109,987 research outputs found
Respiratory health and endotoxin: associations and modification by CD14/-260 genotype
No full textExposure to endotoxin has been associated with increased respiratory symptoms and decrements in lung function in occupational settings but little is known about the health effects of domestic exposure in adults. Here, we describe the association of respiratory disease, immunoglobulin (Ig)E sensitisation, bronchial reactivity and lung function with mattress endotoxin levels in adults, and determine whether these associations are modified by polymorphisms in CD14. Endotoxin levels in mattress dust from a population-based sample of 972 adults were measured. Associations were examined using generalised linear mixed models, adjusting for individual and household confounders. Effect modification of these associations by CD14/-260 (rs2569190) was assessed. Mattress endotoxin levels varied from 0.1 to 402.6 EU · mg(-1). Although there was no overall association of lung function with endotoxin exposure, there was evidence that the association of forced expiratory volume in 1 s and forced vital capacity with endotoxin was modified by CD14/-260 genotype (p-value for interaction 0.005 and 0.013, respectively). There was no evidence that symptoms, IgE sensitisation or bronchial reactivity were associated with mattress endotoxin levels. In this large epidemiological study of adults, there was no evidence that mattress endotoxin level was associated with respiratory symptoms or IgE sensitisation but the association of lung function with endotoxin levels may be modified by CD14 genotype
Systems for the management of respiratory disease in primary care - an international series: United Kingdom
No full textINTRODUCTION: The UK National Health Service (NHS) is essentially publicly funded through general taxation. Challenges facing the NHS include the rise in prevalence of long-term conditions and financial pressures. NATIONAL POLICY TRENDS: Political devolution within the UK has led to variations in the way services are organised and delivered between the four nations. PRIMARY CARE RESPIRATORY SERVICES IN THE UK: Primary care is the first point of contact with services. Most respiratory conditions are managed here, including prevention, diagnosis, treatment and palliative care. EPIDEMIOLOGY: Respiratory disease accounts for more primary care consultations than any other type of illness, with 24 million consultations annually. ACCESS TO CARE: Equitable access to care is an ongoing challenge: telehealthcare is being tried as a possible solution for monitoring of asthma and COPD. REFERRAL AND ACCESS TO SPECIALIST CARE: Referrals for specialist advice are usually to a secondary care respiratory physician, though respiratory General Practitioners with a Special Interest (GPwSIs) are an option in some localities. CONCLUSIONS: Prevalence of asthma and COPD is high. Asthma services are predominantly nurse-led. Self-management strategies are widely promoted but poorly implemented. COPD is high on the policy agenda with a shift in focus to preventive lung health and longterm condition management
The UN-SUSTAINABLE Match in HCV Recipients. Evidences from the Italian D-MELD Study on Balancing Donor-Recipient Risk Factors
No full textThe UN-SUSTAINABLE Match in HCV Recipients. Evidences from the Italian D-MELD Study on Balancing Donor-Recipient Risk Factor
Tools for detection of Mycoplasma amphoriforme : a primary respiratory pathogen?
No full textThis work was supported by a Peter Samuel Royal Free Fund grant, the Primary Immunodeficiency Association, the Special Trustees of the Royal Free London NHS Foundation Trust, Hampstead, and the University of St. Andrews Medical School.Mycoplasma amphoriforme is a recently described organism isolated from the respiratory tracts of patients with immunodeficiency and evidence of chronic infection. Novel assays for the molecular detection of the organism by real-time quantitative PCRs (qPCRs) targeting the uracil DNA glycosylase gene (udg) or the 23S rRNA gene are described here. The analytical sensitivities are similar to the existing conventional M. amphoriforme 16S rRNA gene PCR, with the advantage of being species specific, rapid, and quantitative. By using these techniques, we demonstrate the presence of this organism in 17 (19.3%) primary antibody-deficient (PAD) patients, 4 (5%) adults with lower respiratory tract infection, 1 (2.6%) sputum sample from a patient attending a chest clinic, and 23 (0.21%) samples submitted for viral diagnosis of respiratory infection, but not in normal adult control subjects. These data show the presence of this microorganism in respiratory patients and suggest that M. amphoriforme may infect both immunocompetent and immunocompromised people. Further studies to characterize this organism are required, and this report provides the tools that may be used by other research groups to investigate its pathogenic potential.Peer reviewe
Identification of group B respiratory syncytial viruses that lack the 60-nucleotide duplication after six consecutive epidemics of total BA dominance at coastal Kenya
No full textRespiratory syncytial virus BA genotype has reportedly replaced other group B genotypes worldwide. We report the observation of three group B viruses, all identical in G sequence but lacking the BA duplication, at a coastal district hospital in Kenya in early 2012. This follows a period of six consecutive respiratory syncytial virus (RSV) epidemics with 100% BA dominance among group B isolates. The new strains appear only distantly related to BA variants and to previously circulating SAB1 viruses last seen in the district in 2005, suggesting that they were circulating elsewhere undetected. These results are of relevance to an understanding of RSV persistence
Respiratory health status and its predictors: a cross-sectional study among coal-based sponge iron plant workers in Barjora, India.
No full textOBJECTIVES: During the past decade, coal-based sponge iron plants, a highly polluted industry, have grown rapidly in Barjora, India. The toxic effects of particulate matters and gaseous pollutants include various respiratory diseases. Understanding workers' perception of respiratory health is essential in people-centred healthcare. The aim of the study was to assess their respiratory health status and to determine its predictors. DESIGN: Cross-sectional study. SETTING: Coal-based sponge iron plants in Barjora, India. PARTICIPANTS: 258 coal-based sponge iron plant workers. PRIMARY OUTCOME MEASURE: Respiratory health status was measured using the St. George's respiratory questionnaire (SGRQ) total score. 100 and 0 represent the worst and best possible respiratory health status, respectively. STATISTICAL ANALYSES: The two-part model (frequency (any worse respiratory health status) and severity (amount of worse respiratory health status)) was developed for the score, as the data were positively skewed with many zeros. RESULTS: The mean (SD) SGRQ total score was 7.7 (14.5), the median (IQR) was 0.9 (9.0), and the observed range was 0-86.6. The best possible SGRQ total score was reported by 46.9% of workers. Independent predictors of worse respiratory health status were cleaner domestic cooking fuel (coefficient -0.76, 95% CI -1.46 to -0.06, p=0.034) and personal history of any respiratory disease (1.76, 1.04 to 2.47, p<0.001) in case of frequency; and family history of any respiratory disease (0.43, 0.02 to 0.83, p=0.039) and personal history (1.19, 0.83 to 1.54, p<0.001) in case of severity. CONCLUSIONS: Less than half of the coal-based sponge iron plant workers in Barjora have the best possible respiratory health status. The predictors of worse respiratory health status were identified. The study findings could be taken into consideration in future interventional studies aimed at improving the respiratory health status of these workers
Cancer prevalence is increased in females with sleep apnoea: data from the ESADA study
No full textEuropean Union COST action [B26]; European Respiratory Society; ResMed; Philips Respironics Foundation; European Sleep Research SocietyThe ESADA network has received support from the European Union COST action B26 and is currently a Clinical Research Collaboration funded by the European Respiratory Society. Additionally, the ESADA study group has received unrestricted seeding grants from the ResMed and the Philips Respironics Foundation for the establishment of the database in 2007 and 2011. The ESADA has an ongoing collaboration with Bayer AG. Non-financial support was provided by the European Sleep Research Society and the European Respiratory Society for communication, meetings and data presentations for the ESADA collaborators
Occupational Respiratory Health Symptoms and Associated Factors Among Street Sweepers in Ilala Municipality
No full textStreet working environment condition particularly exposed to organic and inorganic dust and chronic inhalation of dust during street sweeping may associated with increases in respiratory health symptoms among street sweepers. However the street sweepers rarely used PPEs while exposed to high level of dust which may contribute to increases the prevalence’s of respiratory health symptoms. Few published studies have showed the chronic and lung function among street sweepers, but in Tanzania no published study about occupational respiratory health symptoms and associated factors among street sweepers. The objective of this study was to determine prevalence of respiratory health symptoms and associated factors among street sweepers in Ilala Municipality. Materials and Methods: Cross-sectional analytical study was designed 102 street sweepers as exposed group and 85 street vegetable sellers as unexposed group means less exposed to street sweeping dust from Ilala Municipality who worked one year and above and none smoker habit were studied, the respondent rate was 57.7%. Respiratory health symptoms and socio-demographic information were collected by using a modified American Thoracic Society respiratory symptoms questionnaire and level of utilization of PPEs were assessed by closed ended questions. Frequency distribution, Chi square test and logistic regression were used in data analysis. The prevalence of respiratory health symptoms was higher among exposed than unexposed group and the difference was statistically significant, for cough (54.9% vs 12.9%) phlegm (39.2 vs 7.1%), wheezing (32.4% vs 14.1%), nose irritating (35.8% vs 4.7%) and sneezing (63.7% vs 8.2). Street sweeping dust was the main associated factor to cough, phlegm, wheezing, nose irritating and wheezing utcomes, while age associated with cough and phlegm utcomes and duration of employment associated with cough outcomes among street sweepers, and the association was tatistically significant p<0.05. Availability and wearing of mouth/nose mask was reported 70.6% and 61.8%. General availability of PPEs 41.2% responded once after three months and wearing of PPEs 47.1% responded did not wear frequently because not available at any time which did not make them motivation of frequently wearing of PPEs during street sweeping. Respiratory health symptoms are associated with street sweeping dust exposure and the prevalence of respiratory health symptoms are higher among exposed group than unexposed group. The study has recommended that the appropriate and quality PPEs to be available and frequently wearing of PPE during street sweeping and medical intervention to be implemented for further diagnostic like sputum testing, chest x-ray and chest ultrasound for street sweepers.\u
Exposure to indoor mould and children's respiratory health in the PATY study.
No full textBACKGROUND: Living in a damp or mouldy home reportedly damages children's respiratory health, yet mould appears not to be a prominent risk factor in the public's perception. Analyses of data on over 58,000 children from the Pollution and the Young (PATY) study are presented. In this collaboration, researchers from 12 cross-sectional studies pooled their data to assess the effects of air quality on a spectrum of children's respiratory disorders. METHOD: Original studies were conducted in Russia, North America and 10 countries in Eastern and Western Europe. Pooled analyses were restricted to children aged 6-12 years. Associations between visible mould reported in the household and a spectrum of eight respiratory and allergic symptoms were estimated within each study. Logistic regressions were used, controlling for individual risk factors and for study area. Heterogeneity between study-specific results and mean effects (allowing for heterogeneity) were estimated using meta-analysis. RESULTS: Visible mould was reported by 13.9% of respondents in Russia, increasing to 39.1% in North America. Positive associations between exposure to mould and children's respiratory health were seen with considerable consistency across studies and across outcomes. Confounder-adjusted combined ORs ranged from 1.30 (95% CI 1.22 to 1.39) for "nocturnal cough" to 1.50 (1.31 to 1.73) for "morning cough". Evidence of stronger effects in more crowded households was statistically significant for only asthma and sensitivity to inhaled allergens. No consistent interactions between mould and age, sex or parental smoking were found. CONCLUSION: Indoor mould exposure was consistently associated with adverse respiratory health outcomes in children living in these diverse countries
Barotrauma during Noninvasive Respiratory Support in COVID-19 Pneumonia Outside ICU: The Ancillary COVIMIX-2 Study
No full textBackground: Noninvasive respiratory support (NIRS) has been extensively used during the COVID-19 surge for patients with acute respiratory failure. However, little data are available about barotrauma during NIRS in patients treated outside the intensive care unit (ICU) setting. Methods: COVIMIX-2 was an ancillary analysis of the previous COVIMIX study, a large multicenter observational work investigating the frequencies of barotrauma (i.e., pneumothorax and pneumomediastinum) in adult patients with COVID-19 interstitial pneumonia. Only patients treated with NIRS outside the ICU were considered. Baseline characteristics, clinical and radiological disease severity, type of ventilatory support used, blood tests and mortality were recorded. Results: In all, 179 patients were included, 60 of them with barotrauma. They were older and had lower BMI than controls (p < 0.001 and p = 0.045, respectively). Cases had higher respiratory rates and lower PaO2/FiO2 (p = 0.009 and p < 0.001). The frequency of barotrauma was 0.3% [0.1-1.3%], with older age being a risk factor for barotrauma (OR 1.06, p = 0.015). Alveolar-arterial gradient (A-a) DO2 was protective against barotrauma (OR 0.92 [0.87-0.99], p = 0.026). Barotrauma required active treatment, with drainage, in only a minority of cases. The type of NIRS was not explicitly related to the development of barotrauma. Still, an escalation of respiratory support from conventional oxygen therapy, high flow nasal cannula to noninvasive respiratory mask was predictive for in-hospital death (OR 15.51, p = 0.001). Conclusions: COVIMIX-2 showed a low frequency for barotrauma, around 0.3%. The type of NIRS used seems not to increase this risk. Patients with barotrauma were older, with more severe systemic disease, and showed increased mortality
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