Association of respiratory symptoms and lung function with occupation in the multinational Burden of Obstructive Lung Disease (BOLD) study

Background 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. Methods 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 (FEV1)/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. Results 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 FEV1/FVC (β=0.04%, 95% CI −0.49–0.58%). Some findings differed by sex and gross national income. Conclusion 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.publishedVersio

Cohort Profile: Burden of Obstructive Lung Disease (BOLD) study

The Burden of Obstructive Lung Disease (BOLD) study was established to assess the prevalence of chronic airflow obstruction, a key characteristic of chronic obstructive pulmonary disease, and its risk factors in adults (≥40 years) from general populations across the world. The baseline study was conducted between 2003 and 2016, in 41 sites across Africa, Asia, Europe, North America, the Caribbean and Oceania, and collected high-quality pre- and post-bronchodilator spirometry from 28 828 participants. The follow-up study was conducted between 2019 and 2021, in 18 sites across Africa, Asia, Europe and the Caribbean. At baseline, there were in these sites 12 502 participants with high-quality spirometry. A total of 6452 were followed up, with 5936 completing the study core questionnaire. Of these, 4044 also provided high-quality pre- and post-bronchodilator spirometry. On both occasions, the core questionnaire covered information on respiratory symptoms, doctor diagnoses, health care use, medication use and ealth status, as well as potential risk factors. Information on occupation, environmental exposures and diet was also collected

In the Shadow of the State: Gender Contestation and Legal Mobilization in the Context of the Arab Spring in Egypt and Tunisia

Thesis (Ph.D.)--University of Washington, 2018Gender issues emerged in various forms as part of uprisings that swept the Arab world starting from 2011. However, little attention has been paid to the differences among various countries of women's mobilization during and after the Arab Spring. The differences between Tunisia and Egypt, two of the central countries in the uprisings of 2011, have been stark in the ways women mobilized for action. In Tunisia, women's claims were principally channeled through the formal institutions of the state-a top-down process. In Egypt, in contrast, women went outside the standard institutions of the state to voice more radical demands-a bottom-up approach. My project asks why such different forms of women's contestation developed in these two states? I argue that the distinct history and legacy of state feminism in each country was key in the development of novel rights claims on the part of the women's rights activists after the revolutions. Furthermore, this research project argues his that it is often the multiple identities that women develop because of their involvement in politics, as new forms of subject formation, that act as critical symbolic resources in rights-based campaigns. In addition, this manuscript develops an argument on why and how mobilization occurs in contexts where states are direct perpetrators of gender-based violence. I argue such mobilization could lead to one of two possible outcomes: movements either turn to top-down approaches that seek to secure formal wins, or movements employ extra-institutional politics to push forward more radical claims of rights. I argue that the former happened in Tunisia where activists made strong political appeals to the state and developed a collective past legacy of state feminism. This, in turn, made it difficult to hold the state accountable for its violations. In contrast, and because of the ambiguous nature of state feminism in Egypt, the movement against gender-based violence was able to challenge the state hegemonic discourses within a much more repressive political context by employing extra-institutional tactics. The broader implications of these findings question the assumption that democratic transition, transitional justice, and gender justice go hand in hand. Furthermore, the findings show how addressing violation committed by state agents through strictly technical channels could further perpetuate hegemonic understandings of the state's prerogative powers over its citizens