Hypersensitivity pneumonitis

Hypersensitivity pneumonitis (HP) is a pulmonary disease with symptoms of dyspnea and cough resulting from the inhalation of an antigen to which the subject has been previously sensitized. The incidence of HP is unknown. A population-based study estimated the annual incidence of interstitial lung diseases as 30:100,000 and HP accounted for less than 2% of these cases. The diagnosis of HP can often be made or rejected with confidence, especially in areas of high or low prevalence respectively, using simple diagnostic criteria. Chest X-rays may be normal in active HP; High Resolution Computed Tomography is sensitive but not specific for the diagnosis of HP. The primary use of pulmonary function tests is to determine the physiologic abnormalities and the associated impairment. Despite the pitfalls of false positive and false negatives, antigen-specific IgG antibodies analysis can be useful as supportive evidence for HP. Bronchoalveolar lavage plays an important role in the investigation of patients suspected of having HP. A normal number of lymphocytes rules out all but residual disease. Surgical lung biopsy should be reserved for rare cases with puzzling clinical presentation or for verification the clinical diagnosis when the clinical course or response to therapy is unusual. Being an immune reaction in the lung, the most obvious treatment of HP is avoidance of contact with the offending antigen. Systemic corticosteroids represent the only reliable pharmacologic treatment of HP but do not alter the long-term outcome. The use of inhaled steroids is anecdotal. Treatment of chronic or residual disease is supportive

Post-exercise heart rate recovery and mortality in chronic obstructive pulmonary disease

SummaryAbnormal heart rate recovery (HRR) after exercise, a marker of cardiac autonomic dysfunction, is associated with poor prognosis in various populations. As chronic obstructive pulmonary disease (COPD) is associated with cardiac autonomic dysfunction, we tested the hypothesis that patients with COPD have a lower HRR than healthy people, and evaluated whether a delay in HRR is associated with an increased risk of mortality in COPD. The records of 147 COPD patients were reviewed (65.1±9.1 years, mean±sd, 42 women/105 men, forced expiratory volume in 1s (FEV1): 42±15% predicted) and compared to 25 healthy subjects (61.6±4.5 years, 5 women/20 men, FEV1: 100±14% predicted) during recovery after an exercise test. Heart rate was measured at peak exercise and at 1-min recovery, the difference between the two being defined as HRR (11±9 beats in COPD patients vs. 20±9 beats in healthy subjects, P<0.0001). During a mean follow-up of 43.1±22.0 months, 32 patients died. Abnormal HRR (⩽14 beats) was a strong predictor of mortality in COPD patients (adjusted hazard ratio: 5.12, 95% CI [1.54–17.00]). In conclusion, COPD patients have a lower HRR than healthy subjects, and have a worse prognosis when presenting abnormal HRR

Validity of chronic obstructive pulmonary disease diagnoses in a large administrative database,”

H ealth authorities (often the payers of health care) create and maintain administrative databases by compiling claims data sets. Claims data include the patient diagnosis that motivated the provision of services and the charges paid for the services provided. Typically, the database includes patient demographics and patient-level data about their use of health care resources. Administrators and health care researchers can access the information in these databases to ascertain resource use, even if it involved several providers and health care centres (1-3). When one payer reimburses all health care provisions, these databases afford the opportunity to conduct large populationbased observational studies with minimal referral bias, nonresponse and drop-outs. Similar to other investigators, we were interested in exploiting such a database for a series of studies that could answer health services questions (eg, utilization or quality of care) and clinical questions related to chronic obstructive pulmonary disease (COPD). Before doing so, we considered the underlying validity of the diagnoses included in the database. The objective of the present study was, therefore, to determine the extent to which the principal diagnoses of COPD made in hospitalized patients and recorded in a large administrative database were valid, ie, corroborated by clinical history (including smoking status) and pulmonary function tests

The laval questionnaire: a new instrument to measure quality of life in morbid obesity

<p>Abstract</p> <p>Background</p> <p>Our recent review of the literature uncovered eleven obesity-specific quality of life questionnaires, all with incomplete demonstration of their measurement properties. Our objective was to validate a new self-administered questionnaire specific to morbid obesity to be used in clinical trials. The study was carried out at the bariatric surgery clinic of Laval Hospital, Quebec City, Canada.</p> <p>Methods</p> <p>This study followed our description of health-related quality of life in morbid obesity from which we constructed the Laval Questionnaire. Its construct validity and responsiveness were tested by comparing the baseline and changes at 1-year follow-up in 6 domain scores (symptoms, activity/mobility, personal hygiene/clothing, emotions, social interactions, sexual life) with those of questionnaires measuring related constructs (SF-36, Impact of Weight on Quality of Life-Lite, Rosenberg Self-Esteem Scale and Beck Depression Inventory-II).</p> <p>Results</p> <p>112 patients (67 who got bariatric surgery, 45 who remained on the waiting list during the study period) participated in this study. The analysis of the discriminative function of the questionnaire showed moderate-to-high correlations between the scores in each domain of our instrument and the corresponding questionnaires. The analysis of its evaluative function showed (1) significant differences in score changes between patients with bariatric surgery and those without, and (2) moderate-to-high correlations between the changes in scores in the new instrument and the changes in the corresponding questionnaires. Most of these correlations met the <it>a priori </it>predictions we had made regarding their direction and magnitude.</p> <p>Conclusion</p> <p>The Laval Questionnaire is a valid measure of health-related quality of life in patients with morbid obesity and is responsive to treatment-induced changes.</p

Modélisation d’un métier du lien social dans le cadre d’un programme d’intervention nutritionnelle en contexte scolaire défavorisé

Le métier d’agent de développement social dans le cadre d’une intervention nutritionnelle est mal connu, notamment parce qu’il est en cours de définition dans l’action. L’intention de cet article est de mieux comprendre l’agencement des sources conceptuelles de ce métier du lien social afin de contribuer à une meilleure compréhension de son émergence. À partir d’une perspective qualitative, nous avons élaboré une cartographie des différentes représentations des logiques d’intervention caractérisant le développement social dans le cadre du programme Petits cuistots-Parents en réseau. La modélisation proposée illustre l’étonnante dispersion des activités de développement social et révèle les conditions pragmatiques du métier.The social development agent profession is little known, notably because it is in the process of being defined through action. The intention of this article is to comprehend the harmonization of the conceptual sources of this social linkage profession in order to shed light on its emergence. From a qualitative perspective, a map of the various representations of the intervention logics that characterize social development, in the context of the program Petits cuistots-Parents en réseau, was elaborated. The modelization proposed illustrates the astonishing dispersion of social development activities and reveals the pragmatic conditions of the profession

Multi-center, randomized, placebo-controlled trial of nocturnal oxygen therapy in chronic obstructive pulmonary disease: a study protocol for the INOX trial

Abstract\ud \ud Background\ud Long-term oxygen therapy (LTOT) is the only component of the management of chronic obstructive pulmonary disease (COPD) that improves survival in patients with severe daytime hypoxemia. LTOT is usually provided by a stationary oxygen concentrator and is recommended to be used for at least 15–18 h a day. Several studies have demonstrated a deterioration in arterial blood gas pressures and oxygen saturation during sleep in patients with COPD, even in those not qualifying for LTOT. The suggestion has been made that the natural progression of COPD to its end stages of chronic pulmonary hypertension, severe hypoxemia, right heart failure, and death is dependent upon the severity of desaturation occurring during sleep. The primary objective of the International Nocturnal Oxygen (INOX) trial is to determine, in patients with COPD not qualifying for LTOT but who present significant nocturnal arterial oxygen desaturation, whether nocturnal oxygen provided for a period of 3 years decreases mortality or delay the prescription of LTOT.\ud \ud \ud Methods\ud The INOX trial is a 3-year, multi-center, placebo-controlled, randomized trial of nocturnal oxygen therapy added to usual care. Eligible patients are those with a diagnosis of COPD supported by a history of past smoking and obstructive disease who fulfill our definition of significant nocturnal oxygen desaturation (i.e., ≥ 30% of the recording time with transcutaneous arterial oxygen saturation < 90% on either of two consecutive recordings). Patients allocated in the control group receive room air delivered by a concentrator modified to deliver 21% oxygen. The comparison is double blind. The primary outcome is a composite of mortality from all cause or requirement for LTOT. Secondary outcomes include quality of life and utility measures, costs from a societal perspective and compliance with oxygen therapy. The follow-up period is intended to last at least 3 years.\ud \ud \ud Discussion\ud The benefits of LTOT have been demonstrated whereas those of nocturnal oxygen therapy alone have not. The INOX trial will likely determine whether supplemental oxygen during sleep is effective in reducing mortality, delaying the need for LTOT and improving health-related quality of life in patients with COPD who desaturate overnight.\ud \ud \ud Trial registration\ud Current Controlled Trials \ud ISRCTN50085100\ud \ud ; ClinicalTrials.gov \ud NCT01044628\ud \ud (date of registration: January 6, 2010)

Efficacy of theophylline in people with stable chronic obstructive pulmonary disease: a systematic review and meta-analysis

Objectives: To determine the efficacy of oral theophylline compared with placebo in people with stable chronic obstructive pulmonary disease (COPD).Methods: Systematic review of randomized-controlled trials comparing oral Theophylline; with placebo for a minimum of 7 days in people with stable COPD.Results: Twenty randomized-controlled trials were included in this review. the Meta-analysis; following outcomes showed significant improvement with theophylline compared with placebo: FEV, and FVC both improved with theophylline (weighted mean difference [WMD] 0.10 L; 95% confidence interval [95% CI] 0.04-0.16 and WMD 0.21 L; 95% CI 0.10-0.32, respectively). VO2 max also improved with theophylline (WMD 195.27mL/ min; 95% Cl 112.71-277.83), as did PaO2 and PaCO2 (WMD 3.18mmHg;,95% Cl 1.23-5.13 and WMD -2.36mmHg; 95% Cl -3.52 to -1.21, respectively). Patients preferred theophylline over placebo (relative risk 2.27; 95% Cl 1.26-4.11). Theophylline increased the risk of nausea compared with placebo (RR 7.67; 95% Cl 1.47-39.94).Conclusion: This review has shown that theophylline still has a role in the management of stable COPD, and is preferred by patients over placebo. However, the benefits of theophylline in stable COPD have to be weighed against the risk of adverse effects. (C) 2004 Elsevier B.V. All rights reserved.Natl Collaborating Ctr Womens & Childrens Hlth, London, EnglandUniversidade Federal de São Paulo, Div Resp, São Paulo, BrazilEmergency Med Div, São Paulo, BrazilFed Univ Alagoas, Vasc Dis Div, São Paulo, BrazilUNIFESP, Div Resp, Pulm Rehabil Ctr, São Paulo, BrazilUniv Toronto, W Pk Healthcare Ctr, Toronto, ON, CanadaUniv Laval, Hop Laval, Ctr Pneumol, Inst Cardiol & Pneumol, Laval, PQ, CanadaUniversidade Federal de São Paulo, Div Internal Med, São Paulo, BrazilUniversidade Federal de São Paulo, Div Resp, São Paulo, BrazilUNIFESP, Div Resp, Pulm Rehabil Ctr, São Paulo, BrazilUniversidade Federal de São Paulo, Div Internal Med, São Paulo, BrazilWeb of Scienc