Sarcoidosis in Iceland—a nationwide study epidemiology, clinical picture, and environmental exposure

BackgroundThis nationwide study aimed to elucidate the incidence and clinical characteristics of tissue-verified sarcoidosis in Iceland. A secondary aim was to analyse sex differences and identify possible environmental factors contributing to the pathological process.Materials and MethodsThis is a descriptive study covering 36 years (January 1st, 1981, through December 31st, 2016). Histopathological reports and electronic hospital discharge registries were reviewed in context for granulomas and/or sarcoidosis. National data were used for comparison regarding smoking habits and occupation, adjusted for age, gender and year of diagnosis. The data were stored in FileMaker and calculations were made by extracting data from this database to the statistical software package R.ResultsA total of 418 patients (54% females) were diagnosed with tissue-verified sarcoidosis. The incidence rate was 4.15/100 000/year, similar among females and males. The average age at diagnosis was higher among females (53.0±14.2 years) than males (48.2±13.8 years). Fatigue was the most frequent single symptom (49.7%), but when all respiratory symptoms were grouped, they were the most frequent symptoms (60%). No significant difference was found between smoking status and sarcoidosis. Possible hazardous exposure in the workplace was reported by 19.4% of the cases.ConclusionThe incidence of sarcoidosis in Iceland was higher than in an Asian population where the same inclusion criteria were applied. The clinical picture diverges partly from that in the Asian population but resembles that among other Caucasians. Fatigue and respiratory symptoms were predominant. The biphasic pattern of age at disease debut seen elsewhere among females was not evident in Iceland.

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Bronchial Hyperresponsiveness in Farmers: Severity and Work-Relatedness

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2014.097 ◽

2014 ◽

Vol 2 (3) ◽

pp. 536-543 ◽

Cited By ~ 2

Author(s):

Saso Stoleski ◽

Jordan Minov ◽

Jovanka Karadzinska-Bislimovska ◽

Dragan Mijakoski

Keyword(s):

Lung Function ◽

Respiratory Symptoms ◽

Smoking Status ◽

Bronchial Hyperresponsiveness ◽

Smoking History ◽

Full Time ◽

Respiratory Impairment ◽

Occupational Risk Factors ◽

Work Related ◽

Significant Difference

OBJECTIVE: To evaluate the prevalence of respiratory symptoms, lung function and bronchial hyperresponsiveness in farmers, with emphasize to their severity and work-relatedness due occupational risk factors and farming characteristics.METHODS: A cross-sectional survey was performed including 60 cow breeders aged 21 to 65 years, compared to an equal number of agricultural farmers matched by age, job exposure duration, and smoking status. We have used a questionnaire to record the chronic respiratory symptoms, detailed work history, specific farming activities and tasks performed, and smoking history. Evaluation of examined subjects also included lung function spirometry tests, and bronchial hyperresponsiveness testing.RESULTS: We found higher prevalence of work related respiratory symptoms in the last 12 months in cow breeders with significant difference for phlegm (P = 0.039), and wheezing (P = 0.026). Mean values of all spirometric parameters were lower in cow breeders, reaching significance for MEF50 (P = 0.001) and MEF75 (P = 0.000). Significant difference was found for mild bronchial hyperresponsiveness among cow breeders with job exposure of more than 15 years. The risk of developing work-related respiratory symptoms increased significantly with full-time farming, exposure to gases and vapors, and keeping more than 10 cows.CONCLUSION: Our data suggest that workplace exposure in farmers may cause respiratory impairment which is closely related to its duration, characteristics, and intensity. The results suggest that cow breeders in general have higher rates of work-related respiratory symptoms and bronchial hyperresponsiveness than agricultural farmers, whereas their severity increases with an increase in frequency and duration of animal contact.

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Chronic Respiratory Symptoms and Lung Function in a Sample of Agricultural Workers in Skopje Region

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2014.057 ◽

2014 ◽

Vol 2 (2) ◽

pp. 327-334 ◽

Cited By ~ 1

Author(s):

Saso Stoleski ◽

Jordan Minov ◽

Jovanka Karadzinska-Bislimovska ◽

Dragan Mijakoski

Keyword(s):

Lung Function ◽

Respiratory Symptoms ◽

Smoking Status ◽

Agricultural Workers ◽

Smoking History ◽

Workplace Exposure ◽

Cross Sectional ◽

Respiratory Impairment ◽

Mean Values ◽

Significant Difference

OBJECTIVE: To assess the effect of job exposure and its duration on chronic respiratory symptoms and ventilatory capacity among agricultural workers.METHODS: We performed a cross-sectional study including 120 agricultural workers aged 36 to 53 years, compared to an equal number of office workers matched by age, duration of workplace exposure and smoking status. A questionnaire was used to record the chronic respiratory symptoms, detailed job history, specific job activities and tasks performed, and smoking history. Evaluation of examined subjects also included functional lung testing by spirometry.RESULTS: We found non-significantly higher prevalence of respiratory symptoms in the last 12 months in agricultural workers with significant difference for cough (P = 0.044), and wheezing (P = 0.031). Mean values of all spirometric parameters were lower in agricultural workers, being significantly different for MEF50 (P = 0.001) and MEF75 (P = 0.000). Adverse respiratory effects and lung function deterioration were more expressed in agricultural workers with duration of job exposure more than 20 years than in those exposed less than 20 years.CONCLUSION: Our data suggest that workplace exposure in agricultural workers may lead to respiratory impairment which is close related to its duration.

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The The Effectiveness of Early Mobilization Time on Balance and Functional Ability after Ischemic Stroke

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2019.269 ◽

2019 ◽

Vol 7 (7) ◽

pp. 1088-1092

Author(s):

Umi Budi Rahayu ◽

Samekto Wibowo ◽

Ismail Setyopranoto

Keyword(s):

Randomized Controlled Trial ◽

Ischemic Stroke ◽

Functional Ability ◽

Controlled Trial ◽

Early Mobilization ◽

Berg Balance Scale ◽

Early Mobilisation ◽

Inclusion Criteria ◽

Randomized Controlled ◽

Significant Difference

BACKGROUND: Early mobilisation (EM) after-ischemic stroke is a motor learning intervention aimed to restore nerve cells and to improve balance and functional ability. Unfortunately, the study of when this intervention began has not been widely studied. AIM: On this study was compared the effect of EM started at 24 hours and 48 hours after an ischemic stroke on balance and functional ability. MATERIAL AND METHODS: Randomized controlled trial involving 40 patients on 2 groups meeting predefined inclusion criteria. The levels of balance were measured using the Berg Balance Scale, and the functional ability was measured using the Barthel Index, at 5th and 7th day. RESULTS: A significant difference was observed in both balance (p = 0.038) and functional ability (p = 0.021) obtained on the 7th day of assessment between both groups. A significant difference on the 5th day was observed only in the functional ability (p = 0.002) and not in the balance (p = 0.147), between the groups. CONCLUSION: EM started at 24 hours after the ischemic stroke has been found to have a better impact on balance and functional ability compared to that at 48 hours.

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Nonunion Rates in Hind- and Midfoot Arthrodesis in Current, Ex-, and Nonsmokers

Foot & Ankle International ◽

10.1177/1071100720971269 ◽

2020 ◽

pp. 107110072097126

Author(s):

Jack Allport ◽

Jayasree Ramaskandhan ◽

Malik S. Siddique

Keyword(s):

Risk Factor ◽

Cohort Study ◽

Relative Risk ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Smoking Status ◽

Time Frame ◽

Modifiable Risk Factor ◽

Level Of Evidence ◽

Significant Difference

Background: Nonunion rates in hind or midfoot arthrodesis have been reported as high as 41%. The most notable and readily modifiable risk factor that has been identified is smoking. In 2018, 14.4% of the UK population were active smokers. We examined the effect of smoking status on union rates for a large cohort of patients undergoing hind- or midfoot arthrodesis. Methods: In total, 381 consecutive primary joint arthrodeses were identified from a single surgeon’s logbook (analysis performed on a per joint basis, with a triple fusion reported as 3 separate joints). Patients were divided based on self-reported smoking status. Primary outcome was clinical union. Delayed union, infection, and the need for ultrasound bone stimulation were secondary outcomes. Results: Smoking prevalence was 14.0%, and 32.2% were ex-smokers. Groups were comparable for sex, diabetes, and body mass index. Smokers were younger and had fewer comorbidities. Nonunion rates were higher in smokers (relative risk, 5.81; 95% CI, 2.54-13.29; P < .001) with no statistically significant difference between ex-smokers and nonsmokers. Smokers had higher rates of infection ( P = .05) and bone stimulator use ( P < .001). Among smokers, there was a trend toward slower union with heavier smoking ( P = .004). Conclusion: This large retrospective cohort study confirmed previous evidence that smoking has a considerable negative effect on union in arthrodesis. The 5.81 relative risk in a modifiable risk factor is extremely high. Arthrodesis surgery should be undertaken with extreme caution in smokers. Our study shows that after cessation of smoking, the risk returns to normal, but we were unable to quantify the time frame. Level of Evidence: Level III, retrospective cohort study.

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Hybrid cardiac rehabilitation program as a potential enhancer of adherence to cardiac rehabilitation in smoking patients with coronary heart disease - a retrospective single-centre analysis

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.347 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

M Cabral ◽

R Santos ◽

F Januario ◽

A Antunes ◽

R Fonseca-Pinto

Keyword(s):

Mental Health ◽

Cardiac Rehabilitation ◽

Smoking Status ◽

Rehabilitation Program ◽

Anxiety And Depression ◽

Cardiac Rehabilitation Program ◽

Phase 2 ◽

Significant Difference ◽

Group 2 ◽

Group 1

Abstract Funding Acknowledgements Type of funding sources: None. Cardiac rehabilitation (CR) has well known beneficial effects on physical capacity, health-related quality of life, morbidity and mortality following an acute cardiac event. It is also known that smoking status is a powerful predictor of recurrent cardiovascular disease events. However, it has been noted that smoker patients may be less likely to access or complete CR. The aim of this study was to determine the levels of anxiety and depression and its improvement, depending on the smoking status of patients with coronary artery disease (CAD) on phase 2 of the Cardiac Rehabilitation Program (CRP). Additionally, we intend to investigate the mental health impact on smoker patients" group in conventional CR versus telemonitored CR. A retrospective study was conducted and patients in CRP between 2017 and 2020 were included. Patient selection and information collection were obtained through medical records. The outcomes of anxiety and depression were evaluated through the Hospital Anxiety and Depression Scale (HADS). Patients were divided into two groups: group 1 for non-smokers or ex-smokers and group 2 for smokers. For group 2 patients, a sub-analysis was performed for patients following the conventional CR versus the telemonitored CR, with the use of MOVIDA mobile application. Variables were analysed in the beginning (T0) and in the end (T1) of phase 2, around 3 months after. Group comparisons tests and statistical analysis were performed using SPSS software v25.0. A p-value less than 0.05 is statistically significant. We analysed 107 patients, which 93 of these were assiduous and 69 concluded the phase 2 of CRP: 39 patients in group 1 and 30 patients in group 2. Two groups have similar baseline characteristics, except for the higher presence of diabetes (p = 0.02) in group 1. It was noted an improvement in both anxiety and depression items for group 1 (p < 0.01 for both), but only for anxiety item for group 2 (p = 0.03). In subgroup analysis, we observed no improvement for smoking patients following the conventional CR for both anxiety and depression items (p = 0.60 and p = 0.71, respectably) versus a significant difference in telemonitored CR patients (p = 0.02 and p = 0.04). We hypothesise that, when compared to conventional CR, cardiac telemonitored exercise using modern communication methods may result in an improved mental health state among smoking patients, which can lead to a better adherence for CRP. Further studies including more patients and phase 3 of CRP are needed to confirm these results.

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Single-bone versus both-bone plating of unstable paediatric both-bone forearm fractures. A randomized controlled clinical trial

International Orthopaedics ◽

10.1007/s00264-021-05097-z ◽

2021 ◽

Author(s):

Mohamed Khaled ◽

Amr A. Fadle ◽

Ahmed Khalil Attia ◽

Andrew Sami ◽

Abdelkhalek Hafez ◽

...

Keyword(s):

Clinical Trial ◽

Operative Time ◽

Forearm Fractures ◽

Inclusion Criteria ◽

Fracture Union ◽

Exclusion Criteria ◽

Bone Fixation ◽

Fixation Group ◽

Significant Difference ◽

Single Bone

Abstract Purpose This clinical trial compares the functional and radiological outcomes of single-bone fixation to both-bone fixation of unstable paediatric both-bone forearm fractures. Methods This individually randomized two-group parallel clinical trial was performed following the Consolidated Standards of Reporting Trials (CONSORT) statement at a single academic tertiary medical centre with an established paediatric orthopaedics unit. All children aged between nine and 15 years who presented to the emergency department at Assiut university with unstable diaphyseal, both-bone forearm fractures requiring surgical intervention between November 1, 2018, and February 28, 2020, were screened for eligibility against the inclusion and exclusion criteria. Inclusion criteria were diaphyseal unstable fractures defined as shaft fractures between the distal and proximal metaphyses with an angulation of > 10°, and/or malrotation of > 30°, and/or displacement > 10 mm after attempted closed reduction. Exclusion criteria included open fractures, Galeazzi fractures, Monteggia fractures, radial head fractures, and associated neurovascular injuries. Patients who met the inclusion criteria were randomized to either the single-bone fixation group (intervention) or the both-bone fixation group (control). Primary outcomes were forearm range of motion and fracture union, while secondary outcomes were forearm function (price criteria), radius re-angulation, wrist and elbow range of motion, and surgical time Results A total of 50 children were included. Out of these 50 children, 25 were randomized to either arm of the study. All children in either group received the treatment assigned by randomization. Fifty (100%) children were available for final follow-up at six months post-operatively. The mean age of single-bone and both-bone fixation groups was 11.48 ± 1.93 and 13 ± 1.75 years, respectively, with a statistically significant difference (p = 0.006). There were no statistically significant differences in gender, laterality, affection of the dominant hand, or mode of trauma between single-bone and both-bone fixation groups. All patients in both groups achieved fracture union. There mean radius re-angulation of the single-bone fixation groups was 5.36 ± 4.39 (0–20) degrees, while there was no radius re-angulation in the both-bone fixation group, with a statistically significant difference (p < 0.001). The time to union in the single-bone group was 6.28 ± 1.51 weeks, while the time to union in the both-bone fixation group was 6.64 ± 1.75 weeks, with no statistically significant difference (p = 0.44). There were no infections or refractures in either group. In the single-bone fixation group, 24 (96%) patients have regained their full forearm ROM (loss of ROM < 15°), while only one (4%) patient lost between 15 and 30° of ROM. In the both-bone fixation group, 23 (92%) patients have regained their full forearm ROM (loss of ROM < 15°), while only two (8%) patients lost between 15 and 30° of ROM. There was no statistically significant difference between groups in loss of forearm ROM (p = 0.55). All patients in both groups regained full ROM of their elbow and wrist joints. On price grading, 24 (96%) and 23 (92%) patients who underwent single bone fixation and both-bone fixation scored excellent, respectively. Only one (4%) patient in the single-bone fixation group and two (8%) patients in the both-bone fixation group scored good, with no statistically significant difference in price score between groups (p = 0.49). The majority of the patients from both groups had no pain on the numerical pain scale; 22 (88%) patients in the single-bone fixation group and 21 (84%) patients in the both-bone fixation groups, with no statistically significant difference between groups (p = 0.38). The single-bone fixation group had a significantly shorter mean operative time in comparison to both-bones plating (43.60 ± 6.21 vs. 88.60 ± 10.56 (min); p < 0.001). Conclusion Single-bone ulna open reduction and plate fixation and casting are safe and had a significantly shorter operative time than both-bone fixation. However, single-bone ORIF had a higher risk radius re-angulation, alas clinically acceptable. Both groups had equally excellent functional outcomes, forearm ROM, and union rates with no complications or refractures. Long-term studies are required.

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Associations among phthalate exposure, DNA methylation of TSLP, and childhood allergy

Clinical Epigenetics ◽

10.1186/s13148-021-01061-1 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Wan-Ru Wang ◽

Nai-Tzu Chen ◽

Nai-Yun Hsu ◽

I-Ying Kuo ◽

Hsin-Wen Chang ◽

...

Keyword(s):

Dna Methylation ◽

Methylation Level ◽

Respiratory Symptoms ◽

Smoking Status ◽

Phthalate Esters ◽

Allergic Diseases ◽

Percentage Increase ◽

Phthalate Exposure ◽

Settled Dust ◽

Butyl Phthalate

Abstract Background Dysregulation of thymic stromal lymphopoietin (TSLP) expressions is linked to asthma and allergic disease. Exposure to phthalate esters, a widely used plasticizer, is associated with respiratory and allergic morbidity. Dibutyl phthalate (DBP) causes TSLP upregulation in the skin. In addition, phthalate exposure is associated with changes in environmentally induced DNA methylation, which might cause phenotypic heterogeneity. This study examined the DNA methylation of the TSLP gene to determine the potential mechanism between phthalate exposure and allergic diseases. Results Among all evaluated, only benzyl butyl phthalate (BBzP) in the settled dusts were negatively correlated with the methylation levels of TSLP and positively associated with children’s respiratory symptoms. The results revealed that every unit increase in BBzP concentration in the settled dust was associated with a 1.75% decrease in the methylation level on upstream 775 bp from the transcription start site (TSS) of TSLP (β = − 1.75, p = 0.015) after adjustment for child’s sex, age, BMI, parents’ smoking status, allergic history, and education levels, PM2.5, formaldehyde, temperature; and relative humidity. Moreover, every percentage increase in the methylation level was associated with a 20% decrease in the risk of morning respiratory symptoms in the children (OR 0.80, 95% CI 0.65–0.99). Conclusions Exposure to BBzP in settled dust might increase children’s respiratory symptoms in the morning through decreasing TSLP methylation. Therefore, the exposure to BBzP should be reduced especially for the children already having allergic diseases.

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Risk Factors for Postpartum Depression in Active Duty Women

Military Medicine ◽

10.1093/milmed/usab161 ◽

2021 ◽

Author(s):

Valencia Garcia ◽

Eric Meyer ◽

Catherine Witkop

Keyword(s):

Risk Factors ◽

Postpartum Depression ◽

Smoking Status ◽

Technical Information ◽

Active Duty ◽

Military Spouses ◽

Inclusion Criteria ◽

Medical Subject Headings ◽

Complication Risk ◽

Screening And Prevention

ABSTRACT Introduction Postpartum depression (PPD) is a common perinatal complication. Risk factors previously found to correlate with PPD in civilians include prenatal depression, childcare stress, limited social support, difficult infant temperament, and maternity blues. Previously identified risk factors in military spouses include spouse deployment/redeployment cycles. It is unclear if these previously identified risk factors are also a risk factor for AD women or if the additional stressors associated with being on active duty (AD) are risk factors for PPD. The purpose of this review is to determine if civilian risk factors have been found to put AD women at risk for PPD and to identify unique risk factors for PPD in AD women. Materials and Methods A scoping literature review was performed using PubMed, Defense Technical Information Center, and PsychINFO. The searches were conducted using relevant medical subject headings and keywords. The inclusion criteria included articles published since 1948 (the year women were legally allowed to join the military) that reference risk factors for postpartum/peripartum depression in AD women serving in the U.S. military. The following exclusion criteria were also applied: in a language other than English, opinion papers, and/or not published in a peer-reviewed journal. Articles meeting criteria were evaluated and mapped to stressors previously identified in the literature for civilian and military spouses with PPD with novel stressors identified as mapping outside this framework. Results Only two articles met the inclusion criteria. The first study included 87 AD women. The second study, a cohort study between 2001 and 2008, included 1660 AD women. Unique risk factors identified in AD women include previous deployments, serving in the Army, smoking status, alcohol use, and low self-esteem. Conclusions Few studies have investigated the risk factors for PPD in AD women. It appears that AD women share many risk factors, or variants of those risk factors, for PPD as their civilian and AD spouse counterparts, but there are also unique risks to consider. More work is needed to improve screening and prevention efforts.

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The Effect of Monaurally Fitted Hearing Aid Use on the Evolution of Presbycusis

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489421995279 ◽

2021 ◽

pp. 000348942199527

Author(s):

Gabriel Dunya ◽

Fadi Najem ◽

Aurelie Mailhac ◽

Samer Abou Rizk ◽

Marc Bassim

Keyword(s):

Word Recognition ◽

Pure Tone ◽

Hearing Aid ◽

Residual Hearing ◽

Inclusion Criteria ◽

Pure Tone Average ◽

Hearing Aid Use ◽

Deprivation Effect ◽

Significant Difference

Objective: The effect of hearing aid use on the evolution of presbycusis has not been well described in the literature, with only a handful of publications addressing this topic. This paper aims to evaluate the long-term use of amplification and its effect on pure-tone thresholds and word recognition scores. Method: Monaurally fitted patients were followed with serial audiograms. Data was collected from hearing aid centers. Seventy-seven patients with presbycusis met the inclusion criteria and participated in the present study. The progression of hearing loss in both pure tone thresholds and word recognition scores were compared between the hearing aid ears (HA), and the non-hearing aid ears (NHA). Pure tone thresholds were analyzed by comparing the pure tone average at the initial and last audiograms. Word Recognition Scores (WRS) were analyzed using the model of Thornton and Raffin (1978), and by comparing the change in the absolute values of WRS from the initial to the last audiogram between the HA ear and the NHA ear. Results: No significant difference in pure-tone thresholds between the HA ear and NHA ear was found at the last audiogram ( P = .696), even after dividing the patients into groups based on the duration of amplification. Both methods of analysis of patients’ WRS showed a statistically significant worsening in NHA ( P < .05). Conclusion: The present study supports the previously defined auditory deprivation effect on non-fitted ears, which showed worsening of word recognition over time and no effect on pure tone average. It provides an additional argument for the counseling of patients with presbycusis considering amplification, and highlights the importance of bilateral amplification in preserving the residual hearing of hearing impaired patients.

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How different are COPD-specific patient reported outcomes, health status, dyspnoea and respiratory symptoms? An observational study in a working population

BMJ Open ◽

10.1136/bmjopen-2018-025132 ◽

2019 ◽

Vol 9 (7) ◽

pp. e025132 ◽

Cited By ~ 2

Author(s):

Koichi Nishimura ◽

Toru Oga ◽

Kazuhito Nakayasu ◽

Miyoko Ogasawara ◽

Yoshinori Hasegawa ◽

...

Keyword(s):

Health Status ◽

Respiratory Symptoms ◽

Smoking Status ◽

Fixed Ratio ◽

Airflow Limitation ◽

Chronic Obstructive ◽

Working Population ◽

Specific Patient ◽

Patient Reported ◽

D 12

ObjectivesWe hypothesised that chronic obstructive pulmonary disease (COPD)-specific health status measured by the COPD assessment test (CAT), respiratory symptoms by the evaluating respiratory symptoms in COPD (E-RS) and dyspnoea by Dyspnoea-12 (D-12) are independently based on specific conceptual frameworks and are not interchangeable. We aimed to discover whether health status, dyspnoea or respiratory symptoms could be related to smoking status and airflow limitation in a working population.DesignThis is an observational, cross-sectional study.Participants1566 healthy industrial workers were analysed.ResultsRelationships between D-12, CAT and E-RS total were statistically significant but weak (Spearman’s correlation coefficient=0.274 to 0.446). In 646 healthy non-smoking subjects, as the reference scores for healthy non-smoking subjects, that is, upper threshold, the bootstrap 95th percentile values were 1.00 for D-12, 9.88 for CAT and 4.44 for E-RS. Of the 1566 workers, 85 (5.4%) were diagnosed with COPD using the fixed ratio of the forced expiratory volume in one second/forced vital capacity <0.7, and 34 (2.2%) using the lower limit of normal. The CAT and E-RS total were significantly worse in non-COPD smokers and subjects with COPD than non-COPD never smokers, although the D-12 was not as sensitive. There were no significant differences between non-COPD smokers and subjects with COPD on any of the measures.ConclusionsAssessment of health status and respiratory symptoms would be preferable to dyspnoea in view of smoking status and airflow limitation in a working population. However, these patient-reported measures were inadequate in differentiating between smokers and subjects with COPD identified by spirometry.

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