Emphysema Predicts Hospitalisation and Incident Airflow Obstruction among Older Smokers: A Prospective Cohort Study

Emphysema on CT is common in older smokers. We hypothesised that emphysema on CT predicts acute episodes of care for chronic lower respiratory disease among older smokers.Participants in a lung cancer screening study age ≥ 60 years were recruited into a prospective cohort study in 2001-02. Two radiologists independently visually assessed the severity of emphysema as absent, mild, moderate or severe. Percent emphysema was defined as the proportion of voxels ≤ -910 Hounsfield Units. Participants completed a median of 5 visits over a median of 6 years of follow-up. The primary outcome was hospitalization, emergency room or urgent office visit for chronic lower respiratory disease. Spirometry was performed following ATS/ERS guidelines. Airflow obstruction was defined as FEV1/FVC ratio <0.70 and FEV1<80% predicted.Of 521 participants, 4% had moderate or severe emphysema, which was associated with acute episodes of care (rate ratio 1.89; 95% CI: 1.01-3.52) adjusting for age, sex and race/ethnicity, as was percent emphysema, with similar associations for hospitalisation. Emphysema on visual assessment also predicted incident airflow obstruction (HR 5.14; 95% CI 2.19-21.1).Visually assessed emphysema and percent emphysema on CT predicted acute episodes of care for chronic lower respiratory disease, with the former predicting incident airflow obstruction among older smokers

Food Addiction: From Popular Conception to Scientific Validation

In recent years, food addiction has become a popular construct believed to have serious behavioral, emotional and physical consequences. However, its scientific validity is still under investigation. This dissertation evaluated whether food addiction is a valid mental disorder, substance-related disorder, and addiction in three parts. Part 1 reviewed the phenomenological, animal and neurological evidence to assess whether food addiction has face validity and conducted a systematic literature review of studies estimating the prevalence, validating measures, and/or assessing correlates of human food addiction to evaluate construct validity. Part 2 used two community-based convenience samples to assess whether operationalized measures of food addiction are reliable and valid. Part 3 used two large cohorts of nurses to evaluate whether food addiction is associated with potentially positively reinforcing nutrients, food items and food groups. The literature review established that food addiction has face validity, and to some degree, construct validity. The first analytic paper found that the internal and test-retest reliabilities of both scales were moderate to good, and the shorter Modified Yale Food Addiction Scale compared with the original Yale Food Addiction Scale had good sensitivity and negative predictive value. The second analytic paper found strong positive associations between food addiction and consumption of fats and sodium, non-sweet fatty foods, diet foods, and some salty and sweet foods, no association with most starchy and salty food items, and an inverse association with fruits and vegetables. It also found unexpected strong inverse associations between sugar and food addiction, contradicting the popular “sugar addiction” hypothesis. Prospective analyses should reexamine these findings to eliminate potential reverse causation bias. Taken together, this dissertation supported food addiction as a valid mental disorder, substance-related disorder and addiction, although some findings contradicted a priori hypotheses, and gaps in the literature remain

Disease-Specific Health Disparities: A Targeted Review Focusing on Race and Ethnicity

Background: Wide disparities in health status exist in the United States across race and ethnicity, broadly driven by social determinants of health&mdash;most notably race and ethnic group differences in income, education, and occupational status. However, disparities in disease frequency or severity remain underappreciated for many individual diseases whose distribution in the population varies. Such information is not readily accessible, nor emphasized in treatment guidelines or reviews used by practitioners. Specifically, a summary on disease-specific evidence of disparities from population-based studies is lacking. Our goal was to summarize the published evidence for specific disease disparities in the United States so that this knowledge becomes more widely available &ldquo;at the bedside&rdquo;. We hope this summary stimulates health equity research at the disease level so that these disparities can be addressed effectively. Methods: A targeted literature review of disorders in Pfizer&rsquo;s current pipeline was conducted. The 38 diseases included metabolic disorders, cancers, inflammatory conditions, dermatologic disorders, rare diseases, and infectious targets of vaccines under development. Online searches in Ovid and Google were performed to identify sources focused on differences in disease rates and severity between non-Hispanic Whites and Black/African Americans, and between non-Hispanic Whites and Hispanics. As a model for how this might be accomplished for all disorders, disparities in disease rates and disease severity were scored to make the results of our review most readily accessible. After primary review of each condition by one author, another undertook an independent review. Differences between reviewers were resolved through discussion. Results: For Black/African Americans, 29 of the 38 disorders revealed a robust excess in incidence, prevalence, or severity. After sickle cell anemia, the largest excesses in frequency were identified for multiple myeloma and hidradenitis suppurativa. For Hispanics, there was evidence of disparity in 19 diseases. Most notable were metabolic disorders, including non-alcoholic steatohepatitis (NASH). Conclusions: This review summarized recent disease-specific evidence of disparities based on race and ethnicity across multiple diseases, to inform clinicians and health equity research. Our findings may be well known to researchers and specialists in their respective fields but may not be common knowledge to health care providers or public health and policy institutions. Our hope is that this effort spurs research into the causes of the many disease disparities that exist in the United States

Disease-Specific Health Disparities: A Targeted Review Focusing on Race and Ethnicity

Background: Wide disparities in health status exist in the United States across race and ethnicity, broadly driven by social determinants of health—most notably race and ethnic group differences in income, education, and occupational status. However, disparities in disease frequency or severity remain underappreciated for many individual diseases whose distribution in the population varies. Such information is not readily accessible, nor emphasized in treatment guidelines or reviews used by practitioners. Specifically, a summary on disease-specific evidence of disparities from population-based studies is lacking. Our goal was to summarize the published evidence for specific disease disparities in the United States so that this knowledge becomes more widely available “at the bedside”. We hope this summary stimulates health equity research at the disease level so that these disparities can be addressed effectively. Methods: A targeted literature review of disorders in Pfizer’s current pipeline was conducted. The 38 diseases included metabolic disorders, cancers, inflammatory conditions, dermatologic disorders, rare diseases, and infectious targets of vaccines under development. Online searches in Ovid and Google were performed to identify sources focused on differences in disease rates and severity between non-Hispanic Whites and Black/African Americans, and between non-Hispanic Whites and Hispanics. As a model for how this might be accomplished for all disorders, disparities in disease rates and disease severity were scored to make the results of our review most readily accessible. After primary review of each condition by one author, another undertook an independent review. Differences between reviewers were resolved through discussion. Results: For Black/African Americans, 29 of the 38 disorders revealed a robust excess in incidence, prevalence, or severity. After sickle cell anemia, the largest excesses in frequency were identified for multiple myeloma and hidradenitis suppurativa. For Hispanics, there was evidence of disparity in 19 diseases. Most notable were metabolic disorders, including non-alcoholic steatohepatitis (NASH). Conclusions: This review summarized recent disease-specific evidence of disparities based on race and ethnicity across multiple diseases, to inform clinicians and health equity research. Our findings may be well known to researchers and specialists in their respective fields but may not be common knowledge to health care providers or public health and policy institutions. Our hope is that this effort spurs research into the causes of the many disease disparities that exist in the United States

Rates of malignancies among patients with moderate to severe atopic dermatitis: a retrospective cohort study

Objectives Patients with atopic dermatitis (AD), also known as eczema, may be at an increased risk for malignancies compared with patients without AD; however, incidence rates (IRs) of malignancies in patients with moderate to severe AD are largely unknown. The objective of this study was to evaluate and compare IRs of malignancies in adults with moderate to severe AD (aged ≥18 years).Design Retrospective cohort study using data from a Kaiser Permanente Northern California (KPNC) cohort. AD severity classification was adjudicated with medical chart review. Covariates and stratification variables included age, sex and smoking status.Setting Data were obtained from the KPNC healthcare delivery system in northern California, USA. Cases of AD were defined by outpatient dermatologist-rendered codes and prescriptions of topical therapy or phototherapy (moderate) or systemic treatment (severe).Participants KPNC health plan members with moderate or severe AD (2007–2018).Primary and secondary outcome measures Malignancy IRs and 95% CIs per 1000 person-years were calculated.Results 7050 KPNC health plan members with moderate and severe AD met eligibility criteria for inclusion. IRs (95% CI) were highest for non-melanoma skin cancer (NMSC) in patients with moderate and severe AD (4.6 (95% CI 3.9 to 5.5) and 5.9 (95% CI 3.8 to 9.2), respectively) and breast cancer (2.2 (95% CI 1.6 to 3.0) and 0.5 (95% CI 0.1 to 3.9), respectively). Except for breast cancer, which was only evaluated in women, malignancies were higher (with non-overlapping CIs) in patients with moderate and moderate to severe AD in men versus women for basal cell carcinoma and NMSC and in former versus never smokers for NMSC and squamous cell carcinoma.Conclusions This study estimated IRs of malignancies in patients with moderate and severe AD and provides valuable information for dermatology clinicians and ongoing clinical trials in these populations

Episodes of chronic lower respiratory disease by category of emphysema visually.

<p>Model 1 adjusted for age, sex and race/ethnicity.</p><p>Model 2 additionally adjusted for pack years smoking, cotinine at time of CT, private healthcare insurance and suspected chronic lower respiratory disease.</p><p>One person who had percent emphysema measured did not have emphysema assessed visually.</p

Episodes of chronic lower respiratory disease by category of percent emphysema.

<p>Model 1 adjusted for age, sex and race/ethnicity.</p><p>Model 2 additionally adjusted for pack years smoking, cotinine at time of CT, private healthcare insurance and suspected chronic lower respiratory disease.</p

Baseline characteristics by CT percent emphysema quartiles.

<p>FEV1 - forced expiratory volume in one second, FVC - forced vital capacity, CLRD – chronic lower respiratory disease (includes any of asthma, COPD, chronic bronchitis and emphysema).</p

Cumulative incidence plot of time to first episode by percent emphysema.

<p>Cumulative incidence plot of time to first episode by percent emphysema.</p