Respiratory symptoms and chronic obstructive pulmonary disease among cement factory workers

OBJECTIVES: This study assessed chronic respiratory symptoms and chronic obstructive pulmonary disease (COPD) among workers exposed to cement dust at a Tanzanian cement factory. METHODS: A total of 120 exposed workers and 107 controls participated in this cross-sectional investigation. Information on demographics, occupational history, chronic respiratory symptoms, smoking habits, and use of respiratory protection equipment was collected by questionnaire. Ventilatory function testing and measurement of personal total dust exposure were also carried out. COPD was diagnosed for workers with chronic bronchitis who also had spirometric airflow obstruction. Chronic respiratory symptoms and COPD were correlated with cumulative total dust exposure and adjusted for age, pack-years, and education. RESULTS: The exposed workers had more chronic cough [odds ratio (OR) 4.5, 95% confidence interval (95% CI) 1.9-10.4], chronic sputum production (OR 10.8, 95% CI 4.4-26.4.), dyspnea (OR 5.3, 95% CI 1.9-15.2), work-related shortness of breath (OR 4.8, 95% CI 1.6-14.2), and chronic bronchitis (OR 5.5, 95% CI 2.0-15.3) than the controls. Chronic cough, chronic sputum production, dyspnea, work-related shortness of breath, and chronic bronchitis were significantly related to cumulative dust exposure of 20.0-99.9 and > or = 100.0 versus <20.0 mg/m3-years. The prevalence of COPD was higher for the exposed group (18.8%) than for the controls (4.8%). The odds ratio for COPD was significantly increased for cumulative dust exposure, > or = 100.0 versus <20.0 mg/m3-years (OR 11.2, 95% CI 2.2-56.0). CONCLUSIONS: Cement workers seem to be at high risk of developing chronic respiratory symptoms and COPD, probably caused by cumulative total dust exposure independent of smoking habits.     

Dust exposure and the impact on hospital readmission of farming and wood industry workers for asthma and chronic obstructive pulmonary disease (COPD)

Objectives:It is still not well established how occupational air pollutants affect the prognosis of asthma or chronic obstructive pulmonary disease (COPD). This study uses nationwide Danish registers and quantitative dust industry exposure matrices (IEM) for the farming and wood industries to estimate whether previous year dust exposure level impacts hospital readmissions for workers diagnosed with asthma or COPD.Methods:We identified all individuals with a first diagnosis of either asthma (769 individuals) or COPD (342 individuals) between 1997 and 2007 and followed them until the next hospital admission for asthma or COPD, emigration, death or 31 December 2007. We included only individuals who worked in either the wood or farming industries at least one year during follow-up. We used logistic regression analysis to investigate associations between dust exposure level in the previous year and hospital readmission, adjusting for sex, age, time since first diagnosis, socioeconomic status, and labor force participation.Results:Asthma readmissions for individuals with low and high dust exposure were increased [adjusted rate ratio (RR_adj) 2.52, 95% confidence interval (CI) 1.45–4.40] and RR_adj 2.64 (95% CI 1.52–4.60), respectively. For COPD readmission, the risk estimates were RR_adj 1.36 (95% CI 0.57–3.23) for low and RR_adj 1.20 (95% CI 0.49–2.95) for high exposure level in the previous year. For asthma readmission, stratified analyses by type of dust exposure during follow-up showed increased risks for both wood dust [RR_adj 2.67 (95% CI 1.35–5.26) high exposure level] and farming dust [RR_adj 3.59 (95% CI 1.11–11.59) high exposure level]. No clear associations were seen for COPD readmissions.Conclusions:This study indicates that exposure to wood or farm dust in the previous year increases the risk of hospital readmission for individuals with asthma but not for those with COPD.     

The family planning “know–do” gap among married women of reproductive age in urban Pakistan

OBJECTIVE:To examine the prevalence and predictors of family planning (FP) know-do gaps among married women of reproductive age (MWRA) in low socio-economic urban areas of Karachi, Pakistan.DESIGN:This was a cross-sectional survey of randomly selected 7288 MWRA (16–49 years) to identify predictors of the know-do gap in FP using a logistic regression model.RESULTS:More than one third (35.5%) of MWRA had FP know-do gap, i.e., despite having a knowledge of contraceptives and desire to limit or delay childbearing, they were not using contraceptives. Women were less likely to use FP if they were getting older (25–35 years: OR 1.45, 95% CI 1.09–1.94; >35 years: OR 3.02, 95% CI 1.90–4.80), from certain ethnicities (Sindhi: OR 1.64, 95% CI 1.11–2.42; Saraiki: OR 1.66, 95% CI 1.01–2.71; other minorities: OR 2.37, 95% CI 1.63–3.44); did not receive FP counselling: OR 1.43, 95% CI 1.13–1.80; and had not made a joint decision on FP: OR 1.44, 95% CI 1.06–1.98). Conversely, women were more likely to use contraceptives if they had >10 years of schooling (OR 0.66, 95% CI 0.46–0.94), with each increasing number of a living child (OR 0.68, 95% CI 0.62–0.75) and each increasing number of contraceptive method known (OR 0.93, 95% CI 0.88–0.98).CONCLUSION:The predictors associated with the FP know-do gap among MWRA should be considered when planning future strategies to improve the contraceptive prevalence rate in Pakistan.     

Chronic Kidney Disease and Associated Factors among Diabetic Patients at the Diabetic Clinic in a Police Hospital,Addis Ababa

BackgroundDiabetes mellitus remains the leading cause of end-stage renal disease in most countries in the world. In Ethiopia, renal complications of diabetes may remain unrecognized due to limited diagnostic resources. As a result, the prevalence of chronic kidney disease among adult diabetics in Ethiopia has not been well described. Hence, this study was aimed at assessing the prevalence of chronic kidney disease and associated factors among diabetic patients who attended the federal police hospital diabetic clinic in Addis AbabaMethodsA cross-sectional study was conducted among 362 Diabetes Mellitus. Data were collected using face-to-face interviewing questionnaires and analyzed using SPSS version 21.0. Binary logistic regression analyses were performed to identify predictors.ResultsThe prevalence of chronic kidney disease diagnosed by Cockcroft-Gault equation and Modification of Diet in Renal Disease equation was 14.6% and 7.7% respectively. This finding shows the prevalence of chronic kidney disease among Diabetic patients was low. Age 50–59 years [(AOR= 4.0; 95% CI:(1.2, 13)] by Cockroft-Gault equation (CG), age 60–69 years [(AOR=5.8 95% CI:(1.5,21.0)] by Modification of Diet in Renal Disease (MDRD) and (AOR;22.9 95%CI:7.1,74.2) by CG, age 70 years and above (AOR=4.7; 95 CI: 1.1, 19.7) by MDRD and (AOR= 22.9; 95%CI:7.1,74.2) by CG, BMI (AOR=0.2; 95% CI:0.1,0.4) by CG, and previous kidney disease (AOR=6.2 95%CI:2.0,8.4) by MDRD and (AOR;4.6 95%CI:1.9,10.8) C-G equation have a significant association with chronic kidney disease after an adjustment done.ConclusionThe prevalence of chronic kidney disease among Diabetic patients in this study was lower. Age, BMI, and previous recurrent kidney disease were associated with chronic kidney disease. Preventive measures like giving health education and screening of patients with risk factors should get more attention.     

Incidence and aetiology of bacterial meningitis among children aged 1–59 months in South Asia: systematic review and meta-analysis

BackgroundBacterial meningitis is a significant cause of morbidity and mortality worldwide among children aged 1–59 months. We aimed to describe its burden in South Asia, focusing on vaccine-preventable aetiologies.MethodsWe searched five databases for studies published from January 1, 1990, to April 25, 2017. We estimated incidence and aetiology-specific proportions using random-effects meta-analysis. In secondary analyses, we described vaccine impact and pneumococcal meningitis serotypes.ResultsWe included 48 articles cumulatively reporting 20,707 cases from 1987 to 2013. Mean annual incidence was 105 (95% confidence interval [CI], 53–173) cases per 100,000 children. On average, Haemophilus influenzae type b (Hib) accounted for 13% (95% CI, 8–19%) of cases, pneumococcus for 10% (95% CI, 6–15%), and meningococcus for 1% (95% CI, 0–2%). These meta-analyses had substantial between-study heterogeneity (I² > 78%, P < 0.0001). Among studies reporting only confirmed cases, these three bacteria caused a median of 78% cases (IQR, 50–87%). Hib meningitis incidence declined by 72–83% at sentinel hospitals in Pakistan and Bangladesh, respectively, within two years of implementing nationwide vaccination. On average, PCV10 covered 49% (95% CI, 39–58%), PCV13 covered 51% (95% CI, 40–61%), and PPSV23 covered 74% (95% CI, 67–80%) of pneumococcal meningitis serotypes. Lower PCV10 and PCV13 serotype coverage in Bangladesh was associated with higher prevalence of serotype 2, compared to India and Pakistan.ConclusionsSouth Asia has relatively high incidence of bacterial meningitis among children aged 1–59 months, with vaccine-preventable bacteria causing a substantial proportion. These estimates are likely underestimates due to multiple epidemiological and microbiological factors. Further research on vaccine impact and distribution of pneumococcal serotypes will inform vaccine policymaking and implementation.     

Vaccination coverage among older adults: a population-based study in India

ObjectiveTo estimate the prevalence and explore the predictors of vaccine uptake among older adults in India.MethodsWe used data from the national Longitudinal Ageing Study in India, a national household survey conducted during 2017–2018. Based on interviewees’ self-reports, we calculated population-weighted estimates of the uptake of influenza, pneumococcal, typhoid and hepatitis B vaccines among 64 714 Indian adults aged 45 years or older. We performed multivariable binary logistic regression analysis to examine the sociodemographic and health-related predictors of uptake of the vaccinations.FindingsThe coverage of each of the studied vaccinations was less than 2%. The estimated percentages of respondents reporting ever being vaccinated were 1.5% (95% confidence interval, CI: 1.4–1.6) for influenza, 0.6% (95% CI: 0.6–0.7) for pneumococcal disease, 1.9% (95% CI: 1.8–2.0) for typhoid and 1.9% (95% CI: 1.8–2.0) for hepatitis B. Vaccine uptake was higher among respondents with cardiovascular disease, diabetes or lung disease than those without any of these conditions. Uptake of influenza vaccine was higher among those with lung disease, while hepatitis B vaccine uptake was higher among those with cardiovascular disease or diabetes. Male sex, urban residence, wealthier household, more years of schooling, existing medical conditions and sedentary behaviours were significant predictors of vaccine uptake.ConclusionTargeted policies and programmes are needed for improving the low vaccination coverage among older adults in India, especially among those with chronic diseases. Further research could examine vaccine access, vaccine hesitancy, and vaccine-related information and communication channels to older adults and their health-care providers.     

Estimated Prevalence of Cronkhite-Canada Syndrome,Chronic Enteropathy Associated With SLCO2A1 Gene,and Intestinal Behçet’s Disease in Japan in 2017: A Nationwide Survey

BackgroundCronkhite-Canada syndrome (CCS), chronic enteropathy associated with SLCO2A1 gene (CEAS), and intestinal Behçet’s disease (BD) are classified as intractable intestinal disorders in Japan. However, the national prevalence of these diseases remains unknown. We performed a nationwide survey to estimate the patient numbers and prevalence rates of these diseases throughout Japan in 2017.MethodsWe conducted a mail-based survey targeting hospitals across Japan to estimate the annual numbers of patients with CCS, CEAS, and intestinal BD in 2017. Using a stratified random sampling method, we selected 2,979 hospital departments and asked them to report the number of patients who met specific diagnostic criteria. The total number of patients for each disease was estimated by multiplying the reported numbers by the reciprocal of the sampling rate and response rate. The corresponding prevalence rates per 1,000,000 population were calculated based on the mid-year population of Japan in 2017.ResultsThe overall survey response rate was 68.1% (2,029 departments). The estimated numbers of patients with CCS, CEAS, and intestinal BD were 473 (95% confidence interval [CI], 357–589), 388 (95% CI, 289–486), and 3,139 (95% CI, 2,749–3,529), respectively; the prevalence rates per 1,000,000 population were 3.7 (male: 4.0; female: 3.5), 3.1 (male: 3.0; female: 3.1), and 24.8 (male: 24.5; female: 25.0), respectively. The male-to-female ratios were 1.10, 0.94, and 0.93 for patients with CCS, CEAS, and intestinal BD, respectively.ConclusionsEstimates of the national prevalence of CCS, CEAS, and intestinal BD in Japan were generated and found to be higher than those previously reported.Key words: Cronkhite-Canada syndrome, chronic enteropathy associated with SLCO2A1 gene, intestinal Behçet’s disease, nationwide survey, prevalence     

Diagnostic value of oral prednisolone test for chronic obstructive pulmonary disorders

PURPOSE We wanted to determine the diagnostic value of an oral prednisolone test for chronic obstructive pulmonary disorders.METHODS Two hundred thirty-three patients with cough for longer than 14 days, without known chronic obstructive pulmonary disease (COPD) or asthma, participated in a diagnostic study in Dutch primary care between 2006 and 2009. These patients used a 14-day prednisolone test of 30 mg/d and recorded before-after bronchodilator measurements of forced expiratory volume in 1 second (FEV₁). An expert panel determined the presence or absence of COPD and asthma based on an extensive diagnostic workup. The proportion of responders to the prednisolone test (increased FEV₁ exceeding 200 mL or 12% of baseline) per diagnosis group was compared, and the diagnostic value of the test was quantified by logistic regression and analysis of the area under the receiver operating characteristic curve (ROC area).RESULTS In patients with COPD, 23% (14 of 61) responded to the test; in patients with asthma 4% (1 of 25) responded; in patients with asthma and COPD, 7% (1 of 14) responded; and in those without asthma or COPD, 11% (14 of 133) responded. Being a responder was, unexpectedly, associated with COPD (OR = 2.4; 95% confidence interval [CI], 1.1–5.2). After multivariate analysis, adjusting for age, sex, and smoking, the OR = 2.0 (95% CI, 0.8–5.0) and the ROC area did not increase (0.78; 95% CI, 0.72–0.85 vs 0.79; 95% CI, 0.72–0.85).CONCLUSION A response to a prednisolone test was suggestive of COPD, but added no diagnostic value to more easily obtainable characteristics.     

Pesticide use and chronic bronchitis among farmers in the Agricultural Health Study

BACKGROUND: Farmers have increased risk for chronic bronchitis. Few investigators have considered pesticides. METHODS: We evaluated pesticides as risk factors for chronic bronchitis using the Agricultural Health Study enrollment data on lifetime pesticide use and history of doctor-diagnosed chronic bronchitis from 20,908 private pesticide applicators, primarily farmers. RESULTS: A total of 654 farmers (3%) reported chronic bronchitis diagnosed after age 19. After adjustment for correlated pesticides as well as confounders, 11 pesticides were significantly associated with chronic bronchitis. Heptachlor use had the highest odds ratio (OR=1.50, 95% Confidence Interval (CI)=1.19, 1.89). Increased prevalence for chronic bronchitis was also seen for individuals who had a history of a high pesticide exposure event (OR=1.85, 95% CI=1.51, 2.25) and for those who also applied pesticides in off-farm jobs (OR=1.40, 95% CI=1.04, 1.88). Co-morbid asthma and current farm activities did not explain these results. CONCLUSIONS: These results provide preliminary evidence that pesticide use may increase chronic bronchitis prevalence.     

Characterizing Micronutrient Status and Risk Factors among Late Adolescent and Young Women in Rural Pakistan: A Cross-Sectional Assessment of the MaPPS Trial

Nutritional deficiencies are a leading underlying risk factor contributing to the global burden of disease. In Pakistan, late adolescence is considered a nutritionally vulnerable period, as micronutrient requirements are increased to support maturation, and dietary staples are nutrient poor. However, there has been limited evaluation of micronutrient status beyond anemia and its determinants. Using cross-sectional data from late adolescent and young women (15–23 years) at enrolment in the Matiari emPowerment and Preconception Supplementation (MaPPS) Trial, we aimed to describe the prevalence of key micronutrient deficiencies of public health concern, and generate hierarchical models to examine associations with proxies for social determinants of health (SDoH). The prevalence of micronutrient deficiencies was high: 53.6% (95% confidence interval (CI): 53.0–54.3%) had anemia; 38.0% (95% CI: 36.4–39.6%) iron deficiency anemia; 31.8% (95% CI: 30.2–33.3%) vitamin A deficiency; and 81.1% (95% CI: 79.8–82.4%) vitamin D deficiency. At least one deficiency was experienced by 91.0% (95% CI: 90.1–92.0%). Few SDoH were maintained in the final hierarchical models, although those maintained were often related to socioeconomic status (e.g., education, occupation). To improve the micronutrient status of late adolescent and young women in Pakistan, a direct micronutrient intervention is warranted, and should be paired with broader poverty alleviation methods.     

Psychological distress and chronic obstructive pulmonary disease in the Renfrew and Paisley (MIDSPAN) study

BACKGROUND: This study examined whether psychological distress might be a predictor of chronic obstructive pulmonary disease (COPD). METHOD: The relation between psychological distress at baseline, measured by the general health questionnaire (GHQ), and chronic bronchitis three years later, as measured by the Medical Research Council (MRC) bronchitis questionnaire and forced expiratory flow in one second (FEV(1)), was examined in 1682 men and 2203 women from the Renfrew and Paisley (MIDSPAN) study. The analyses were run on men and women separately and adjustments were made for age, socioeconomic position, and lung function at baseline (FEV(1)). People with chronic diseases at baseline were then excluded to give a "healthy" baseline cohort. The effect of psychological distress on individual components of the MRC bronchitis questionnaire and FEV(1) was also assessed. RESULTS: In multivariate analyses of the whole cohort baseline psychological distress in women was associated with reduced FEV(1) at follow up (OR 1.31 95% CI 1.0 to 1.73) after adjustment. In women, in the healthy cohort, psychological distress was associated with chronic bronchitis (OR 2.00, 95% CI 1.16 to 3.46), symptoms of bronchial infection (OR 2.14, 95% CI 1.44 to 3.19), symptoms of breathlessness (OR 3.02, 95% CI 1.99 to 4.59), and reduced FEV(1) (OR 1.62, 95% CI 1.13 to 2.32). In men psychological distress predicted symptoms of bronchial infection (OR 2.09, 95% CI 1.28 to 3.42). CONCLUSION: This study supports research suggesting that psychological distress is associated with COPD and shows that psychological distress predicts COPD in women. The robustness of the association and the exact mechanism requires further investigation.     

Burnout among primary health-care professionals in low- and middle-income countries: systematic review and meta-analysis

ObjectiveTo estimate the prevalence of burnout among primary health-care professionals in low- and middle-income countries and to identify factors associated with burnout.MethodsWe systematically searched nine databases up to February 2022 to identify studies investigating burnout in primary health-care professionals in low- and middle-income countries. There were no language limitations and we included observational studies. Two independent reviewers completed screening, study selection, data extraction and quality appraisal. Random-effects meta-analysis was used to estimate overall burnout prevalence as assessed using the Maslach Burnout Inventory subscales of emotional exhaustion, depersonalization and personal accomplishment. We narratively report factors associated with burnout.FindingsThe search returned 1568 articles. After selection, 60 studies from 20 countries were included in the narrative review and 31 were included in the meta-analysis. Three studies collected data during the coronavirus disease 2019 pandemic but provided limited evidence on the impact of the disease on burnout. The overall single-point prevalence of burnout ranged from 2.5% to 87.9% (43 studies). In the meta-analysis (31 studies), the pooled prevalence of a high level of emotional exhaustion was 28.1% (95% confidence interval, CI: 21.5–33.5), a high level of depersonalization was 16.4% (95% CI: 10.1–22.9) and a high level of reduced personal accomplishment was 31.9% (95% CI: 21.7–39.1).ConclusionThe substantial prevalence of burnout among primary health-care professionals in low- and middle-income countries has implications for patient safety, care quality and workforce planning. Further cross-sectional studies are needed to help identify evidence-based solutions, particularly in Africa and South-East Asia.     

Sensitivity and specificity of typhoid fever rapid antibody tests for laboratory diagnosis at two sub-Saharan African sites

Objective

To evaluate three commercial typhoid rapid antibody tests for Salmonella Typhi antibodies in patients suspected of having typhoid fever in Mpumalanga, South Africa, and Moshi, United Republic of Tanzania.

Methods

The diagnostic accuracy of Cromotest^® (semiquantitative slide agglutination and single tube Widal test), TUBEX^® and Typhidot^® was assessed against that of blood culture. Performance was modelled for scenarios with pretest probabilities of 5% and 50%.

Findings

In total 92 patients enrolled: 53 (57.6%) from South Africa and 39 (42.4%) from the United Republic of Tanzania. Salmonella Typhi was isolated from the blood of 28 (30.4%) patients. The semiquantitative slide agglutination and single-tube Widal tests had positive predictive values (PPVs) of 25.0% (95% confidence interval, CI: 0.6–80.6) and 20.0% (95% CI: 2.5–55.6), respectively. The newer typhoid rapid antibody tests had comparable PPVs: TUBEX^®, 54.1% (95% CI: 36.9–70.5); Typhidot^® IgM, 56.7% (95% CI: 37.4–74.5); and Typhidot^® IgG, 54.3% (95% CI: 36.6–71.2). For a pretest probability of 5%, PPVs were: TUBEX^®, 11.0% (95% CI: 6.6–17.9); Typhidot^® IgM, 9.1% (95% CI: 5.8–14.0); and Typhidot^® IgG, 11.0% (6.3–18.4). For a pretest probability of 50%, PPVs were: TUBEX^®, 70.2% (95% CI: 57.3–80.5); Typhidot^® IgM, 65.6% (95% CI: 54.0–75.6); and Typhidot^® IgG, 70.0% (95% CI: 56.0–81.1).

Conclusion

Semiquantitative slide agglutination and single-tube Widal tests performed poorly. TUBEX^® and Typhidot^® may be suitable when pretest probability is high and blood cultures are unavailable, but their performance does not justify deployment in routine care settings in sub-Saharan Africa.     

Different Labelling of Obstructive Airway Diseases in Estonia,Finland, and Sweden

Large differences in prevalence of asthma have been reported between westernised countries and the former Eastern European countries, and still no consensus about the reasons for the differences exists. The aim of this study was to assess diagnostic labelling of obstructive airway diseases, comparing subjects with respiratory symptoms and the diagnoses obtained in Estonia, Finland, and Sweden. A postal questionnaire was sent to population-based random samples, and 44,483 (76%) answers were obtained from the 58,661 invited in 1996. Among men, current smoking was most common in Estonia, 60%, followed by Finland, 39%, and Sweden, 28%. In all three countries, 30% of women were current smokers. Most respiratory symptoms including wheezing were most common in Estonia, also among non-smokers. The prevalence of asthma was 2.0% and chronic bronchitis 10.7% in Estonia, while the opposite was found in Sweden with an asthma prevalence of 7.8% and a chronic bronchitis prevalence of 3.1%. The pattern in Finland was similar to that of Sweden. The same differences between the three countries were found also among young subjects. The total proportion of diagnosed obstructive lung diseases in subjects with respiratory symptoms was similar, but the diagnosis of asthma was considerably more common in Finland and Sweden. Chronic bronchitis was favoured in Estonia, also among young adults irrespectively of what symptoms were present. In a multivariate model with correction for confounders, the risk (OR) for having a diagnosis of asthma was 5.65 (95% CI: 4.86–6.56) when living in Sweden, and 3.51 (95% CI: 3.00–4.12) in Finland, whereas risk for chronic bronchitis was 0.28 (0.25–0.31) and 0.22 (0.19–0.25), respectively, compared to Estonia. The study indicates differences in diagnostic practices of obstructive lung diseases between the three countries.     

Occupation and chronic bronchitis among Chinese women

OBJECTIVE: To examine the association between occupation and chronic bronchitis among a cross section of Chinese women who participated in the Shanghai Women's Health Study. METHODS: Cases were 4873 women who self-reported a physician-diagnosed bronchitis during adulthood. Controls were 9746 women randomly selected from Shanghai Women's Health Study participants and matched with the cases by year of birth and age at diagnosis. Lifetime occupational histories were obtained. Logistic regressions were used to evaluate the association between chronic bronchitis and occupation, adjusting for smoking, education, family income, and concurrent asthma. RESULTS: We observed excess prevalence of bronchitis for textile occupation (odds ratio, OR = 1.09; 95% CI = 1.00-1.18) and industry (OR = 1.11; 95% CI = 1.03-1.19), welders (OR = 1.40; 95% CI = 1.01-1.92), packing and baling workers (OR = 1.39; 95% CI = 1.15-1.68), and warehousing industry (OR = 1.58; 95% CI = 1.08-2.30) We also identified several new associations that may warrant further exploration and confirmation, including employment in some metal fabrication industries, postal and telecommunication industry, and a few white-collar occupations and industries. CONCLUSIONS: Our study indicates that the risk of chronic bronchitis among women may be increased in some occupations and industries.     

The association between occupational factors and adverse health outcomes in chronic obstructive pulmonary disease

Background and Aims: Despite recognition that occupational exposures may make a substantive contribution to the aetiology of COPD, little is known about the potential role of work related factors in COPD related health outcomes.

Methods: Prospective cohort study using structured telephone interviews among a random sample of adults aged 55–75 reporting a COPD condition (emphysema, chronic bronchitis, or COPD). Using multivariate models adjusting for smoking and demographic factors, the separate and combined associations were estimated between occupational exposure to vapours, gas, dust, or fumes (VGDF) and leaving work due to lung disease (respiratory related work disability) with health outcomes and utilisation ascertained at one year follow up.

Results: Of 234 subjects, 128 (55%) reported exposure to VGDF on their longest held jobs, 58 (25%) reported respiratory related work disability, and 38 (16%) subjects reported both. Combined exposure to VGDF and respiratory related work disability (rather than either factor alone) was associated with the greatest risk at follow up of frequent (everyday) restricted activity days attributed to a breathing or lung condition (OR 3.8; 95% CI 1.4 to 10.1), emergency department (ED) visit (OR 3.9; 95% CI 1.4 to 10.5), and hospitalisation (OR 7.6; 95% CI 1.8 to 32).

Conclusions: Among persons with COPD, past occupational exposures and work disability attributed to lung disease, particularly in combination, appear to be risk factors for adverse health related outcomes.

     

Effectiveness of Preventive Therapy for Persons Exposed at Home to Drug-Resistant Tuberculosis,Karachi, Pakistan

In Karachi, Pakistan, a South Asian megacity with a high prevalence of tuberculosis (TB) and low HIV prevalence, we assessed the effectiveness of fluoroquinolone-based preventive therapy for drug-resistant (DR) TB exposure. During February 2016–March 2017, high-risk household contacts of DR TB patients began a 6-month course of preventive therapy with a fluoroquinolone-based, 2-drug regimen. We assessed effectiveness in this cohort by comparing the rate and risk for TB disease over 2 years to the rates and risks reported in the literature. Of 172 participants, TB occurred in 2 persons over 336 person-years of observation. TB disease incidence rate observed in the cohort was 6.0/1,000 person-years. The incidence rate ratio ranged from 0.29 (95% CI 0.04–1.3) to 0.50 (95% CI 0.06–2.8), with a pooled estimate of 0.35 (95% CI 0.14–0.87). Overall, fluoroquinolone-based preventive therapy for DR TB exposure reduced risk for TB disease by 65%.     

COVID-19 cases,hospitalizations and deaths after vaccination: a cohort event monitoring study,Islamic Republic of Iran

ObjectiveTo investigate the incidence of coronavirus disease 2019 (COVID-19) cases, hospitalizations and deaths in Iranians vaccinated with either AZD1222 Vaxzevria, CovIran® vaccine, SARS-CoV-2 Vaccine (Vero Cell), Inactivated (lnCoV) or Sputnik V.MethodsWe enrolled individuals 18 years or older receiving their first COVID-19 vaccine dose between April 2021 and January 2022 in seven Iranian cities. Participants completed weekly follow-up surveys for 17 weeks (25 weeks for AZD1222) to report their COVID-19 status and hospitalization. We used Cox regression models to assess risk factors for contracting COVID-19, hospitalization and death.FindingsOf 89 783 participants enrolled, incidence rates per 1 000 000 person-days were: 528.2 (95% confidence interval, CI: 514.0–542.7) for contracting COVID-19; 55.8 (95% CI: 51.4–60.5) for hospitalization; and 4.1 (95% CI: 3.0–5.5) for death. Compared with SARS-CoV-2 Vaccine (Vero Cell), hazard ratios (HR) for contracting COVID-19 were: 0.70 (95% CI: 0.61−0.80) with AZD1222; 0.73 (95% CI: 0.62–0.86) with Sputnik V; and 0.73 (95% CI: 0.63–0.86) with CovIran®. For hospitalization and death, all vaccines provided similar protection 14 days after the second dose. History of COVID-19 protected against contracting COVID-19 again (HR: 0.76; 95% CI: 0.69–0.84). Diabetes and respiratory, cardiac and renal disease were associated with higher risks of contracting COVID-19 after vaccination.ConclusionThe rates of contracting COVID-19 after vaccination were relatively high. SARS-CoV-2 Vaccine (Vero Cell) provided lower protection against COVID-19 than other vaccines. People with comorbidities had higher risks of contracting COVID-19 and hospitalization and should be prioritized for preventive interventions.     

Association between Mother’s Education and Infant and Young Child Feeding Practices in South Asia

The association between mother’s education and the World Health Organization’s (WHO’s) eight Infant and Young Child Feeding (IYCF) core indicators has yet to be explored in South Asia (SA). This study aimed to explore the association between mother’s education and the WHO’s eight IYCF core indicators in SA. We analyzed data from the most recent nationally representative Demographic and Health Surveys of six South Asian Countries (SACs)—Afghanistan, Bangladesh, India, Maldives, Nepal, and Pakistan. We found significantly higher odds (adjusted odds ratio, AOR, 1.13 to 1.47) among mothers who completed secondary or higher education than among mothers with education levels below secondary for the following seven IYCF indicators: early initiation of breastfeeding (EIBF), exclusive breastfeeding under 6 months (EBF), the introduction of solid, semisolid or soft foods (ISSSF), minimum dietary diversity (MDD), minimum meal frequency (MMF), minimum acceptable diet (MAD), and consumption of iron-rich or iron-fortified foods (CIRF); the exception was for the indicator of continued breastfeeding at one year. Country-specific analyses revealed significantly higher odds in EIBF (AOR 1.14; 95% CI: 1.11, 1.18) and EBF (AOR 1.27; 95% CI: 1.19, 1.34) among mothers with secondary or higher education levels in India. In contrast, the odds were lower for EIBF in Bangladesh and for EBF in Pakistan among mothers with secondary or higher education levels. For country-specific analyses for complementary feeding indicators such as ISSSF, MDD, MMF, MAD, and CIRF, significantly higher odds (AOR, 1.15 to 2.34) were also observed among mothers with secondary or higher education levels. These findings demonstrate a strong positive association between mother’s education and IYCF indicators. Strengthening national policies to educate women at least to the secondary level in SACs might be a cost-effective intervention for improving IYCF practices.