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A comparison of obese and nonobese people with asthma: exploring an asthma-obesity interaction.

https://arctichealth.org/en/permalink/ahliterature145424
Source
Chest. 2010 Jun;137(6):1316-23
Publication Type
Article
Date
Jun-2010
Author
Smita Pakhale
Steve Doucette
Katherine Vandemheen
Louise-Philippe Boulet
R Andrew McIvor
J Mark Fitzgerald
Paul Hernandez
Catherine Lemiere
Sat Sharma
Stephen K Field
Gonzalo G Alvarez
Robert E Dales
Shawn D Aaron
Author Affiliation
MSc, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6. spakhale@ohri.ca
Source
Chest. 2010 Jun;137(6):1316-23
Date
Jun-2010
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Algorithms
Asthma - complications - diagnosis - epidemiology - physiopathology
Body mass index
Canada - epidemiology
Chi-Square Distribution
Female
Forced expiratory volume
Gastroesophageal Reflux - complications - epidemiology
Humans
Hypertension - complications - epidemiology
Logistic Models
Male
Middle Aged
Obesity - complications - epidemiology - physiopathology
Quality of Life
Respiratory Function Tests
Risk factors
Severity of Illness Index
Abstract
The objectives of our study were to compare patient characteristics and severity of disease in obese and normal-weight-confirmed people with asthma and to explore reasons for misdiagnosis of asthma, including potential interactions with obesity.
We randomly selected patients with physician-diagnosed asthma from eight Canadian cities. Asthma diagnosis was confirmed via a sequential lung function testing algorithm. Logistic analysis was conducted to compare obese and normal-weight-confirmed people with asthma and to assess characteristics associated with misdiagnosis of asthma. Interaction with obesity was investigated.
Complete assessments were obtained on 496 subjects who reported physician-diagnosed asthma (242 obese and 254 normal-weight subjects); 346 had asthma confirmed with sequential lung testing, and in 150 subjects a diagnosis of asthma was ruled out. Obese subjects with asthma were significantly more likely to be men, have a history of hypertension and gastroesophageal reflux disease, and have a lower FEV(1) compared with normal-weight subjects with asthma. Older subjects, men, and subjects with higher FEV(1) were more likely to have received misdiagnoses of asthma. Obesity was not an independent predictor of misdiagnosis, however there was an interaction between obesity and urgent visits for respiratory symptoms. The odds ratio for receiving a misdiagnosis of asthma for obese individuals as compared with normal-weight individuals was 4.08 (95% CI, 1.23-13.5) for those with urgent visits in the past 12 months.
Obese people with asthma have lower lung function and more comorbidities compared with normal-weight people with asthma. Obese individuals who make urgent visits for respiratory symptoms are more likely to receive a misdiagnosis of asthma.
PubMed ID
20154078 View in PubMed
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Determinants of tuberculosis trends in six Indigenous populations of the USA, Canada, and Greenland from 1960 to 2014: a population-based study.

https://arctichealth.org/en/permalink/ahliterature298373
Source
Lancet Public Health. 2018 03; 3(3):e133-e142
Publication Type
Article
Date
03-2018
Author
Kianoush Dehghani
Zhiyi Lan
Peizhi Li
Sascha Wilk Michelsen
Sean Waites
Andrea Benedetti
Pierre Lejeune
Jill Torrie
Elizabeth Robinson
Berenica Vejvoda
Muhammad Mullah
Diana Redwood
Michael Cooper
Anne Fanning
Wadieh Yacoub
Gonzalo G Alvarez
Bolette Søborg
Richard Long
Dick Menzies
Author Affiliation
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada; Public Health Department of the Cree Board of Health and Social Services of James Bay, Montreal, QC, Canada. Electronic address: kianoush.dehghani@mcgill.ca.
Source
Lancet Public Health. 2018 03; 3(3):e133-e142
Date
03-2018
Language
English
Geographic Location
Canada
Greenland
U.S.
Publication Type
Article
Keywords
Adult
Alaska Natives - statistics & numerical data
Canada - epidemiology
Female
Greenland - epidemiology
Humans
Incidence
Indians, North American - statistics & numerical data
Inuits - statistics & numerical data
Male
Risk factors
Tuberculosis - epidemiology
United States - epidemiology
Abstract
Tuberculosis continues to disproportionately affect many Indigenous populations in the USA, Canada, and Greenland. We aimed to investigate whether population-based tuberculosis-specific interventions or changes in general health and socioeconomic indicators, or a combination of these factors, were associated with changes in tuberculosis incidence in these Indigenous populations.
For this population-based study we examined annual tuberculosis notification rates between 1960 and 2014 in six Indigenous populations of the USA, Canada, and Greenland (Inuit [Greenland], American Indian and Alaska Native [Alaska, USA], First Nations [Alberta, Canada], Cree of Eeyou Istchee [Quebec, Canada], Inuit of Nunavik [Quebec, Canada], and Inuit of Nunavut [Canada]), as well as the general population of Canada. We used mixed-model linear regression to estimate the association of these rates with population-wide interventions of bacillus Calmette-Guérin (BCG) vaccination of infants, radiographic screening, or testing and treatment for latent tuberculosis infection (LTBI), and with other health and socioeconomic indicators including life expectancy, infant mortality, diabetes, obesity, smoking, alcohol use, crowded housing, employment, education, and health expenditures.
Tuberculosis notification rates declined rapidly in all six Indigenous populations between 1960 and 1980, with continued decline in Indigenous populations in Alberta, Alaska, and Eeyou Istchee thereafter but recrudescence in Inuit populations of Nunavut, Nunavik, and Greenland. Annual percentage reductions in tuberculosis incidence were significantly associated with two tuberculosis control interventions, relative to no intervention, and after adjustment for infant mortality and smoking: BCG vaccination (-11%, 95% CI -6 to -17) and LTBI screening and treatment (-10%, -3 to -18). Adjusted associations were not significant for chest radiographic screening (-1%, 95% CI -7 to 5). Declining tuberculosis notification rates were significantly associated with increased life expectancy (-37·8 [95% CI -41·7 to -33·9] fewer cases per 100?000 for each 1-year increase) and decreased infant mortality (-9·0 [-9·5 to -8·6] fewer cases per 100?000 for each death averted per 1000 livebirths) in all six Indigenous populations, but no significant associations were observed for other health and socioeconomic indicators examined.
Population-based BCG vaccination of infants and LTBI screening and treatment were associated with significant decreases in tuberculosis notification rates in these Indigenous populations. These interventions should be reinforced in populations still affected by tuberculosis, while also addressing the persistent health and socioeconomic disparities.
Public Health Department of the Cree Board of Health and Social Services of James Bay.
Notes
CommentIn: Lancet Public Health. 2018 Mar;3(3):e105-e106 PMID 29426598
PubMed ID
29426597 View in PubMed
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Developing and Field Testing a Community Based Youth Initiative to Increase Tuberculosis Awareness in Remote Arctic Inuit Communities.

https://arctichealth.org/en/permalink/ahliterature274320
Source
PLoS One. 2016;11(7):e0159241
Publication Type
Article
Author
Gonzalo G Alvarez
Deborah D Van Dyk
Heather Colquhoun
Katherine A Moreau
Sunita Mulpuru
Ian D Graham
Source
PLoS One. 2016;11(7):e0159241
Language
English
Publication Type
Article
Abstract
Inuit in Canada have the highest reported tuberculosis (TB) incidence rate in Canada, even higher than other Canadian Indigenous groups. The aim of this study was to increase TB awareness among Inuit youth and their communities by equipping those who can best reach this population with a community based, youth focused, education initiative built on interventions adapted from a previous TB awareness study.
The Taima TB Youth Education Initiative was a field test case study of a knowledge translation (KT) strategy aimed at community members who provide health education in these communities. In the first stage of this study, interventions from a larger TB awareness campaign were adapted to focus on youth living in remote Inuit communities. During the second stage of the study, investigators field tested the initiative in two isolated Inuit communities. It was then applied by local implementation teams in two other communities. Evaluation criteria included feasibility, acceptability, knowledge uptake and health behavior change.
Implementation of the adapted KT interventions resulted in participation of a total of 41 youth (19 females, 22 males) with an average age of 16 years (range 12-21 years) in four different communities in Nunavut. Community celebration events were attended by 271 community members where TB messaging were presented and discussed. All of the health care workers and community members surveyed reported that the adapted interventions were acceptable and a useful way of learning to some extent. Knowledge uptake measures indicated an average TB knowledge score of 64 out of 100. Local partners in all four communities indicated that they would use the Taima TB Youth Education Initiative again to raise awareness about TB among youth in their communities.
The TB awareness interventions adapted for the Taima TB Youth Education Initiative were acceptable to the Inuit communities involved in the study. They resulted in uptake of knowledge among participants. Implementation by local implementation teams was feasible as evidenced by the participation and attendance of youth and community members in all communities. The ability to implement the interventions by local implementation teams indicates there is potential to scale up in other remote communities in the arctic setting.
PubMed ID
27415757 View in PubMed
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The Feasibility, Accuracy, and Impact of Xpert MTB/RIF Testing in a Remote Aboriginal Community in Canada.

https://arctichealth.org/en/permalink/ahliterature268272
Source
Chest. 2015 Sep;148(3):767-73
Publication Type
Article
Date
Sep-2015
Author
Gonzalo G Alvarez
Deborah D Van Dyk
Marc Desjardins
Abdool S Yasseen
Shawn D Aaron
D William Cameron
Natan Obed
Maureen Baikie
Smita Pakhale
Claudia M Denkinger
Hojoon Sohn
Madhukar Pai
Source
Chest. 2015 Sep;148(3):767-73
Date
Sep-2015
Language
English
Publication Type
Article
Keywords
Adult
Antibiotics, Antitubercular - therapeutic use
Drug Resistance, Bacterial
Feasibility Studies
Female
Humans
Incidence
Inuits
Male
Mycobacterium tuberculosis - drug effects - isolation & purification
Nunavut - epidemiology
Prospective Studies
Real-Time Polymerase Chain Reaction - methods
Rifampin - therapeutic use
Tuberculosis, Pulmonary - diagnosis - drug therapy - epidemiology
Abstract
Xpert MTB/RIF testing for Mycobacterium tuberculosis and rifampin resistance is being used extensively in countries with a high burden of TB. However, recent evidence suggests that it may not have the same accuracy or impact in high-income, low-burden TB countries.
A prospective, pragmatic study was done between March 2012 and March 2014 to determine the feasibility, accuracy, and impact on TB disease management provided by the Xpert test in a remote, medically underserved, predominantly Inuit population in Iqaluit, Nunavut, Canada.
A total of 453 Xpert tests were run on sputum samples from 344 patients with suspected TB. Twenty-seven patients were identified as having active TB disease by culture. There were no cases of drug-resistant TB. Using culture as the gold standard, one Xpert test compared with one, two, or three sputum samples cultured per patient had a sensitivity of 85% (95% CI, 66%-95%) and a specificity of 99% (95% CI, 97%-100%) for detection of M tuberculosis. The indeterminate rate was 4.4% of all samples run. Treatment initiation was significantly shortened using Xpert vs the national standard of three smears (1.8 days vs 7.7 days, P
PubMed ID
25789458 View in PubMed
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The feasibility of the interferon gamma release assay and predictors of discordance with the tuberculin skin test for the diagnosis of latent tuberculosis infection in a remote aboriginal community.

https://arctichealth.org/en/permalink/ahliterature258079
Source
PLoS One. 2014;9(11):e111986
Publication Type
Article
Date
2014
Author
Gonzalo G Alvarez
Deborah D Van Dyk
Naomi Davies
Shawn D Aaron
D William Cameron
Marc Desjardins
Ranjeeta Mallick
Natan Obed
Maureen Baikie
Author Affiliation
Ottawa Hospital Research Institute, University of Ottawa, Divisions of Respirology and Infectious Diseases, Departments of Medicine and Microbiology, The Ottawa Hospital, Ottawa, Ontario, Canada.
Source
PLoS One. 2014;9(11):e111986
Date
2014
Language
English
Publication Type
Article
Abstract
The tuberculin skin test (TST) is the standard test used to screen for latent TB infection (LTBI) in the northern Canadian territory of Nunavut. Interferon gamma release assays (IGRA) are T cell blood-based assays to diagnose LTBI. The Bacillus Calmette-Guerin (BCG) vaccine is part of the routine immunization schedule in Nunavut. The objective of this study was to test the feasibility, and predictors of discordance between the Tuberculin Skin Test (TST) and the IGRA assay in a medically under-serviced remote arctic Aboriginal population.
Both the TST and QuantiFERON-TB Gold (Qiagen group) IGRA tests were offered to people in their homes as part of a public health campaign aimed at high TB risk residential areas in Iqaluit, Nunavut, Canada. Feasibility was measured by the capacity of the staff to do the test successfully as measured by the proportion of results obtained.
In this population of predominantly young Inuit who were mostly BCG vaccinated, the use of IGRA for the diagnosis of LTBI was feasible. IGRA testing resulted in more available test results reaching patients (95.6% vs 90.9% p?=?0.02) but took longer (median 8 days (IGRA) vs 2 days (TST), p value
PubMed ID
25386908 View in PubMed
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Improving access to lung cancer treatment in northern Canada: the role of oral molecularly targeted agents.

https://arctichealth.org/en/permalink/ahliterature104907
Source
CMAJ. 2014 Apr 15;186(7):485-6
Publication Type
Article
Date
Apr-15-2014

Overdiagnosis of asthma in obese and nonobese adults.

https://arctichealth.org/en/permalink/ahliterature154179
Source
CMAJ. 2008 Nov 18;179(11):1121-31
Publication Type
Article
Date
Nov-18-2008
Author
Shawn D Aaron
Katherine L Vandemheen
Louis-Philippe Boulet
R Andrew McIvor
J Mark Fitzgerald
Paul Hernandez
Catherine Lemiere
Sat Sharma
Stephen K Field
Gonzalo G Alvarez
Robert E Dales
Steve Doucette
Dean Fergusson
Author Affiliation
Ottawa Health Research Institute, Ottawa, Ont, USA. saaron@ohri.ca
Source
CMAJ. 2008 Nov 18;179(11):1121-31
Date
Nov-18-2008
Language
English
Publication Type
Article
Keywords
Adult
Age Distribution
Asthma - diagnosis - epidemiology
Body mass index
Body Weight
Canada - epidemiology
Confidence Intervals
Diagnostic Errors - statistics & numerical data
Female
Forced expiratory volume
Health Surveys
Humans
Longitudinal Studies
Male
Middle Aged
Obesity - diagnosis - epidemiology
Odds Ratio
Prevalence
Probability
Reference Values
Respiratory Function Tests
Sensitivity and specificity
Severity of Illness Index
Sex Distribution
Spirometry
Abstract
It is unclear whether asthma is overdiagnosed in developed countries, particularly among obese individuals, who may be more likely than nonobese people to experience dyspnea.
We conducted a longitudinal study involving nonobese (body mass index 20-25) and obese (body mass index >/= 30) individuals with asthma that had been diagnosed by a physician. Participants were recruited from 8 Canadian cities by means of random-digit dialing. A diagnosis of current asthma was excluded in those who did not have evidence of acute worsening of asthma symptoms, reversible airflow obstruction or bronchial hyperresponsiveness, despite being weaned off asthma medications. We stopped asthma medications in those in whom a diagnosis of asthma was excluded and assessed their clinical outcomes over 6 months.
Of 540 individuals with physician-diagnosed asthma who participated in the study, 496 (242 obese and 254 nonobese) could be conclusively assessed for a diagnosis of asthma. Asthma was ultimately excluded in 31.8% (95% confidence interval [CI] 26.3%-37.9%) in the obese group and in 28.7% (95% CI 23.5%-34.6%) in the nonobese group. Overdiagnosis of asthma was no more likely to occur among obese individuals than among nonobese individuals (p = 0.46). Of those in whom asthma was excluded, 65.5% did not need to take asthma medication or seek health care services because of asthma symptoms during a 6-month follow-up period.
About one-third of obese and nonobese individuals with physician-diagnosed asthma did not have asthma when objectively assessed. This finding suggests that, in developed countries such as Canada, asthma is overdiagnosed.
Notes
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Erratum In: CMAJ. 2008 Dec 2;179(12):1301
PubMed ID
19015563 View in PubMed
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The potential impact and cost-effectiveness of tobacco reduction strategies for tuberculosis prevention in Canadian Inuit communities.

https://arctichealth.org/en/permalink/ahliterature297992
Source
BMC Med. 2019 Feb 04; 17(1):26
Publication Type
Journal Article
Date
Feb-04-2019
Author
Dieynaba S N'Diaye
Ntwali Placide Nsengiyumva
Aashna Uppal
Olivia Oxlade
Gonzalo G Alvarez
Kevin Schwartzman
Author Affiliation
Montreal Chest Institute, Montreal, Quebec, Canada.
Source
BMC Med. 2019 Feb 04; 17(1):26
Date
Feb-04-2019
Language
English
Publication Type
Journal Article
Abstract
Tuberculosis (TB) remains a significant public health problem in Canadian Inuit communities. In 2016, Canadian Inuit had an incidence rate 35 times the Canadian average. Tobacco use is an important risk factor for TB, and over 60% of Inuit adults smoke. We aimed to estimate changes in TB-related outcomes and costs from reducing tobacco use in Inuit communities.
Using a transmission model to estimate the initial prevalence of latent TB infection (LTBI), followed by decision analysis modelling, we conducted a cost-effectiveness analysis that compared the current standard of care for management of TB and LTBI without additional tobacco reduction intervention (Status Quo) with (1) increased tobacco taxation, (2) pharmacotherapy and counselling for smoking cessation, (3) pharmacotherapy, counselling plus mass media campaign, and (4) the combination of all these. Projected outcomes included the following: TB cases, TB-related deaths, quality-adjusted life years (QALYs), and health system costs, all over 20?years.
The combined strategy was projected to reduce active TB cases by 6.1% (95% uncertainty range 4.9-7.0%) and TB deaths by 10.4% (9.5-11.4%) over 20?years, relative to the status quo. Increased taxation was the only cost-saving strategy.
Currently available strategies to reduce commercial tobacco use will likely have a modest impact on TB-related outcomes in the medium term, but some may be cost saving.
PubMed ID
30712513 View in PubMed
Less detail

The potential impact and cost-effectiveness of tobacco reduction strategies for tuberculosis prevention in Canadian Inuit communities.

https://arctichealth.org/en/permalink/ahliterature301113
Source
BMC Med. 2019 02 04; 17(1):26
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
02-04-2019
Author
Dieynaba S N'Diaye
Ntwali Placide Nsengiyumva
Aashna Uppal
Olivia Oxlade
Gonzalo G Alvarez
Kevin Schwartzman
Author Affiliation
Montreal Chest Institute, Montreal, Quebec, Canada.
Source
BMC Med. 2019 02 04; 17(1):26
Date
02-04-2019
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adult
Canada - epidemiology
Cost-Benefit Analysis
Decision Support Techniques
Humans
Inuits
Latent Tuberculosis - epidemiology - prevention & control
Prevalence
Public Health - methods
Risk factors
Tobacco Smoking - adverse effects - prevention & control
Tobacco Use Cessation - economics - methods
Tuberculosis - epidemiology - etiology - prevention & control
Abstract
Tuberculosis (TB) remains a significant public health problem in Canadian Inuit communities. In 2016, Canadian Inuit had an incidence rate 35 times the Canadian average. Tobacco use is an important risk factor for TB, and over 60% of Inuit adults smoke. We aimed to estimate changes in TB-related outcomes and costs from reducing tobacco use in Inuit communities.
Using a transmission model to estimate the initial prevalence of latent TB infection (LTBI), followed by decision analysis modelling, we conducted a cost-effectiveness analysis that compared the current standard of care for management of TB and LTBI without additional tobacco reduction intervention (Status Quo) with (1) increased tobacco taxation, (2) pharmacotherapy and counselling for smoking cessation, (3) pharmacotherapy, counselling plus mass media campaign, and (4) the combination of all these. Projected outcomes included the following: TB cases, TB-related deaths, quality-adjusted life years (QALYs), and health system costs, all over 20?years.
The combined strategy was projected to reduce active TB cases by 6.1% (95% uncertainty range 4.9-7.0%) and TB deaths by 10.4% (9.5-11.4%) over 20?years, relative to the status quo. Increased taxation was the only cost-saving strategy.
Currently available strategies to reduce commercial tobacco use will likely have a modest impact on TB-related outcomes in the medium term, but some may be cost saving.
PubMed ID
30712513 View in PubMed
Less detail

Social determinants of health among residential areas with a high tuberculosis incidence in a remote Inuit community.

https://arctichealth.org/en/permalink/ahliterature297978
Source
J Epidemiol Community Health. 2019 Feb 06; :
Publication Type
Journal Article
Date
Feb-06-2019
Author
Elaine Kilabuk
Franco Momoli
Ranjeeta Mallick
Deborah Van Dyk
Christopher Pease
Alice Zwerling
Sharon Edmunds Potvin
Gonzalo G Alvarez
Author Affiliation
Department of Internal Medicine, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada.
Source
J Epidemiol Community Health. 2019 Feb 06; :
Date
Feb-06-2019
Language
English
Publication Type
Journal Article
Abstract
Tuberculosis (TB) remains a significant health burden among Inuit in Canada. Social determinants of health (SDH) play a key role in TB infection, disease and ongoing transmission in this population. The objective of this research was to estimate the prevalence of social determinants of Inuit health as they relate to latent TB infection (LTBI) among people living in residential areas at high risk for TB in Iqaluit, Nunavut.
Inperson home surveys were conducted among those who lived in predetermined residential areas at high risk for TB identified in a door-to-door TB prevention campaign in Iqaluit, Nunavut in 2011. Risk ratios for SDH and LTBI were estimated, and multiple imputation was used to address missing data.
261 participants completed the questionnaire. Most participants identified as Inuit (82%). Unadjusted risk ratios demonstrated that age, education, smoking tobacco, crowded housing conditions and Inuit ethnicity were associated with LTBI. After adjusting for other SDH, multivariable analysis showed an association between LTBI with increasing age (relative risk, RR 1.07, 95% CI 1.04 to 1.11), crowded housing (RR 1.48, 95% CI 1.10 to 2.00) and ethnicity (RR 2.76, 95% CI 1.33 to 5.73) after imputing missing data.
Among high-risk residential areas for TB in a remote Arctic region of Canada, crowded housing and Inuit ethnicity were associated with LTBI after adjusting for other SDH. In addition to strong screening and treatment programmes, alleviating the chronic housing shortage will be a key element in the elimination of TB in the Canadian Inuit Nunangat.
PubMed ID
30728201 View in PubMed
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12 records – page 1 of 2.