predictors for snoring in children with rhinitis at Age 5
Publisher: Wiley
Date: 2007
DOI: 10.1002/PPUL.20606
Abstract: Snoring is often found in allergic diseases and may be an early manifestation of more serious sleep-disordered breathing. We aimed to investigate whether the risk factors for snoring among pre-school children with rhinitis are similar to those for allergic diseases in a birth cohort. The study cohort was drawn from participants in the Childhood Asthma Prevention Study (CAPS). This is a randomized controlled trial of dietary intervention and house dust mite avoidance during the first 5 years of life, aimed at reducing the risk of acquiring asthma and other allergic conditions in children at high-risk for allergic diseases. Parents of children with symptoms of rhinitis at age 5 years (n = 219 out of 516 cohort members) were asked if their child snored: 127 (60%) reported some snoring and 56 (26%) snored more than three times per week. Multiple logistic regression analyses indicated that children who were first-born (adjusted odds ratio, 2.50, 95% CI 1.20-5.21), were exposed to maternal tobacco smoke during the first year of life (2.40, 1.1-5.25), or who had asthma (2.51, 1.14-5.55) and/or eczema (2.29, 1.02-5.13) at age 5 years were more likely to snore. Birth-weight, body mass index at age 4.5, spirometry, and breastfeeding were not related to snoring. Risk factors for snoring are similar to risk factors for allergic disorders. Snoring may be part of the allergic spectrum of diseases. Our data may contribute to clinician's ability to effectively screen for snoring in preschool children.
The Role of Single-Channel Nasal Airflow Pressure Transducer in the Diagnosis of OSA in the Sleep Laboratory
Publisher: American Academy of Sleep Medicine (AASM)
Date: 15-08-2010
DOI: 10.5664/JCSM.27876
Household-Contact Investigation for Detection of Tuberculosis in Vietnam
Publisher: Massachusetts Medical Society
Date: 31-05-2018
DOI: 10.1056/NEJMC1804977
Meta-analysis identifies seven susceptibility loci involved in the atopic march
Publisher: Springer Science and Business Media LLC
Date: 06-11-2015
DOI: 10.1038/NCOMMS9804
Abstract: Eczema often precedes the development of asthma in a disease course called the ‘atopic march’. To unravel the genes underlying this characteristic pattern of allergic disease, we conduct a multi-stage genome-wide association study on infantile eczema followed by childhood asthma in 12 populations including 2,428 cases and 17,034 controls. Here we report two novel loci specific for the combined eczema plus asthma phenotype, which are associated with allergic disease for the first time rs9357733 located in EFHC1 on chromosome 6p12.3 (OR 1.27 P= 2.1 × 10 −8 ) and rs993226 between TMTC2 and SLC6A15 on chromosome 12q21.3 (OR 1.58 P= 5.3 × 10 −9 ). Additional susceptibility loci identified at genome-wide significance are FLG (1q21.3), IL4/KIF3A (5q31.1), AP5B1/OVOL1 (11q13.1), C11orf30/LRRC32 (11q13.5) and IKZF3 (17q21). We show that predominantly eczema loci increase the risk for the atopic march. Our findings suggest that eczema may play an important role in the development of asthma after eczema.
Lung Function Is Associated with Arterial Stiffness in Children
Publisher: Public Library of Science (PLoS)
Date: 25-10-2011
Hormone replacement therapy and asthma onset in menopausal women: National cohort study
Publisher: Elsevier BV
Date: 05-2021
Sputum IL-1β is reduced with Azithromycin add-on therapy in patients with poorly controlled asthma
Publisher: European Respiratory Society
Date: 09-2017
The allergic paradox: A key to progress in primary prevention of asthma
Publisher: Elsevier BV
Date: 10-2011
Counting, analysing and reporting exacerbations of COPD in randomised controlled trials
Publisher: BMJ
Date: 17-09-2007
Abstract: Clinical trials measure exacerbations of chronic obstructive pulmonary disease (COPD) inconsistently. A study was undertaken to determine if different methods for ascertaining and analysing COPD exacerbations lead to biased estimates of treatment effects. Information on the methods used to count, analyse and report COPD exacerbation rates was abstracted from clinical trials of long-acting bronchodilators or long-acting bronchodilator/inhaled steroid combination products published between 2000 and 2006. Data from the Canadian Optimal Therapy of COPD Trial was used to illustrate how different analytical approaches can affect the estimate of exacerbation rates and their confidence intervals. 22 trials (17,156 patients) met the inclusion criteria and were reviewed. None of the trials adjudicated exacerbations or determined independence of events. 14/22 studies (64%) introduced selection bias by not analysing outcome data for subjects who prematurely stopped study medications. Only 31% of trials used time-weighted analyses to calculate the mean number of exacerbations atient-year and only 15% accounted for between-subject variation. In the Canadian Optimal Therapy of COPD Trial the rate ratio for exacerbations atient-year was 0.85 when all data were included in a time-weighted analysis, but was overestimated as 0.79 when data for those who prematurely stopped study medications were excluded and was further overestimated as 0.46 when a time-weighted analysis was not conducted p values ranged from 0.03 to 0.24 depending on how exacerbations were determined and analysed. Clinical trials have used widely different methods to define and analyse COPD exacerbations and this can lead to biased estimates of treatment effects. Future trials should strive to include blinded adjudication and assessment of the independence of exacerbation events, and trials should report time-weighted intention-to-treat analyses with adjustments for between-subject variation in COPD exacerbations.
Rhinoviruses significantly affect day-to-day respiratory symptoms of children with asthma
Publisher: Elsevier BV
Date: 03-2015
Estimating the long-term effects of mass screening for latent and active tuberculosis in the Marshall Islands
Publisher: Oxford University Press (OUP)
Date: 22-03-2022
DOI: 10.1093/IJE/DYAC045
Abstract: Ambitious population-based screening programmes for latent and active tuberculosis (TB) were implemented in the Republic of the Marshall Islands in 2017 and 2018. We used a transmission dynamic model of TB informed by local data to capture the Marshall Islands epidemic’s historical dynamics. We then used the model to project the future epidemic trajectory following the active screening interventions, as well as considering a counterfactual scenario with no intervention. We also simulated future scenarios including periodic interventions similar to those previously implemented, to assess their ability to reach the End TB Strategy targets and TB pre-elimination in the Marshall Islands. The screening activities conducted in 2017 and 2018 were estimated to have reduced TB incidence and mortality by around one-third in 2020, and are predicted to achieve the End TB Strategy milestone of 50% incidence reduction by 2025 compared with 2015. Screening interventions had a considerably greater impact when latent TB screening and treatment were included, compared with active case finding alone. Such combined programmes implemented at the national level could achieve TB pre-elimination around 2040 if repeated every 2 years. Our model suggests that it would be possible to achieve TB pre-elimination by 2040 in the Marshall Islands through frequent repetition of the same interventions as those already implemented in the country. It also highlights the importance of including latent infection testing in active screening activities.
Infant and early childhood dietary predictors of overweight at age 8 years in the CAPS population
Publisher: Springer Science and Business Media LLC
Date: 23-02-2011
DOI: 10.1038/EJCN.2011.7
Abstract: Programs to address obesity are a high priority for public policy especially for young children. Research into dietary determinants of obesity is challenging but important for rational planning of interventions to prevent obesity, given that both diet and energy expenditure influence weight status. We investigated whether early life dietary factors were predictive of weight status at 8 years in a cohort of Australian children. We used data from the Childhood Asthma Prevention Study-a birth cohort at high risk of asthma. Dietary data (3-day weighed food records) were collected at 18 months and height, weight and waist circumference were collected at 8 years. We assessed the relationship between dietary predictor variables and measures of adiposity using linear regression. Intakes of protein, meat and fruit at age 18 months were positively associated with measures of adiposity at age 8 years, namely, body mass index and/or waist circumference. We also showed a significant negative relationship between these measures of adiposity at 8 years and intake at 18 months of dairy foods as a percent of total energy, and intake of energy dense cereal-based foods such as cookies and crackers. This birth cohort study with rigorous design, measures and analyses, has shown a number of associations between early dietary intake and subsequent adiposity that contribute to the growing evidence base in this important field.
Behaviors and Attitudes Toward Smoking Among Health Care Workers at Health Facilities in 4 Provinces of Vietnam: A Representative Cross-Sectional Survey.
Publisher: SAGE Publications
Date: 30-07-2022
DOI: 10.1177/10105395211036275
Abstract: Tobacco smoking is a leading cause of premature death. Smoking prevalence in Vietnam ranks among the highest in Southeast Asia. Given the important role of health care workers (HCWs) in promoting and supporting smoking cessation, this project aimed to characterize the prevalence of smoking among HCWs in Vietnam, and their attitudes toward smoking cessation interventions. A cross-sectional survey was conducted among care workers in four levels of the health system, within four provinces of Vietnam. Descriptive statistics evaluated participant attitudes, perception, behaviors, and knowledge about smoking. Multivariable logistic regression models evaluated risk factors for smoking. Among 3343 HCWs, 7.5% identified as current smokers, comprising 22.2% males and 0.5% of females. Males had substantially greater odds (adjusted odds ratio = 55.3 95% confidence interval [29.0, 105.6] of identifying as current smokers compared with females. HCWs in urban settings had higher odds of identifying as smokers compared with rural workers (adjusted odds ratio = 1.72 95% confidence interval [1.23, 2.24]. Strong support for smoking cessation policies and interventions were identified, even among staff who smoked. HCWs play an integral role in identifying smokers and supporting smoking cessation interventions for their patients. Efforts to support affordable smoking cessation interventions within health facilities are likely to contribute to a reduction in smoking prevalence in Vietnam.
Contact Investigation in Households of Patients with Tuberculosis in Hanoi, Vietnam: A Prospective Cohort Study
Publisher: Public Library of Science (PLoS)
Date: 15-11-2012
Reducing the burden of respiratory symptoms and illness in the elderly and general population requires multi-pronged strategies
Publisher: Wiley
Date: 25-07-2020
DOI: 10.1111/RESP.13654
Benefit of treatment of latent tuberculosis infection in individual patients
Publisher: European Respiratory Society (ERS)
Date: 30-04-2016
Respiratory health before and after the opening of a road traffic tunnel
Publisher: Public Library of Science (PLoS)
Date: 29-11-2012
It’s time to rethink mite allergen avoidance
Publisher: Elsevier BV
Date: 10-2011
DOI: 10.1016/J.JACI.2011.07.009
Abstract: The role of allergen exposure in the etiology of allergic sensitization and asthma is complex. Advice on strategies to avoid domestic allergens remains contentious because trials of interventions aimed to prevent asthma or reduce symptoms have often failed to demonstrate benefits. Asthma management guidelines differ widely in their recommendations, while Web-based information often claims benefits associated with products. In this rostrum we argue that although many factors have a role in both the etiology and the exacerbation of asthma, allergen exposure probably remains an important contributor to the manifestations of the disease. Currently, there is no evidence-based framework for effective domestic allergen avoidance interventions to reduce chronic aeroallergen exposure. The development of an effective approach to allergen avoidance requires a better understanding of (a) the physical nature of chronic aeroallergen exposure and methods for measuring and reducing this, (b) the interaction between allergen exposure and innate immune modulators at different disease stages, and (c) markers enabling the identification of in iduals who would benefit from this. The strategic risk of overemphasizing other novel mechanisms and approaches to asthma management is that we will prematurely abandon and fail to improve an existing approach that could have a significant impact on the development, progression, and symptoms of the disease.
Beyond patient delay, navigating structural health system barriers to timely care and treatment in a high burden TB setting in Papua New Guinea
Publisher: Informa UK Limited
Date: 02-01-2023
Multi-centre research in Australia: Analysis of a recent National Health and Medical Research Council-funded project
Publisher: Wiley
Date: 09-2009
DOI: 10.1111/J.1440-1843.2009.01595.X
Abstract: Human research ethics committees provide essential review of research projects to ensure the ethical conduct of human research. Several recent reports have highlighted a complex process for successful application for human research ethics committee approval, particularly for multi-centre studies. Limited resources are available for the execution of human clinical research in Australia and around the world. This report overviews the process of ethics approval for a National Health and Medical Research Council-funded multi-centre study in Australia, focussing on the time and resource implications of such applications in 2007 and 2008. Applications were submitted to 16 hospital and two university human research ethics committees. The total time to gain final approval from each committee ranged between 13 and 77 days (median = 46 days) the entire process took 16 months to complete and the research officer's time was estimated to cost $A34 143. Obstacles to timely human research ethics committee approval are reviewed, including recent, planned and potential initiatives that could improve the ethics approval of multi-centre research.
Interventions of latex allergen inhaled by health care workers through use of breathing masks or non-powdered gloves
Publisher: Elsevier BV
Date: 2002
Sex differences in aortic augmentation index in adolescents
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2017
An investigation of methods to improve recall for the patient-reported outcome measurement in COPD patients: a pilot randomised control trial and feasibility study protocol
Publisher: Springer Science and Business Media LLC
Date: 18-07-2019
A randomised cross-over cohort study of exposure to emissions from a road tunnel ventilation stack
Publisher: BMJ
Date: 2012
Building operational research capacity in the Pacific
Publisher: International Union Against Tuberculosis and Lung Disease
Date: 21-06-2014
DOI: 10.5588/PHA.13.0091
Community-wide active case finding and tuberculosis infection in children
Publisher: Elsevier BV
Date: 07-2021
Public health opportunities in the Australian air quality standards review
Publisher: Elsevier BV
Date: 08-2021
Characteristics in Stages of Change and Decisional Balance among Smokers: The Burden of Obstructive Lung Diseases (BOLD)-Australia Study
Publisher: MDPI AG
Date: 12-09-2019
Abstract: Smoking cessation remains a health promotion target. Applying the Transtheoretical Model to Australian Burden of Obstructive Lung Diseases (BOLD) data, we examined differences in stages of change (SoC) and readiness to quit decisional behaviours. Factors were identified likely to influence readiness of smokers, ≥40 years old, to quit. Analysis was restricted to current smokers classified to one of three stages: pre-contemplation (PC), contemplation (C) or preparation (P) to quit. Their ability to balance positive and negative consequences was measured using decisional balance. Among 314 smokers, 43.0% females and 60.8% overweight/obese, the distribution of SoC was: 38.1% PC, 38.3% C and 23.5% P. Overweight/obesity was associated with readiness to quit in stages C and P and there were more negative than positive attitudes towards smoking in those stages. Males were significantly heavier smokers in PC and C stages. Females used smoking cessation medication more frequently in PC stage, were more embarrassed about smoking and had greater negative reinforcements from smoking. Age started smoking and factors related to smoking history were associated with readiness to quit and increased the odds of being in stage C or P. An overweight/obese smoker was likely to be contemplating or preparing to quit. In these stages, smokers have more negative attitudes toward smoking. Starting smoking later, taking advice on cessation from health providers and using quit medications indicate increased readiness to quit. Evaluating these factors in smokers and developing cessation gain-framed messages may prove useful to healthcare providers.
The Australian Child Health and Air Pollution Study (ACHAPS): A national population-based cross-sectional study of long-term exposure to outdoor air pollution, asthma, and lung function
Publisher: Elsevier BV
Date: 11-2018
DOI: 10.1016/J.ENVINT.2018.08.025
Abstract: Most studies of long-term air pollution exposure and children's respiratory health have been performed in urban locations with moderate pollution levels. We assessed the effect of outdoor nitrogen dioxide (NO
Improving access to affordable quality-assured inhaled medicines in low- and middle-income countries
Publisher: International Union Against Tuberculosis and Lung Disease
Date: 11-2022
Abstract: BACKGROUND: Access to affordable inhaled medicines for chronic respiratory diseases (CRDs) is severely limited in low- and middle-income countries (LMICs), causing avoidable morbidity and mortality. The International Union Against Tuberculosis and Lung Disease convened a stakeholder meeting on this topic in February 2022. METHODS: Focused group discussions were informed by literature and presentations summarising experiences of obtaining inhaled medicines in LMICs. The virtual meeting was moderated using a topic guide around barriers and solutions to improve access. The thematic framework approach was used for analysis. RESULTS: A total of 58 key stakeholders, including patients, healthcare practitioners, members of national and international organisations, industry and WHO representatives attended the meeting. There were 20 pre-meeting material submissions. The main barriers identified were 1) low awareness of CRDs 2) limited data on CRD burden and treatments in LMICs 3) ineffective procurement and distribution networks and 4) poor communication of the needs of people with CRDs. Solutions discussed were 1) generation of data to inform policy and practice 2) capacity building 3) improved procurement mechanisms 4) strengthened advocacy practices and 5) a World Health Assembly Resolution. CONCLUSION: There are opportunities to achieve improved access to affordable, quality-assured inhaled medicines in LMICs through coordinated, multi-stakeholder, collaborative efforts.
IL-5 T-cell responses to house dust mite are associated with the development of allergen-specific IgE responses and asthma in the first 5 years of life
Publisher: Elsevier BV
Date: 08-2007
DOI: 10.1016/J.JACI.2007.06.034
Abstract: Allergen-specific T(H)2-like cytokine responses are considered to be important in sensitization and allergic diseases. To examine the profile of house dust mite (HDM) stimulated T-cell cytokines and their relationship to allergic disease in children over the period of the first 5 years of life. Subjects with a family history of asthma who were enrolled antenatally in the Childhood Asthma Prevention Study and had skin prick tests, clinical evaluation for asthma and eczema, and in vitro assessment of lymphocyte cytokine responses to HDM extract performed at ages 18 months (n = 281), 3 years (n = 349), and 5 years (n = 370). IL-13 at 3 and 5 years and IL-5, IL-10, and IFN- gamma at 18 months, 3 years, and 5 years were measured by ELISA. House dust mite-specific cytokine responses increased with age for all cytokines except IFN-gamma. HDM-specific IL-5 responses at 3 years and 5 years were significantly positively related to skin prick test positivity at 5 years. IL-5 responses at 5 years were also significantly related to asthma at 5 years. Other HDM-specific cytokine responses were not related to asthma or eczema at 5 years. Responses were not altered by a HDM avoidance intervention. IL-5 responses to HDM, the dominant local inhalant allergen, are related to the expression of clinical illness at age 5 years. The T-cell response to HDM, as reflected in IL-5 production, is acquired over the first years of life and may play a role in the expression of allergic airways disease.
Use of “preventer” medications and written asthma management plans among adults with asthma in New South Wales
Publisher: AMPCo
Date: 10-2000
DOI: 10.5694/J.1326-5377.2000.TB139268.X
Abstract: (1) To measure the extent of use of preventer medications (ie, inhaled corticosteroids or cromones) and possession of written asthma management plans (AMPs) among people with asthma in New South Wales in 1997. (2) To assess factors associated with underuse of preventer medications and AMPs. A cross-sectional survey by computer-assisted telephone interviews of a stratified random s le of the adult population of New South Wales, Australia. People aged 16 to 54 years with asthma diagnosed by a doctor and causing symptoms or requiring treatment in the preceding year (n = 1,372). Although 55.2% of survey participants had used preventer medications in the preceding year, only 27.8% had used them regularly. Only 34.7% had a written AMP. Preventer medications were judged to be indicated for 54% of the study population, but only 42.5% of this group had used them regularly (43.1% had a written AMP). Younger adults were less likely to use preventer medications regularly, but there was no difference in use of preventer medications by sex, urban/rural residence, or manner of purchasing reliever medications (either on prescription or "over the counter"). Past smokers used preventers more commonly than current smokers, with never smokers having an intermediate prevalence of regular preventer use. Age, sex, urban/rural residence, and manner of purchasing reliever medications were not related to the possession of an AMP. Despite the trend towards increased use of preventer medications and written AMPs during the 1990s, undertreated asthma remains a major public health problem in Australia.
A systematic literature review and critical appraisal of epidemiological studies on outdoor air pollution and tuberculosis outcomes
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.ENVRES.2018.12.011
Abstract: Ambient air pollution is the leading environmental risk factor for disease globally. Air pollutants can increase the risk of some respiratory infections, but their effects on tuberculosis (TB) are unclear. In this systematic literature review, we aimed to assess epidemiological studies on the association between outdoor air pollutants and TB incidence, hospital admissions and death (collectively referred to here as 'TB outcomes'). We sought to consolidate available evidence on this topic and propose recommendations for future studies. Following PRISMA guidelines, we searched PubMed, Web of Science, Google Scholar, and Scopus with no restrictions imposed on year of publication. A total of 11 epidemiological studies, performed in Asia, Europe and North America, met our inclusion criteria (combined s le size: 215,337 people). We extracted key study characteristics from each eligible publication, including design, exposure assessment, analytical approaches and effect estimates. The studies were assessed for overall quality and risk of bias using standard criteria. The pollutant most frequently associated with statistically significant effects on TB outcomes was fine particulate matter ( < 2.5 µm PM
The effect of respiratory activity, non‐invasive respiratory support and facemasks on aerosol generation and its relevance to COVID‐19
Publisher: Wiley
Date: 30-03-2021
DOI: 10.1111/ANAE.15475
Abstract: Respirable aerosols ( 5 µm in diameter) present a high risk of SARS‐CoV‐2 transmission. Guidelines recommend using aerosol precautions during aerosol‐generating procedures, and droplet ( 5 µm) precautions at other times. However, emerging evidence indicates respiratory activities may be a more important source of aerosols than clinical procedures such as tracheal intubation. We aimed to measure the size, total number and volume of all human aerosols exhaled during respiratory activities and therapies. We used a novel chamber with an optical particle counter s ling at 100 l.min ‐1 to count and size‐fractionate close to all exhaled particles (0.5–25 µm). We compared emissions from ten healthy subjects during six respiratory activities (quiet breathing talking shouting forced expiratory manoeuvres exercise and coughing) with three respiratory therapies (high‐flow nasal oxygen and single or dual circuit non‐invasive positive pressure ventilation). Activities were repeated while wearing facemasks. When compared with quiet breathing, exertional respiratory activities increased particle counts 34.6‐fold during talking and 370.8‐fold during coughing (p 0.001). High‐flow nasal oxygen 60 at l.min ‐1 increased particle counts 2.3‐fold (p = 0.031) during quiet breathing. Single and dual circuit non‐invasive respiratory therapy at 25/10 cm.H 2 O with quiet breathing increased counts by 2.6‐fold and 7.8‐fold, respectively (both p 0.001). During exertional activities, respiratory therapies and facemasks reduced emissions compared with activities alone. Respiratory activities (including exertional breathing and coughing) which mimic respiratory patterns during illness generate substantially more aerosols than non‐invasive respiratory therapies, which conversely can reduce total emissions. We argue the risk of aerosol exposure is underappreciated and warrants widespread, targeted interventions.
Omega-3 supplementation during the first 5 years of life and later academic performance: a randomised controlled trial
Publisher: Springer Science and Business Media LLC
Date: 13-08-2015
Treatable Traits in Elderly Asthmatics from the Australasian Severe Asthma Network: A Prospective Cohort Study
Publisher: Elsevier BV
Date: 07-2021
Effect of comorbid diabetes on length of stay and risk of death in patients admitted with acute exacerbations of COPD
Publisher: Wiley
Date: 21-07-2010
DOI: 10.1111/J.1440-1843.2010.01781.X
Abstract: Hyperglycaemia during hospital admission is associated with poor outcomes in patients admitted with acute myocardial infarction, stroke and pneumonia. Less evidence exists for effect of diabetes mellitus (DM) on those admitted with an acute exacerbation of COPD (AECOPD). We proposed that comorbidity with DM is associated with an increased length of stay in patients admitted with AECOPD. Records of patients admitted with AECOPD during 2007 were reviewed. Data on the presence of diagnosed DM, length of stay and markers of disease severity and other comorbidities were collected. Analysis was performed using generalized estimating equations to adjust for correlation between multiple admissions in some in iduals. Log-transformed length of stay and death were the dependent variables. There were 246 admissions in 172 subjects. Diabetes was a comorbid condition in 22% of admissions for AECOPD. There was a trend for increased length of stay and deaths in those with diabetes (geometric mean 7.8 days and 8% mortality respectively) compared with those without diabetes (6.5 days and 4%). However, after adjustment for covariates, the differences were not statistically significant. Taken together with a previous study that revealed a similar trend, our study suggests that comorbid DM prolongs length of stay and increases risk of death in patients with AECOPD. Further studies are now required to elucidate the reasons for these poorer outcomes, in particular whether premorbid glycaemic control or inpatient control is responsible, as these are potentially modifiable factors.
Cohort profile
Publisher: Oxford University Press (OUP)
Date: 25-05-2018
DOI: 10.1093/IJE/DYY078
The Asthma Drug Facility and the future management of asthma
Publisher: International Union Against Tuberculosis and Lung Disease
Date: 05-2022
Global asthma network identifies gaps in essential asthma medicines
Publisher: European Respiratory Society
Date: 09-2016
Outbreak investigation for COVID-19 in northern Vietnam
Publisher: Elsevier BV
Date: 05-2020
Continued increase in the prevalence of asthma and atopy
Publisher: BMJ
Date: 2001
DOI: 10.1136/ADC.84.1.20
Abstract: To describe the change in the prevalence of wheeze, diagnosed asthma, and atopy in Wagga Wagga, NSW, Australia, between 1992 and 1997, and to compare this to the increase in prevalence reported between 1982 and 1992. A cross sectional study of the prevalence of respiratory symptoms and atopy in schoolchildren aged 8-11 years (n = 1016, response rate 71%) in 1997 compared with studies of similar design in 1992 (response rate 83%, n = 850) and 1982 (response rate 88%, n = 769). Main outcome measures were respiratory symptoms measured by parent completed questionnaire and atopy measured by skin prick tests. Between 1992 and 1997, the prevalence of wheeze increased by 5.1% (95% CI 1.2 to 9.0), asthma diagnosis by 8.1% (95% CI 3.8 to 12.4), and atopy by 6.7% (95% CI 2.2 to 11.2). Similar increases in prevalence had been found between 1982 and 1992. The prevalence of wheeze, asthma diagnosis, and atopy in Wagga Wagga has continued to increase.
Lung function growth and its relation to airway hyperresponsiveness and recent wheeze: Results from a longitudinal population study
Publisher: American Thoracic Society
Date: 06-2000
DOI: 10.1164/AJRCCM.161.6.9809118
Abstract: To evaluate the association between growth in height and growth in lung function, and to identify the potential temporal relationships between airway hyperresponsiveness (AHR), respiratory symptoms, and lung function growth during adolescence and young adulthood, we analyzed data collected from the Belmont cohort. Among the 718 schoolchildren initially studied at 1982 (aged 8-10 yr), 557 were studied between two times and six times at 2-yr intervals until 1992. Baseline lung function, AHR by histamine inhalation test, and recent wheeze by questionnaires, were measured at each visit. We found that between 17 and 19 yr of age, when growth in height had stopped, growth in FEV(1) was approximately 200 ml/yr in boys and 100 ml/yr in girls. Peak growth velocity of height occurred at age 13 both in boys and in girls, whereas peak growth velocity of FEV(1) occurred at the same age only in girls and 1 yr later in boys. Having AHR and recent wheeze at the previous study time were both associated with lower subsequent growth in FEV(1), but not with subsequent growth in FVC. We conclude that lung function continues to grow after the cessation of height growth and that growth in FEV(1) is reduced in subjects with AHR and/or recent wheeze.
Contribution of obesity to breathlessness in a large nationally representative sample of Australian adults.
Publisher: Wiley
Date: 06-11-2022
DOI: 10.1111/RESP.14400
Abstract: Breathlessness is prevalent and associated with medical consequences. Obesity is related to breathlessness. However, the magnitude of its contribution has not been clearly documented. This investigation aimed to determine the contribution of obesity to breathlessness by estimating the population attributable fraction (PAF) in a representative s le of Australian adults. A cross-sectional, nationally representative survey of Australian residents aged ≥18 years was conducted in October 2019. Breathlessness was defined as modified Medical Research Council (mMRC) dyspnoea scale grade ≥2. BMI was calculated from self-reported height and weight. Adjusted relative risks (aRRs) were estimated using a generalized linear model with Poisson distribution, adjusted for age group and/or participant-reported diagnosed illnesses. Adjusted PAFs were estimated using aRR and obesity prevalence in Australian adults. Among those who completed the National Breathlessness Survey, 9769 participants (51.4% female) were included in the analysis 28.1% of participants were obese. The prevalence of breathlessness was 9.54%. The aRR of obesity for breathlessness was 2.04, adjusted for age. Adjusting for various co-morbid conditions, the aRR was slightly attenuated to around 1.85-1.98. The PAF, adjusted only for age, was 24.6% (95% CI 20.1-29.1) and after further adjustment for co-morbid conditions, the PAF ranged from 21.1% to 23.6%. Obesity accounted for a higher proportion of breathlessness in women than in men. Our results demonstrate that obesity accounts for around a quarter of breathlessness symptoms in Australian adults. This has important implications for health policy in light of the global trend in increasing obesity.
Completion of Treatment for Latent Tuberculosis Infection with Monthly Drug Dispensation Directly through the Tuberculosis Clinic
Publisher: Public Library of Science (PLoS)
Date: 05-11-2012
A reliable method to retrieve accident & emergency data stored on a free-text basis
Publisher: Elsevier BV
Date: 02-1997
DOI: 10.1016/S0954-6111(97)90069-X
Abstract: Accident & Emergency (A & E) data on asthma-related attendances are useful for studies on the effectiveness of asthma interventions, and to determine the relationship of environmental factors to asthma and asthma epidemics. The final diagnoses made in the A & E departments are not usually coded when entered into hospital databases in the U.K., although the "presenting complaint' can be retrieved from the computerized Hospital Information & Support Systems (HISS), from a free-text attendance diagnosis field entered by the reception clerk when the patient arrives at the A & E department. The validity of this as an indication of the final diagnosis is unevaluated. The aim of this study was to measure the validity of the string "asth' in the A & E attendance diagnosis field for identifying patients attending the A & E departments of two hospitals for asthma-related conditions. A list of patients who attended the A & E department of two hospitals was retrieved from the HISS along with the attendance diagnosis field. If the attendance diagnosis field contained the text string "asth', mentioned wheeze or breathing problems, or the patients were referred by their GP without any diagnostic information entered on HISS, the records were selected for evaluation. The remaining attendances, which were not evaluated further, were attributed to another diagnosis based on the evidence of the recorded attendance diagnosis. The results indicated that the string "asth' in the attendance diagnosis field had a sensitivity of 80.3% (95% CI 75.1-85.5%) and a specificity of 96.7% (95% CI 95.6-97.8%) for a final diagnosis of asthma. It is concluded that free-text attendance diagnosis fields in hospital databases can be searched with suitable strings to obtain reliable data on attendance with asthma. As part of another investigation, the present authors attempted to retrieve a list of the attendances with asthma at the same two A & E departments at a time that was reportedly associated with an epidemic of asthma following a thunderstorm. On this occasion, the string "asth' proved to be significantly less sensitive. The possible reasons for this and the implications for using this method for identifying cases are discussed.
Effect of Budesonide on the Perception of Induced Airway Narrowing in Subjects with Asthma
Publisher: American Thoracic Society
Date: 2002
DOI: 10.1164/AJRCCM.165.1.2106130
Abstract: The perception of bronchoconstriction may be modulated by airway inflammation. However, the effect of inhaled corticosteroid (ICS) treatment on perception in subjects with asthma has received limited study. The aim of this study was to determine the effect of inhaled budesonide on the perception of breathlessness induced by histamine challenge. Thirty-five subjects with poorly controlled asthma were randomized to receive budesonide (1,600 or 3,200 microg/d) for 8 wk, followed by 8 wk at 1,600 microg/d and subsequent downtitration according to a clinical algorithm. Borg scores were recorded during histamine challenges performed at baseline and at 8, 16, 24, 48, and 72 wk. Perception was estimated as the slope of Borg/% fall FEV(1). The Borg/FEV(1) slope increased significantly after 8 wk of budesonide (0.09 [0.08-0.12] to 0.15 [0.11-0.19], p = 0.002), and remained increased compared with baseline values at all subsequent visits. There were no significant differences in Borg/ FEV(1) slope between subjects who were and were not taking ICS at study entry. The magnitude of change in the Borg/FEV(1) slope did not differ significantly between treatment groups and was not related to changes in baseline FEV(1), airway hyperresponsiveness, blood eosinophils, or serum eosinophil cationic protein (ECP). We conclude that treatment with budesonide enhances the perception of airway narrowing, but the effect is unrelated to budesonide dose, or to changes in circulating eosinophil markers.
Analysis of adherence to peak flow monitoring when recording of data is electronic
Publisher: BMJ
Date: 19-01-2002
A cluster randomised controlled trial of nurse and GP partnership for care of chronic obstructive pulmonary disease
Publisher: Springer Science and Business Media LLC
Date: 03-06-2008
Reply to: “The impact of contact evaluation and TB preventive therapy on TB incidence” and “A new paradigm: testing household contacts of adolescents with incident TB infection”
Publisher: International Union Against Tuberculosis and Lung Disease
Date: 07-2021
The effect of changes in house dust mite allergen exposure on the severity of asthma
Publisher: Wiley
Date: 02-1995
DOI: 10.1111/J.1365-2222.1995.TB01015.X
Abstract: To measure the association between changes in house dust mite (HDM) allergen Der p I exposure and changes in the severity of asthma, we re-analysed data from a clinical trial in which 34 HDM-allergic subjects with asthma (18 women, mean age 35 years) were followed for between 3 and 12 months. The concentration of Der p I in fine dust from the bed, the bedroom floor and the living room floor was measured at 3-monthly intervals along with assessment of subjects' spirometric function and airway hyperresponsiveness (AHR, measured by histamine inhalation test). Daily symptom scores, morning peak expiratory flow rate and peak flow variability were measured throughout the study period. The mean Der p I concentration in the bed at baseline was 25.4 micrograms/g (95% CI: 15.8-40.6). During the course of the study large within-subject fluctuations were observed in allergen concentrations and in the measurements of the severity of asthma. Changes in allergen concentration in the bed were significantly correlated with changes in AHR (P = 0.003) and symptom score (P = 0.04). Changes in allergen concentration in the living room floor were correlated with changes in symptom scores (P = 0.01). Although these correlations were significant the magnitude of the effect was relatively modest. We conclude that a large reduction in HDM allergen concentration, particularly in the bed, results in a modest reduction in AHR and improvement in symptoms in HDM-allergic subjects with asthma.
Sex, asthma and obesity: an intimate relationship?
Publisher: Wiley
Date: 14-12-2010
Predictors of house‐dust‐mite allergen concentrations in dry regions in Australia
Publisher: Wiley
Date: 12-2001
DOI: 10.1034/J.1398-9995.2001.00085.X
Abstract: House-dust-mite allergen content differs between houses and is thought to be a function of the housing characteristics and furnishing choices that affect indoor microclimate and mite proliferation. The importance of these features may differ with regional climates. Concentrations of mite allergen were analysed as a function of housing features. Information on housing features was collected by questionnaire in 50 houses in two towns in a dry inland region of Australia. Mite allergen (Der p 1) was measured by ELISA in dust s les collected on five occasions over 2 years from beds and floors. Der p 1 was detected in all houses. Many housing features did not influence mite allergen concentrations. However, the presence of evaporative cooling increased mite allergen by 3.34-fold in beds (P=0.007) and 3.94-fold in floors (P=0.003). Mite allergen was threefold higher in mattresses >5 years old, and synthetic and feather duvets tended to have higher and lower levels of mite allergen, respectively. In houses in dry, inland regions of Australia, evaporative cooling and older mattresses are associated with higher concentrations of mite allergen. Alternative forms of air conditioning to evaporative cooling may be useful for control of mite allergen in dry regions.
Asthma and hayfever in Aboriginal and non‐Aboriginal children living in non‐remote rural towns
Publisher: AMPCo
Date: 07-2001
DOI: 10.5694/J.1326-5377.2001.TB143503.X
Abstract: To compare the prevalence and risk factors for wheeze, asthma diagnosis and hayfever in Aboriginal and non-Aboriginal children living in rural towns in Australia. Cross-sectional study in two towns in rural NSW, Australia, 1997. Primary school children (aged 7-12 years) classified by their parents as being of Aboriginal (n = 158) or of non-Aboriginal (n = 1,282) origin. Atopy measured by skinprick tests and respiratory symptoms measured by parent-completed questionnaire. Aboriginal children were less likely to be atopic (36.2% v 45.6% 95% CI for the difference, -17.6 to -1.3) and to have hayfever (23.3% v 35.2% 95% CI for the difference, -19.1 to -4.6) than non-Aboriginal children, but were equally likely to have had wheeze (31.0% v 27.3%) and asthma (39.4% v 39.3%). Among Aboriginal children, having had bronchitis before age two was a strong risk factor for wheeze (adjusted odds ratio (aOR), 9.3 95% CI, 2.8-30.2) and asthma (aOR, 19.3 95% CI, 4.7-79.3) and having a parent with hayfever was a strong risk factor for hayfever (aOR, 17.9 95% CI, 3.5-90.8), but these risk factors were weaker among non-Aboriginal children. Asthma and wheeze are equally prevalent in Aboriginal and non-Aboriginal children living in the same towns, but appear to have a different aetiology.
Tuberculosis associates with both airflow obstruction and low lung function: BOLD results
Publisher: European Respiratory Society (ERS)
Date: 25-06-2015
DOI: 10.1183/13993003.02325-2014
Abstract: In small studies and cases series, a history of tuberculosis has been associated with both airflow obstruction, which is characteristic of chronic obstructive pulmonary disease, and restrictive patterns on spirometry. The objective of the present study was to assess the association between a history of tuberculosis and airflow obstruction and spirometric abnormalities in adults. The study was performed in adults, aged 40 years and above, who took part in the multicentre, cross-sectional, general population-based Burden of Obstructive Lung Disease study, and had provided acceptable post-bronchodilator spirometry measurements and information on a history of tuberculosis. The associations between a history of tuberculosis and airflow obstruction and spirometric restriction were assessed within each participating centre, and estimates combined using meta-analysis. These estimates were stratified by high- and low/middle-income countries, according to gross national income. A self-reported history of tuberculosis was associated with airflow obstruction (adjusted odds ratio 2.51, 95% CI 1.83–3.42) and spirometric restriction (adjusted odds ratio 2.13, 95% CI 1.42–3.19). A history of tuberculosis was associated with both airflow obstruction and spirometric restriction, and should be considered as a potentially important cause of obstructive disease and low lung function, particularly where tuberculosis is common.
Assessment of the Reliability, Validity, and Responsiveness of a Spanish Asthma Quality of Life Questionnaire
Publisher: Informa UK Limited
Date: 1998
DOI: 10.3109/02770909809071005
Abstract: A Spanish-language questionnaire designed for measuring the impact of asthma on quality of life in adults was developed. It was derived, by the application of a rigorous translation protocol, from a previously validated, English-language Asthma Quality of Life (AQL) questionnaire which had been developed in Australia. The aim of this study was to evaluate the psychometric properties of the Spanish AQL questionnaire using a cross-sectional and longitudinal design. Two hundred ninety-four clinically stable subjects with asthma (168 women, mean baseline forced expiratory volume in 1 sec [FEV1] = 85% predicted), aged 17-70, attended for the initial baseline assessment. All subjects completed the AQL questionnaire and a full history and physical examination were performed. The clinical assessment of severity was based on the classification recommended by the Global Initiative on Asthma (GINA). One week after the initial assessment subjects completed the AQL questionnaire for a second time. Six months later, subjects were assessed clinically and completed all the assessment measures at baseline. Principal components analysis of the AQL questionnaire responses at the baseline visit revealed a structure that was almost identical to that seen in the original English-language questionnaire. The questionnaire was shown to be internally consistent (Cronbach's alpha 0.91 for total score and 0.80-0.86 for the four subscales) and repeatable (intraclass correlation coefficient 0.91 for the total scale and 0.78-0.92 for the subscales). The finding of expected strong correlations with the subject's global assessment of severity (p = 0.70) and dyspnea (p = 0.63), a weak inverse correlation with FEV1 (p = -0.17), and good discrimination among the four GINA severity categories (F3,291 = 37.16, p < 0.0001) supports the construct validity of the questionnaire. AQL scores increased with age (p = 0.31) and were higher in women (p < 0.005). The AQL was responsive to both improvement (mean change 1.02, p < 0.0001) and deterioration (mean change -1.13, p < 0.001) in the severity of asthma over a 6-month period. This disease-specific, Spanish-language AQL questionnaire was shown to have sound psychometric properties which make it suitable for use in cross-sectional or longitudinal studies where it is appropriate to assess the impact of asthma on the quality of life of in idual patients.
Exhaled nitric oxide levels in atopic children: relation to specific allergic sensitisation, AHR, and respiratory symptoms
Publisher: BMJ
Date: 06-2002
Abstract: Exhaled nitric oxide (eNO), which has been proposed as a measure of airway inflammation, is increased in atopic subjects. This raises the question of whether eNO provides any additional information about airway inflammation in asthmatic subjects, other than as a marker for atopy. A study was undertaken to determine whether eNO levels in a population of atopic children are associated with sensitisation or natural exposure to specific allergens, and to examine the relationship between eNO, airway responsiveness, and current respiratory symptoms. Exhaled NO and airway responsiveness to histamine were measured in winter and in summer in 235 children aged 8-14 years who had been classified as atopic by skin prick testing. Current respiratory symptoms, defined as wheeze or cough during the month preceding the test, were measured by a parent completed questionnaire. Airway hyperresponsiveness (AHR) was defined as a dose response ratio (DRR) of >8.1 (% fall in forced expiratory volume in 1 second (FEV(1))/micromol + 3). Sensitisation to house dust mite was associated with raised eNO levels in winter while sensitisation to Cladosporium was associated with raised eNO levels in both winter and summer. Grass pollen sensitisation was not associated with raised eNO levels in either season. Exhaled NO correlated significantly with DRR histamine (r=0.43, p<0.001) independently of whether the children had current symptoms or not. In children with current wheeze, those with AHR had eNO levels 1.53 (95% CI 1.41 to 1.66) times higher than those without AHR (p=0.006). Neither DRR (p=1.0) nor eNO levels (p=0.92) differed significantly between children with or without persistent dry cough in the absence of wheeze. In atopic children, raised eNO levels are associated with sensitisation to perennial allergens, but not to seasonal allergens such as grass pollen. In this population, an increase in eNO is associated with AHR and current wheezing, suggesting that eNO is more than just a marker for atopy.
Overdiagnosis of COPD in Subjects With Unobstructed Spirometry
Publisher: Elsevier BV
Date: 08-2019
DOI: 10.1016/J.CHEST.2019.01.015
Abstract: There are several reports on underdiagnosis of COPD, while little is known about COPD overdiagnosis and overtreatment. We describe the overdiagnosis and the prevalence of spirometrically defined false positive COPD, as well as their relationship with overtreatment across 23 population s les in 20 countries participating in the BOLD Study between 2003 and 2012. A false positive diagnosis of COPD was considered when participants reported a doctor's diagnosis of COPD, but postbronchodilator spirometry was unobstructed (FEV Among 16,177 participants, 919 (5.7%) reported a previous medical diagnosis of COPD. Postbronchodilator spirometry was unobstructed in 569 subjects (61.9%): false positive COPD. A similar rate of overdiagnosis was seen when using the fixed ratio criterion (55.3%). In a subgroup analysis excluding participants who reported a diagnosis of "chronic bronchitis" or "emphysema" (n = 220), 37.7% had no airflow limitation. The site-specific prevalence of false positive COPD varied greatly, from 1.9% in low- to middle-income countries to 4.9% in high-income countries. In multivariate analysis, overdiagnosis was more common among women, and was associated with higher education former and current smoking the presence of wheeze, cough, and phlegm and concomitant medical diagnosis of asthma or heart disease. Among the subjects with false positive COPD, 45.7% reported current use of respiratory medication. Excluding patients with reported asthma, 34.4% of those with normal spirometry still used a respiratory medication. False positive COPD is frequent. This might expose nonobstructed subjects to possible adverse effects of respiratory medication.
2.4 RELATIONSHIP BETWEEN ADULT TRANSFER FUNCTION DERIVED CENTRAL AORTIC SYSTOLIC PRESSURE AND MEASURED SYSTOLIC PRESSURE IN THE HEALTHY CHILDREN POPULATION
Publisher: Springer Science and Business Media LLC
Date: 2014
Waste-to-Energy processes: what is the impact on air pollutants and health?
Publisher: Queensland University of Technology
Date: 19-04-2019
Are the prevalence and treatment of asthma similar in elite athletes and the aged‐matched non‐athlete population?
Publisher: Wiley
Date: 20-02-2007
DOI: 10.1111/J.1600-0838.2006.00598.X
Abstract: The objective of this study was to determine the prevalence of asthma and use of asthma medications in elite athletes compared with an age-matched non-athlete population. Data were collected from the respiratory component of annual medical screening of 424 elite athletes from the Queensland Academy of Sport. Measures included the prevalence of current asthma and ever doctor-diagnosed asthma, and the prevalence of use of treatment for asthma including beta-agonists and inhaled corticosteroid medication. The prevalence of current asthma in athletes aged 18-29 years was 14% (95% CI, 9-19%), which did not differ significantly from the prevalence in the non-athlete control population (11% 95% CI, 9-12%, P=0.3). Of athletes with current asthma, 27% were not taking any medications for asthma, and 25% were treated with short-acting beta-agonist medications alone and were not taking inhaled corticosteroids. These data indicate that the overall cumulative and period prevalence of asthma in Queensland athletes is similar to that in the general age-matched population. Athletes use beta-agonists with a frequency similar to the general population.
Early predictors for developing allergic disease and asthma: Examining separate steps in the 'allergic march'
Publisher: Wiley
Date: 06-08-2007
DOI: 10.1111/J.1365-2222.2007.02796.X
Abstract: Sensitization and symptoms of allergic disease are strongly correlated, but little is known about the early clinical precursors of the development of allergen sensitization in childhood. The aim of this study was to identify these predictors, and to examine separately the effect of early sensitization on subsequent wheeze, asthma, rhinitis and eczema. In the Childhood Asthma Prevention Study, children with a family history of asthma were assessed for allergen sensitization, total serum IgE, wheeze, asthma, eczema and rhinitis at ages 18 months and 5 years. To examine predictors, at 18 months, for subsequent sensitization, children who were non-sensitized at 18 months and had data on sensitization at 5 years were investigated, n=375. To examine the predictors, at age 18 months, of subsequent onset of symptoms, children who did not have wheeze, asthma, eczema or rhinitis at 18 months were followed-up at 5 years, n=177. Among children who were non-sensitized at age 18 months, the presence of eczema [adjusted relative risk (aRR), 1.67, 95% confidence interval (CI) 1.20-2.33], but not wheeze, asthma or rhinitis, was an independent predictor of the onset of sensitization by age 5 years. Among children who were asymptomatic at age 18 months, sensitization to any allergen at 18 months was an independent predictor for the presence of wheeze (aRR 2.41, 95% CI 1.28-4.55), asthma (aRR 4.66, 95% CI 1.88-11.54) and rhinitis (aRR 1.77, 95% CI 1.08-2.90), but not for the development of eczema (aRR 0.78, 95% CI 0.23-2.64) at 5 years. In non-sensitized children, eczema, but not wheeze, asthma or rhinitis is a predictor for subsequent development of sensitization. This suggests that early childhood eczema, rather than wheeze and rhinitis, may promote subsequent allergen sensitization and raises the possibility that early management of eczema may reduce the prevalence of sensitization in children.
Molecular epidemiology of tuberculosis and recent developments in understanding the epidemiology of tuberculosis
Publisher: Wiley
Date: 08-2004
Maternal cigarette smoking is associated with reduced high-density lipoprotein cholesterol in healthy 8-year-old children
Publisher: Oxford University Press (OUP)
Date: 21-06-2011
Abstract: Smoking in pregnancy is common. Its effects on lipoprotein levels and arterial structure in childhood are not well characterized. We aimed to determine the effects of maternal smoking in pregnancy on lipoprotein levels and arterial wall thickness in healthy pre-pubertal children. A community-based longitudinal study with prospective ascertainment of exposure to smoking in pregnancy and environmental tobacco smoke (ETS) since birth and then lipoprotein and arterial measurements at age 8 years. In 616 newborn infants (gestation >36 weeks and birth weight >2.5 kg) data were collected prospectively by questionnaire on smoking in pregnancy and ETS exposure in childhood. At age 8-years, 405 of the children had measurements of lipoproteins, blood pressure (BP) and carotid intima-media thickness. Children born to mothers who smoked in pregnancy had lower HDL cholesterol [1.32 vs. 1.50 mmol/L, 95% confidence interval (CI) for difference -0.28 to -0.08, P = 0.0005], higher triglycerides (1.36 vs. 1.20 mmol/L, 95% CI for ratio 1.01-1.30, P = 0.04) and higher systolic BP (102.1 vs. 99.9 mmHg, 95% CI for difference 0.6-3.8, P = 0.006). After adjustment for maternal passive smoking, post-natal ETS exposure, gender, breast feeding duration, physical inactivity, and adiposity, smoking in pregnancy remained significantly associated with lower HDL cholesterol (difference = -0.22 mmol/L, 95% CI -0.36 to -0.08, P = 0.003) but not with higher systolic BP. Neither smoking in pregnancy nor post-natal ETS exposure was associated with alterations of carotid artery wall thickness. Smoking in pregnancy is independently associated with significantly lower HDL cholesterol in healthy 8-year-old children.
Improved spirometric detection of small airway narrowing: concavity in the expiratory flow–volume curve in people aged over 40 years
Publisher: Informa UK Limited
Date: 12-2017
DOI: 10.2147/COPD.S150280
Associations between statins and COPD: a systematic review
Publisher: Springer Science and Business Media LLC
Date: 12-07-2009
Daycare attendance before the age of two protects against atopy in preschool age children
Publisher: Wiley
Date: 2000
DOI: 10.1002/1099-0496(200011)30:5<377::AID-PPUL3>3.0.CO;2-3
Abstract: Early attendance at daycare has been shown to protect against atopy, as defined by a positive skin prick test. One proposed hypothesis for this association is that early exposure to other children protects against atopy by facilitating the spread of infections among children. An alternative hypothesis is that children attending daycare centers have less atopy due to lower levels of exposure to indoor allergens. Our aim was to determine whether attendance at daycare before age 2 years protects against atopy in Australian preschool age children and to test the two alternative hypotheses, as well as a number of potential confounding factors. We conducted a cross-sectional study of children aged 3-5 years living in one humid coastal city (Lismore, n = 286) and one dry, inland city (Wagga Wagga, n = 364) in New South Wales, Australia, in 1995. Atopy was assessed by skin prick tests to six common allergens. Daycare attendance and other possible risk factors for atopy were measured by a parent-completed questionnaire. Children who attended daycare before age 2 years had a reduced risk of atopy at 3-5 years. The greatest effect was seen in children who attended a daycare center (odds ratio (OR), 0.26 95% CI, 0.14-0.50) rather than family daycare (OR, 0.66 95% CI, 0.41-1.04). The results of this study do not support either of the proposed hypotheses, nor can the effect be explained by any of the other potential confounders measured. Further work is needed to determine the exposure that is responsible for the protective effect of daycare attendance on atopy.
How to build Urbanome, the genome of the city?
Publisher: Elsevier BV
Date: 03-2022
DOI: 10.1016/J.SCITOTENV.2021.152310
Abstract: The world's population is shifting to the cities, and consequently, cities worldwide are growing in number and in size. Cities are complex systems, making it extremely difficult to build and run cities in a way that all the elements of the system operate in harmony. Recently a concept of urbanome, the genome of the city was proposed to address this complexity. Here we first explore this concept and analogy, taking advantage of the potential of other 'omics, modern data collection techniques, Big Data analysis methods and a transdisciplinary approach. Then, we propose a theoretical approach to build the urbanome as a means of quantifying and qualifying population outcomes, being a function of the form of an urban area including the built environment, the physical and social services it provides, and the population density.
Methods and effectiveness of environmental control
Publisher: Elsevier BV
Date: 02-1999
DOI: 10.1016/S0091-6749(99)70488-4
Abstract: In recent years the role of allergen exposure and atopy, and the interaction between them in the clinical expression of allergic disease, has been examined in a quantitative manner in epidemiologic studies. Such analyses suggest that avoidance of exposure to domestic allergens is a critical element in integrated strategies for both the prevention and the management of asthma. The promise of primary intervention in high-risk infants, as shown in the Isle of White study, has been confirmed in a recent study in Japan, and at least 4 similar trials are in progress. Applying these principles to the management of symptoms in patients with chronic asthma has proved more difficult, and it is likely that many earlier studies were poorly designed to test the hypothesis that allergen avoidance was clinically useful. Recent studies with patients moved to high altitudes during seasonal reductions in mite exposure and randomized controlled interventions in houses have all shown improvements in clinical manifestations of asthma. These recent trials have also demonstrated something that was less certain-that massive reductions in domestic allergen exposure can be achieved and that people will adopt the significant changes to their domestic environment and lifestyles if the risks and benefits are known. In the future, it seems likely that better study designs, as well as improvements in methods to monitor exposure and clinical outcomes, will provide further support for the role of allergen avoidance in the prevention and management of asthma.
Recurrence of tuberculosis in a low-incidence setting
Publisher: European Respiratory Society (ERS)
Date: 2009
DOI: 10.1183/09031936.00104108
Abstract: Recurrence of active tuberculosis following treatment of an initial disease episode can occur due to endogenous re-activation or exogenous re-infection. Cases of recurrent tuberculosis in the Australian state of New South Wales between 1994 and 2006 were identified by data linkage analysis with confirmatory review of case notes. Patients with more than one culture-positive disease episode during that time period who had completed treatment for the initial disease episode were included. Genotyping of Mycobacterium tuberculosis was used to determine whether recurrence was likely to be due to re-activation or re-infection. There were 5,723 tuberculosis notifications between 1994 and 2006, 3,731 of which were culture-positive. Fifteen (0.4%) patients had recurrent culture-positive disease over a mean 5.7 yrs of follow-up (crude annual incidence 71 per 100,000 population). Recurrent tuberculosis was attributable to re-activation (indistinguishable strains) in 11 (73%) cases and to re-infection (different strains) in four (27%). In a low-incidence setting of tuberculosis, a control programme incorporating directly observed therapy for active disease resulted in a very low rate of recurrent tuberculosis over a long period of follow-up. Re-infection is less likely than re-activation, but still contributes significantly to the number of cases with recurrent disease.
Health effects of daily airborne particle dose in children: Direct association between personal dose and respiratory health effects
Publisher: Elsevier BV
Date: 09-2013
DOI: 10.1016/J.ENVPOL.2013.05.039
Abstract: Air pollution is a widespread health problem associated with respiratory symptoms. Continuous exposure monitoring was performed to estimate alveolar and tracheobronchial dose, measured as deposited surface area, for 103 children and to evaluate the long-term effects of exposure to airborne particles through spirometry, skin prick tests and measurement of exhaled nitric oxide (eNO). The mean daily alveolar deposited surface area dose received by children was 1.35 × 10(3) mm(2). The lowest and highest particle number concentrations were found during sleeping and eating time. A significant negative association was found between changes in pulmonary function tests and in idual dose estimates. Significant differences were found for asthmatics, children with allergic rhinitis and sensitive to allergens compared to healthy subjects for eNO. Variation is a child's activity over time appeared to have a strong impact on respiratory outcomes, which indicates that personal monitoring is vital for assessing the expected health effects of exposure to particles.
Prevalence and Population-Attributable Risk for Chronic Airflow Obstruction in a Large Multinational Study
Publisher: American Thoracic Society
Date: 06-2021
Emerging threats to Malaysia’s national security
Publisher: Informa UK Limited
Date: 08-2010
Childhood factors that predict asthma in young adulthood
Publisher: European Respiratory Society (ERS)
Date: 2004
DOI: 10.1183/09031936.03.00046903
Abstract: Predicting adult asthma, using childhood characteristics, is important for advising on prognosis and, potentially, for secondary prevention. A novel use of multivariate likelihood ratios (LRs) to quantify prognosis is described here. Of 718 subjects of a community-based cohort, 575 (80%) members were recruited at age 8-10 yrs and were re-assessed 15-17 yrs later. At baseline, information about symptoms, spirometry, histamine challenge and skin-prick tests were collected. At follow-up "asthma symptoms" were defined as wheeze, sleep disturbance from asthma or inhaled steroid use within the previous year. LRs were calculated for significant predictors of this outcome. Shinkage factors were applied to yield multivariate LRs. Childhood characteristics that independently predicted asthma symptoms in adulthood were obstructive spirometry (adjusted (adj)LR 2.9, 95% confidence interval (CI) 1.3-6.5), airway hyperresponsiveness (adjLR 2.6, 95% CI 1.8-3.7), atopy (adjLR 2.0, 95% CI 1.5-2.7), recent wheeze (adjLR 1.9, 95% CI 1.5-2.5) and being female (adjLR 1.29, 95% CI 0.8-2.1). Children with all five characteristics had a cumulative LR of 36.9 for asthma symptoms in adulthood. Most adults who had asthma symptoms did not have manifestations of asthma as children. However, the presence of obstructive spirometry, airway hyperresponsiveness and atopy in childhood identifies in iduals with increased likelihood of having asthma in adulthood. Cumulative likelihood ratios are more valuable than odds ratios for quantifying risk in in iduals and for identifying people with most to gain from preventive interventions.
Redistribution of Traffic Related Air Pollution Associated with a New Road Tunnel
Publisher: American Chemical Society (ACS)
Date: 22-02-2012
DOI: 10.1021/ES202686R
Abstract: The aim of this study was to assess the effect of a new road tunnel on the concentration and distribution of traffic-related air pollution (TRAP), specifically nitrogen dioxide (NO(2)) and particulate matter (PM), and to determine its relationship to change in traffic flow. We used continuously recorded data from four monitoring stations at nonroadside locations within the study area and three regional monitors outside the area. The four monitors in the study area were in background locations where smaller pollutant changes were expected compared with changes near the bypassed main road. We also deployed passive s lers to assess finer spatial variability in NO(2) including application of a land use regression model (LUR). The study was conducted from 2006 to 2008. Analysis of the continuously recorded data showed that the tunnel intervention did not lead to consistent reductions in NO(2) or PM over the wider study area. However, there were significant decreases in NO(2), NO(x), and PM(10) in the eastern section of the study area. Analysis of passive s ler data indicated that the greatest reductions in NO(2) concentrations occurred within 100 m of the bypassed main road. The LUR model also demonstrated that changes in NO(2) were most marked adjacent to the bypassed main road. These findings support the use of methods that highlight fine spatial variability in TRAP and demonstrate the utility of traffic interventions in reducing air pollution exposures for populations living close to main roads.
Inflammatory phenotypes in patients with severe asthma are associated with distinct airway microbiology
Publisher: Elsevier BV
Date: 2018
DOI: 10.1016/J.JACI.2017.03.044
Abstract: Asthma pathophysiology and treatment responsiveness are predicted by inflammatory phenotype. However, the relationship between airway microbiology and asthma phenotype is poorly understood. We aimed to characterize the airway microbiota in patients with symptomatic stable asthma and relate composition to airway inflammatory phenotype and other phenotypic characteristics. The microbial composition of induced sputum specimens collected from adult patients screened for a multicenter randomized controlled trial was determined by using 16S rRNA gene sequencing. Inflammatory phenotypes were defined by sputum neutrophil and eosinophil cell proportions. Microbiota were defined by using α- and β- ersity measures, and interphenotype differences were identified by using similarity of percentages, network analysis, and taxon fold change. Phenotypic predictors of airway microbiology were identified by using multivariate linear regression. Microbiota composition was determined in 167 participants and classified as eosinophilic (n = 84), neutrophilic (n = 14), paucigranulocytic (n = 60), or mixed neutrophilic-eosinophilic (n = 9) asthma phenotypes. Airway microbiology was significantly less erse (P = .022) and more dissimilar (P = .005) in neutrophilic compared with eosinophilic participants. Sputum neutrophil proportions, but not eosinophil proportions, correlated significantly with these ersity measures (α- ersity: Spearman r = -0.374, P < .001 β- ersity: r = 0.238, P = .002). Interphenotype differences were characterized by a greater frequency of pathogenic taxa at high relative abundance and reduced Streptococcus, Gemella, and Porphyromonas taxa relative abundance in patients with neutrophilic asthma. Multivariate regression confirmed that sputum neutrophil proportion was the strongest predictor of microbiota composition. Neutrophilic asthma is associated with airway microbiology that is significantly different from that seen in patients with other inflammatory phenotypes, particularly eosinophilic asthma. Differences in microbiota composition might influence the response to antimicrobial and steroid therapies and the risk of lung infection.
Population Prevalence of Hypercapnic Respiratory Failure from Any Cause.
Publisher: American Thoracic Society
Date: 15-04-2022
Long-term exposure to low concentrations of air pollutants and hospitalisation for respiratory diseases: A prospective cohort study in Australia
Publisher: Elsevier BV
Date: 12-2018
DOI: 10.1016/J.ENVINT.2018.08.050
Abstract: Short- and long-term spatiotemporal variation in exposure to air pollution is associated with respiratory morbidity in areas with moderate-to-high level of air pollution, but very few studies have examined whether these associations also exist in areas with low level exposure. We assessed the association between spatial variation in long-term exposure to PM We recorded data on hospitalisations for 100,084 participants, who were aged >45 years at entry in 2006-2009 until June 2014. Annual NO NO We found weak positive associations of exposure to air pollution with hospitalisation for asthma while there was no evidence of an association for all respiratory diseases.
Air pollution and fasting blood glucose: A longitudinal study in China
Publisher: Elsevier BV
Date: 2016
DOI: 10.1016/J.SCITOTENV.2015.09.132
Abstract: Limited studies have examined the associations between air pollutants [particles with diameters of 10 μm or less (PM10), sulphur dioxide (SO2), and nitrogen dioxide (NO2)] and fasting blood glucose (FBG). We collected data for 27,685 participants who were followed during 2006 and 2008. Generalized Estimating Equation models were used to examine the effects of air pollutants on FBG while controlling for potential confounders. We found that increased exposure to NO2, SO2 and PM10 was significantly associated with increased FBG levels in single pollutant models (p<0.001). For exposure to 4 days' average of concentrations, a 100 μg/m(3) increase in SO2, NO2, and PM10 was associated with 0.17 mmol/L (95% CI: 0.15-0.19), 0.53 mmol/L (95% CI: 0.42-0.65), and 0.11 mmol/L (95% CI: 0.07-0.15) increase in FBG, respectively. In the multi-pollutant models, the effects of SO2 were enhanced, while the effects of NO2 and PM10 were alleviated. The effects of air pollutants on FBG were stronger in female, elderly, and overweight people than in male, young and underweight people. In conclusion, the findings suggest that air pollution increases the levels of FBG. Vulnerable people should pay more attention on highly polluted days to prevent air pollution-related health issues.
Gaps in using bronchodilators, inhaled corticosteroids and influenza vaccine among 23 high- and low-income sites
Publisher: International Union Against Tuberculosis and Lung Disease
Date: 2015
Fast Approximation Algorithms for Multiple Coverage with Unit Disks
Publisher: IEEE
Date: 06-2022
Association of respiratory symptoms and lung function with occupation in the multinational Burden of Obstructive Lung Disease (BOLD) study
Publisher: European Respiratory Society (ERS)
Date: 25-08-2022
DOI: 10.1183/13993003.00469-2022
Abstract: Chronic obstructive pulmonary disease has been associated with exposures in the workplace. We aimed to assess the association of respiratory symptoms and lung function with occupation in the Burden of Obstructive Lung Disease study. We analysed cross-sectional data from 28 823 adults (≥40 years) in 34 countries. We considered 11 occupations and grouped them by likelihood of exposure to organic dusts, inorganic dusts and fumes. The association of chronic cough, chronic phlegm, wheeze, dyspnoea, forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV 1 )/FVC with occupation was assessed, per study site, using multivariable regression. These estimates were then meta-analysed. Sensitivity analyses explored differences between sexes and gross national income. Overall, working in settings with potentially high exposure to dusts or fumes was associated with respiratory symptoms but not lung function differences. The most common occupation was farming. Compared to people not working in any of the 11 considered occupations, those who were farmers for ≥20 years were more likely to have chronic cough (OR 1.52, 95% CI 1.19–1.94), wheeze (OR 1.37, 95% CI 1.16–1.63) and dyspnoea (OR 1.83, 95% CI 1.53–2.20), but not lower FVC (β=0.02 L, 95% CI −0.02–0.06 L) or lower FEV 1 /FVC (β=0.04%, 95% CI −0.49–0.58%). Some findings differed by sex and gross national income. At a population level, the occupational exposures considered in this study do not appear to be major determinants of differences in lung function, although they are associated with more respiratory symptoms. Because not all work settings were included in this study, respiratory surveillance should still be encouraged among high-risk dusty and fume job workers, especially in low- and middle-income countries.
HOUSE DUST MITES AND MITE ALLERGENS IN PUBLIC PLACES
Publisher: Elsevier BV
Date: 06-1992
Chronic airflow obstruction after successful treatment of multidrug-resistant tuberculosis
Publisher: European Respiratory Society (ERS)
Date: 07-2017
DOI: 10.1183/23120541.00026-2017
Abstract: Cross-sectional studies reveal an association between tuberculosis (TB) and chronic airflow obstruction, but cannot adequately address confounding. We hypothesised that treated pulmonary TB is an independent risk factor for chronic airflow obstruction. The Pulmones Post TB cohort study enrolled participants from Lima, Peru, aged 10–70 years with a history of drug-susceptible (DS)- or multidrug-resistant (MDR)-TB who had completed treatment and were clinically cured. Unexposed participants without TB were randomly selected from the same districts. We assessed respiratory symptoms, relevant environmental exposures, and spirometric lung function pre- and post-bronchodilator. In total, 144 participants with DS-TB, 33 with MDR-TB and 161 unexposed participants were fully evaluated. Compared with unexposed participants, MDR-TB patients had lower lung volumes (adjusted mean difference in forced vital capacity −370 mL, 95% CI −644– −97) and post-bronchodilator airflow obstruction (adjusted OR 4.89, 95% CI 1.27–18.78). Participants who had recovered from DS-TB did not have lower lung volumes than unexposed participants, but were more likely to have a reduced forced expiratory volume in 1 s/forced vital capacity ratio .70 (adjusted OR 2.47, 95% CI 1.01–6.03). In iduals successfully treated for TB may experience long-lasting sequelae. Interventions facilitating earlier TB treatment and management of chronic respiratory disease should be explored.
Latent tuberculous infection in household contacts of multidrug-resistant and newly diagnosed tuberculosis
Publisher: International Union Against Tuberculosis and Lung Disease
Date: 03-2017
Abstract: Differences in the prevalence of latent tuberculous infection (LTBI) and tuberculosis (TB) disease among contacts of patients with multidrug-resistant TB (MDR-TB) and drug-susceptible TB are not well understood. To compare the prevalence of tuberculin skin test (TST) positivity in household contacts of patients with MDR-TB and in contacts of patients never previously treated for TB ('new TB'). Consecutive patients with MDR-TB and their household contacts at nine urban district clinics in Viet Nam were screened for TB and LTBI, and followed up for 6 months. LTBI was defined as a TST result of at least 10 mm. A total of 167 patients with TB and their 337 household contacts were recruited. A total of 167/180 (25.8%) contacts of new TB patients and 60/147 (40.8%) contacts of MDR-TB patients were TST-positive (odds ratio [OR] 2.0, 95%CI 1.3-3.2). Contacts of MDR-TB patients were more likely to have baseline chest radiograph findings consistent with TB (OR 2.6, 95%CI 1.4-5.0). Contacts of MDR-TB patients have a high risk of developing TB. Measures to reduce Mycobacterium tuberculosis transmission and accelerate the detection of disease among high-risk contacts should be prioritised to curb the MDR-TB epidemic.
Particulate masks and non-powdered gloves reduce latex allergen inhaled by healthcare workers
Publisher: Wiley
Date: 08-2002
DOI: 10.1046/J.1365-2745.2002.01432.X
Abstract: Although allergy to latex is a well-characterized phenomenon, some hospitals continue to provide staff with powdered latex gloves as an option to low- or non-powdered gloves. We aimed to measure the extent to which inhalation of latex particles could be reduced by the use of protective masks or by replacing powdered latex gloves with non-powdered latex gloves. Twenty healthcare workers in a hospital setting wore nasal air s lers (NAS) and Institute of Occupational Medicine (IOM) s lers for four 20-min periods. Subjects wore powdered gloves, non-powdered gloves and no gloves during three s ling periods, and in the fourth, subjects applied an aerosol barrier face-mask or a particulate face-mask (N95) while wearing powdered gloves. All s les were stained for particles bearing Hev b 5 allergen by the Halogen assay. All subjects inhaled Hev b 5 bearing particles in all s ling periods. IOM s lers collected particles at 70% of the rate of NAS. The number of particles inhaled while wearing powdered gloves was 23.8-fold higher than when not wearing gloves and 9.7-fold higher than when wearing non-powdered latex gloves (P < 0.0001). Wearing an aerosol barrier mask did not significantly reduce the number of particles inhaled (P = 0.108), while use of particulate masks significantly reduced the number of particles inhaled by 17.4-fold (P = 0.003). Use of non-powdered gloves is the most effective method of reducing occupational aeroallergen exposure to latex arising from gloves. However, secondary protection using particulate masks is a valid alternative, and may be helpful for preventing respiratory sensitization.
Unemployment in chronic airflow obstruction around the world: results from the BOLD study
Publisher: European Respiratory Society (ERS)
Date: 09-2017
Inappropriate supply of antibiotics for common viral infections by community pharmacies in Vietnam: A standardised patient survey
Publisher: Elsevier BV
Date: 06-2022
Safety and Side Effects of Rifampin versus Isoniazid in Children
Publisher: Massachusetts Medical Society
Date: 02-08-2018
Four Months of Rifampin or Nine Months of Isoniazid for Latent Tuberculosis in Adults
Publisher: Massachusetts Medical Society
Date: 02-08-2018
Barriers to adherence with tuberculosis contact investigation in six provinces of Vietnam: A nested case-control study
Publisher: Springer Science and Business Media LLC
Date: 26-02-2015
Healthy indoor air is our fundamental need: the time to act is now
Publisher: Wiley
Date: 13-11-2022
DOI: 10.5694/MJA2.51768
Having lived on a farm and protection against allergic diseases in Australia
Publisher: Wiley
Date: 04-2001
DOI: 10.1046/J.1365-2222.2001.01070.X
Abstract: Farmers' children in northern Europe have a lower prevalence of atopy, hay fever and asthma than other children. Farms in Australia differ in scale and operation from those in Europe and the prevalence of allergic diseases in children is higher. To investigate whether having lived on a farm as a child in Australia is associated with a lower risk of allergic diseases. Cross-sectional study of children (n = 1500) aged 7-12 years from two rural towns: Wagga Wagga in a mixed farming region, and Moree in a crop farming region. Parents answered a questionnaire and children had a skin prick test for atopy. Twenty percent of children had lived on a farm for at least 1 year. The effect of having lived on a farm differed between the towns (P < 0.001). It was associated with a lower risk of atopy in Wagga (adjusted odds ratio (aOR) 0.47, 95% confidence interval (CI) 0.32-0.72) but not in Moree (aOR 0.97, 95% CI 0.62-1.53). Children from Wagga were more likely to have lived on a livestock farm than children from Moree (26.1% vs. 9.1%, 95% CI for the difference 8.9-25.4). Having lived on a farm in Australia can confer protection against atopy in children. Further studies are needed to identify possible protective mechanisms associated with farm animals or to establish whether the protective effect is explained by other related exposures.
Prevalence of latent tuberculous infection among adults in the general population of Ca Mau, Viet Nam
Publisher: International Union Against Tuberculosis and Lung Disease
Date: 03-2018
Abstract: The study was conducted in a randomly selected s le of persons aged 15 years living in Ca Mau Province, southern Viet Nam. To estimate the prevalence of latent tuberculous infection (LTBI) in the general adult population of this province of Viet Nam. The secondary objective was to examine age and sex differences in prevalence. A cross-sectional survey was conducted in a cluster-random s le of the population. Clusters were subcommunes. The presence of LTBI was assessed using the QuantiFERON®-TB Gold In-Tube test system. QuantiFERON tests were performed among 1319 persons aged 15 years (77.7% of those selected). The overall prevalence of positive tests was 36.8% (95%CI 33.4-40.3). The prevalence of a positive test was lower in females than in males (31.0% vs. 44.7%, OR 0.57, 95%CI 0.45-0.72, P < 0.0001). The prevalence of positive tests increased with increasing age quintile (P < 0.0001). More than one third of the general adult population in a province in southern Viet Nam have evidence of LTBI. Although LTBI prevalence is higher in males, the sex difference is not as great as that for TB notification rates.
Sero-Prevalence of SARS-CoV-2 Antibodies in High-Risk Populations in Vietnam
Publisher: MDPI AG
Date: 11-06-2021
Abstract: As a response to the coronavirus disease 2019 (COVID-19) pandemic, Vietnam enforced strict quarantine, contact tracing and physical distancing policies resulting in one of the lowest numbers of in iduals infected with severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) globally. This study aimed to determine the prevalence of SARS-CoV-2 antibody positivity among high-risk populations in Vietnam. A prevalence survey was undertaken within four communities in Vietnam, where at least two COVID-19 cases had been confirmed. Participants were classified according to the location of exposure: household contacts, close contacts, community members, and healthcare workers (HCWs) responsible for treating COVID-19 cases. Participants completed a baseline questionnaire and SARS-CoV-2 IgG antibodies were quantified using a commercial assay. A total of 3049 community members and 149 health care workers consented to the study. Among 13 in iduals who were seropositive (0.4%), five household contacts (5/27, 18.5%), one close contact (1/53, 1.9%), and seven community members (7/2954, 0.2%) had detectable SARS-CoV-2 antibodies. All HCWs were negative for SARS-CoV-2 antibodies. Participants were tested a median of 15.1 (interquartile range from 14.9 to 15.2) weeks after exposure. Our study found a low prevalence of SARS-CoV-2 antibodies in high-risk communities and healthcare workers in communities in Vietnam with known COVID-19 cases.
Identifying preventable risk factors for hospitalised asthma in young Aboriginal children: a whole-population cohort study
Publisher: BMJ
Date: 08-01-2021
DOI: 10.1136/THORAXJNL-2020-216189
Abstract: Australia has one of the highest rates of asthma worldwide. Indigenous children have a particularly high burden of risk determinants for asthma, yet little is known about the asthma risk profile in this population. To identify and quantify potentially preventable risk factors for hospitalised asthma in Australian Aboriginal children (1–4 years of age). Birth, hospital and emergency data for all Aboriginal children born 2003–2012 in Western Australia were linked (n=32 333). Asthma was identified from hospitalisation codes. ORs and population attributable fractions were calculated for maternal age at birth, remoteness, area-level disadvantage, prematurity, low birth weight, maternal smoking in pregnancy, mode of delivery, maternal trauma and hospitalisations for acute respiratory tract infection (ARTI) in the first year of life. There were 705 (2.7%) children hospitalised at least once for asthma. Risk factors associated with asthma included: being hospitalised for an ARTI (OR 4.06, 95% CI 3.44 to 4.78), area-level disadvantage (OR 1.58, 95% CI 1.28 to 1.94), being born at weeks’ gestation (OR 3.30, 95% CI 2.52 to 4.32) or birth weight g (OR 2.35, 95% CI 1.39 to 3.99). The proportion of asthma attributable to an ARTI was 31%, area-level disadvantage 18%, maternal smoking 5%, and low gestational age and birth weight were 3%–7%. We did not observe a higher risk of asthma in those children who were from remote areas. Improving care for pregnant Aboriginal women as well as for Aboriginal infants with ARTI may help reduce the burden of asthma in the Indigenous population.
Direct or indirect stimuli for bronchial challenge testing: what is the relevance for asthma epidemiology?
Publisher: Wiley
Date: 2004
Polymorphisms of SP110 are associated with both pulmonary and extra-pulmonary tuberculosis among the Vietnamese
Publisher: Public Library of Science (PLoS)
Date: 09-07-2014
Opportunity to reduce paediatric asthma in New South Wales through nitrogen dioxide control
Publisher: Elsevier BV
Date: 08-2021
Experience in responding to COVID-19 outbreaks from Vietnam
Publisher: Elsevier BV
Date: 02-2021
Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global
Publisher: Elsevier BV
Date: 08-2015
The environment is a first order issue for lung health
Publisher: International Union Against Tuberculosis and Lung Disease
Date: 12-2019
Real-life effectiveness of omalizumab in severe allergic asthma above the recommended dosing range criteria
Publisher: Wiley
Date: 22-07-2016
DOI: 10.1111/CEA.12774
Abstract: Omalizumab (Xolair) dosing in severe allergic asthma is based on serum IgE and bodyweight. In Australia, patients eligible for omalizumab but exceeding recommended ranges for IgE (30-1500 IU/mL) and bodyweight (30-150 kg) may still receive a ceiling dose of 750 mg/4 weeks. About 62% of patients receiving government-subsidized omalizumab are enrolled in the Australian Xolair Registry (AXR). To determine whether AXR participants above the recommended dosing ranges benefit from omalizumab and to compare their response to within-range participants. Data were stratified according to dose range status (above-range or within-range). Further sub-analyses were conducted according to the reason for being above the dosing range (IgE only vs. IgE and weight). Data for 179 participants were analysed. About 55 (31%) were above recommended dosing criteria other characteristics were similar to within-range participants. Above-range participants had higher baseline IgE [812 (IQR 632, 1747) IU/mL vs. 209 (IQR 134, 306) IU/mL] and received higher doses of omalizumab [750 (IQR 650, 750) mg] compared to within-range participants [450 (IQR, 300, 600) mg]. At 6 months, improvements in Juniper 5-item Asthma Control Questionnaire (ACQ-5, 3.61 down to 2.01 for above-range, 3.47 down to 1.93 for within-range, P < 0.0001 for both) and Asthma Quality of Life Questionnaire (AQLQ mean score (3.22 up to 4.41 for above-range, 3.71 up to 4.88 for within-range, P < 0.0001) were observed in both groups. Forced expiratory volume in one second (FEV Patients with severe allergic asthma above recommended dosing criteria for omalizumab have significantly improved symptom control, quality of life and lung function to a similar degree to within-range participants, achieved without dose escalation above 750 mg.
Central blood pressure in children and adolescents: Non-invasive development and testing of novel transfer functions
Publisher: Springer Science and Business Media LLC
Date: 24-08-2017
DOI: 10.1038/JHH.2017.59
Asthma in Australia 2005
Publisher: AMPCo
Date: 11-2005
DOI: 10.5694/J.1326-5377.2005.TB07119.X
Abstract: A recent report outlines the good and the bad news about asthma.
Hormonal contraceptives and onset of asthma in reproductive-age women: Population-based cohort study
Publisher: Elsevier BV
Date: 08-2020
Breeding, Management and Environmental Issues at Peri-Urban Dairy Farms
Publisher: InTech
Date: 26-09-2012
DOI: 10.5772/47904
Asthma and atopy prevalence are not reduced among former tuberculosis patients compared with controls in Lima, Peru
Publisher: Springer Science and Business Media LLC
Date: 13-02-2019
A new model for clinical trials to address the COVID-19 emergency
Publisher: European Respiratory Society (ERS)
Date: 06-2020
Chronic obstructive pulmonary disease mortality and prevalence: the associations with smoking and poverty—a BOLD analysis
Publisher: BMJ
Date: 18-12-2013
Does continuous use of inhaled corticosteroids improve outcomes in mild asthma? A double-blind randomised controlled trial
Publisher: Springer Science and Business Media LLC
Date: 05-03-2008
Revisiting Styblo's law: could mathematical models aid in estimating incidence from prevalence data?
Publisher: Cambridge University Press (CUP)
Date: 19-09-2014
DOI: 10.1017/S0950268814002428
Abstract: Estimation of the true incidence of tuberculosis (TB) is challenging. The approach proposed by Styblo in 1985 is known to be inaccurate in the modern era where there is widespread availability of treatment for TB. This study re-examines the relationship of incidence to prevalence and other disease indicators that can be derived from surveys. We adapt a simple, previously published model that describes the epidemiology of TB in the presence of treatment to investigate a revised ratio-based approach to estimating incidence. We show that, following changes to treatment programmes for TB, the ratio of incidence to prevalence reaches an equilibrium value rapidly long before other model indicators have stabilized. We also show that this ratio relies on few parameters but is strongly dependent on, and requires knowledge of, the efficacy and timeliness of treatment.
Monitoring Asthma in Populations
Publisher: CRC Press
Date: 12-08-2005
DOI: 10.1201/B14271-20
Long-term effects of mass screening for latent and active tuberculosis in the Marshall Islands
Publisher: Cold Spring Harbor Laboratory
Date: 07-03-2021
DOI: 10.1101/2021.03.03.21252859
Abstract: The Marshall Islands implemented ambitious population-based screening programs for latent and active tuberculosis in 2017 and 2018. These interventions’ long-term effects remain to be estimated. To predict the long-term impact of the previous interventions and identify strategies to drive tuberculosis towards elimination. We built a transmission model of tuberculosis informed by local data to capture the epidemic’s historical dynamics. We used the model to project the future epidemic trajectory following the screening interventions, as well as considering a counterfactual scenario with no intervention. We also simulated future scenarios including periodic interventions similar to those previously implemented, to assess the feasibility of reaching the End TB Strategy targets and tuberculosis pre-elimination. The 2017-2018 screening activities were estimated to have reduced tuberculosis incidence and mortality by more than one third in 2020, and are predicted to achieve the End TB Strategy milestone of 50% incidence reduction by 2025 compared to 2015. Interventions had a considerably greater impact when in iduals were also screened for latent infection than active case finding alone. Such combined programs implemented at the national level could achieve tuberculosis pre-elimination by 2035 if repeated every two years, and around 2045 if repeated every five years. We predict that it is possible to achieve tuberculosis pre-elimination by 2035 in the Marshall Islands through periodic repetition of the same ambitious interventions as those previously implemented. Including latent infection testing in active screening activities will be a critical pillar for achieving these ambitious goals.
A pragmatic cluster randomized controlled trial of early intervention for chronic obstructive pulmonary disease by practice nurse-general practitioner teams
Publisher: Springer Science and Business Media LLC
Date: 07-09-2012
Abstract: Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of disability, hospitalization, and premature mortality. General practice is well placed to diagnose and manage COPD, but there is a significant gap between evidence and current practice, with a low level of awareness and implementation of clinical practice guidelines. Under-diagnosis of COPD is a world-wide problem, limiting the benefit that could potentially be achieved through early intervention strategies such as smoking cessation, dietary advice, and exercise. General practice is moving towards more structured chronic disease management, and the increasing involvement of practice nurses in delivering chronic care. A pragmatic cluster randomised trial will test the hypothesis that intervention by a practice nurse-general practitioner (GP) team leads to improved health-related quality of life and greater adherence with clinical practice guidelines for patients with newly-diagnosed COPD, compared with usual care. Forty general practices in greater metropolitan Sydney Australia will be recruited to identify patients at risk of COPD and invite them to attend a case finding appointment. Practices will be randomised to deliver either practice nurse-GP partnership care, or usual care, to patients newly-diagnosed with COPD. The active intervention will involve the practice nurse and GP working in partnership with the patient in developing and implementing a care plan involving (as appropriate), smoking cessation, immunisation, pulmonary rehabilitation, medication review, assessment and correction of inhaler technique, nutritional advice, management of psycho-social issues, patient education, and management of co-morbidities. The primary outcome measure is health-related quality of life, assessed with the St George’s Respiratory Questionnaire 12 months after diagnosis. Secondary outcome measures include validated disease-specific and general health related quality of life measures, smoking and immunisation status, medications, inhaler technique, and lung function. Outcomes will be assessed by project officers blinded to patients’ randomization groups. This study will use proven case-finding methods to identify patients with undiagnosed COPD in general practice, where improved care has the potential for substantial benefit in health and healthcare utilization. The study provides the capacity to trial a new model of team-based assessment and management of newly diagnosed COPD in Australian primary care. ACTRN12610000592044\\
Body mass index (BMI) trajectories from birth to 11.5 years: relation to early life food intake.
Publisher: MDPI AG
Date: 09-10-2012
DOI: 10.3390/NU4101382
Adherence to peak flow monitoring
Publisher: BMJ
Date: 11-05-2002
Air pollution control efficacy and health impacts: A global observational study from 2000 to 2016
Publisher: Elsevier BV
Date: 10-2021
A sputum 6-gene signature predicts future exacerbations of poorly controlled asthma
Publisher: Elsevier BV
Date: 07-2019
DOI: 10.1016/J.JACI.2018.12.1020
Abstract: Improved diagnostic tools for predicting future exacerbation frequency in asthmatic patients are required. A sputum gene expression signature of 6 biomarkers (6-gene signature [6GS], including Charcot-Leyden crystal galectin [CLC] carboxypeptidase 3 [CPA3] deoxyribonuclease 1-like 3 [DNASE1L3] alkaline phosphatase, liver/bone/kidney [ALPL] CXCR2 and IL1B) predicts inflammatory and treatment response phenotypes in patients with stable asthma. Recently, we demonstrated that azithromycin (AZM) add-on treatment in patients with uncontrolled moderate-to-severe asthma significantly reduced asthma exacerbations (AMAZES clinical trial). We sought to test whether the 6GS predicts future exacerbation and inflammatory phenotypes in a subpopulation of AMAZES and to test the effect of AZM therapy on 6GS expression and prognostic capacity. One hundred forty-two patients (73 placebo-treated and 69 AZM-treated patients) had sputum stored for quantitative PCR of 6GS markers at baseline and after 48 weeks of treatment. Logistic regression and receiver operating characteristic and area under the curve (AUC) determination were performed on baseline measures, and in an exploratory analysis the predictive value of the 6GS was compared with conventional biomarkers for exacerbation and inflammatory phenotypes. The 6GS significantly predicted all future exacerbation phenotypes tested. Calculated AUCs for the 6GS were significantly greater than AUCs for peripheral blood eosinophil counts, sputum neutrophil counts, and combined sputum eosinophil and neutrophil counts. 6GS AUCs were also numerically but not significantly greater than those for fractional exhaled nitric oxide values and sputum eosinophil counts. AZM treatment altered neither 6GS expression nor the predictive capacity of the 6GS for future exacerbation phenotypes. The 6GS was a significant predictor of airway inflammatory phenotype in this population. We demonstrate that a sputum gene signature can predict future exacerbation phenotypes of asthma, with the greatest biomarker performance in identifying those who would experience frequent severe exacerbations. AZM therapy did not modify 6GS expression or biomarker performance, suggesting the therapeutic action of AZM is independent of 6GS-related inflammatory pathways.
Differences between asthma exacerbations and poor asthma control
Publisher: Elsevier BV
Date: 1999
Factors affecting healthcare pathways for chronic lung disease management in Vietnam: a qualitative study on patients’ perspectives
Publisher: Springer Science and Business Media LLC
Date: 15-06-2021
DOI: 10.1186/S12889-021-11219-4
Abstract: Chronic obstructive pulmonary disease (COPD) and asthma rank among the leading causes of respiratory morbidity, particularly in low- and middle-income countries. This qualitative study aimed to explore the healthcare pathways of patients with chronic respiratory disease, and factors influencing their ability to access healthcare in Vietnam, where COPD and asthma are prevalent. We conducted 41 in-depth interviews among patients, including 31 people with COPD, eight with asthma and two with asthma-COPD overlap syndrome. Participants were recruited at provincial- or national-level health facilities in two urban and two rural provinces in Vietnam. The interviews were audio-recorded, transcribed, and analysed using thematic analysis. Patients’ healthcare pathways were complex and involved visits to multiple health facilities before finally obtaining a definitive diagnosis at a provincial- or national-level hospital. Access to healthcare was affected considerably by participants’ limited knowledge of their respiratory conditions, the availability of social support, especially from family members, the costs of healthcare as well as health system factors (including the coverage of public health insurance, the distance to health facilities, and attitude of healthcare providers). The study demonstrated the need for improved access to timely diagnosis and treatment of chronic lung disease within the lower level of the health system. This can be achieved by enhancing the communication skills and diagnostic capacity of local healthcare workers. Health education programmes for patients and caregivers will contribute to improved control of lung disease.
Current transmission prevention methods: Reducing disease spread from infected individuals
Publisher: Future Medicine Ltd
Date: 2014
DOI: 10.2217/EBO.13.507
The Immunological Mysteries of Tuberculosis
Publisher: Elsevier BV
Date: 02-2019
The association between infant feeding practices and subsequent atopy among children with a family history of asthma.
Publisher: Wiley
Date: 20-04-2007
DOI: 10.1111/J.1365-2222.2007.02696.X
Abstract: Although longer duration of breastfeeding and later introduction of solid foods are both recommended for the prevention of asthma and allergic disease, evidence to support these recommendations is controversial. To examine the relation between infant feeding practices and the risk of asthma and allergic disease at age 5 years. A cohort of children with a family history of asthma in Sydney, Australia, was followed from birth to age 5 years. Data on infant feeding practices and on early manifestations of eczema were collected prospectively. The presence of eczema, asthma and atopy (positive allergen skin prick tests) were determined at age 5 years. In 516 children evaluated at age 5 years, there was no significant association between the duration of breastfeeding or timing of introduction of solid foods and protection against asthma or other allergic disease, after adjustment for confounding factors. However, breastfeeding for 6 months or more and introduction of solid foods after 3 months were both associated with an increased risk of atopy at age 5 years (P=0.02 and 0.01, respectively). There was no significant association between the presence of eczema at 4 weeks and at 3 months and continued breastfeeding beyond those times. Longer duration of breastfeeding and later introduction of solid foods did not prevent the onset of asthma, eczema or atopy by age 5 years.
HDL-Cholesterol, Blood Pressure, and Asymmetric Dimethylarginine Are Significantly Associated With Arterial Wall Thickness in Children
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2009
DOI: 10.1161/ATVBAHA.109.184184
Abstract: Objective— Atherosclerosis is found at autopsy in the arteries of adolescents and young adults. Arterial wall thickening may be assessed in vivo by ultrasound measurement of the carotid intima media thickness (CIMT), a marker of subclinical atherosclerosis. As the determinants of arterial wall thickness in childhood are unknown, we assessed the influence of cardiovascular risk factors on CIMT in 8-year-old children. Methods and Results— A community-based s le of 405 children (age 8.0±0.1 years, 49% girls) had anthropometry, family history, blood pressure (BP), and CIMT measured. A blood s le was collected for HDL and non-HDL cholesterol, apolipoproteins A1 and B, high-sensitivity C-reactive protein, bilirubin, and asymmetric dimethylarginine (ADMA, an endogenous nitric oxide inhibitor). CIMT was significantly associated with systolic BP ( r =0.17, P .001), diastolic BP ( r =0.10, P =0.04), HDL ( r =−0.13, P =0.02), and ADMA ( r =0.18, P =0.001). CIMT was significantly higher in children with premature parental CHD (0.63±0.07 versus 0.59±0.06 mm, P =0.03). On multivariate analysis, HDL (β coefficient=−0.02, P =0.04), ADMA (β coefficient=0.05, P .001), and systolic BP (β coefficient=0.001, P =0.003) were significantly and independently associated with CIMT. Conclusions— Lower HDL-cholesterol, higher levels of ADMA, and systolic BP are significantly associated with greater arterial wall thickness in early childhood.
The Global Burden of Exposure to Pesticide Mixtures
Publisher: Elsevier BV
Date: 2020
DOI: 10.2139/SSRN.3684494
Active case finding in contacts of people with tuberculosis
Publisher: Wiley
Date: 07-09-2011
We are not doing enough to prevent the spread of COVID‐19 and other respiratory viruses in Australian hospitals
Publisher: AMPCo
Date: 21-07-2021
DOI: 10.5694/MJA2.51183
The impact of COPD on health status: findings from the BOLD study
Publisher: European Respiratory Society (ERS)
Date: 30-05-2013
A Direct Measure of Tuberculosis Incidence — Effect of Community Screening
Publisher: Massachusetts Medical Society
Date: 07-04-2022
DOI: 10.1056/NEJMC2114176
A precise and objective tool for tuberculosis detection – Author's reply
Publisher: Elsevier BV
Date: 12-2016
Accuracy of STOP‐Bang Questionnaire as a Screening Tool for Obstructive Sleep Apnoea among surgical population
Publisher: Wiley
Date: 10-2018
DOI: 10.1111/JSR.02_12766
Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013
Publisher: Elsevier BV
Date: 2015
The Dose–Response Association between Nitrogen Dioxide Exposure and Serum Interleukin-6 Concentrations
Publisher: MDPI AG
Date: 08-05-2017
DOI: 10.3390/IJMS18051015
What patient factors predict physicians' decision not to treat latent tuberculosis infection in tuberculosis contacts?
Publisher: Public Library of Science (PLoS)
Date: 30-09-2013
The burden of asthma, hay fever and eczema in children in 25 countries: GAN Phase I study
Publisher: European Respiratory Society (ERS)
Date: 10-02-2022
DOI: 10.1183/13993003.02866-2021
Abstract: There have been no worldwide standardised surveys of prevalence and severity of asthma, rhinoconjunctivitis and eczema in school children for 15 years. The present study aims to provide this information. Following the exact International Study of Asthma and Allergies in Childhood (ISAAC) methodology (cross-sectional questionnaire-based survey), Global Asthma Network (GAN) Phase I was carried out between 2015 and 2020 in many centres worldwide. The study included 157 784 adolescents (13–14 years of age) in 63 centres in 25 countries and 101 777 children (6–7 years of age) in 44 centres in 16 countries. The current prevalence of symptoms, respectively, was 11.0% and 9.1% for asthma, 13.3% and 7.7% for rhinoconjunctivitis and 6.4% and 5.9% for eczema. The prevalence of asthma ever was 10.5% and 7.6%, hay fever ever was 15.2% and 11.1% and eczema ever was 10.6% and 13.4%, respectively. Centres in low or lower middle gross national income countries (LICs or LMICs) had significantly lower prevalence of the three disease symptoms and diagnoses (except for hay fever). In children, the prevalence of asthma and rhinoconjunctivitis symptoms was higher in boys, while the reverse occurred among adolescents. For eczema, while the prevalence among female adolescents was double that of males, there was no sex difference among children. Centre accounted for non-negligible variability in all disease symptoms (10–20%). The burdens of asthma, rhinoconjunctivitis and eczema vary widely among the limited number of countries studied. Although symptom prevalence is lower in LICs and LMICs, it represents a considerable burden everywhere studied.
Impact of obstructive sleep apnoea on post‐operative outcomes
Publisher: Wiley
Date: 10-2017
DOI: 10.1111/JSR.10_12619
Most Personal Exposure to House Dust Mite Aeroallergen Occurs during the Day
Publisher: Public Library of Science (PLoS)
Date: 24-07-2013
The burden of asthma in Australia
Publisher: Wiley
Date: 08-2001
DOI: 10.5694/J.1326-5377.2001.TB143062.X
Abstract: In 1997, 27% of Australian children had current wheeze, and this is increasing by 1.4% per year. The prevalence of wheeze among adults is lower and appears to be stable. The prevalence of persistent asthma (wheezing episodes with abnormal airway function between episodes) in children has increased from 5% to 9% in the past 20 years. In adults, the prevalence is 5%-6%. Up to 80% of adults with persistent asthma have abnormal lung function. Asthma deaths in Australia have fallen 28% since peaking in 1989, but the mortality rate is still twice that of England.
Eight-year outcomes of the Childhood Asthma Prevention Study
Publisher: Elsevier BV
Date: 08-2010
Weight Gain Trajectories from Birth to Adolescence and Cardiometabolic Status in Adolescence
Publisher: Elsevier BV
Date: 05-2019
DOI: 10.1016/J.JPEDS.2018.12.034
Abstract: To assess the influence of the trajectory of weight gain from birth to adolescence on cardiovascular and metabolic risk. We studied childhood body mass index (BMI) trajectories from birth to age 14 years and cardiometabolic risk factors at age 14 years. In total, 410 children with weight and height measurements were assessed from birth throughout childhood, from the Childhood Asthma Prevention Study, a prospective community-based cohort. BMI trajectory groups were determined by latent basis growth mixture models. Of these subjects, 190 had detailed cardiometabolic risk factors assessed at age 14 years. Three BMI trajectory groups were identified normal BMI, "early rising" excess BMI from 2 years, and "late rising" excess BMI from 5 years. Differences were found between normal and excess BMI in children at 14 years of age. In addition, children with an early rising BMI trajectory had statistically significantly higher central adiposity and a more atherogenic lipoprotein profile at age 14 years than children with a late rising BMI trajectory (P < .05). No differences between BMI trajectory groups in vascular structure or function was identified at age 14 years. Earlier onset of an elevated BMI trajectory persisting from birth to age 14 years results in an unfavorable cardiometabolic risk profile at age 14 years, including central adiposity and more atherogenic lipoproteins, independent of achieved BMI.
Risk of tuberculosis in dialysis patients: a nationwide cohort study
Publisher: Public Library of Science (PLoS)
Date: 27-12-2011
Effect of omega-3 fatty acid concentrations in plasma on symptoms of asthma at 18 months of age.
Publisher: Wiley
Date: 12-2004
DOI: 10.1111/J.1399-3038.2004.00187.X
Abstract: The objective of this study was to assess the relation between observed levels of omega-3 fatty acids in plasma and symptoms of asthma and atopy in children at 18 months of age. A total of 616 women at risk of having a child who would develop asthma because of a family history were recruited from the antenatal clinics of six hospitals in Sydney, Australia. Families were randomized to either active omega-3 supplemented or control group. The active group received a daily tuna fish oil supplement and omega-3-rich margarines and cooking oils and the control group received a placebo supplement with polyunsaturated margarines and cooking oils. When the children were 18 months of age an assessment of symptoms was carried out by a research nurse blinded to treatment group allocation. Atopy was measured by skin prick tests, blood was collected to determine serum immunoglobulin E (IgE), and plasma fatty acid concentrations. A total of 376 children (61.0% of total recruited) completed an assessment at 18 months and had blood taken to determine plasma fatty acid concentrations. Omega-3 fatty acid levels were expressed in quintiles of exposure 'as treated' without reference to treatment group allocation. Wheeze ever, doctor visits for wheeze, bronchodilator use and nocturnal coughing were significantly reduced in children in the higher exposure quintiles. Serum IgE was reduced in the highest quintile but not significantly so. There was no difference in diagnosed asthma or atopy between the exposure quintiles. Although wheeze at this age may not be a good indicator of asthma in later childhood, it is encouraging that some symptoms have been reduced in children with high omega-3 fatty acid concentrations in plasma.
Active case‐finding in contacts of people with TB
Publisher: International Union Against Tuberculosis and Lung Disease
Date: 02-2021
Abstract: BACKGROUND: Exposure to people with TB substantially elevates a person's risk of tuberculous infection and TB disease. Systematic screening of TB contacts enables the early detection and treatment of co‐prevalent disease, and the opportunity to prevent future TB disease. However, scale‐up of contact investigation in high TB transmission settings remains limited. METHODS: We undertook a narrative review to evaluate the evidence for contact investigation and identify strategies that TB programmes may consider when introducing contact investigation and management. RESULTS: Selection of contacts for priority screening depends upon their proximity and duration of exposure, along with their susceptibility to develop TB. Screening algorithms can be tailored to the target population, the availability of diagnostic tests and preventive therapy, and healthcare worker expertise. Contact investigation may be performed in the household or at communal locations. Local contact investigation policies should support vulnerable patients, and ensure that drop‐out during screening can be mitigated. Ethical issues should be anticipated and addressed in each setting. CONCLUSION: Contact investigation is an important strategy for TB elimination. While its epidemiological impact will be greatest in lower‐transmission settings, the early detection and prevention of TB have important benefits for contacts and their communities.
Potential benefits of active case finding to reduce the burden of TB
Publisher: International Union Against Tuberculosis and Lung Disease
Date: 02-2021
Tuberculosis, public health and gathering new evidence to guide control efforts
Publisher: The Sax Institute
Date: 2013
DOI: 10.1071/NB12124
Hormonal contraception and the risk of severe asthma exacerbation: 17-year population-based cohort study
Publisher: BMJ
Date: 23-11-2020
DOI: 10.1136/THORAXJNL-2020-215540
Abstract: Longitudinal studies investigating impact of exogenous sex steroids on clinical outcomes of asthma in women are lacking. We investigated the association between use of hormonal contraceptives and risk of severe asthma exacerbation in reproductive-age women with asthma. We used the Optimum Patient Care Research Database, a population-based, longitudinal, anonymised primary care database in the UK, to construct a 17-year (1 January 2000–31 December 2016) retrospective cohort of reproductive-age (16–45 years, n=83 084) women with asthma. Using Read codes, we defined use, subtypes and duration of use of hormonal contraceptives. Severe asthma exacerbation was defined according to recommendations of the European Respiratory Society/American Thoracic Society as asthma-related hospitalisation, accident and emergency department visits due to asthma and/or oral corticosteroid prescriptions. Analyses were done using multilevel mixed-effects Poisson regression with QR decomposition. The 17-year follow-up resulted in 456 803 person-years of follow-up time. At baseline, 34% of women were using any hormonal contraceptives, 25% combined (oestrogen rogestogen) and 9% progestogen-only contraceptives. Previous (incidence rate ratio (IRR) 0.94, 95% CI 0.92 to 0.97) and current (IRR 0.96, 95% CI 0.94 to 0.98) use of any, previous (IRR 0.92, 95% CI 0.87 to 0.97) and current use of combined (IRR 0.93, 95% CI 0.91 to 0.96) and longer duration of use (3–4 years: IRR 0.94, 95% CI 0.92 to 0.97 5+ years: IRR 0.91, 95% CI 0.89 to 0.93) of hormonal contraceptives, but not progestogen-only contraceptives, were associated with reduced risk of severe asthma exacerbation compared with non-use. Use of hormonal contraceptives may reduce the risk of severe asthma exacerbation in reproductive-age women. Mechanistic studies investigating the biological basis for the influence of hormonal contraceptives on clinical outcomes of asthma in women are required. European Union electronic Register of Post-Authorisation Studies (EUPAS22967).
Seasonal trends in house dust mite allergen in children’s beds over a 7‐year period
Publisher: Wiley
Date: 30-10-2007
DOI: 10.1111/J.1398-9995.2007.01533.X
Abstract: House dust mite (HDM) allergy is closely linked to the expression of asthma and other allergic diseases. Understanding factors influencing variation in allergen may help in controlling allergic disease. The objective of this study was to investigate the effects of seasonal changes in climate, type of bed used in very early childhood and anti-mite interventions on HDM allergen concentration. Participants were enrolled in a randomized-controlled trial of HDM avoidance. Der p 1 was measured in dust s les from children's beds on 13 occasions, from birth to age 5 years, between 1997 and 2004. Bed types were categorized as bassinette, cot or bed. The effects of study month, type of bed and intervention group on HDM allergen concentration were estimated by multiple linear regression. The relation between climatic variables and HDM allergen concentration was investigated using a polynomial distributed lag model. House dust mite allergen concentrations were initially low in cots and bassinettes in 1997/1998, peaked in bassinettes and beds between 1999 and 2001 and then slowly declined during the period 2002/2004. Seasonal fluctuations occurred with minima in summer and two- to threefold higher maxima during late autumn. Allergen peaks were correlated with relative humidity peaks 2 months previously. Seasonal changes in allergen were not affected by the HDM avoidance intervention. House dust mite allergen concentrations in Sydney beds fluctuate approximately two- to threefold on an annual cycle, partly determined by relative humidity, with peaks in late autumn and minima in summer. Fluctuations of this magnitude might be sufficient to influence asthma symptoms.
Satellite-Based Land-Use Regression for Continental-Scale Long-Term Ambient PM 2.5 Exposure Assessment in Australia
Publisher: American Chemical Society (ACS)
Date: 02-10-2018
Abstract: Australia has relatively erse sources and low concentrations of ambient fine particulate matter (<2.5 μm, PM
Asthma management and outcomes in Australia: A nation-wide telephone interview survey
Publisher: Wiley
Date: 13-02-2007
DOI: 10.1111/J.1440-1843.2006.01010.X
Abstract: Asthma is a high-burden disease for which effective treatment is available. In Australia, there has been a public health c aign directed at increasing the implementation of effective management with the aim of improving asthma outcomes. The aim of this study was to assess the burden of asthma and describe current asthma management in Australia. A computer-assisted telephone interview survey was conducted in 2003/04 among randomly selected participants. Current asthma was defined as self-reported asthma, confirmed by doctor, which was still present and/or associated with symptoms in the last 12 months. From 46,855 eligible telephone numbers dialled there were 14,271 (30.5%) responses to the screening questionnaire. Among 1734 respondents with current asthma, 1205 (69.5%) completed the detailed questionnaire. Among these, 24.2% of adults and 14.3% children had symptoms during the day or night on most days 11.3% of adults and 6.0% of children avoided exercise because of asthma symptoms during exercise and 19.4% of adults and 29.7% of children had sought urgent medical care because of an exacerbation of asthma during the preceding year. Among adults with asthma, only 35.6% with daily symptoms and 41.4% with symptoms on most days were taking inhaled steroids. Only 31.1% of adults with daily symptoms had a written asthma action plan. Compared with similar international studies, this study revealed a lower prevalence of frequent asthma symptoms and a higher prevalence of use of inhaled steroids among people with asthma. However, there remains le scope for improvement in management of patients with frequent symptoms.
Severe asthma: Current management, targeted therapies and future directionsA roundtable report
Publisher: Wiley
Date: 30-11-2017
DOI: 10.1111/RESP.12957
Abstract: Asthma is a chronic respiratory disease characterized by respiratory symptoms, airway inflammation, airway obstruction and airway hyper-responsiveness. Asthma is common and directly affects 10% of Australians, 1-5% of adults in Asia and 300 million people worldwide. It is a heterogeneous disorder with many clinical, molecular, biological and pathophysiological phenotypes. Current management strategies successfully treat the majority of patients with asthma who have access to them. However, there is a subset of an estimated 5-10% of patients with asthma who have severe disease and are disproportionately impacted by symptoms, exacerbations and overall illness burden. The care required for this relatively small proportion of patients is also significant and has a major impact on the healthcare system. A number of new therapies that hold promise for severe asthma are currently in clinical trials or are entering the Australian and international market. However, recognition of severe asthma in clinical practice is variable, and there is little consensus on the best models of care or how to integrate emerging and often costly therapies into current practice. In this article, we report on roundtable discussions held with severe asthma experts from around Australia, and make recommendations about approaches for better patient diagnosis and assessment. We assess current models of care for patient management and discuss how approaches may be optimized to improve patient outcomes. Finally, we propose mechanisms to assess new therapies and how to best integrate these approaches into future treatment.
Shared Pseudomonas aeruginosa genotypes are common in Australian cystic fibrosis centres
Publisher: European Respiratory Society (ERS)
Date: 09-08-2013
DOI: 10.1183/09031936.00060512
Abstract: Recent molecular-typing studies suggest cross-infection as one of the potential acquisition pathways for Pseudomonas aeruginosa in patients with cystic fibrosis (CF). In Australia, there is only limited evidence of unrelated patients sharing indistinguishable P. aeruginosa strains. We therefore examined the point-prevalence, distribution, ersity and clinical impact of P. aeruginosa strains in Australian CF patients nationally. 983 patients attending 18 Australian CF centres provided 2887 sputum P. aeruginosa isolates for genotyping by enterobacterial repetitive intergenic consensus-PCR assays with confirmation by multilocus sequence typing. Demographic and clinical details were recorded for each participant. Overall, 610 (62%) patients harboured at least one of 38 shared genotypes. Most shared strains were in small patient clusters from a limited number of centres. However, the two predominant genotypes, AUST-01 and AUST-02, were widely dispersed, being detected in 220 (22%) and 173 (18%) patients attending 17 and 16 centres, respectively. AUST-01 was associated with significantly greater treatment requirements than unique P. aeruginosa strains. Multiple clusters of shared P. aeruginosa strains are common in Australian CF centres. At least one of the predominant and widespread genotypes is associated with increased healthcare utilisation. Longitudinal studies are now needed to determine the infection control implications of these findings.
Reassessment of the positive predictive value and specificity of Xpert MTB/RIF: a diagnostic accuracy study in the context of community-wide screening for tuberculosis
Publisher: Elsevier BV
Date: 09-2016
The Global Asthma Network rationale and methods for Phase I global surveillance: prevalence, severity, management and risk factors
Publisher: European Respiratory Society (ERS)
Date: 23-12-2016
DOI: 10.1183/13993003.01605-2016
Abstract: The Global Asthma Network (GAN), established in 2012, followed the International Study of Asthma and Allergies in Childhood (ISAAC). ISAAC Phase One involved over 700 000 adolescents and children from 156 centres in 56 countries it found marked worldwide variation in symptom prevalence of asthma, rhinitis and eczema that was not explained by the current understanding of these diseases ISAAC Phase Three involved over 1 187 496 adolescents and children (237 centres in 98 countries). It found that asthma symptom prevalence was increasing in many locations especially in low- and middle-income countries where severity was also high, and identified several environmental factors that required further investigation. GAN Phase I, described in this article, builds on the ISAAC findings by collecting further information on asthma, rhinitis and eczema prevalence, severity, diagnoses, asthma emergency room visits, hospital admissions, management and use of asthma essential medicines. The subjects will be the same age groups as ISAAC, and their parents. In this first global monitoring of asthma in children and adults since 2003, further evidence will be obtained to understand asthma, management practices and risk factors, leading to further recognition that asthma is an important non-communicable disease and to reduce its global burden.
Global Asthma Network survey suggests more national asthma strategies could reduce burden of asthma
Publisher: Codon Publications
Date: 03-2017
DOI: 10.1016/J.ALLER.2016.10.013
Abstract: Several countries or regions within countries have an effective national asthma strategy resulting in a reduction of the large burden of asthma to in iduals and society. There has been no systematic appraisal of the extent of national asthma strategies in the world. The Global Asthma Network (GAN) undertook an email survey of 276 Principal Investigators of GAN centres in 120 countries, in 2013-2014. One of the questions was: "Has a national asthma strategy been developed in your country for the next five years? For children? For adults?". Investigators in 112 (93.3%) countries answered this question. Of these, 26 (23.2%) reported having a national asthma strategy for children and 24 (21.4%) for adults 22 (19.6%) countries had a strategy for both children and adults 28 (25%) had a strategy for at least one age group. In countries with a high prevalence of current wheeze, strategies were significantly more common than in low prevalence countries (11/13 (85%) and 7/31 (22.6%) respectively, p<0.001). In 25% countries a national asthma strategy was reported. A large reduction in the global burden of asthma could be potentially achieved if more countries had an effective asthma strategy.
It's blowing in the wind: New insights into thunderstorm-related asthma
Publisher: Elsevier BV
Date: 09-2007
Do Variants in GSTs Modify the Association between Traffic Air Pollution and Asthma in Adolescence?
Publisher: MDPI AG
Date: 04-2016
DOI: 10.3390/IJMS17040485
Most House Dust Mite Aeroallergen Exposure Occurs During the Day, Not in Bed
Publisher: Elsevier BV
Date: 02-2013
Asthma diagnosis and treatment - 1016. Is atopy in people aged 40 and over related to fixed airflow obstruction?
Publisher: Elsevier BV
Date: 2013
Parametric Studies on Hydrodeoxygenation of Rubber Seed Oil for Diesel Range Hydrocarbon Production
Publisher: American Chemical Society (ACS)
Date: 31-01-2020
Clinical and organizational factors associated with mortality during the peak of first COVID-19 wave: the global UNITE-COVID study
Publisher: Springer Science and Business Media LLC
Date: 21-05-2022
Breastfeeding, asthma, and allergy: a tale of two cities
Publisher: Wiley
Date: 04-12-2011
DOI: 10.1111/J.1399-3038.2011.01229.X
Abstract: The effect of breastfeeding duration on subsequent asthma and allergy remains the subject of much controversy. To investigate whether differences in study design or disease-related exposure modification were the cause of the differences in study findings. The data from two cohorts, the Childhood Asthma Prevention Study (CAPS) from Australia and the Barn Allergi Miljo Stockholm cohort from Sweden, which had reported different findings on the association between breastfeeding and asthma, were combined. For this analysis, the definitions for breastfeeding, asthma, and allergy were harmonized. Subjects were included if they had at least one parent with wheeze or asthma and had a gestational age of more than 36 wks (combined n = 882). The risk of disease-related exposure modification was assessed using survival analysis. Breastfeeding reduced the risk of asthma at 4/5 and 8 yrs of age in children with a family history of asthma. The effect was stronger in the Swedish cohort. Breastfeeding had no effect on the prevalence of sensitization to inhaled allergens in this cohort with a family history of asthma but was a risk factor for sensitization to cow's milk, peanuts, and eggs in the CAPS cohort at 4/5 yrs and in the combined cohort at 8 yrs. There was no evidence to support the existence of disease-related exposure modification in either cohort. These findings point to the importance of harmonization of features of study design, including subject selection criteria and variable definitions, in resolving epidemiological controversies such as those surrounding the impact of breastfeeding on asthma and allergic sensitization.
Costs of a contact screening activity in a neonatal intensive care unit
Publisher: The Sax Institute
Date: 2013
DOI: 10.1071/NB12108
Efficacy of azithromycin in severe asthma from the AMAZES randomised trial
Publisher: European Respiratory Society (ERS)
Date: 10-2019
DOI: 10.1183/23120541.00056-2019
Abstract: Low-dose azithromycin is an effective therapy for persistent asthma however, its benefit in severe asthma is not defined. Participants with severe asthma were identified from the AMAZES randomised, placebo-controlled trial of long-term (48 weeks) low-dose azithromycin. Participants who met one of the following severe asthma definitions were included: 1) Global Initiative for Asthma step 4 treatment with poor asthma control (asthma control questionnaire score ≥0.75) 2) International Severe Asthma Registry definition 3) American Thoracic Society and European Respiratory Society severe asthma definitions. The rate of total exacerbations was calculated for each subgroup and efficacy of azithromycin compared with placebo. Asthma-related quality of life was assessed before and after treatment along with adverse effects. Azithromycin significantly reduced asthma exacerbations in each group. In patients meeting the American Thoracic Society and European Respiratory Society task force definition of severe asthma (n=211), the rate of exacerbations with treatment was 1.2 per person-year, which was significantly less than for placebo (2.01 per person-year), giving an incidence rate ratio (95% CI) of 0.63 (0.41, 0.96). The proportion of participants experiencing at least one asthma exacerbation was reduced by azithromycin from 64% to 49% (p=0.021). A similar beneficial treatment effect was seen in participants poorly controlled with Global Initiative for Asthma step 4 treatment and those with International Severe Asthma Registry-defined severe asthma. Azithromycin also significantly improved the quality of life in severe asthma (p .05). Treatment was well tolerated, with gastrointestinal symptoms being the main adverse effect. Long-term, low-dose azithromycin reduced asthma exacerbations and improved the quality of life in patients with severe asthma, regardless of how this was defined. These data support the addition of azithromycin as a treatment option for patients with severe asthma.
Asymmetric dimethylarginine and asthma: results from the Childhood Asthma Prevention Study
Publisher: European Respiratory Society (ERS)
Date: 30-04-2013
The message from the World Asthma Meeting. The Working Groups of the World Asthma Meeting, held in Barcelona, Spain, December 9-13, 1998
Publisher: European Respiratory Society (ERS)
Date: 12-1999
DOI: 10.1183/09031936.99.14614359
Abstract: The 1998 World Asthma Meeting (WAM) has been the first multidisciplinary event aimed to consider asthma as a global public health problem in children and adults. The purpose of the meeting was to present state-of-the-art scientific information and to make recommendations on the research agenda for the coming years. Five Working Groups of invited experts were appointed to pin-point the established knowledge and the important questions in the areas of epidemiology, prevention, pathogenesis, management, and education. Their reports were discussed during the final plenary session, and are forming the current proceedings of the meeting. The message of the World Asthma Meeting provides a research agenda supported by the major international bodies involved in this disease. An integrated approach is considered to be essential in order to improve the prevention and care of asthma in all countries of the world.
Non-invasive positive airway pressure therapy for obesity hypoventilation syndrome in adults
Publisher: Wiley
Date: 02-03-2018
A transcriptional blood signature distinguishes early tuberculosis disease from latent tuberculosis infection and uninfected individuals in a Vietnamese cohort
Publisher: Elsevier BV
Date: 07-2020
Air pollution control efficacy and health impacts: A global observed study from 2000 to 2016
Publisher: Cold Spring Harbor Laboratory
Date: 06-2020
DOI: 10.1101/2020.05.31.20118752
Abstract: PM 2.5 concentrations vary between countries with similar CO 2 emissions, possibly due to differences in air pollution control efficacy. However, no indicator of the level of air pollution control efficacy has yet been developed. We aimed to develop such an indicator, and to evaluate its global and temporal distribution and its association with country-level health metrics. A novel indicator, ground level population-weighted average PM 2.5 concentration per unit CO 2 emission per capita ( PM 2.5 / CO 2 , written as PC in abbreviation), was developed to assess country-specific air pollution control efficacy. We estimated and mapped the global average distribution of PC and PC changes during 2000–2016 across 196 countries. Pearson correlation coefficients and Generalized Additive Mixed Model (GAMM) were used to evaluate the relationship between PC and health metrics. PC varied by country with an inverse association with the economic development. PC showed an almost stable trend globally from 2000 to 2016 with the low income groups increased. The Pearson correlation coefficients between PC and life expectancy at birth (LE), Infant-mortality rate (IMR), Under-five mortality rate (U5MR) and logarithm of GDP per capita (LPGDP) were –0.566, 0.646, 0.659, –0.585 respectively (all P-values .001). Compared with PM 2.5 or CO 2 , PC could explain more variation of LE, IMR and U5MR. The association between PC and health metrics was independent of GDP per capita. PC might be a good indicator for air pollution control efficacy and was related to important health indicators. Our findings provide a new way to interpret health inequity across the globe from the point of air pollution control efficacy.
Azithromycin add-on therapy reduces airway inflammation and extracellular DNA: An AMAZES sub-study
Publisher: European Respiratory Society
Date: 28-09-2019
Barriers and outcomes of an evidence-based approach to diagnosis and management of chronic obstructive pulmonary disease (COPD) in Australia: A qualitative study
Publisher: Oxford University Press (OUP)
Date: 30-09-2017
Abstract: Chronic obstructive pulmonary disease (COPD) is commonly managed in primary care but there is poor awareness of evidence-based guidelines and the quality and interpretation of spirometry is suboptimal. The aims of this qualitative study were to explore how an intervention involving case finding and management of COPD was implemented, and the extent to which the GPs and practice nurses (PNs) worked in partnership to diagnose and manage COPD. Semi-structured interviews with PNs (n = 7), GPs (n = 4) and patients (n = 26) who had participated in the Primary care EarLy Intervention for Copd mANagement (PELICAN) study. The Theoretical Domains Framework was used to guide the coding and analysis of the interviews with PN and GPs. The patient interviews were analysed thematically. PNs developed technical skills and understood the requirements for good-quality spirometry. However, many lacked confidence in its interpretation and felt this was not part of their professional role. This was reflected in responses from the GPs. Once COPD was diagnosed, the GPs tended to manage the patients with the PNs less involved. This was in contrast with PNs' active role in managing patients with other chronic diseases such as diabetes. The extent to which the GPs and PNs worked in partnership to manage COPD varied. PNs improved their skills and confidence in performing spirometry. Beliefs about their professional role, identity and confidence influenced the extent to which PNs were involved in interpretation of the spirometry results and managing the patient in partnership with the GP.
Changes in mite allergen Der p I in house dust following spraying with a tannic acid/acaricide solution
Publisher: Wiley
Date: 1992
DOI: 10.1111/J.1365-2222.1992.TB00116.X
Abstract: The beds, carpets and furnishings in 15 houses were sprayed with a solution containing tannic acid and an acaricide in an attempt to reduce allergen concentrations. Dust was collected from these sites for 4 weeks following spraying and the mite allergen Der p I concentration was measured and compared with baseline concentrations. In a subgroup of houses, counts of live mites and estimates of aeroallergen were also made. Four untreated houses were monitored over the same period. In dust s les collected 3 days after spraying, the mean concentrations of Der p I in beds, carpets and furniture were 23%, 28% and 26% of the pretreatment levels. All these reductions were significant compared to untreated controls. S les collected 4 weeks after treatment were not significantly different to baseline for each group. After the initial reduction, the rate of increase in allergen concentration was significantly greater in the spray-only beds than in the beds which had been both sprayed and fitted with occlusive covers. Both aeroallergen and live mites continued to be detected in houses after treatment with the spray. These studies suggest that such sprays are only temporarily effective when applied at the manufacturer's recommended volumes and additional approaches are required to control the bulk of allergens in houses.
A profile of asthma and its management in a New South Wales provincial centre
Publisher: AMPCo
Date: 03-1994
The social network of cystic fibrosis centre care and shared Pseudomonas aeruginosa strain infection: A cross-sectional analysis
Publisher: Elsevier BV
Date: 08-2015
Attributable risks of emergency hospital visits due to air pollutants in China: A multi-city study
Publisher: Elsevier BV
Date: 09-2017
DOI: 10.1016/J.ENVPOL.2017.05.026
Abstract: Air pollution is associated with risks of mortality in China, but the evidence is still limited for morbidity. This study aims to examine overall effects of ambient air pollutants on emergency hospital visits (EHVs) at the national level in China and calculate corresponding attributable risks. We collected daily data for EHVs from 33 largest hospitals in China between Oct 2013 and Dec 2014, as well as daily measurements of particulate matter (PM
The unreliability of the Kato‐Katz technique limits its usefulness for evaluating S. mansoni infections
Publisher: Wiley
Date: 03-2001
DOI: 10.1046/J.1365-3156.2001.00687.X
Abstract: The Kato-Katz technique, a (semi) quantitative stool examination technique, is generally recommended for diagnosis and evaluation of Schistosoma mansoni infection by schistosome experts. However, egg counts are subject to important variability. In order to quantify the reproducibility of egg counts using the Kato-Katz technique, field data of 1255 observations on 299 subjects infected with Schistosoma mansoni were analysed. Agreement between repeated observations was assessed both categorically (kappa statistic) and continuously (analysis of variance). The day-to-day variation of egg counts was much greater than the variation due to different observers or different slides. The quantitative reproducibility was low: the weighted kappa statistic was 0.39 between specimens of different days, 0.62 between slides of the same specimen and 0.81 between observers of the same slide. Therefore the classification of in idual patients into groups based on egg counts, used as a measure of morbidity, must be interpreted with great care, especially in longitudinal studies. Usefulness of the Kato-Katz technique appears limited. Its reproducibility is low. It cannot be recommended as a routine test in a primary health care setting or in a hospital laboratory because safety and detection of other parasites are better assured by other techniques. It can be used in epidemiological studies and evaluation of schistosomiasis control programmes, but here too, other techniques might be preferred.
Co-infection and ICU-acquired infection in COVID-19 ICU patients: a secondary analysis of the UNITE-COVID data set
Publisher: Springer Science and Business Media LLC
Date: 03-08-2022
DOI: 10.1186/S13054-022-04108-8
Abstract: The COVID-19 pandemic presented major challenges for critical care facilities worldwide. Infections which develop alongside or subsequent to viral pneumonitis are a challenge under sporadic and pandemic conditions however, data have suggested that patterns of these differ between COVID-19 and other viral pneumonitides. This secondary analysis aimed to explore patterns of co-infection and intensive care unit-acquired infections (ICU-AI) and the relationship to use of corticosteroids in a large, international cohort of critically ill COVID-19 patients. This is a multicenter, international, observational study, including adult patients with PCR-confirmed COVID-19 diagnosis admitted to ICUs at the peak of wave one of COVID-19 (February 15th to May 15th, 2020). Data collected included investigator-assessed co-infection at ICU admission, infection acquired in ICU, infection with multi-drug resistant organisms (MDRO) and antibiotic use. Frequencies were compared by Pearson’s Chi-squared and continuous variables by Mann–Whitney U test. Propensity score matching for variables associated with ICU-acquired infection was undertaken using R library MatchIT using the “full” matching method. Data were available from 4994 patients. Bacterial co-infection at admission was detected in 716 patients (14%), whilst 85% of patients received antibiotics at that stage. ICU-AI developed in 2715 (54%). The most common ICU-AI was bacterial pneumonia (44% of infections), whilst 9% of patients developed fungal pneumonia 25% of infections involved MDRO. Patients developing infections in ICU had greater antimicrobial exposure than those without such infections. Incident density (ICU-AI per 1000 ICU days) was in considerable excess of reports from pre-pandemic surveillance. Corticosteroid use was heterogenous between ICUs. In univariate analysis, 58% of patients receiving corticosteroids and 43% of those not receiving steroids developed ICU-AI. Adjusting for potential confounders in the propensity-matched cohort, 71% of patients receiving corticosteroids developed ICU-AI vs 52% of those not receiving corticosteroids. Duration of corticosteroid therapy was also associated with development of ICU-AI and infection with an MDRO. In patients with severe COVID-19 in the first wave, co-infection at admission to ICU was relatively rare but antibiotic use was in substantial excess to that indication. ICU-AI were common and were significantly associated with use of corticosteroids. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021).
Diagnostic accuracy of chest X-ray interpretation for tuberculosis by three artificial intelligence-based software in a screening use-case: an individual patient meta-analysis of global data
Publisher: Cold Spring Harbor Laboratory
Date: 27-01-2022
DOI: 10.1101/2022.01.24.22269730
Abstract: Chest X-ray (CXR) screening is a useful diagnostic tool to test in iduals at high risk of tuberculosis (TB), yet image interpretation requires trained human readers who are in short supply in many high TB burden countries. Therefore, CXR interpretation by computer-aided detection software (CAD) may overcome some of these challenges, but evidence on its accuracy is still limited. We established a CXR library with images and metadata from in iduals and risk groups that underwent TB screening in a variety of countries to assess the diagnostic accuracy of three commercial CAD solutions through an in idual participant meta-analysis. We collected digital CXRs and demographic and clinical data from 6 source studies involving a total of 2756 participants, 1753 (64%) of whom also had microbiological test information. All CXR images were analyzed with CAD4TB v6 (Delft Imaging), Lunit Insight CXR TB algorithm v4.9.0 (Lunit Inc.), and qXR v2 (Qure.ai) and re-read by an expert radiologist who was blinded to the initial CXR reading, the CAD scores, and participant information. While the performance of CAD varied across source studies, the pooled, meta-analyzed summary receiver operating characteristic (ROC) curves of the three products against a microbiological reference standard were similar, with area under the curves (AUCs) of 76.4 (95% CI 72.1-80.3) for CAD4TB, 83.3 (95% CI 78.4-87.2) for Lunit, and 76.4 (95% CI 72.1-80.3) for qXR. None of the CAD products, or the radiologists, met the targets for a triage test of 90% sensitivity and 70% specificity. At the same sensitivity of the expert radiologist (94.0%), all CAD had slightly lower point estimates for specificity (22.4% (95% CI 16.9-29.0) for CAD4TB, 34.6% (95% CI 25.3-45.1) for qXR, and 41.0% (95% CI 30.1-53.0) for Lunit compared to 45.6% for the expert radiologist). At the same specificity of 45.6%, all CAD products had lower point estimates for sensitivity but overlapping CIs with the sensitivity estimate of the radiologist. We showed that, overall, three commercially available CAD products had a reasonable diagnostic accuracy for microbiologically confirmed pulmonary TB and may achieve a sensitivity and specificity that approximates those of experienced radiologists. While threshold setting and cost-effectiveness modelling are needed to inform the optimal implementation of CAD products as part of screening programs, the availability of CAD will assist in scaling up active case finding for TB and hence contribute to TB elimination in these settings.
Increased sputum FKBP51 gene expression following Azithromycin add-on therapy in asthma
Publisher: European Respiratory Society
Date: 15-09-2018
Perinatal factors and respiratory health in children
Publisher: Wiley
Date: 29-10-2012
The effects of body weight on airway calibre
Publisher: European Respiratory Society (ERS)
Date: 05-2005
DOI: 10.1183/09031936.05.00104504
Abstract: Increased wheeze and asthma diagnosis in obesity may be due to reduced lung volume with subsequent airway narrowing. Asthma (wheeze and airway hyperresponsiveness), functional residual capacity (FRC) and airway conductance (Gaw) were measured in 276 randomly selected subjects aged 28-30 yrs. Data were initially adjusted for smoking and asthma before examining relationships between weight and FRC (after adjustment for height), and between body mass index (BMI = weight.height(-2)) and Gaw (after adjustment for FRC) by multiple linear regression, separately for females and males. For males and females, BMI (+/-95% confidence interval) was 27.0+/-4.6 kg.m(-2) and 25.6+/-6.0 kg.m(-2) respectively, Gaw was 0.64+/-0.04 L.s(-1).cmH2O(-1) and 0.57+/-0.03 L.s(-1).cmH2O(-1), and FRC was 85.3+/-3.4 and 84.0+/-2.9% of predicted. Weight correlated independently with FRC in males and females. BMI correlated independently and inversely with Gaw in males, but only weakly in females. In conclusion, obesity is associated with reduced lung volume, which is linked with airway narrowing. However, in males, airway narrowing is greater than that due to reduced lung volume alone. The mechanisms causing airway narrowing and sex differences in obesity are unknown.
Hormone Replacement Therapy and Risk of Severe Asthma Exacerbation in Perimenopausal and Postmenopausal Women: 17-Year National Cohort Study
Publisher: Elsevier BV
Date: 07-2021
DOI: 10.1016/J.JAIP.2021.02.052
Abstract: The impact of hormone replacement therapy (HRT) on clinical outcomes in menopausal women is uncertain. To investigate the association between use of HRT and severe asthma exacerbation in perimenopausal and postmenopausal women with asthma. We used the Optimum Patient Care Research Database, a population-based longitudinal primary care database in the United Kingdom, to construct a 17-year (January 1, 2000, to December 31, 2016) cohort of perimenopausal and postmenopausal (46-70 years, N = 31,656) women. We defined use of HRT, its subtypes, and duration of HRT use. Severe asthma exacerbation was defined as an asthma-related hospitalization, emergency department visits due to asthma, and/or prescription of oral corticosteroids. Analyses were undertaken using multilevel mixed-effects Poisson regression. At baseline, 22% of women were using any HRT, 11% combined HRT, and 11% estrogen-only HRT. Previous, but not current, use of any (incidence rate ratio [IRR]: 1.24, 95% confidence interval [CI]: 1.22-1.26), combined (IRR: 1.28, 95% CI: 1.25-1.31), and estrogen-only HRT (IRR: 1.18, 95% CI: 1.14-1.21), and longer duration (1-2 years: IRR: 1.16, 95% CI: 1.13-1.19 3-4 years: IRR: 1.43, 95% CI: 1.38-1.48 5+ years: IRR: 1.32, 95% CI: 1.28-1.36) of HRT use were associated with increased risk of severe asthma exacerbation compared with nonuse. The risk estimates were greater among lean women (body mass index [BMI] <25 kg/m Use of HRT and subtypes, particularly previous, but not current, use and use for more than 2 years, is associated with an increased risk of severe asthma exacerbation in perimenopausal ostmenopausal women with established asthma. Lean women and smokers are at greater risk than heavier women and nonsmokers, respectively.
Effect of Allergen Concentrations on Symptoms of Asthma at 18 Months
Publisher: Mary Ann Liebert Inc
Date: 12-2004
International variation in the prevalence of COPD (The BOLD Study): a population-based prevalence study
Publisher: Elsevier BV
Date: 09-2007
Elastic Properties of the Central Airways in Obstructive Lung Diseases Measured Using Anatomical Optical Coherence Tomography
Publisher: American Thoracic Society
Date: 03-2011
Respiratory symptoms and illness in older Australians: The Burden of obstructive Lung Disease (BOLD) study
Publisher: AMPCo
Date: 02-2013
DOI: 10.5694/MJA11.11640
Abstract: To measure the prevalence of chronic obstructive pulmonary disease (COPD) among people aged 40 years or older in Australia. A cross-sectional study of people in the community aged ≥ 40 years, selected at random using electoral rolls, in six sites chosen to reflect the sociodemographic and geographic ersity of Australia, conducted between 2006 and 2010. Standardised questionnaires were administered by interview. Forced expiratory volume in 1 second (FEV₁), forced vital capacity (FVC), and the FEV1/FVC ratio were measured by spirometry, before and after bronchodilator administration. Prevalence of COPD, classified according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2006 criteria. Complete data were available for 1620 men (participation rate, 26%) and 1737 women (participation rate, 28%). The prevalence of GOLD Stage II or higher COPD (defined as post-bronchodilator FEV₁/FVC ratio < 0.70 and FEV₁ < 80% predicted) was 7.5% (95% CI, 5.7%-9.4%) among people aged ≥ 40 years, and 29.2% (95% CI, 18.1%-40.2%) among those aged ≥ 75 years. Among people aged ≥ 40 years, the prevalence of wheeze in the past 12 months was 30.0% (95% CI, 27.5%-32.5%), and prevalence of shortness of breath when hurrying on the level or climbing a slight hill was 25.2% (95% CI, 22.7%-27.6%). Symptoms and spirometric evidence of COPD are common among people aged 40 years or older and increase with age. Further research is needed to better understand the diagnosis and management of COPD in Australia, along with continuing efforts to prevent the disease.
Worldwide patterns of bronchodilator responsiveness: results from the Burden of Obstructive Lung Disease study
Publisher: BMJ
Date: 29-04-2012
Post-treatment mortality among patients with tuberculosis: A prospective cohort study of 10 964 patients in Vietnam
Publisher: Oxford University Press (OUP)
Date: 07-09-2019
DOI: 10.1093/CID/CIY665
Abstract: Tuberculosis is the leading infectious cause of death. Steep reductions in tuberculosis-related mortality are required to realize the World Health Organization's "End Tuberculosis Strategy." However, accurate mortality estimates are lacking in many countries, particularly following discharge from care. This study aimed to establish the mortality rate among patients with pulmonary tuberculosis in Vietnam and to quantify the excess mortality in this population. We conducted a prospective cohort study among adult patients treated for smear-positive pulmonary tuberculosis in 70 clinics across Vietnam. People living in the same households were recruited as controls. Participants were re-interviewed and their survival was established at least 2 years after their treatment with an 8-month standardized regimen. The presence of relapse was established by linking identifying data on patients and controls to clinic registries. Verbal autopsies were performed. The cumulative mortality among patients was compared to that among a control population, adjusting for age and gender. We enrolled 10964 patients and 25707 household controls. Among enrolled tuberculosis patients, 9% of patients died within a median follow-up period of 2.9 years: 342 (3.1%) during treatment and 637 (5.8%) after discharge. The standardized mortality ratio was 4.0 (95% confidence interval 3.7-4.2) among patients with tuberculosis, compared to the control population. Tuberculosis was the likely cause of death for 44.7% of these deceased patients. Patients treated for tuberculosis had a markedly elevated risk of death, particularly in the post-treatment period. Interventions to reduce tuberculosis mortality must enhance the early detection of drug-resistance, improve treatment effectiveness, and address non-communicable diseases.
Association Between CD4+CD25highFoxP3+ T Regulatory Cells And Asthma, Eczema And Atopy In 8 Year Old Children
Publisher: Elsevier BV
Date: 02-2008
A national cross-sectional study of exposure to outdoor nitrogen dioxide and aeroallergen sensitization in Australian children aged 7–11 years
Publisher: Elsevier BV
Date: 02-2021
Adverse Health Effects in People with and without Preexisting Respiratory Conditions during Bushfire Smoke Exposure in the 2019/2020 Australian Summer
Publisher: American Thoracic Society
Date: 08-2021
Effectiveness of Postmigration Screening in Controlling Tuberculosis Among Refugees: A Historical Cohort Study, 1984–1998
Publisher: American Public Health Association
Date: 11-2001
Abstract: Objectives. This study assessed the effectiveness of postmigration screening for the control of tuberculosis (TB) among refugee migrants. Methods. We conducted a historical cohort study among 24 610 predominantly Southeast Asian refugees who had arrived in Sydney, Australia, between 1984 and 1994. All had been screened for TB before arrival and had radiologic follow-up for 18 months after arrival. Incident cases of TB were identified by record linkage analysis with confirmatory review of case notes. Results. The crude annual incidence rate over 10-year follow-up was 74.9 per 100 000 person-years. Only 29.6% of the cases were diagnosed as a result of routine follow-up procedures. Conclusions. Enhanced passive case finding is likely to be more effective than active case finding for the control of TB among refugees.
House dust mite exposure as a risk factor for asthma: benefits of avoidance
Publisher: Wiley
Date: 12-1998
DOI: 10.1111/J.1398-9995.1998.TB05010.X
Abstract: There is a dose-response relation between the level of exposure to house dust mite allergen and the risk of acquiring sensitization to this allergen as well as the risk of developing asthma. This relation is apparent at levels of exposure below 10 microg/g. In communities where nearly all houses have house dust mite allergen levels above this threshold, all susceptible in iduals will be affected, and the relation to house dust mite exposure will not be apparent. Although these observational data would suggest that reducing exposure to house dust mite allergen should lessen the risk of developing sensitization and asthma, definitive evidence from randomized controlled trials is not yet available. Of the many clinical trials of house dust mite avoidance as therapy for asthma, only a few have produced sustained, substantial reductions in allergen levels in the bed. These effective interventions all included allergen-impermeable encasement of mattresses along with other strategies. In most trials where allergens levels were successfully reduced, there were clinical benefits for patients with asthma.
An evaluation of an asthma quality of life questionnaire as a measure of change in adults with asthma
Publisher: Elsevier BV
Date: 10-1993
DOI: 10.1016/0895-4356(93)90109-E
Abstract: In assessing the effectiveness of management strategies for patients with asthma, it is important to measure outcomes which are relevant to the concerns of patients. Quality of life is one such outcome which may not be adequately reflected in lung function measurements. We have developed an asthma quality of life questionnaire (the AQLQ) for this purpose. The aim of this study was to test the validity and responsiveness of the AQLQ as a measure of change. Forty four adults with asthma were assessed on two occasions 4 months apart. On each occasion subjects completed the AQLQ and the Sickness Impact Profile (SIP). Lung function and the degree of bronchial hyperresponsiveness (BHR) were measured and diary cards were used to derive a symptom score and mean daily peak flow variability. The relation of change in AQLQ scores to change in the other outcomes was assessed. Questionnaire responsiveness was assessed by comparing the change in AQLQ scores between 19 improved and 20 stable subjects. Improvement was assessed on lung function and BHR criteria. As expected, change in AQLQ score was correlated with change in symptom score (r = 0.37, 95% CI -0.04 to 0.64) and change in BHR (r = 0.38, 95% CI 0.06 to 0.64). The associations with change in peak flow variability (r = 0.12, 95% CI -0.26 to 0.47) and change in SIP score (r = 0.18, 95% CI -0.12 to 0.45) were in the expected direction but weaker than expected. The AQLQ was capable of detecting differences between improved and stable subjects (p = 0.007).(ABSTRACT TRUNCATED AT 250 WORDS)
Towards Urbanome the genome of the city to enhance the form and function of future cities
Publisher: Springer Science and Business Media LLC
Date: 05-09-2019
Change in the manifestations of asthma and asthma-related traits in childhood: a latent transition analysis
Publisher: European Respiratory Society (ERS)
Date: 22-10-2015
DOI: 10.1183/13993003.00284-2015
Abstract: It is known that asthma is a heterogeneous entity whose manifestations vary with age. Our objective was to examine changes in the manifestation of asthma and asthma-related traits in childhood by defining empirically derived childhood asthma phenotypes and examining their transitions over time. To define the phenotypes we used data on respiratory symptoms, healthcare utilisation, medications, spirometry, airway hyperresponsiveness (AHR), exhaled nitric oxide concentration and atopy from a birth cohort recruited on the basis of having a first-degree relative with asthma. Data were acquired at ages 1.5–11.5 years and analysed using latent transition analysis. In a study population of 370 participants, we classified subjects into four phenotypes: 1) nonatopic, few symptoms (prevalence range from 1.5 to 5 years: 52–60%), 2) atopic, few symptoms (3–21%), 3) nonatopic, asthma and rhinitis symptoms (13–35%), and 4) atopic, asthma and rhinitis symptoms (2–14%) in early childhood and 1) nonatopic, no respiratory disease (prevalence range from 8 to 11.5 years: 41–46%), 2) atopic, no respiratory disease (23–33%), 3) nonatopic, asthma symptoms, no AHR or airway inflammation (8–12%) and 4) atopic asthma (19%) in mid-childhood. Transitioning between phenotypes was common in early childhood, but less common in later childhood. This analysis represents the first attempt to incorporate longitudinal patterns of several manifestations of asthma into a single model to simultaneously define phenotypes and examine their transitions over time. It provides quantitative support for the view that asthma is a heterogeneous entity, and that some children with wheeze and other respiratory symptoms in early life progress to asthma in mid-childhood, while others become asymptomatic.
Scoping review to understand the potential for public health impacts of transitioning to lower carbon emission technologies and policies
Publisher: IOP Publishing
Date: 20-05-2020
Household contact investigation for tuberculosis in Vietnam: Study protocol for a cluster randomized controlled trial
Publisher: Springer Science and Business Media LLC
Date: 2013
Outcomes of the childhood asthma prevention study at 11.5 years
Publisher: Elsevier BV
Date: 11-2013
Low rates of Pseudomonas aeruginosa misidentification in isolates from cystic fibrosis patients
Publisher: American Society for Microbiology
Date: 05-2009
DOI: 10.1128/JCM.00014-09
Abstract: Pseudomonas aeruginosa is an important cause of pulmonary infection in cystic fibrosis (CF). Its correct identification ensures effective patient management and infection control strategies. However, little is known about how often CF sputum isolates are falsely identified as P. aeruginosa . We used P. aeruginosa -specific duplex real-time PCR assays to determine if 2,267 P. aeruginosa sputum isolates from 561 CF patients were correctly identified by 17 Australian clinical microbiology laboratories. Misidentified isolates underwent further phenotypic tests, lified rRNA gene restriction analysis, and partial 16S rRNA gene sequence analysis. Participating laboratories were surveyed on how they identified P. aeruginosa from CF sputum. Overall, 2,214 (97.7%) isolates from 531 (94.7%) CF patients were correctly identified as P. aeruginosa . Further testing with the API 20NE kit correctly identified only 34 (59%) of the misidentified isolates. Twelve (40%) patients had previously grown the misidentified species in their sputum. Achromobacter xylosoxidans ( n = 21), Stenotrophomonas maltophilia ( n = 15), and Inquilinus limosus ( n = 4) were the species most commonly misidentified as P. aeruginosa . Overall, there were very low rates of P. aeruginosa misidentification among isolates from a broad cross section of Australian CF patients. Additional improvements are possible by undertaking a culture history review, noting colonial morphology, and performing stringent oxidase, DNase, and colistin susceptibility testing for all presumptive P. aeruginosa isolates. Isolates exhibiting atypical phenotypic features should be evaluated further by additional phenotypic or genotypic identification techniques.
Trends in hospitalizations for anaphylaxis, angioedema, and urticaria in Australia, 1993-1994 to 2004-2005
Publisher: Elsevier BV
Date: 10-2007
DOI: 10.1016/J.JACI.2007.07.040
Abstract: Recent investigations in developed countries have found marked increases in the prevalence of allergic conditions. We sought to examine recent time trends in the prevalence of anaphylaxis, angioedema, and urticaria by describing trends and age and sex differentials in hospitalizations for these conditions in Australia. Data on hospital admissions and deaths for anaphylaxis, angioedema, and urticaria were extracted for the periods 1993-1994 to 2004-2005 and 1997-2004, respectively. For hospital admissions, age-standardized rates were calculated. Time trends and sex differences were quantified by using negative binomial models. During the study period, there was a continuous increase in the rate of hospital admissions for angioedema (3.0% per year), urticaria (5.7% per year), and, most notably, anaphylaxis (8.8% per year). There was a particularly steep increase in the incidence of hospitalization for food-related anaphylaxis among children aged less than 5 years. Admissions for non-food-related anaphylaxis occurred predominantly in adults, particularly those more than 35 years of age. Among children, admission rates were higher in boys, but the sex difference was reversed among adults. Over an 8-year period, there were 106 deaths associated with anaphylaxis or angioedema. Hospitalization rates for allergic conditions are on the increase, but the nature and causative factors differ between adults and children. The relation of these changes to those in the prevalence of specific allergen sensitization in the community requires further investigation in population studies. Among older persons, angioedema is becoming an increasing problem. Among children, hospitalization because of food-induced anaphylaxis is a growing concern.
Variability and repeatability of house dust mite allergen measurement: implications for study design and interpretation
Publisher: Wiley
Date: 12-1995
DOI: 10.1111/J.1365-2222.1995.TB03043.X
Abstract: To interpret in idual measurements of house dust mite (HDM) allergen and to design and analyse HDM studies it is necessary to quantify the variability which is inherent in the measurement of this exposure. To estimate the repeatability of one method of HDM allergen measurement. We analysed data from one or more HDM allergen measurements in 215 houses included in four previous studies conducted in Sydney (a high allergen environment) and Busselton, Western Australia (a moderate allergen environment). S les were collected from the bed by vacuuming above and below the sheets and inside the pillow case and from the bedroom and living room floors by vacuuming a 1 m2 area for 1 min. Extracts from aliquots of fine dust from each s le were assayed for HDM allergen Der p I using a monoclonal antibody enzyme linked immunosorbent assay (ELISA). The values for HDM allergen were positively skewed and the suitability of a log transformation was established by the resulting normal distribution and stable within-site variance. The range of single determination (within which the true value lies with 95% certainty) was 3.1-fold for s les from the bed and 3.5-fold for s les from the floor. The coefficient of repeatability (the ratio beyond which a change between two estimates is established with 95% certainty) was 4.9 for the bed and 5.8 for the floor. We estimate that, to detect a twofold difference or change in allergen levels, 35 houses per group will be required in cross-sectional studies and 30 houses per group in parallel-group, randomized controlled trials. We recommend that beds be s led by collecting dust from the layer of bedding below the bottom sheet. A single site within the bedroom floor may be taken as representative of this site but this is not true for the living-room floor.
Natural exposure to Alternaria spores induces allergic rhinitis symptoms in sensitized children
Publisher: Wiley
Date: 04-2003
DOI: 10.1034/J.1399-3038.2003.00031.X
Abstract: Allergic rhinitis is associated with exposure to inhaled allergens. Allergic sensitization to the fungus Alternaria is common, especially in warm climates, but the relevance of sensitization to Alternaria in the generation of rhinitis has not been elucidated. The aim of this study was to determine whether natural exposure to Alternaria induces rhinoconjuctivitis symptoms in Alternaria-sensitized children. Symptoms of rhinoconjuctivitis in 132 atopic (measured by skin prick tests) children (aged 7-12 years) in inland New South Wales Australia were measured using parent-completed questionnaires in summer and winter 1998. Airborne concentrations of Alternaria spores and grass pollen were measured throughout the study period using a Burkard volumetric trap. The relation between airborne concentrations of Alternaria spores and symptoms of rhinoconjunctivitis was examined using Wilcoxon's matched pairs signed ranked test and generalized estimating equations. The proportion of children atopic to Alternaria reporting symptoms of rhinitis was significantly higher in the summer, when airborne concentrations of Alternaria were high, than in the winter, when airborne concentrations were low (66.2% vs. 38.2% for nasal symptoms at night, p = 0.0001, 70.6% vs. 51.52% for nasal symptoms during the day, p = 0.02). The proportion of children using anti-allergic treatment was also higher in summer than in winter (anti-allergic medication for the nose 39.7% vs. 17.7%, p = 0.0003). A strong correlation between airborne concentrations of grass pollen and Alternaria was found (R = 0.94, p < 0.001). However, when all children atopic to ryegrass were excluded from the analyses, significant associations between symptoms and season remained. We conclude that exposure to Alternaria spores may be an important cause of allergic rhinoconjunctivitis.
Age-specific relationship between CD14 and atopy in a cohort assessed from age 8 to 25 years
Publisher: American Thoracic Society
Date: 03-2004
Non-pharmacological and complementary interventions to manage asthma
Publisher: Wiley
Date: 22-11-2005
Retrospective Cohort Study of Effects of the COVID-19 Pandemic on Tuberculosis Notifications, Vietnam, 2020
Publisher: Centers for Disease Control and Prevention (CDC)
Date: 03-2022
Abstract: We evaluated the effects of the coronavirus disease pandemic on diagnosis of and treatment for tuberculosis (TB) in Vietnam. We obtained quarterly notifications for TB and multidrug-resistant/rif in-resistant (MDR/RR) TB from 2015-2020 and evaluated changes in monthly TB case notifications. We used an interrupted time series to assess the change in notifications and treatment outcomes. Overall, TB case notifications were 8% lower in 2020 than in 2019 MDR/RR TB notifications were 1% lower. TB case notifications decreased by 364 (95% CI -1,236 to 508) notifications per quarter and MDR/RR TB by 1 (95% CI -129 to 132) notification per quarter. The proportion of successful TB treatment outcomes decreased by 0.1% per quarter (95% CI -1.1% to 0.8%) in 2020 compared with previous years. Our study suggests that Vietnam was able to maintain its TB response in 2020, despite the pandemic.
Active tuberculosis case finding: why, when and how? [Editorial]
Publisher: International Union Against Tuberculosis and Lung Disease
Date: 03-2013
Serum eosinophil cationic protein: distribution and reproducibility in a randomly selected sample of men living in rural Norfolk, UK
Publisher: Wiley
Date: 11-1998
DOI: 10.1046/J.1365-2222.1998.00409.X
Abstract: It has been proposed that serum levels of eosinophil cationic protein (ECP) may be a clinically useful measure in allergic illness. The aim of this report is to describe the distribution and reproducibility of serum ECP levels in a population s le and to examine its relationship with other markers of disease. The study was conducted in rural areas of Norfolk, UK in a random s le of men aged 20-44 years enriched with subjects drawn from general practice 'asthma registers'. Asthma symptoms were assessed using the EC Respiratory Health Survey questionnaire. Atopy was measured by skin prick tests and serum IgE. Airway hyperresponsiveness (AHR) was tested by methacholine challenge test. Serum IgE and ECP was measured by fluoroimmunoassay using the Pharmacia CAP system. Reference equations were derived in subjects from the random s le who did not have symptoms of asthma, abnormal lung function or AHR. The relation of serum ECP with various clinical characteristics was examined in the whole study population. Reproducibility of serum ECP measurement was assessed in 57 subjects 4 weeks after the initial test. The study population comprised 311 from the random s le and 58 from the asthma s le. The reference equation for serum ECP for healthy men was log10 ECP = 1.3966 - [(age - 20) x 0.0057]. The estimated mean serum ECP for a 20-year-old man was 25 microg/L. Current smokers have higher serum ECP levels that non-smokers (P = 0.014). ECP levels were not related to the skin prick test reactivity, serum IgE, a questionnaire-based diagnosis of asthma, or impaired lung function (all P > 0.05). Levels were higher in subjects with AHR (P = 0.003) and those who reported wheeze (P = 0.017) but there was no clinically useful separation in ECP levels between subjects classified by these criteria. The test was moderately reproducible over a 4-week period (intraclass correlation coefficient = 0.62). Serum ECP levels were higher in this rural English population than reported in a comparable population in Sweden. Serum ECP is a reproducible test but cross-sectionally does not relate in any clinically useful way to markers of asthma. The meaning of between- subject differences in ECP levels requires further exploration.
Comparison between a Single-Channel Nasal Airflow Device and Oximetry for the Diagnosis of Obstructive Sleep Apnea
Publisher: Oxford University Press (OUP)
Date: 08-2010
Clinical Phenotypes of Patients Hospitalized for an Asthma Exacerbation: Prognostic Implications
Publisher: Elsevier BV
Date: 02-2021
Asthma and Allergy Associated with Occupational Exposure to Ispaghula and Senna Products in a Pharmaceutical Work Force
Publisher: American Thoracic Society
Date: 11-1991
DOI: 10.1164/AJRCCM/144.5.1065
Abstract: A cross-sectional study of 125 pharmaceutical workers engaged in the manufacture of bulk laxatives based on ispaghula husks (psyllium) and senna pods was conducted. Skin prick tests with extracts of these components revealed that 7.6% were allergic to ispaghula and 15.3% were allergic to senna. Four (3.2%) cases of occupational asthma were identified. The overall prevalence of asthma (6.4%) was less than in a comparable nonexposed Australian population (odds ration, 0.44). Symptoms referrable to the upper airways, eyes, and skin were more prevalent (52.0%) than in the reference population (odds ratio, 1.53). Smokers and nonatopic subjects were more likely to complain of these symptoms if they were sensitized to senna and/or ispaghula than if they were not sensitized (relative risks, 1.9 and 2.6, respectively). Sensitization to ispaghula and/or senna was not a risk factor for asthma. An IgE-mediated allergic mechanism is probably responsible for the allergic symptoms in many of these subjects. Smoking seems to be a cofactor in this process.
The role of TRAP exposure in the development and persistence of asthma and low lung function
Publisher: European Respiratory Society
Date: 09-2017
Bug Breakfast in theBulletin: Tuberculosis
Publisher: The Sax Institute
Date: 2009
DOI: 10.1071/NB08046
Age- and height-based prediction bias in spirometry reference equations
Publisher: European Respiratory Society (ERS)
Date: 19-12-2011
DOI: 10.1183/09031936.00161011
Abstract: Prediction bias in spirometry reference equations can arise from combining equations for different age groups, rounding age or height to integers or using self-reported height. To assess the bias arising from these sources, the fit of 13 prediction equations was tested against the Global Lungs Initiative (GLI) dataset using spirometric data from 55,136 healthy Caucasians (54% female). The effects on predicted values of using whole-year age versus decimal age, and of a 1% bias in height, were quantified. In children, the prediction bias relative to GLI ranged from -22% to +17%. Switching equations at 18 yrs of age led to biases of between -846 (-14%) and +1,309 (+38%) mL. Using age in whole years rather than decimal age introduced biases from -8% to +7%, whereas a 1% overestimation of height introduced bias that ranged from +1% to +40%. Bias was greatest in children and adolescents, and in short elderly subjects. Using a single spirometry equation applicable across all ages and populations reduces prediction bias. Measuring and recording age and height accurately are also essential if bias is to be minimised.
A Controlled Trial of Long-Term Inhaled Hypertonic Saline in Patients with Cystic Fibrosis
Publisher: Massachusetts Medical Society
Date: 19-01-2006
DOI: 10.1056/NEJMOA043900
The technological imperative in tuberculosis care and prevention in Vietnam
Publisher: Informa UK Limited
Date: 17-08-2019
DOI: 10.1080/17441692.2019.1650950
Abstract: A monocausal bacteriological understanding of infectious disease orients tuberculosis control efforts towards antimicrobial interventions. A bias towards technological solutions can leave multistranded public health and social interventions largely neglected. In the context of globalising biomedical approaches to infectious disease control, this ethnography-inspired review article reflects upon the implementation of rapid diagnostic technology in low- and middle-income countries. Fieldwork observations in Vietnam provided a stimulus for a critical review of the global rollout of tuberculosis diagnostic technology. To address local needs in tuberculosis control, health managers in resource-poor settings are readily cooperating with international donors to deploy novel diagnostic technologies throughout national tuberculosis programme facilities. Increasing investment in new diagnostic technologies is predicated on the supposition that these interventions will ameliorate disease outcomes. However, suboptimal treatment control persists even when accurate diagnostic technologies are available, suggesting that promotion of singular technological solutions can distract from addressing systemic change, without which disease susceptibility, propagation of infection, detection gaps, diagnostic delays, and treatment shortfalls persist.
Mortality Burden due to Exposure to Outdoor Fine Particulate Matter in Hanoi, Vietnam: Health Impact Assessment
Publisher: Frontiers Media SA
Date: 14-04-2022
DOI: 10.3389/IJPH.2022.1604331
Abstract: Objective: This study reports the mortality burden due to PM 2.5 exposure among adults (age & ) living in Hanoi in 2017. Methods: We applied a health impact assessment methodology with the global exposure mortality model and a PM 2.5 map with 3 × 3 km resolution derived from multiple data sources. Results: The annual average PM 2.5 concentration for each grid ranged from 22.1 to 37.2 µg/m³. The district average concentration values ranged from 26.9 to 37.2 µg/m³, which means that none of the 30 districts had annual average values below the Vietnam Ambient National Standard of 25 µg/m 3 . Using the Vietnam Ambient National Standard as the reference standard, we estimated that 2,696 deaths (95% CI: 2,225 to 3,158) per year were attributable to exposure to elevated PM 2.5 concentrations in Hanoi. Using the Interim Target 4 value of 10 µg/m 3 as the reference standard, the number of excess deaths attributable to elevated PM 2.5 exposure was 4,760 (95% CI: 3,958–5,534). Conclusion : A significant proportion of deaths in Hanoi could be avoided by reducing air pollution concentrations to a level consistent with the Vietnam Ambient National Standard.
Predicting tuberculosis without knowing test specificity: Authors' reply
Publisher: Elsevier BV
Date: 11-2016
Effective domestic allergen control
Publisher: Wiley
Date: 04-1995
Does Sleep Deprivation Worsen Mild Obstructive Sleep Apnea?
Publisher: Oxford University Press (OUP)
Date: 12-2003
Abstract: Sleep deprivation is believed to worsen obstructive sleep apnea (OSA). We assessed the effect of acute sleep deprivation on polysomnography in a cohort of subjects with mild OSA and a cohort of subjects without OSA. Crossover study in which subjects initially had polysomnography after a normal night's sleep or after 36 hours of sleep deprivation, followed by a 2- to 4-week interval, after which subjects were restudied under the alternate testing condition. 13 subjects with mild OSA and 16 subjects without OSA were studied in a university teaching hospital sleep laboratory. 36 hours of supervised sleep deprivation. Subjects' age, body mass index, neck circumference and Epworth Sleepiness Scale scores were measured actigraphy and sleep diaries were used to estimate prior sleep debt before each sleep study. Sleep deprivation was found to significantly increase total sleep time, sleep efficiency, and rapid eye movement and slow-wave sleep time. Subjects with OSA showed a lower minimum oxygen saturation after sleep deprivation. However, subjects did not show a significantly different respiratory disturbance index, arousal index, or length of the longest apnea after sleep deprivation. Acute sleep deprivation did not worsen most OSA parameters as measured by polysomnography. A lower minimum oxygen saturation in mild OSA subjects after sleep deprivation may be important in patients with significant cardiorespiratory disease. More research is needed to assess whether daytime performance and function (eg, driving, sleepiness) is more greatly impaired in OSA subjects who are sleep deprived, compared to normal subjects who are sleep deprived.
Severe asthma assessment, management and the organisation of care in Australia and New Zealand: expert forum roundtable meetings
Publisher: Wiley
Date: 02-2021
DOI: 10.1111/IMJ.14806
Incidence and remission of asthma in Australian children: findings from a population cohort
Publisher: European Respiratory Society
Date: 28-09-2019
Asthma in Greenwich, UK: impact of the disease and current management practices
Publisher: European Respiratory Society (ERS)
Date: 06-1997
DOI: 10.1183/09031936.97.10061224
Abstract: A great deal of the care of patients with asthma takes place in general practices. The aim of the present study was to describe the impact of asthma in the community and to identify current asthma self-management practices. A two-part questionnaire survey was conducted in a random s le (23% n=24,398) of persons aged 16-50 yrs, registered with one of the 41 general practices in Greenwich, London, UK. The two parts were: a screening questionnaire identifying persons with current asthma (defined as waking with shortness of breath in the last 12 months, attack of asthma in the last 12 months, or currently taking treatment for asthma) and an asthma questionnaire (completed by those with asthma) assessing quality of life, frequency of asthma symptoms, possession and use of self-management tools, and action in the event of an exacerbation of asthma. The crude response rate was 51%, but this may be an underestimate due to errors in the s ling frame. The prevalences of wheeze and asthma in the past 12 months were 26% and 14%, respectively. Among asthma patients: 43% reported symptoms occurring three or more times per week, and 20% were woken by asthma symptoms on three or more nights per week most had asthma with a mild impact on quality of life 26% used inhaled steroids on most days in the preceding month 16% had a peak flow meter at home and 7% had oral steroids available. Of the 44% of subjects with asthma, who could identify an exacerbation of asthma in the preceding 6 months: 19% had used a peak flow meter during the episode 19% had changed their treatment without first being told to do so by a doctor and 50% had sought urgent medical help. Smokers used less appropriate asthma management and subjects whose asthma had a severe impact on quality of life used more treatment and peak flow monitoring. In conclusion, the prevalence of asthma among adults in Greenwich, UK, has increased since a similar survey in 1986. Many people have fairly mild asthma and a smaller number have severe disease. Much remains to be done to promote appropriate strategies for self-management of asthma exacerbations.
Chronic airflow obstruction and ambient particulate air pollution
Publisher: BMJ
Date: 11-05-2021
DOI: 10.1136/THORAXJNL-2020-216223
Abstract: Smoking is the most well-established cause of chronic airflow obstruction (CAO) but particulate air pollution and poverty have also been implicated. We regressed sex-specific prevalence of CAO from 41 Burden of Obstructive Lung Disease study sites against smoking prevalence from the same study, the gross national income per capita and the local annual mean level of ambient particulate matter (PM 2.5 ) using negative binomial regression. The prevalence of CAO was not independently associated with PM 2.5 but was strongly associated with smoking and was also associated with poverty. Strengthening tobacco control and improved understanding of the link between CAO and poverty should be prioritised.
Non-invasive positive airway pressure therapy for obesity hypoventilation syndrome in adults
Publisher: Wiley
Date: 11-11-2021
A smoking quitline integrated with clinician counselling at outpatient health facilities in Vietnam: a single-arm prospective cohort study
Publisher: Springer Science and Business Media LLC
Date: 13-04-2022
DOI: 10.1186/S12889-022-13203-Y
Abstract: Limited evidence is available about the combination of multiple smoking cessation modalities in low- and middle-income countries. The study aimed to assess the feasibility of a smoking cessation intervention that integrates follow-up counselling phone calls and scheduled text messages with brief advice from physicians in Vietnam. This was a single-arm intervention study. Smokers were referred to the study Quitline after brief advice by physicians at three rural district hospitals in Hanoi, Vietnam. Following referral, participants received nine counselling phone calls in 12 months and a scheduled text message service that lasted for three months. Participants who reported smoking cessation for at least 30 days at the 12-month follow-up were invited for a urinary cotinine test to confirm cessation. The Quitline centre had 431 referrals from participating hospitals. Among them, 221 (51.3%) were enrolled. After the baseline phone call, 141 (63.8%) participated in all 4 follow-up calls within the first month and 117 (52.9%) participated in all phone calls in 12 months. The median number of successful phone calls was 8 (interquartile range: 6 – 8). At the end of the study, 90 (40.7%) self-reported abstinence from smoking over the previous 30 days. Among them, 22 (24.4%) submitted a s le for cotinine test, of which 13 (59.1% of those tested) returned a negative result. The proportion of biochemically-verified quitters was 5.9%. The integration of brief advice and referral from healthcare facilities, Quitline counselling phone calls, and scheduled text messaging was feasible in rural health facilities in northern Vietnam. ACTRN12619000554167 .
Ultrafine particle exposure and biomarkers of effect on small airways in children
Publisher: Elsevier BV
Date: 11-2022
DOI: 10.1016/J.ENVRES.2022.113860
Abstract: The small size and large surface area of ultrafine particles (UFP) enhance their ability to deposit in the lung periphery and their reactivity. The Ultrafine Particles from Traffic Emissions and Children's Health (UPTECH) cross-sectional study was conducted in 8-11-year-old schoolchildren attending 25 primary (elementary) schools, randomly selected from the Brisbane Metropolitan Area, Queensland, Australia. Main study findings outlined indirect evidence of distal airway deposition (raised C reactive protein) but as yet, there is no direct evidence in the literature of effects of UFP exposure on peripheral airway function. We present further UPTECH study data from two sensitive peripheral airway function tests, Oscillometry and Multiple Breath Nitrogen Washout (MBNW), performed in 577 and 627 children (88% and 96% of UPTECH study cohort) respectively: mean(SD) age 10.1(0.9) years, 46% male, with 50% atopy and 14% current asthma. Bayesian generalised linear mixed effects regression models were used to estimate the effect of UFP particle number count (PNC) exposure on key oscillometry (airway resistance, (Rrs), and reactance, (Xrs)) and MBNW (lung clearance index, (LCI) and functional residual capacity, (FRC)) indices. We adjusted for age, sex, and height, and potential confounders including socio-economic disadvantage, PM
Central arterial pulse wave augmentation is greater in girls than boys, independent of height
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2010
The Indoor Environment and Otitis Media among Australian Children: A National Cross-Sectional Study
Publisher: MDPI AG
Date: 29-01-2022
Abstract: The association between the indoor environment and lifetime prevalence of otitis media (OM) in Australian children was assessed. We analysed data from a cross-sectional study of children, aged 7–11 years, performed in twelve Australian cities during 2007–2008. The main outcome was a parental report of their child’s diagnosis with OM by a doctor. Information on the indoor environment (energy sources used for heating, cooling, and cooking, pets, and second-hand smoke exposure), in the first year of life and at present, was collected from parents by a questionnaire. Multi-level logistic regression models were used to adjust for in idual- and area-level confounders. Our analysis comprised 2872 children (51% female, mean age: 10.0 (SD 1.2)). Of those, 1097 (39%) were reported to have OM. Exposure to gas heating in the first year of life was significantly associated with higher odds of OM in adjusted models (OR:1.22 95% CI: 1.00,1.47), as was current exposure to reverse-cycle air conditioning (OR: 1.52, 95% CI: 1.27,1.82). Ownership of a cat or dog at any time was also associated with high odds of OM (OR: 1.50 95% CI: 1.17,1.92). No other significant associations were observed. In this national study of Australian children, indoor environmental exposures associated with the lifetime prevalence of OM were gas heating, reverse-cycle air conditioning and pet ownership. Exposures in both early life and later childhood may both play a role in OM.
The effect of dairy consumption on blood pressure in mid-childhood: CAPS cohort study
Publisher: Springer Science and Business Media LLC
Date: 11-01-2012
Abstract: It has been postulated that a higher dairy consumption may affect blood pressure regulation. The aim of this study was to examine the association between dairy consumption and blood pressure in mid-childhood. Subjects (n = 335) were participants of a birth cohort at high risk of asthma with information on diet at 18 months and blood pressure at 8 years. Multivariate analyses were used to assess the association of dairy consumption (serves) and micronutrient intakes (mg). In a subgroup of children (n = 201), dietary intake was also measured at approximately 9 years. Children in the highest quintile of dairy consumption at 18 months had lower systolic blood pressure (SBP) and diastolic blood pressure (DBP) at 8 years (2.5 mm Hg, P=0.046 and 1.9 mm Hg, P = 0.047, respectively) than those in the lowest quintiles. SBP was lowest among children in the highest quintiles of calcium, magnesium and potassium intakes. Significant negative linear trends were observed between SBP and intakes of dairy serves, calcium, magnesium and potassium. Furthermore, SBP and DBP were lowest in the group of children that consumed at least two dairy serves at both 18 months and the follow-up dietary data collection at 9 years, compared with all other children (SBP 98.7 vs 101.0 mm Hg, P = 0.07 and DBP 56.5 vs 59.3 mm Hg, P = 0.006, respectively). These results are consistent with a protective effect of dairy consumption in childhood on blood pressure at age 8 years.
Epidemiological approach to ending tuberculosis in high-burden countries
Publisher: Elsevier BV
Date: 11-2022
Are reference equations for spirometry an appropriate criterion for diagnosing disease and predicting prognosis?
Publisher: BMJ
Date: 08-08-2011
DOI: 10.1136/THORAXJNL-2011-200584
Abstract: In the last few years, there has been considerable debate on the use of threshold criteria for the diagnosis of obstructive lung disease based on FEV(1) and FEV(1)/FVC ratio. It has been argued that a fixed ratio and fixed percentage criterion result in misclassification. The author argues that this critique is based on a false presumption about the validity of reference equations as a criterion for normality. The flaw lies in the methods used to derive reference equations, which involve arbitrary and circular criteria for exclusion of some members of the population, use potentially non-representative reference populations and include predictive variables that are really risk factors for disease or for adverse outcomes of disease. The author argues for a new interpretative approach for the use of lung function data in clinical practice based on prognostic equations analogous to the Framingham cardiovascular risk factor equations. These interpretative equations should be based on data from cohort studies and randomised controlled trials, rather than cross-sectional studies, and if properly formulated, will prove to be valuable aids to clinical decision making.
A user-centred home monitoring and self-management system for patients with heart failure: a multicentre cohort study
Publisher: Oxford University Press (OUP)
Date: 09-07-2015
Chronic obstructive pulmonary disease mortality and prevalence: the associations with smoking and poverty: a BOLD analysis—authors’ reply
Publisher: BMJ
Date: 05-2014
Carotid extramedial thickness is associated with local arterial stiffness in children
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2016
Parentally reported snoring is not enough information to justify treatment
Publisher: Wiley
Date: 2012
Strabismus Measurements with Novel Video Goggles
Publisher: Elsevier BV
Date: 12-2017
DOI: 10.1016/J.OPHTHA.2017.06.020
Abstract: To assess the validity of a novel, simplified, noninvasive test for strabismus using video goggles. Cross-sectional method comparison study in which the new test, the strabismus video goggles, is compared with the existing reference standard, the Hess screen test. We studied 41 adult and child patients aged ≥6 years with ocular misalignment owing to congenital or acquired paralytic or comitant strabismus and 17 healthy volunteers. All participants were tested with binocular infrared video goggles with built-in laser target projection and liquid crystal display shutters for alternate occlusion of the eyes and the conventional Hess screen test. In both tests, ocular deviations were measured on a 9-point target grid located at 0±15° horizontal and vertical eccentricity. Horizontal and vertical ocular deviations at 9 different gaze positions of each eye were measured by the strabismus video goggles and the Hess screen test. Agreement was quantified as the intraclass correlation coefficient. Secondary outcomes were the utility of the goggles in patients with visual suppression and in children. There was good agreement between the strabismus video goggles and the Hess screen test in the measurements of horizontal and vertical deviation (intraclass correlation coefficient horizontal 0.83, 95% confidence interval [0.77, 0.88], vertical 0.76, 95% confidence interval [0.68, 0.82]). Both methods reproduced the characteristic strabismus patterns in the 9-point grid. In contrast to Hess screen testing, strabismus video goggle measurements were even possible in patients with comitant strabismus and visual suppression. The new device is simple and is fast and accurate in measuring ocular deviations, and the results are closely correlated with those obtained using the conventional Hess screen test. It can even be used in patients with visual suppression who are not suitable for the Hess screen test. The device can be applied in children as young as 6 years of age.
The role of macroscopic sputum quality assessments to optimise sputum testing for tuberculosis
Publisher: International Union Against Tuberculosis and Lung Disease
Date: 03-2016
Abstract: Community-wide active case finding for tuberculosis (TB) using Xpert® MTB/RIF as the primary screening tool, Ca Mau Province, Viet Nam. To determine whether macroscopic sputum quality characteristics (sputum colour and volume) can be used to predict Xpert MTB-negative sputum and hence exclude sputum s les from testing. Field staff conducted household visits to approximately 51,200 adults in 58 villages randomly selected from throughout the province. Sputum s les from all screened participants who were able to produce ⩾1 ml sputum underwent macroscopic sputum assessment and were tested with Xpert. Of the 21,624 sputum s les tested, 159 (0.74%) were Xpert MTB-positive 93% of the s les were 1-2 ml and nearly all were mucoid (93%) or mucopurulent (5.7%). One salivary s le was Xpert MTB-positive (2.0% of all salivary s les). The lowest positive predictive value for any sputum volume or colour characteristic was 0.66%. This was not substantially different from the overall prevalence of positive sputum Xpert MTB (0.74%). Sputum colour and volume cannot be used to predict the presence or absence of M. tuberculosis in sputum detected using Xpert. These sputum quality parameters cannot therefore be used to exclude sputum s les from testing for TB.
Absence of back to school peaks in human rhinovirus detections and respiratory symptoms in a cohort of children with asthma
Publisher: Wiley
Date: 08-09-2016
DOI: 10.1002/JMV.24371
Abstract: Much of what is known about the seasonality of human rhinovirus (hRV) infections has been learned from the study of acute asthma exacerbations presenting to emergency care, including those among children at the start of the school term. Much less is known about the patterns of hRVs in the community. In this study, viruses and day-to-day symptoms of asthma and colds were monitored twice weekly in 67 children with asthma aged 5-12 years, over a 15 month period in Sydney, Australia. Overall hRV was detected in 314/1232 (25.5%) of nasal wash s les and 142/1231 (11.5%) of exhaled breath s les of these, 231 and 24 respectively were genotyped. HRVs were detected with similar prevalence rate throughout the year, including no peak in hRV prevalence following return to school. No peaks were seen in asthma and cold symptoms using twice-weekly diary records. However, over the same period in the community, there were peaks in asthma emergency visits both at a large local hospital and in state-wide hospitalizations, following both return to school (February) and in late autumn (May) in children of the same age. This study suggests that hRV infections are common throughout the year among children, and differences in virus prevalence alone may not account for peaks in asthma symptoms.
Cardiovascular, respiratory, and related disorders: key messages from Disease Control Priorities, 3rd edition
Publisher: Elsevier BV
Date: 03-2018
Cord blood mononuclear cell cytokine responses in relation to maternal house dust mite allergen exposure
Publisher: Wiley
Date: 03-2002
DOI: 10.1046/J.1365-2222.2002.01292.X
Abstract: Cord blood mononuclear cells have demonstrated specific immune responses to environmental allergens. To establish whether the nature of this response is related to the level of maternal antenatal exposure to house dust mite (HDM) allergen and, hence, whether antenatal allergen avoidance may have a role in the prevention of allergic sensitization in children. Children with a family history of asthma were recruited antenatally as subjects in a randomised controlled trial: the Childhood Asthma Prevention Study. HDM allergen (Der p 1) concentrations were measured in dust collected from the maternal bed at 36 weeks gestation. Cord blood mononuclear cells were stimulated in culture, separately, with phytohaemaglutinin (PHA) and HDM extract. Cytokine IL-4, IL-5, IL-10 and IFN-gamma concentrations in supernatant were measured by ELISA. mRNA signals for these cytokines were measured using RT-PCR. The median concentration of HDM allergen was 18.4 microg/g (interquartile range 7.3-35.3 microg/g). Median concentrations of IL-4, IL-5, IL-10 and IFN-gamma, after PHA stimulation were 4, 19, 401 and 1781 pg/mL, respectively. After HDM allergen stimulation the median concentrations were 0, 0, 20 and 14 pg/mL, respectively. The distribution of mRNA cytokine signals was similar. Neither cytokine protein concentrations nor cytokine mRNA signal levels were correlated with the concentration of HDM allergen in the mothers' beds at 36 weeks gestation. These findings do not support the view that the prevention of allergic disease in children requires the institution of HDM avoidance interventions during pregnancy.
Weight gain in infancy and vascular risk factors in later childhood.
Publisher: American Academy of Pediatrics (AAP)
Date: 06-2013
Abstract: We hypothesized that early weight gain would be associated with incident obesity, higher blood pressure, systemic inflammation, and arterial wall thickening in later childhood. A longitudinal birth cohort was recruited antenatally from 2 maternity hospitals in Sydney, Australia, between September 1997 and December 1999. Three hundred ninety-five nondiabetic children who were followed to age 8 years had complete data for early weight gain and arterial wall thickness. Independent predictors of excess early weight gain (age 0–18 months adjusted for height gain) included male gender (0.411 kg [SE: 0.103], P & .001), fewer weeks’ gestation (−0.121 kg [SE: 0.044] per week, P = .006), birth length (0.156 kg [SE: 0.024] per cm, P & .001), and failure to breastfeed to 6 months of age (0.498 kg [SE: 0.108], P & .001). Early height-adjusted weight gain was significantly associated with later childhood overweight (odds ratio [OR]: 1.67 [95% confidence interval (CI): 1.26 to 2.20] per kg) and obesity (OR: 2.07 [95% CI: 1.53 to 2.79] per kg), excess central adiposity (OR: 1.54 [95% CI: 1.20 to 1.98] per kg), higher systolic blood pressure (1.24 mm Hg [SE: 0.33] per kg, P & .001), higher C-reactive protein (0.17 mg/dL [SE: 0.06] per 100% increase in weight gain, P = .006), and greater carotid intima-media thickness (0.012 mm [SE: 0.004] per kg, P = .002). Early postnatal weight gain from birth to age 18 months is significantly associated with later childhood overweight and obesity, excess central adiposity, and greater arterial wall thickness.
Crystallization and preliminary X-ray analysis of two pH-dependent forms of cytochromec2fromRhodopseudomonas palustris
Publisher: International Union of Crystallography (IUCr)
Date: 12-2000
DOI: 10.1107/S0907444900013573
Abstract: Cytochrome c(2) from Rhodopseudomonas palustris has been crystallized in two different crystal forms: a monoclinic form I at pH 4.4 from both reduced and oxidized protein solution and a trigonal form II at pH 9.0 from reduced protein solution. Complete 1. 7 and 1.4 A resolution data sets were collected from the oxidized form I and from the form II, respectively. The preliminary structures show an important change in the iron coordination environment in the trigonal form obtained at basic pH arising from the substitution of the Met ligand by an ammonia molecule.
The childhood asthma prevention study (CAPS): design and research protocol of a randomized trial for the primary prevention of asthma.
Publisher: Elsevier BV
Date: 04-2001
DOI: 10.1016/S0197-2456(01)00112-X
Abstract: The Childhood Asthma Prevention Study is a randomized controlled trial to measure whether the incidence of atopy and asthma can be reduced by house dust mite allergen reduction, a diet supplemented with omega-3 fatty acids, or a combination of both interventions. Six hundred and sixteen pregnant women whose unborn children were at high risk of developing asthma because of a family history were randomized prenatally. Study groups are as follows: Group A (placebo diet intervention, no house dust mite reduction), Group B (placebo diet intervention, active house dust mite reduction), Group C (active diet intervention, no house dust mite reduction), and Group D (active diet intervention, active house dust mite reduction). The house dust mite reduction intervention comprises use of physical and chemical methods to reduce allergen contact. The dietary intervention comprises use of a daily oil supplement from 6 months or at onset of bottle-feeding, and use of margarine and cooking oils based on sunflower or canola oils to increase omega-3 dietary intake. Data is collected quarterly until the infant is 1 year old and then half yearly until age 5 years. Questionnaires are used to collect respiratory illness history and information about diet and home environment. Dust is collected from the child's bed and bedroom and playroom floors. Blinded assessments are conducted at 18 months, 3 years, and 5 years. Skin prick tests to common allergens, blood tests, and detailed illness, medication use, and vaccination histories are collected. Primary outcomes will be the development of allergic sensitization and the presence and severity of asthma. This study is designed to measure the effectiveness of allergen reduction and dietary supplementation, both separately and in combination, for the primary prevention of atopy and asthma. The results of this study may have important implications for public health policies to reduce the incidence of childhood asthma. Control Clin Trials 2001 :333-354
Impact of childhood asthma on growth trajectories in early adolescence
Publisher: Wiley
Date: 08-11-2017
DOI: 10.1111/RESP.12928
Abstract: Understanding the associations between childhood asthma and growth in early adolescence by accounting for the heterogeneity of growth during puberty has been largely unexplored. The objective was to identify sex‐specific classes of growth trajectories during early adolescence, using a method which takes the heterogeneity of growth into account and to evaluate the association between childhood asthma and different classes of growth trajectories in adolescence. Our longitudinal study included participants with a family history of asthma born during 1997–1999 in Sydney, Australia. Hence, all participants were at high risk for asthma. Asthma status was ascertained at 8 years of age using data from questionnaires and lung function tests. Growth trajectories between 11 and 14 years of age were classified using a latent basis growth mixture model. Multinomial regression analyses were used to evaluate the association between asthma and the categorized classes of growth trajectories. In total, 316 participants (51.6% boys), representing 51.3% of the entire cohort, were included. Sex‐specific classes of growth trajectories were defined. Among boys, asthma was not associated with the classes of growth trajectories. Girls with asthma were more likely than girls without asthma to belong to a class with later growth ( OR : 3.79, 95% CI : 1.33, 10.84). Excluding participants using inhaled corticosteroids or adjusting for confounders did not significantly change the results for either sex. We identified sex‐specific heterogeneous classes of growth using growth mixture modelling. Associations between childhood asthma and different classes of growth trajectories were found for girls only.
Prevention of asthma during the first 5 years of life: a randomized controlled trial.
Publisher: Elsevier BV
Date: 07-2006
DOI: 10.1016/J.JACI.2006.04.004
Abstract: Early life exposures may be important in the development of asthma and allergic disease. To test house dust mite (HDM) avoidance and dietary fatty acid modification, implemented throughout the first 5 years of life, as interventions to prevent asthma and allergic disease. We recruited newborns with a family history of asthma antenatally and randomized them, separately, to HDM avoidance or control and to dietary modification or control. At age 5 years, they were assessed for asthma and eczema and had skin prick tests for atopy. Of 616 children randomized, 516 (84%) were evaluated at age 5 years. The HDM avoidance intervention resulted in a 61% reduction in HDM allergen concentrations (microg/g dust) in the child's bed but no difference in the prevalence of asthma, wheeze, or atopy (P > .1). The prevalence of eczema was higher in the active HDM avoidance group (26% vs 19% P = .06). The ratio of omega-6 to omega-3 fatty acids in plasma was lower in the active diet group (5.8 vs 7.4 P .1). Further research is required to establish whether other interventions can be recommended for the prevention of asthma and allergic disease. House dust mite avoidance measures and dietary fatty acid modification, as implemented in this trial during infancy and early childhood, did not prevent the onset of asthma, eczema, or atopy in high-risk children.
Occupational asthma in New South Wales (NSW)
Publisher: Oxford University Press (OUP)
Date: 06-2006
Abstract: The proportion of asthma in adults that is due to occupational exposures is not known. To examine the contribution of workplace exposures to the development of asthma in adults in New South Wales (NSW) in a cross sectional, population-based study. A randomly selected population of 5,331 18- to 49-year olds completed and returned a mailed questionnaire (response rate 37%). In adult-onset asthmatics we examined the association of asthma with reported exposure, within 1 year of asthma onset, to a list of occupations and exposures known to be at risk for occupational asthma (high-risk jobs and exposures). Among 910 subjects (18%) with asthma, 383 (7%) subjects reported adult-onset disease. After adjusting for sex, age and smoking, working in any high-risk job or exposure at the time of asthma onset was significantly associated with adult-onset asthma (OR 1.51, 95% CI 1.19-1.92). The population attributable risk (PAR) of adult-onset asthma for either a high-risk job or an exposure was 9.5%. Sudden onset, irritant or reactive airways dysfunction syndrome type exposures were associated with adult-onset asthma (OR 4.65, 95% CI 1.64-13.2). The PAR of adult-onset asthma for these exposures was 0.2%. Reported adult onset of asthma is common and occupational exposures may be associated with 9.5% of prevalent cases of adult-onset asthma in NSW.
What are the most effective community-based antimicrobial stewardship interventions in low- and middle-income countries? A narrative review
Publisher: Oxford University Press (OUP)
Date: 25-01-2021
DOI: 10.1093/JAC/DKAA556
Abstract: Antimicrobial resistance (AMR) is a major global issue and antimicrobial stewardship is central to tackling its emergence. The burden of AMR disproportionately impacts low- and middle-income countries (LMICs), where capacity for surveillance and management of resistant pathogens is least developed. Poorly regulated antibiotic consumption in the community is a major driver of AMR, especially in LMICs, yet community-based interventions are neglected in stewardship research, which is often undertaken in high-income settings and/or in hospitals. We reviewed the evidence available to researchers and policymakers testing or implementing community-based antimicrobial stewardship strategies in LMICs. We critically appraise that evidence, deliver recommendations and identify outstanding areas of research need. We find that multifaceted, education-focused interventions are likely most effective in our setting. We also confirm that the quality and quantity of community-based stewardship intervention research is limited, with research on microbiological, clinical and economic sustainability most urgently needed.
Stepped treatment algorithm using budesonide-formoterol for chronic respiratory diseases: A single arm interventional study
Publisher: Public Library of Science (PLoS)
Date: 11-07-2022
DOI: 10.1371/JOURNAL.PONE.0271178
Abstract: While the safety and efficacy of inhaled budesonide-formoterol, used as-needed for symptoms, has been established for patients with asthma, it has not been trialed in undifferentiated patients with chronic respiratory diseases. We aimed to assess the feasibility of a pragmatic intervention that entails a stepped algorithm using inhaled budesonide-formoterol (dry powder inhaler, 160μg/4.5μg per dose) for patients presenting with chronic respiratory diseases to three rural district hospitals in Hanoi, Vietnam. We recruited patients with evidence of airflow obstruction on spirometry and/or symptoms consistent with asthma. The algorithm consisted of three steps: 1. as-needed inhaled budesonide-formoterol for symptoms, 2. maintenance plus as-needed inhaled budesonide-formoterol, and 3. referral to a higher-level healthcare facility. All participants started at step 1, with escalation to the next step at review visits if there had been exacerbation(s) or inadequate symptom control. Patients were followed for 12 months. Among 313 participants who started the treatment algorithm, 47.2% had ≥ 1 episode of acute respiratory symptoms requiring a visit to hospital or clinic and 35.4% were diagnosed with an exacerbation. Twelve months after enrolment, 50.7% still adhered to inhaled budesonide-formoterol at the recommended treatment step. The mean and median number of doses per day was 1.5 (standard deviation 1.2) doses and 1.3 (interquartile range 0.7–2.3) doses, respectively. The proportion of patients taking more than 800μg budesonide per day was 3.8%. This novel therapeutic algorithm is feasible for patients with chronic respiratory diseases in a rural setting in Vietnam. Further studies are required to establish the effectiveness, safety and cost-effectiveness of similar approaches in different settings. ACTRN12619000554167 .
Optimal asthma control, starting with high doses of inhaled budesonide
Publisher: European Respiratory Society (ERS)
Date: 08-2000
The effect of respiratory activity, ventilatory therapy and facemasks on total aerosol emissions
Publisher: Cold Spring Harbor Laboratory
Date: 09-02-2021
DOI: 10.1101/2021.02.07.21251309
Abstract: Exhaled respirable aerosols ( µm diameter) present a high risk of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) transmission. Many guidelines recommend using aerosol precautions during ‘aerosol generating procedures’ (AGPs) and droplet ( µm) precautions at other times. However, there is emerging evidence that respiratory activities such as cough and not AGPs are the important source of aerosols. We used a novel chamber with an optical particle counter s ling at 100 L/min to count and size-fractionate all exhaled particles (0.5-25 µm). We compared emissions from ten healthy subjects during respiratory ‘activities’ (quiet breathing, talking, shouting, forced expiratory maneuvers, exercise and coughing) with respiratory ‘therapies’ designated as AGPs: high flow nasal oxygen (HFNO) and single or dual circuit non-invasive positive pressure ventilation, NIPPV-S and NIPPV-D, respectively. Activities were repeated wearing facemasks. Compared to quiet breathing, respiratory activities increased particle counts between 34.6-fold (95% confidence interval [CI], 15.2 to 79.1) during talking, to 370.8-fold (95% CI, 162.3 to 847.1) during coughing (p .001). During quiet breathing, HFNO at 60 L/min increased counts 2.3-fold (95% CI, 1.2 to 4.4) (p=0.03) and NIPPV-S and NIPPV-D at 25/10 cm H 2 O increased counts by 2.6-fold (95% CI, 1.7 to 4.1) and 7.8-fold (95% CI, 4.4 to 13.6) respectively (p .001). During activities, respiratory therapies and facemasks reduced emissions compared to activities alone. Talking, exertional breathing and coughing generate substantially more aerosols than the respiratory therapies HFNO and NIPPV which can reduce total emissions. The risk of aerosol exposure is underappreciated and warrants widespread targeted interventions.
Effects of gas and other fume emitting heaters on the development of asthma during childhood
Publisher: BMJ
Date: 09-2004
Clinical Importance of Alternaria Exposure in Children
Publisher: American Thoracic Society
Date: 08-2001
DOI: 10.1164/AJRCCM.164.3.2008042
Abstract: The fungus Alternaria is known to be allergenic and is one of the most common fungi worldwide. We investigated the extent to which exposure to Alternaria increases the severity of asthma. We undertook a prospective cohort study in Australia of 399 school children who had positive skin tests to one or more aeroallergens. Airway responsiveness to histamine, wheeze, and bronchodilator use in 1 mo was measured five times between 1997 and 1999. Airway hyperresponsiveness was defined as PD(20)FEV(1) = 3.9 micromol histamine. Airborne concentrations of Alternaria spores were measured throughout the study, and mean daily concentrations over 1 mo ranged from 2.2 to 307.7 spores/m(3) of ambient air. Using generalized estimating equations, we found that airway responsiveness, wheeze, and bronchodilator use increased significantly in association with increased spore concentrations and that the increase in airway responsiveness was greater in children sensitized to Alternaria than in other children (p = 0.01). The odds ratio for airway hyperresponsiveness in children sensitized to Alternaria was 1.26 (95% CI, 1.14 to 1.39) after an increase in mean exposure of 100 spore/m(3)/d over 1 mo. These results suggest that Alternaria allergens contribute to severe asthma in regions where exposure to the fungus is high.
Machine and Deep Learning for Tuberculosis Detection on Chest X-Rays: Systematic Literature Review (Preprint)
Publisher: JMIR Publications Inc.
Date: 10-2022
Abstract: uberculosis (TB) was the leading infectious cause of mortality globally prior to COVID-19 and chest radiography has an important role in the detection, and subsequent diagnosis, of patients with this disease. The conventional experts reading has substantial within- and between-observer variability, indicating poor reliability of human readers. Substantial efforts have been made in utilizing various artificial intelligence–based algorithms to address the limitations of human reading of chest radiographs for diagnosing TB. his systematic literature review (SLR) aims to assess the performance of machine learning (ML) and deep learning (DL) in the detection of TB using chest radiography (chest x-ray [CXR]). n conducting and reporting the SLR, we followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 309 records were identified from Scopus, PubMed, and IEEE (Institute of Electrical and Electronics Engineers) databases. We independently screened, reviewed, and assessed all available records and included 47 studies that met the inclusion criteria in this SLR. We also performed the risk of bias assessment using Quality Assessment of Diagnostic Accuracy Studies version 2 (QUADAS-2) and meta-analysis of 10 included studies that provided confusion matrix results. arious CXR data sets have been used in the included studies, with 2 of the most popular ones being Montgomery County (n=29) and Shenzhen (n=36) data sets. DL (n=34) was more commonly used than ML (n=7) in the included studies. Most studies used human radiologist’s report as the reference standard. Support vector machine (n=5), k-nearest neighbors (n=3), and random forest (n=2) were the most popular ML approaches. Meanwhile, convolutional neural networks were the most commonly used DL techniques, with the 4 most popular applications being ResNet-50 (n=11), VGG-16 (n=8), VGG-19 (n=7), and AlexNet (n=6). Four performance metrics were popularly used, namely, accuracy (n=35), area under the curve (AUC n=34), sensitivity (n=27), and specificity (n=23). In terms of the performance results, ML showed higher accuracy (mean ~93.71%) and sensitivity (mean ~92.55%), while on average DL models achieved better AUC (mean ~92.12%) and specificity (mean ~91.54%). Based on data from 10 studies that provided confusion matrix results, we estimated the pooled sensitivity and specificity of ML and DL methods to be 0.9857 (95% CI 0.9477-1.00) and 0.9805 (95% CI 0.9255-1.00), respectively. From the risk of bias assessment, 17 studies were regarded as having unclear risks for the reference standard aspect and 6 studies were regarded as having unclear risks for the flow and timing aspect. Only 2 included studies had built applications based on the proposed solutions. indings from this SLR confirm the high potential of both ML and DL for TB detection using CXR. Future studies need to pay a close attention on 2 aspects of risk of bias, namely, the reference standard and the flow and timing aspects. ROSPERO CRD42021277155 www.crd.york.ac.uk rospero/display_record.php?RecordID=277155
Related Organisations
Forensic And Scientific Services, Queensland Health
Location: Australia
Royal College Of Physicians
Location: United Kingdom of Great Britain and Northern Ireland
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End Date: 2015
Funder: Canadian Institutes of Health Research
View Funded ActivitySex-related Changes In Asthma During The Transition Through Puberty In The CAPS Birth Cohort
Start Date: 2009
End Date: 2014
Funder: National Health and Medical Research Council
View Funded ActivityEnvironmental Influences On Allergic Airways Disease From Birth To 8yrs: Long-term Outcomes Of A Randomised Trial (CAPS)
Start Date: 2005
End Date: 2007
Funder: National Health and Medical Research Council
View Funded ActivityPractitioner Fellowship 168106
Start Date: 2001
End Date: 2005
Funder: National Health and Medical Research Council
View Funded ActivityEvaluation Of A Financial Incentive To Improve The Use Of Preventive Medicines By People With Asthma
Start Date: 2014
End Date: 2017
Funder: National Health and Medical Research Council
View Funded ActivityDevelopment And Validation Of A Latent Tuberculosis Diagnostic
Start Date: 2017
End Date: 2019
Funder: National Health and Medical Research Council
View Funded ActivityPrevention Of Multi-drug Resistant Tuberculosis In A High Prevalence Setting: ‘Connecting The DOTS’ In Vietnam
Start Date: 2015
End Date: 2020
Funder: National Health and Medical Research Council
View Funded ActivityDoes Neonatal Vaccination With BCG Reduce The Subsequent Incidence Of Allergic Sensitisation?
Start Date: 1999
End Date: 2001
Funder: National Health and Medical Research Council
View Funded ActivityA New Direction For TB Control In Highly Endemic Countries: A RCT Of Active Case Finding
Start Date: 2010
End Date: 2016
Funder: National Health and Medical Research Council
View Funded ActivityMultidimensional Assessment Of The Health Impacts Of Infrasound: Two Randomised Controlled Trials
Start Date: 2016
End Date: 2020
Funder: National Health and Medical Research Council
View Funded ActivityPractitioner Fellowship - Grant ID:402827
Start Date: 2006
End Date: 2010
Funder: National Health and Medical Research Council
View Funded ActivityThe Diagnosis Of Obstructive Sleep Apnea In Primary Care
Start Date: 2008
End Date: 2011
Funder: National Health and Medical Research Council
View Funded ActivityCommunity-wide Active Case Finding For Tuberculosis
Start Date: 2013
End Date: 2018
Funder: National Health and Medical Research Council
View Funded ActivityA Randomized Clinical Trial Comparing Effectiveness Of 4RIF And 9INH For Treatment Of Latent TB Infection
Start Date: 2010
End Date: 2015
Funder: National Health and Medical Research Council
View Funded ActivityThe Role Of Viruses In Childhood Asthma
Start Date: 2010
End Date: 2012
Funder: National Health and Medical Research Council
View Funded ActivityAirborne Ultrafine Particles In Australian Cities
Start Date: 2019
End Date: 2021
Funder: Australian Research Council
View Funded ActivityAir Pollution And Mortality And Morbidity In Adult Australians (APMMA Study): A Large Population Based Cohort Study
Start Date: 2018
End Date: 2020
Funder: National Health and Medical Research Council
View Funded ActivityMulti-Country Study On Health Effects Of Bushfire Air Pollution
Start Date: 2021
End Date: 2023
Funder: Australian Research Council
View Funded ActivityThe Effects Of Nano And Ultrafine Particles From Traffic Emissions On Children's Health
Start Date: 2009
End Date: 2013
Funder: Australian Research Council
View Funded ActivityTuberculosis Control
Start Date: 2012
End Date: 2018
Funder: National Health and Medical Research Council
View Funded ActivityUnderstanding And Ameliorating The Human Health Effects Of Exposure To Air Pollution: From Knowledge To Policy And Public Health Practice
Start Date: 2012
End Date: 2017
Funder: National Health and Medical Research Council
View Funded ActivityCentre Of Research Excellence In Energy Transitions, Air Pollution And Health In Australia
Start Date: 2017
End Date: 2022
Funder: National Health and Medical Research Council
View Funded ActivityARC Training Centre For Advanced Building Systems Against Airborne Infection Transmission
Start Date: 2022
End Date: 2026
Funder: Australian Research Council
View Funded ActivityImproving Global Tuberculosis Control With The AuTuMN Platform
Start Date: 2018
End Date: 2020
Funder: National Health and Medical Research Council
View Funded ActivityCentre Of Research Excellence In Tuberculosis Control On Both Sides Of Our Border.
Start Date: 2018
End Date: 2020
Funder: National Health and Medical Research Council
View Funded Activity