Trends in Asthma Prevalence in Canadians, Asthma Course Trajectories in Children, and the Effect of Maternal Gestational Diabetes Mellitus on the Risk of Asthma in the Offspring

Asthma causes substantial public health burden. An enhanced understanding of asthma burden, asthma course and identification of intervenable risk factor is warranted. The objectives of this research were to: 1) examine the age, period and cohort effects on asthma prevalence among Canadian adults during 1994–2011 (manuscript one); 2) identify the trajectories of asthma exacerbation and their predictors in children with incident asthma (manuscript two); and 3) examine the effect of maternal gestational diabetes mellitus on the risk of asthma in offspring (manuscript three). Longitudinal data from 13,616 individuals in the National Population Health Survey, household component were used to address objective one using generalized estimating equations. Data from 403 children with asthma in the National Longitudinal Survey of Children and Youth (NLSCY) were used to address objective two using latent class growth modeling and multinomial logistic regression. Pooled logistic regression was performed on data from 19,933 children in the NLSCY to address objective three. By age, asthma prevalence was 12% in 20-year-olds, 6% in 50–60-year-olds, and 8% in 80-year-olds in Canadian adults. By period, asthma prevalence increased from 5% in 1994/1995 to 11% in 2010/2011. There was some evidence of cohort effect on asthma prevalence. Three distinct trajectories of asthma exacerbation were identified in children with incident asthma: low increasing (21.3% of children), medium decreasing (45.8% of children) and high decreasing (32.8% of children). Number of siblings at home and age at asthma diagnosis predicted trajectory group membership. The adjusted hazard ratio for the association between maternal gestational diabetes mellitus and incident asthma in the offspring was 1.25 (95% confidence interval [CI]: 1.03, 1.51). Our findings suggest the presence of age, period and cohort effects on prevalence of asthma in Canadian adults. Children with incident asthma apparently follow three distinct trajectories of asthma exacerbations. Gestational diabetes mellitus appears to increase the risk of asthma in the offspring. The findings from this research provide further insights into trends in asthma burden in Canadian adults, asthma exacerbation trajectories in children that would aid physicians in prognosticating its course, and potential opportunity for prevention of asthma in children

Food Adulteration and Consumer Awareness in Dhaka City, 1995-2011

We conducted this study to investigate the magnitude of food adulteration during 1995\u20132011 and consumer awareness in Dhaka city. We reviewed results of food sample testing by Public Health Food Laboratory of Dhaka City Corporation, Bangladesh Standards and Testing Institution, Consumers Association of Bangladesh publications, reports from lay press, including those on mobile magistrate court operations. We conducted a cross-sectional survey among 96 residents of Dhaka city, using a structured questionnaire in 2006. The overall proportion of food samples adulterated decreased during 2001-2005, and 40-54% of daily-consumed food was adulterated during 1995-2011. More than 35 food items were commonly adulterated. Consumers considered expiry date and quality or freshness as the best criteria while buying packaged and open food items respectively; only 11 (12%) respondents considered approval of regulatory authority for buying packaged food items. More than half of the food consumed in Dhaka city is adulterated, which warrants actions by the Government, the industry, and the consumers

Asthma exacerbation trajectories and their predictors in children with incident asthma.

BACKGROUND: Asthma exacerbation trajectories in children after incident asthma diagnosis are understudied. OBJECTIVE: To identify trajectories of asthma exacerbation and predictors of these trajectories in children with incident asthma. METHODS: Children from the National Longitudinal Survey of Children and Youth, Canada, with incident asthma were followed-up for up to 12 years during childhood. Latent class growth modeling was used to identify distinct asthma exacerbation trajectory groups. Multinomial logistic regression was performed to identify predictors of trajectory group membership. RESULTS: The mean age at asthma diagnosis among 403 children was 5.9 years. Three distinct trajectories were identified: low increasing (21.3% of children), medium decreasing (45.8% of children), and high decreasing (32.8% of children). Asthma attack probability increased gradually after diagnosis in low increasing group, decreased from moderate level after diagnosis to almost zero probability at the end of follow-up in the medium decreasing group, and decreased after diagnosis but remained higher in the high decreasing group than the other 2 groups at 12 years after diagnosis. Children having more siblings at home were more likely to belong to the medium decreasing and high decreasing trajectory groups, whereas children older at asthma diagnosis were less likely to belong to the medium decreasing and high decreasing trajectory groups than the low increasing trajectory group. CONCLUSION: Our results suggest that children with incident asthma follow 3 distinct trajectories of asthma exacerbations after asthma diagnosis. The trajectory group with initial moderate exacerbation probability has better long-term prognosis

Competing biosecurity and risk rationalities in the Chittagong poultry commodity chain, Bangladesh

This paper anthropologically explores how key actors in the Chittagong live bird trading network perceive biosecurity and risk in relation to avian influenza between production sites, market maker scenes and outlets. They pay attention to the past and the present, rather than the future, downplaying the need for strict risk management, as outbreaks have not been reported frequently for a number of years. This is analysed as ‘temporalities of risk perception regarding biosecurity’, through Black Swan theory, the idea that unexpected events with major effects are often inappropriately rationalized (Taleb in The Black Swan. The impact of the highly improbable, Random House, New York, 2007). This incorporates a sociocultural perspective on risk, emphasizing the contexts in which risk is understood, lived, embodied and experienced. Their risk calculation is explained in terms of social consent, practical intelligibility and convergence of constraints and motivation. The pragmatic and practical orientation towards risk stands in contrast to how risk is calculated in the avian influenza preparedness paradigm. It is argued that disease risk on the ground has become a normalized part of everyday business, as implied in Black Swan theory. Risk which is calculated retrospectively is unlikely to encourage investment in biosecurity and, thereby, points to the danger of unpredictable outlier events

Pneumococcal disease burden and vaccination coverage in older adults: where does Canada stand?

Prevention of vaccine-preventable infectious diseases in aging adult population is imperative for healthy aging. Here we reflect on where Canada stands with regard to vaccine-preventable pneumococcal diseases in older adults, specifically the continuing high disease burden, current evidence on effectiveness and observed impact of pneumococcal vaccines, and suboptimal vaccine uptake in older adults. The need for ongoing strong disease surveillance is emphasized, and the implications of a lack of adult vaccine registry are also discussed

Age, period, and cohort effects on asthma prevalence in Canadian adults, 1994-2011.

PURPOSE: To examine the age, period, and cohort effects on asthma prevalence among Canadian adults from 1994/1995 to 2010/2011. METHODS: Using data from the National Population Health Survey, 13,616 Canadian adults were followed for 16 years. Age was limited to 18-80 years during follow-up. Modified Poisson regression models with generalized estimating equations were used to estimate age, period, and cohort effects on asthma and active asthma prevalence after accounting for sociodemographic factors. Model-based standardization was performed to estimate standardized rates. RESULTS: Overall asthma prevalence increased from 5% in 1994/1995 to 11% in 2010/2011; decreasing from 12% for 20-year-olds to 6% for 50-60-year-olds and then increased to 8% for 80-year-olds. Individuals aged 20 years had the steepest increase in prevalence between 1994/1995 and 2010/2011. Active asthma prevalence increased from 5% in 1994/1995 to 8% in 2010/2011; decreasing from 8% for 20-year-olds to 5% for 50-60-year-olds and then increased to 6% for 80-year-olds. CONCLUSIONS: Our findings suggest the presence of age, period, and cohort effects on prevalence of asthma overall and presence of age and period effects on active asthma prevalence in Canadian adults

Prevalence of Latent Tuberculosis among Health Care Workers in High Burden Countries: A Systematic Review and Meta-Analysis

<div><p>Background</p><p>Tuberculosis is one of the leading causes of death worldwide. Twenty-two high burden countries contributed to the majority of worldwide tuberculosis cases in 2015. Health care workers are at high risk of acquiring tuberculosis through occupational exposure.</p><p>Objective</p><p>To estimate the prevalence of latent tuberculosis infection (LTBI) among health care workers in high burden countries.</p><p>Methods</p><p>Databases including MEDLINE (Ovid), EMBASE (Ovid), CINAHL (Ovid) and ISI Web of Science (Thompson-Reuters), and grey literature were searched for English language records on relevant medical subject headings (MeSH) terms of LTBI and health care providers. Literature was systematically reviewed using EPPI-Reviewer4 software. Prevalence and incidence of LTBI and 95% confidence intervals (CI) were reported. Pooled prevalence of LTBI and 95% CI were calculated using random-effects meta-analysis models and heterogeneity was assessed using <i>I</i>^<i>2</i> statistics. Sub-group analysis was conducted to assess the cause of heterogeneity.</p><p>Results</p><p>A total of 990 records were identified. Of those, 18 studies from only 7 high burden countries representing 10,078 subjects were included. Tuberculin skin test results were available for 9,545 participants. The pooled prevalence of LTBI was 47% (95% CI 34% to 60%, <i>I</i>^<i>2</i> = 99.6%). In subgroup analyses according to the country of the study, the pooled prevalence of LTBI was lowest in Brazil (37%) and highest in South Africa (64%). The pooled prevalence of LTBI among medical and nursing students was 26% (95% CI 6% to 46%, <i>I</i>^<i>2</i> = 99.3%) while the prevalence among all types of health care workers was 57% (95% CI 44% to 70%, <i>I</i>^<i>2</i> = 99.1%). Incidence of LTBI was available for health care workers in four countries. The cumulative incidence ranged from 2.8% in Brazilian medical students to 38% among all types of health care workers in South Africa.</p><p>Conclusion</p><p>The findings of this study suggest that there is a high burden of LTBI among health care workers in high burden countries. Adequate infection control measures are warranted to prevent and control transmission in health care settings.</p></div

Forest plot showing country-specific pooled estimates of prevalence of LTBI.

<p>Forest plot showing country-specific pooled estimates of prevalence of LTBI.</p

Funnel plot for included studies on latent tuberculosis among health care workers.

<p>Funnel plot for included studies on latent tuberculosis among health care workers.</p