101 research outputs found
Global Epidemiology of Lung Cancer.
While lung cancer has been the leading cause of cancer-related deaths for many years in the United States, incidence and mortality statistics - among other measures - vary widely worldwide. The aim of this study was to review the evidence on lung cancer epidemiology, including data of international scope with comparisons of economically, socially, and biologically different patient groups. In industrialized nations, evolving social and cultural smoking patterns have led to rising or plateauing rates of lung cancer in women, lagging the long-declining smoking and cancer incidence rates in men. In contrast, emerging economies vary widely in smoking practices and cancer incidence but commonly also harbor risks from environmental exposures, particularly widespread air pollution. Recent research has also revealed clinical, radiologic, and pathologic correlates, leading to greater knowledge in molecular profiling and targeted therapeutics, as well as an emphasis on the rising incidence of adenocarcinoma histology. Furthermore, emergent evidence about the benefits of lung cancer screening has led to efforts to identify high-risk smokers and development of prediction tools. This review also includes a discussion on the epidemiologic characteristics of special groups including women and nonsmokers. Varying trends in smoking largely dictate international patterns in lung cancer incidence and mortality. With declining smoking rates in developed countries and knowledge gains made through molecular profiling of tumors, the emergence of new risk factors and disease features will lead to changes in the landscape of lung cancer epidemiology
Barriers to adherence to COPD guidelines among primary care providers
Background:
Despite efforts to disseminate guidelines for managing chronic obstructive pulmonary disease (COPD), adherence to COPD guidelines remains suboptimal. Barriers to adhering to guidelines remain poorly understood.
Methods:
Clinicians from two general medicine practices in New York City were surveyed to identify barriers to implementing seven recommendations from the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. Barriers assessed included unfamiliarity, disagreement, low perceived benefit, low self-efficacy, and time constraints. Exact conditional regression was used to identify barriers independently associated with non-adherence.
Results:
The survey was completed by 154 clinicians. Adherence was lowest to referring patients with a forced expiratory volume in 1 s (FEV_1) <80% predicted to pulmonary rehabilitation (5%); using FEV_1 to guide management (12%); and ordering pulmonary function tests (PFTs) in smokers (17%). Adherence was intermediate to prescribing inhaled corticosteroids when FEV1 <50% predicted (41%) and long-acting bronchodilators when FEV1 <80% predicted (54%). Adherence was highest for influenza vaccination (90%) and smoking cessation counseling (91%). In unadjusted analyses, low familiarity with the guidelines, low self-efficacy, and time constraints were significantly associated with non-adherence to ≥2 recommendations. In adjusted analyses, low self-efficacy was associated with less adherence to prescribing inhaled corticosteroids (OR: 0.28; 95% CI: 0.10, 0.74) and time constraints were associated with less adherence to ordering PFTs in smokers (OR: 0.31; 95% CI: 0.08, 0.99).
Conclusions:
Poor familiarity with recommendations, low self-efficacy, and time constraints are important barriers to adherence to COPD guidelines. This information can be used to develop tailored interventions to improve guideline adherence
Survival and risk of adverse events in older patients receiving postoperative adjuvant chemotherapy for resected stages II-IIIA lung cancer: observational cohort study
Objective To compare the survival and risk of serious adverse events in older patients with stages II-IIIA non-small cell lung cancer treated with or without postoperative platinum based chemotherapy
Allergen Sensitization and Asthma Outcomes among World Trade Center Rescue and Recovery Workers
A large number of World Trade Center (WTC) rescue and recovery workers are affected by asthma. While physical and mental health comorbidities have been associated with poor asthma control in this population, the potential role of allergen sensitization is unknown. This study examined the association of indoor sensitization and exposure as a risk factor for increased asthma morbidity in WTC workers. We used data from a prospective cohort of 331 WTC workers with asthma. Sensitization to indoor allergens was assessed by measurement of antigen-specific serum immunoglobulin E (IgE) levels. We used validated tools to evaluate the exposure to indoor allergens. Asthma morbidity outcomes included level of control (Asthma Control Questionnaire, ACQ), quality of life (Asthma Quality of Life Questionnaire, AQLQ) and acute resource utilization. The prevalence of sensitization to cat, dog, mouse, dust mite, cockroach, and mold allergens were 33%, 21%, 17%, 40%, 17%, and 17%, respectively. Unadjusted and regression analyses showed no significant relationship between sensitization and increased asthma morbidity (p \u3e 0.05 for all comparisons), except for sensitization to Aspergillus Fumigatus, cat and mouse epithelium, which were associated with decreased morbidity
Assessing the relationship between lung cancer risk and emphysema detected on low-dose CT of the chest.
Identification of risk factors for lung cancer can help in selecting
patients who may benefit the most from smoking cessation interventions, early
detection, or chemoprevention. OBJECTIVE: To evaluate whether the presence of
emphysema on low-radiation-dose CT (LDCT) of the chest is an independent risk
factor for lung cancer. METHODS: The study used data from a prospective cohort of
1,166 former and current smokers participating in a lung cancer screening study.
All individuals underwent a baseline LDCT and spirometry followed by yearly
repeat LDCT studies. The incidence density of lung cancer among patients with and
without emphysema on LDCT was estimated. Stratified and multiple regression
analyses were used to assess whether emphysema is an independent risk factor for
lung cancer after adjusting for age, gender, smoking history, and the presence of
airway obstruction on spirometry. RESULTS: On univariate analysis, the incidence
density of lung cancer among individuals with and without emphysema on LDCT was
25.0 per 1,000 person-years and 7.5 per 1,000 person-years, respectively (risk
ratio [RR], 3.33; 95% confidence interval [CI], 1.41 to 7.85). Emphysema was also
associated with increased risk of lung cancer when the analysis was limited to
individuals without airway obstruction on spirometry (RR, 4.33; 95% CI, 1.04 to
18.16). Multivariate analysis showed that the presence of emphysema (RR, 2.51;
95% CI, 1.01 to 6.23) on LDCT but not airway obstruction (RR, 2.10; 95% CI, 0.79
to 5.58) was associated with increased risk of lung cancer after adjusting for
potential cofounders. CONCLUSIONS: Results suggest that the presence of emphysema
on LDCT is an independent risk factor for lung cancer
Emphysema scores predict death from COPD and lung cancer
OBJECTIVE:
Our objective was to assess the usefulness of emphysema scores in predicting death from COPD and lung cancer.
METHODS:
Emphysema was assessed with low-dose CT scans performed on 9,047 men and women for whom age and smoking history were documented. Each scan was scored according to the presence of emphysema as follows: none, mild, moderate, or marked. Follow-up time was calculated from time of CT scan to time of death or December 31, 2007, whichever came first. Cox regression analysis was used to calculate the hazard ratio (HR) of emphysema as a predictor of death.
RESULTS:
Median age was 65 years, 4,433 (49%) were men, and 4,133 (46%) were currently smoking or had quit within 5 years. Emphysema was identified in 2,637 (29%) and was a significant predictor of death from COPD (HR, 9.3; 95% CI, 4.3-20.2; P < .0001) and from lung cancer (HR, 1.7; 95% CI, 1.1-2.5; P = .013), even when adjusted for age and smoking history.
CONCLUSIONS:
Visual assessment of emphysema on CT scan is a significant predictor of death from COPD and lung cancer
The utility of B-type natriuretic peptide in the diagnosis of heart failure in the emergency department: a systematic review
<p>Abstract</p> <p>Background</p> <p>Dyspnea is a common chief complaint in the emergency department (ED); differentiating heart failure (HF) from other causes can be challenging. Brain Natriuretic Peptide (BNP) is a new diagnostic test for HF for use in dyspneic patients in the ED. The purpose of this study is to systematically review the accuracy of BNP in the emergency diagnosis of HF.</p> <p>Methods</p> <p>We searched MEDLINE (1975–2005) supplemented by reference tracking. We included studies that reported the sensitivity and specificity of BNP for diagnosing HF in ED patients with acute dyspnea. Two reviewers independently assessed study quality. We pooled sensitivities and specificities within five ranges of BNP cutoffs.</p> <p>Results</p> <p>Ten studies including 3,344 participants met inclusion criteria. Quality was variable; possible verification or selection bias was common. No studies eliminated patients with obvious medical causes of dyspnea. Most studies used the Triage BNP assay; all utilized a clinical reference standard. Pooled sensitivity and specificity at a BNP cutoff of 100–105 pg/ml were 90% and 74% with negative likelihood ratio (LR) of 0.14; pooled sensitivity was 81% with specificity of 90% at cutoffs between 300 and 400 pg/ml with positive LR of 7.6.</p> <p>Conclusion</p> <p>Our analysis suggests that BNP has moderate accuracy in detecting HF in the ED. Our results suggest utilizing a BNP of less than 100 pg/ml to rule out HF and a BNP of greater than 400 pg/ml to diagnose HF. Many studies were of marginal quality, and all included patients with varying degrees of diagnostic uncertainty. Further studies focusing on patients with diagnostic uncertainty will clarify the real-world utility of BNP in the emergency management of dyspnea.</p
Risks associated with dispersive nocturnal flights of sylvatic Triatominae to artificial lights in a model house in the northeastern plains of Colombia
The global burden of pulmonary diseases: most prevalent problems and opportunities for improvement
Diseases of the respiratory system are a leading cause of morbidity, mortality and disability worldwide. The lungs are constantly exposed to a myriad of noxious agents present in ambient air, such as particles, chemicals and infectious organisms. At least 2 billion people are exposed globally to the toxic smoke produced by combustion of biomass fuel, inefficiently burned in poorly ventilated indoor stoves or fireplaces used for cooking or warming. One billion people inhale polluted outdoor air, and another billion are exposed primarily or secondarily to tobacco smoke. As a consequence, respiratory disease is a major cause of morbidity, disability and death worldwide primarily affecting individuals of low socioeconomic status, who are exposed to crowding, environmental exposures and poor living conditions
The global burden of pulmonary diseases: most prevalent problems and opportunities for improvement
Diseases of the respiratory system are a leading cause of morbidity, mortality and disability worldwide. The lungs are constantly exposed to a myriad of noxious agents present in ambient air, such as particles, chemicals and infectious organisms. At least 2 billion people are exposed globally to the toxic smoke produced by combustion of biomass fuel, inefficiently burned in poorly ventilated indoor stoves or fireplaces used for cooking or warming. One billion people inhale polluted outdoor air, and another billion are exposed primarily or secondarily to tobacco smoke. As a consequence, respiratory disease is a major cause of morbidity, disability and death worldwide primarily affecting individuals of low socioeconomic status, who are exposed to crowding, environmental exposures and poor living conditions
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