MultiTex RCT - A multifaceted intervention package for protection against cotton dust exposure among textile workers - A cluster randomized controlled trial in Pakistan: Study protocol

Background: In the Pakistani textile industry the prevalence of workplace respiratory illnesses, including byssinosis, is high. The MultiTex RCT study aims to determine the effectiveness of a multifaceted intervention package in reducing dust levels in cotton mills, decreasing the frequency of respiratory symptoms among cotton textile workers, and improving their lung function.Methods/design: We will conduct a cluster-randomized controlled trial at 28 textile mills in Karachi. The intervention will comprise: training in occupational health for all workers and managers reinforced by regular refresher sessions; the formation of workplace committees to draw up, agree and promote a health and safety plan that includes wet mopping, safe disposal of cotton dust, and the use of simple face-masks, as well as further publicity about the risks from cotton dust; and provision of adequate supplies of face-masks to support the health and safety plan. Participating mills will be randomized to intervention and control arms following a baseline survey. The impact of the intervention will be determined through follow-up surveys conducted at 3, 12 and 18 months. Data collection in the surveys will include spirometry, questionnaire-based interviews and cotton-dust measurements.Discussion: If successful, the study may pave the way for simple, low-cost interventions that can help reduce cotton-dust levels in textile mills, and improve the respiratory health of textile workers in developing countries such as Pakistan

Epidemiology of asthma and associated factors in an urban Pakistani population: Adult asthma study-Karachi

Background: This study was conducted in order to determine the prevalence of asthma and associated risk factors in the adult population of Karachi, Pakistan.Methods: This multi-stage, cross-sectional survey was conducted from May 2014-August 2015; comprising 1629 adults in 75 randomly selected clusters in Karachi, Pakistan. Definitions included: \u27self-reported asthma\u27, \u27reversibility in FEV1\u27 and \u27respiratory symptoms and reversibility in FEV1\u27.Results: Prevalence of asthma was 1.8% (self-reported) (95% CI: 1.0-2.6), 11.3% (reversibility in FEV1) (95% CI: 9.4-13.3) and 6.6% (symptoms and reversibility in FEV1) (95% CI: 5.1-8.1). Asthmatics were more likely to belong to the age group ≥38 years according to \u27reversibility in FEV1\u27 and \u27respiratory symptoms and reversibility in FEV1\u27 (AOR: 1.9, 95% CI: 1.2-3.3) and (AOR: 2.1, 95% CI: 1.1-4.2), respectively. Asthmatics were more likely to report history of allergies (AOR: 1.9, 95% CI: 1.2-2.9) and (AOR: 2.8, 95% CI: 1.7-4.8); and were exposed to environmental tobacco smoke (AOR: 1.6, 95% CI: 1.1-2.5) and (AOR: 1.9, 95% CI: 1.1-3.3) according to \u27reversibility in FEV1\u27 and \u27respiratory symptoms and reversibility in FEV1\u27, respectively. Asthmatics were more likely to report pack years of smoking ≥5 (AOR: 2.3, 95% CI: 1.1-4.7) according to \u27respiratory symptoms and reversibility in FEV1\u27.Conclusion: This study reports a high prevalence of asthma among Pakistani adults and calls for developing appropriate public health policies for prevention and control of asthma in the country. Further studies should be conducted to determine the national prevalence as well as follow-up studies to identify preventable causes for adult asthma

Risk factors for COPD spirometrically defined from the lower limit of normal in the BOLD project.

To access publisher full text version of this article. Please click on the hyperlink in Additional Links field.Chronic obstructive pulmonary disease (COPD) is predicted to become the third most common cause of death and disability worldwide by 2020. The prevalence of COPD defined by the lower limit of normal was estimated using high-quality spirometry in surveys of 14 populations aged ≥ 40 yrs. The strength and consistency of associations were assessed using random effects meta-analysis. Pack-years of smoking were associated with risk of COPD at each site. After adjusting for this effect, we still observed significant associations of COPD risk with age (OR 1.52 for a 10 yr age difference, 95% CI 1.35-1.71), body mass index in obese compared with normal weight (OR 0.50, 95% CI 0.37-0.67), level of education completed (OR 0.76, 95% CI 0.67-0.87), hospitalisation with a respiratory problem before age 10 yrs (OR 2.35, 95% CI 1.42-3.91), passive cigarette smoke exposure (OR 1.24, 95% CI 1.05-1.47), tuberculosis (OR 1.78, 95%CI 1.17-2.72) and a family history of COPD (OR 1.50, 95% CI 1.19-1.90). Although smoking is the most important risk factor for COPD, other risk factors are also important. More research is required to elucidate relevant risk factors in low- and middle-income countries where the greatest impact of COPD will occur.ALTANA Aventis AstraZeneca Boehringer-Ingelheim Chiesi GlaxoSmithKline Merck Novartis Pfizer Schering-Plough Sepracor University of Kentucky Boehringer Ingelheim China (Guangzhou, China) Turkish Thoracic Society Pfizer (Adana, Turkey) Merck Sharpe Dohme Salzburger Gebietskrankenkasse Salzburg Local Government (Salzburg, Austria) Research for International Tobacco Control International Development Research Centre South African Medical Research Council South African Thoracic Society GlaxoSmithKline University of Cape Town Lung Institute (Cape Town, South Africa) Landspitali-University Hospital GlaxoSmithKline Iceland AstraZeneca Iceland (Reykjavik, Iceland) GlaxoSmithKline Pharmaceuticals Polpharma Ivax Pharma Poland AstraZeneca Pharma Poland ZF Altana Pharma Pliva Krakow Linde Gaz Polska Novartis Poland Lek Polska Farmaceutyczne Polfa Starostwo Proszowice Skanska Zasada Agencja Mienia Wojskowego w Krakowie Telekomunikacja Polska Biernacki Amplus Bucki Skrzydlewski Sotwin Agroplon (Krakow, Poland) Pfizer Germany (Hanover, Germany) Norwegian Ministry of Health's Foundation for Clinical Research Haukeland University Hospital's Medical Research Foundation for Thoracic Medicine (Bergen, Norway) GlaxoSmithKline (Vancouver, Canada) Marty Driesler Cancer Project (Lexington, KY, USA) Philippine College of Chest Physicians Boehringer Ingelheim (Phil) Philippine College of Physicians United Laboratories (Phil) (Manila, Philippines) Air Liquide Healthcare P/L AstraZeneca P/L Boehringer Ingelheim P/L GlaxoSmithKline Australia P/L Pfizer Australia P/L (Sydney, Australia) UK Department of Health's Policy (London, UK) Swedish Heart-Lung Foundation Swedish Heart and Lung Association GlaxoSmithKline (Uppsala, Sweden) Adamed Lek Polska Biogra

Worldwide patterns of bronchodilator responsiveness: results from the Burden of Obstructive Lung Disease study.

To access publisher's full text version of this article. Please click on the hyperlink in Additional Links field.Criteria for a clinically significant bronchodilator response (BDR) are mainly based on studies in patients with obstructive lung diseases. Little is known about the BDR in healthy general populations, and even less about the worldwide patterns. 10 360 adults aged 40 years and older from 14 countries in North America, Europe, Africa and Asia participated in the Burden of Obstructive Lung Disease study. Spirometry was used before and after an inhaled bronchodilator to determine the distribution of the BDR in population-based samples of healthy non-smokers and individuals with airflow obstruction. In 3922 healthy never smokers, the weighted pooled estimate of the 95th percentiles (95% CI) for bronchodilator response were 284 ml (263 to 305) absolute change in forced expiratory volume in 1 s from baseline (ΔFEV(1)); 12.0% (11.2% to 12.8%) change relative to initial value (%ΔFEV(1i)); and 10.0% (9.5% to 10.5%) change relative to predicted value (%ΔFEV(1p)). The corresponding mean changes in forced vital capacity (FVC) were 322 ml (271 to 373) absolute change from baseline (ΔFVC); 10.5% (8.9% to 12.0%) change relative to initial value (ΔFVC(i)); and 9.2% (7.9% to 10.5%) change relative to predicted value (ΔFVC(p)). The proportion who exceeded the above threshold values in the subgroup with spirometrically defined Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 2 and higher (FEV(1)/FVC <0.7 and FEV(1)% predicted <80%) were 11.1%, 30.8% and 12.9% respectively for the FEV(1)-based thresholds and 22.6%, 28.6% and 22.1% respectively for the FVC-based thresholds. The results provide reference values for bronchodilator responses worldwide that confirm guideline estimates for a clinically significant level of BDR in bronchodilator testing.ALTANA Aventis AstraZeneca Boehringer-Ingelheim Chiesi GlaxoSmithKline Merck Novartis Pfizer Schering-Plough Sepracor University of Kentucky Boehringer Ingelheim Schering Ploug

Nitrogen deficiency in barley (<i>Hordeum vulgare)</i> seedlings induces molecular and metabolic adjustments that trigger aphid resistance

Agricultural N2O pollution resulting from the use of synthetic fertilisers represents a significant contribution to anthropogenic greenhouse gas emissions, providing a rationale for reduced use of nitrogen fertilisers. Nitrogen limitation results in extensive systems rebalancing that remodels metabolism and defence processes. To analyse the regulation underpinning these responses, barley (Horedeum vulgare) seedlings were grown for seven days under nitrogen-deficient conditions until net photosynthesis was 50% lower than in nitrogen-replete controls. Although shoot growth was decreased there was no evidence for the induction of oxidative stress despite lower total concentrations of nitrogen containing antioxidants. Nitrogen deficient barley leaves were rich in amino acids, sugars and tricarboxylic acid cycle intermediates. In contrast to N-replete leaves one day old nymphs of the green peach aphid (Myzus persicae) failed to reach adulthood when transferred to N-deficient barley leaves. Transcripts encoding cell, sugar and nutrient signalling, protein degradation and secondary metabolism were over-represented in nitrogen-deficient leaves while those associated with hormone metabolism were similar under both nutrient regimes with the exception of mRNAs encoding proteins involved in auxin metabolism and responses. Significant similarities were observed between the N-limited barley leaf transcriptome and that of aphid infested Arabidopsis leaves. These findings not only highlight significant similarities between biotic and abiotic stress signalling cascades but also identify potential targets for increasing aphid resistance with implications for the development of sustainable agriculture

Initiation of Dialysis Is Associated With Impaired Cardiovascular Functional Capacity

Background The transition to dialysis period carries a substantial increased cardiovascular risk in patients with chronic kidney disease. Despite this, alterations in cardiovascular functional capacity during this transition are largely unknown. The present study therefore sought to assess ventilatory exercise response measures in patients within 1 year of initiating dialysis. Methods and Results We conducted a cross‐sectional study of 241 patients with chronic kidney disease stage 5 from the CAPER (Cardiopulmonary Exercise Testing in Renal Failure) study and from the intradialytic low‐frequency electrical muscle stimulation pilot randomized controlled trial cohorts. Patients underwent cardiopulmonary exercise testing and echocardiography. Of the 241 patients (age, 48.9 [15.0] years; 154 [63.9%] men), 42 were predialytic (mean estimated glomerular filtration rate, 14 mL·min −1 ·1.73 m −2 ), 54 had a dialysis vintage ≤12 months, and 145 had a dialysis vintage &gt;12 months. Dialysis vintage ≤12 months exhibited a significantly impaired cardiovascular functional capacity, as assessed by oxygen uptake at peak exercise (18.7 [5.8] mL·min −1 ·kg −1 ) compared with predialysis (22.7 [5.2] mL·min −1 ·kg −1 ; P &lt;0.001). Dialysis vintage ≤12 months also exhibited reduced peak workload, impaired peak heart rate, reduced circulatory power, and increased left ventricular mass index ( P &lt;0.05 for all) compared with predialysis. After excluding those with prior kidney transplant, dialysis vintage &gt;12 months exhibited a lower oxygen uptake at peak exercise (17.0 [4.9] mL·min −1 ·kg −1 ) compared with dialysis vintage ≤12 months (18.9 [5.9] mL·min −1 ·kg −1 ; P =0.033). Conclusions Initiating dialysis is associated with a significant impairment in oxygen uptake at peak exercise and overall decrements in ventilatory and hemodynamic exercise responses that predispose patients to functional dependence. The magnitude of these changes is comparable to the differences between low‐risk New York Heart Association class I and higher‐risk New York Heart Association class II to IV heart failure

Comparison of Oxidative Properties, Light Absorbance, and Total and Elemental Mass Concentration of Ambient PM(2.5) Collected at 20 European Sites

OBJECTIVE: It has been proposed that the redox activity of particles may represent a major determinant of their toxicity. We measured the in vitro ability of ambient fine particles [particulate matter with aerodynamic diameters ≤2.5 μm (PM(2.5))] to form hydroxyl radicals ((•)OH) in an oxidant environment, as well as to deplete physiologic antioxidants (ascorbic acid, glutathione) in the naturally reducing environment of the respiratory tract lining fluid (RTLF). The objective was to examine how these toxicologically relevant measures were related to other PM characteristics, such as total and elemental mass concentration and light absorbance. DESIGN: Gravimetric PM(2.5) samples (n = 716) collected over 1 year from 20 centers participating in the European Community Respiratory Health Survey were available. Light absorbance of these filters was measured with reflectometry. PM suspensions were recovered from filters by vortexing and sonication before dilution to a standard concentration. The oxidative activity of these particle suspensions was then assessed by measuring their ability to generate (•)OH in the presence of hydrogen peroxide, using electron spin resonance and 5,5-dimethyl-1-pyrroline-N-oxide as spin trap, or by establishing their capacity to deplete antioxidants from a synthetic model of the RTLF. RESULTS AND CONCLUSION: PM oxidative activity varied significantly among European sampling sites. Correlations between oxidative activity and all other characteristics of PM were low, both within centers (temporal correlation) and across communities (annual mean). Thus, no single surrogate measure of PM redox activity could be identified. Because these novel measures are suggested to reflect crucial biologic mechanisms of PM, their use may be pertinent in epidemiologic studies. Therefore, it is important to define the appropriate methods to determine oxidative activity of PM

Is fruit and vegetable intake associated with asthma or chronic rhino-sinusitis in European adults? Results from the Global Allergy and Asthma Network of Excellence (GA(2)LEN) Survey

Background: Fruits and vegetables are rich in compounds with proposed antioxidant, anti-allergic and anti-inflammatory properties, which could contribute to reduce the prevalence of asthma and allergic diseases. Objective: We investigated the association between asthma, and chronic rhino-sinusitis (CRS) with intake of fruits and vegetables in European adults. Methods: A stratified random sample was drawn from the Global Allergy and Asthma Network of Excellence (GA(2)LEN) screening survey, in which 55,000 adults aged 15-75 answered a questionnaire on respiratory symptoms. Asthma score (derived from self-reported asthma symptoms) and CRS were the outcomes of interest. Dietary intake of 22 subgroups of fruits and vegetables was ascertained using the internationally validated GA(2)LEN Food Frequency Questionnaire. Adjusted associations were examined with negative binomial and multiple regressions. Simes procedure was used to control for multiple testing. Results: A total of 3206 individuals had valid data on asthma and dietary exposures of interest. 22.8% reported having at least 1 asthma symptom (asthma score >= 1), whilst 19.5% had CRS. After adjustment for potential confounders, asthma score was negatively associated with intake of dried fruits (beta-coefficient -2.34;95% confidence interval [CI] -4.09,-0.59), whilst CRS was statistically negatively associated with total intake of fruits (OR 0.73; 95% CI 0.55, 0.97). Conversely, a positive association was observed between asthma score and alliums vegetables (adjusted beta-coefficient 0.23; 95% CI 0.06, 0.40). None of these associations remained statistically significant after controlling for multiple testing. Conclusion and clinical relevance: There was no consistent evidence for an association of asthma or CRS with fruit and vegetable intake in this representative sample of European adults.Peer reviewe

Evolution of Asthma Severity in a Cohort of Young Adults: Is There Any Gender Difference?

INTRODUCTION:Little is known about the distribution of asthma severity in men and women in the general population. The objective of our study was to describe asthma severity and change in severity according to gender in a cohort of adult asthmatics METHODS:Subjects with asthma were identified from random samples of the 22 to 44 year-olds from the general population, screened for asthma from 1991 to 1993 in 48 centers from 22 countries and followed-up during 1998-2002, as part of the European Community Respiratory Health Survey (ECRHS). All participants to follow-up with current asthma at baseline were eligible for the analysis. To assess change over the follow-up, asthma severity at the two surveys was defined using standardized data on respiratory symptoms, lung function and medication according to the Global Initiative for Asthma (GINA) Guidelines. Another quantitative score (Ronchetti) further considering hospitalizations was also analysed. RESULTS:The study included 685 subjects with asthma followed-up over a mean period of 8.65 yr (min 4.3-max 11.7). At baseline, asthma severity according to GINA was distributed as intermittent: 40.7%, 31.7% as mild persistent, 14% as moderate persistent, and 13.5% as severe persistent. Using the Ronchetti score derived classification, the distribution of asthma severity was 58% mild, (intermittent and mild persistent), 25.8% moderate, and 15.4% severe. Whatever the classification, there was no significant difference in the severity distribution between men and women. There was also no gender difference in the severity distribution among incident cases which developed asthma between the two surveys. Men with moderate-to-severe asthma at baseline were more likely than women to have moderate-to-severe asthma at follow-up. Using GINA, 69.2% of men vs. 53.1% of women (p = 0.09) with moderate-to-severe asthma at baseline were still moderate-to-severe at follow-up. Using Ronchetti score, 53.3% of men vs. 36.2% of women (p = 0.03) with moderate-to-severe asthma at baseline were still moderate-to-severe at follow-up. CONCLUSIONS:There was no gender difference in asthma severity at the two surveys. However, our findings suggest that asthma severity might be less stable in women than in men