1
|
Feldman C, Theron AJ, Cholo MC, Anderson R. Cigarette Smoking as a Risk Factor for Tuberculosis in Adults: Epidemiology and Aspects of Disease Pathogenesis. Pathogens 2024; 13:151. [PMID: 38392889 PMCID: PMC10892798 DOI: 10.3390/pathogens13020151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/25/2024] Open
Abstract
It has been noted by the World Health Organisation that cases of tuberculosis in 2022 globally numbered 10.6 million, resulting in 1.3 million deaths, such that TB is one of the infectious diseases causing the greatest morbidity and mortality worldwide. Since as early as 1918, there has been an ongoing debate as to the relationship between cigarette smoking and TB. However, numerous epidemiological studies, as well as meta-analyses, have indicated that both active and passive smoking are independent risk factors for TB infection, development of reactivation TB, progression of primary TB, increased severity of cavitary disease, and death from TB, among several other considerations. With this considerable body of evidence confirming the association between smoking and TB, it is not surprising that TB control programmes represent a key potential preventative intervention. In addition to coverage of the epidemiology of TB and its compelling causative link with smoking, the current review is also focused on evidence derived from clinical- and laboratory-based studies of disease pathogenesis, most prominently the protective anti-mycobacterial mechanisms of the alveolar macrophage, the primary intracellular refuge of M. tuberculosis. This section of the review is followed by an overview of the major strategies utilised by the pathogen to subvert these antimicrobial mechanisms in the airway, which are intensified by the suppressive effects of smoke inhalation on alveolar macrophage function. Finally, consideration is given to a somewhat under-explored, pro-infective activity of cigarette smoking, namely augmentation of antibiotic resistance due to direct effects of smoke per se on the pathogen. These include biofilm formation, induction of cellular efflux pumps, which eliminate both smoke-derived toxicants and antibiotics, as well as gene modifications that underpin antibiotic resistance.
Collapse
Affiliation(s)
- Charles Feldman
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, York Road, Parktown, Johannesburg 2193, South Africa;
| | - Annette J. Theron
- Department of Immunology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Bophelo Road, Prinshof, Pretoria 0083, South Africa; (A.J.T.); (M.C.C.)
| | - Moloko C. Cholo
- Department of Immunology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Bophelo Road, Prinshof, Pretoria 0083, South Africa; (A.J.T.); (M.C.C.)
| | - Ronald Anderson
- Department of Immunology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Bophelo Road, Prinshof, Pretoria 0083, South Africa; (A.J.T.); (M.C.C.)
| |
Collapse
|
2
|
Sailo CV, Tonsing MV, Sanga Z, Chhakchhuak Z, Kharkongor F, Fela V, Chhakchhuak L, Ralte L, Nemi L, Senthil Kumar N. Risk factors of tuberculosis in Mizoram: First report of the possible role of water source. Indian J Tuberc 2022; 69:675-681. [PMID: 36460407 DOI: 10.1016/j.ijtb.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 03/03/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Various risk factors of tuberculosis have been studied across the globe, but these may be altered over time and can be specific to geographical regions and there is not much information available from Northeastern region of India. This study aims to investigate the various risk factors of tuberculosis and analyze the presence of any less-established risk factors. METHODS A total of 400 TB cases and 840 healthy controls were interviewed from December 2017 - June 2020. Logistic regression model was used to analyze associated risk factors. Patients were categorized into pulmonary and extrapulmonary TB. RESULTS Clinical presentation such as fever, cough, weight loss, chest pain and night sweats were more prominent among pulmonary TB patients. The most common mode of diagnosis among pulmonary and extrapulmonary TB were GeneXpert and X-ray, respectively. Tuberculosis was found to be strongly prevalent among patients from lower socio-economic status, less educated, unemployed and improper housing condition. Other risk factors associated were alcohol consumption, neighbours with TB, travel history, no BCG vaccine, mass gathering, and non-ideal weight. An interesting less-established risk factor that demands attention is the source of water supply (p-0.017, OR-2.313, CI: 1.160-4.613), which was significant in this study. CONCLUSION Our data suggests that apart from all the well-established risk factors for TB, water supply might play a crucial role towards the transmission of TB, since proper hospital waste water treatment is yet to be adopted in Mizoram, Northeast India. From a public health standpoint, this highlights the need for further research in this area.
Collapse
Affiliation(s)
| | | | - Zothan Sanga
- Department of Health and Family Welfare, Directorate of Health Services, Aizawl, 796009, Mizoram, India
| | | | - Febiola Kharkongor
- Department of Health and Family Welfare, Directorate of Health Services, Aizawl, 796009, Mizoram, India
| | - Vanlal Fela
- Department of Health and Family Welfare, Directorate of Health Services, Aizawl, 796009, Mizoram, India
| | - Lily Chhakchhuak
- National Health Mission, Directorate of Health Services, Aizawl, 796009, Mizoram, India
| | - Lalremruata Ralte
- Department of Microbiology and Pathology, Synod Hospital, Durtlang, 796025, Mizoram, India
| | - Lalnun Nemi
- Department of Microbiology and Pathology, Synod Hospital, Durtlang, 796025, Mizoram, India
| | | |
Collapse
|
3
|
Tengku Khalid TNF, Wan Mohammad WMZ, Ab Samat R, Nik Husain NR. Predictors of tuberculosis disease in smokers: a case-control study in northeastern Malaysia. PeerJ 2022; 10:e13984. [PMID: 36093335 PMCID: PMC9462367 DOI: 10.7717/peerj.13984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 08/10/2022] [Indexed: 01/21/2023] Open
Abstract
Objective Tuberculosis (TB) is a leading infectious disease. However, many TB cases remain undetected and only present symptoms at a late stage of the infection. Therefore, targeted TB screening in high-risk populations, including smokers, is crucial. This study aimed to determine the predictors of TB disease among the smoker population in northeast Malaysia from 2019 to 2020. Methods A case-control study was conducted involving smokers aged 18 years and older from health clinics in Bachok Kelantan, Malaysia. Data were collected via face-to-face interviews or telephone calls from 159 participants, randomly selected from outpatient TB records. Simple and multiple logistic regression, using R software, were used to identify the determinants of TB. Results Most participants were male (59.1%) and had a secondary education (56.0%). Active smokers constituted 35.2% of the group, and the mean (SD) duration of exposure to smoking was 23.9 (16.47) and 18.4 (12.84) years for the case and control groups, respectively. Being an ex-smoker (adjusted odds ratio (AOR) 6.17; 95% CI [1.55-28.32]; p = 0.013), weight loss (AOR 13.45; 95% CI [4.58-44.46]; p < 0.005), night sweats (AOR 63.84; 95% CI [8.99-1392.75]; p < 0.005) and duration of symptoms (AOR 1.02; 95% CI [1.01-1.04]; p = 0.022) were shown to be significant predictors for TB disease. Conclusion Four predictors of TB disease in the population of smokers were recognised in this study and should be prioritised for early TB screening and diagnosis. This may help increase TB detection, initiate prompt treatment and reduce complications among the group at risk for TB.
Collapse
Affiliation(s)
- Tengku Noor Farhana Tengku Khalid
- Universiti Sains Malaysia, Department of Community Medicine, School of Medical Sciences, Health Campus, Kubang Kerian, Kelantan, Malaysia
| | - Wan Mohd Zahiruddin Wan Mohammad
- Universiti Sains Malaysia, Department of Community Medicine, School of Medical Sciences, Health Campus, Kubang Kerian, Kelantan, Malaysia
| | - Razan Ab Samat
- Bachok District Health Office, Bachok, Kelantan, Malaysia
| | - Nik Rosmawati Nik Husain
- Universiti Sains Malaysia, Department of Community Medicine, School of Medical Sciences, Health Campus, Kubang Kerian, Kelantan, Malaysia
| |
Collapse
|
4
|
Kellar I, Al Azdi Z, Jackson C, Huque R, Mdege ND, Siddiqi K. Muslim Communities Learning About Second-hand Smoke in Bangladesh (MCLASS II): a combined evidence and theory-based plus partnership intervention development approach. Pilot Feasibility Stud 2022; 8:136. [PMID: 35780245 PMCID: PMC9250240 DOI: 10.1186/s40814-022-01100-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 04/14/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction Deaths from second-hand smoke (SHS) exposure are increasing, but there is not sufficient evidence to recommend a particular SHS intervention or intervention development approach. Despite the available guidance on intervention reporting, and on the role and nature of pilot and feasibility studies, partial reporting of SHS interventions is common. The decision-making whilst developing such interventions is often under-reported. This paper describes the processes and decisions employed during transitioning from the aim of adapting an existing mosque-based intervention focused on public health messages, to the development of the content of novel community-based Smoke-Free Home (SFH) intervention. The intervention aims to promote smoke-free homes to reduce non-smokers’ exposure to SHS in the home via faith-based messages. Methods The development of the SFH intervention had four sequential phases: in-depth interviews with adults in households in Dhaka, identification of an intervention programme theory and content with Islamic scholars from the Bangladesh Islamic Foundation (BIF), user testing of candidate intervention content with adults, and iterative intervention development workshops with Imams and khatibs who trained at the BIF. Results It was judged inappropriately to take an intervention adaptation approach. Following the identification of an intervention programme theory and collaborating with stakeholders in an iterative and collaborative process to identify barriers, six potentially modifiable constructs were identified. These were targeted with a series of behaviour change techniques operationalised as Quranic verses with associated health messages to be used as the basis for Khutbahs. Following iterative user testing, acceptable intervention content was generated. Conclusion The potential of this community-based intervention to reduce SHS exposure at home and improve lung health among non-smokers in Bangladesh is the result of an iterative and collaborative process. It is the result of the integration of behaviour change evidence and theory and community stakeholder contributions to the production of the intervention content. This novel combination of intervention development frameworks demonstrates a flexible approach that could provide insights for intervention development in related contexts. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01100-5.
Collapse
Affiliation(s)
- Ian Kellar
- School of Psychology, Faculty of Medicine & Health, University of Leeds, Leeds, LS2 9JT, UK.
| | - Zunayed Al Azdi
- ARK Foundation, Suite C-3, C-4, House number 06, Road 109, Dhaka, 1212, Bangladesh
| | - Cath Jackson
- Valid Research Ltd., Sandown House, Sandbeck Way, Wetherby, LS22 7DN, UK.,Department of Health Sciences, Faculty of Sciences, University of York, York, YO10 5DD, UK
| | - Rumana Huque
- ARK Foundation, Suite C-3, C-4, House number 06, Road 109, Dhaka, 1212, Bangladesh.,Department of Economics, Dhaka University, Dhaka, Bangladesh
| | - Noreen Dadirai Mdege
- Department of Health Sciences, Faculty of Sciences, University of York, York, YO10 5DD, UK
| | - Kamran Siddiqi
- Department of Health Sciences, Faculty of Sciences, University of York, York, YO10 5DD, UK.,Hull York Medical School, University of York, Heslington, York, YO10 5DD, UK
| | | |
Collapse
|
5
|
Altet N, Latorre I, Jiménez-Fuentes MÁ, Soriano-Arandes A, Villar-Hernández R, Milà C, Rodríguez-Fernández P, Muriel-Moreno B, Comella-del-Barrio P, Godoy P, Millet JP, de Souza-Galvão ML, Jiménez-Ruiz CA, Domínguez J. Tobacco Smoking and Second-Hand Smoke Exposure Impact on Tuberculosis in Children. J Clin Med 2022; 11:jcm11072000. [PMID: 35407608 PMCID: PMC8999260 DOI: 10.3390/jcm11072000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 03/28/2022] [Accepted: 03/31/2022] [Indexed: 11/16/2022] Open
Abstract
Little is known about whether second-hand smoke (SHS) exposure affects tuberculosis (TB). Here, we investigate the association of cigarette smoke exposure with active TB and latent TB infection (LTBI) in children, analyzing Interferon-Gamma Release Assays’ (IGRAs) performance and cytokine immune responses. A total of 616 children from contact-tracing studies were included and classified regarding their smoking habits [unexposed, SHS, or smokers]. Risk factors for positive IGRAs, LTBI, and active TB were defined. GM-CSF, IFN-γ, IL-2, IL-5, IL-10, IL-13, IL-22, IL-17, TNF-α, IL-1RA and IP-10 cytokines were detected in a subgroup of patients. Being SHS exposed was associated with a positive IGRA [aOR (95% CI): 8.7 (5.9–12.8)] and was a main factor related with LTBI [aOR (95% CI): 7.57 (4.79–11.94)] and active TB [aOR (95% CI): 3.40 (1.45–7.98)]. Moreover, IGRAs’ sensitivity was reduced in active TB patients exposed to tobacco. IL-22, GM-CSF, IL-5, TNF-α, IP-10, and IL-13 were less secreted in LTBI children exposed to SHS. In conclusion, SHS is associated with LTBI and active TB in children. In addition, false-negative IGRAs obtained on active TB patients exposed to SHS, together with the decrease of specific cytokines released, suggest that tobacco may alter the immune response.
Collapse
Affiliation(s)
- Neus Altet
- Unitat de Tuberculosi Vall d’Hebron-Drassanes, Hospital Universitari Vall d’Hebron, 08001 Barcelona, Spain; (N.A.); (M.Á.J.-F.); (A.S.-A.); (C.M.); (M.L.d.S.-G.)
- Serveis Clínics, Unitat Clínica de Tractament Directament Observat de la Tuberculosi, 08022 Barcelona, Spain;
| | - Irene Latorre
- Institut d’Investigació Germans Trias i Pujol, CIBER Enfermedades Respiratorias, Universitat Autònoma de Barcelona, 08916 Badalona, Spain; (R.V.-H.); (P.R.-F.); (B.M.-M.); (P.C.-d.-B.); (J.D.)
- Correspondence: ; Tel.: +34-93-033-0537
| | - María Ángeles Jiménez-Fuentes
- Unitat de Tuberculosi Vall d’Hebron-Drassanes, Hospital Universitari Vall d’Hebron, 08001 Barcelona, Spain; (N.A.); (M.Á.J.-F.); (A.S.-A.); (C.M.); (M.L.d.S.-G.)
| | - Antoni Soriano-Arandes
- Unitat de Tuberculosi Vall d’Hebron-Drassanes, Hospital Universitari Vall d’Hebron, 08001 Barcelona, Spain; (N.A.); (M.Á.J.-F.); (A.S.-A.); (C.M.); (M.L.d.S.-G.)
| | - Raquel Villar-Hernández
- Institut d’Investigació Germans Trias i Pujol, CIBER Enfermedades Respiratorias, Universitat Autònoma de Barcelona, 08916 Badalona, Spain; (R.V.-H.); (P.R.-F.); (B.M.-M.); (P.C.-d.-B.); (J.D.)
| | - Celia Milà
- Unitat de Tuberculosi Vall d’Hebron-Drassanes, Hospital Universitari Vall d’Hebron, 08001 Barcelona, Spain; (N.A.); (M.Á.J.-F.); (A.S.-A.); (C.M.); (M.L.d.S.-G.)
| | - Pablo Rodríguez-Fernández
- Institut d’Investigació Germans Trias i Pujol, CIBER Enfermedades Respiratorias, Universitat Autònoma de Barcelona, 08916 Badalona, Spain; (R.V.-H.); (P.R.-F.); (B.M.-M.); (P.C.-d.-B.); (J.D.)
- Institut de Biotecnologia i Biomedicina, 08193 Cerdanyola del Vallès, Spain
| | - Beatriz Muriel-Moreno
- Institut d’Investigació Germans Trias i Pujol, CIBER Enfermedades Respiratorias, Universitat Autònoma de Barcelona, 08916 Badalona, Spain; (R.V.-H.); (P.R.-F.); (B.M.-M.); (P.C.-d.-B.); (J.D.)
| | - Patricia Comella-del-Barrio
- Institut d’Investigació Germans Trias i Pujol, CIBER Enfermedades Respiratorias, Universitat Autònoma de Barcelona, 08916 Badalona, Spain; (R.V.-H.); (P.R.-F.); (B.M.-M.); (P.C.-d.-B.); (J.D.)
| | - Pere Godoy
- Departament de Salut, Generalitat de Catalunya, 08028 Barcelona, Spain;
- CIBER Epidemiología y Salud Pública, 28029 Madrid, Spain
- IRB-Lleida, Universitat de Lleida, 25198 Lleida, Spain
| | - Joan-Pau Millet
- Serveis Clínics, Unitat Clínica de Tractament Directament Observat de la Tuberculosi, 08022 Barcelona, Spain;
- CIBER Epidemiología y Salud Pública, 28029 Madrid, Spain
| | - Maria Luiza de Souza-Galvão
- Unitat de Tuberculosi Vall d’Hebron-Drassanes, Hospital Universitari Vall d’Hebron, 08001 Barcelona, Spain; (N.A.); (M.Á.J.-F.); (A.S.-A.); (C.M.); (M.L.d.S.-G.)
| | | | - Jose Domínguez
- Institut d’Investigació Germans Trias i Pujol, CIBER Enfermedades Respiratorias, Universitat Autònoma de Barcelona, 08916 Badalona, Spain; (R.V.-H.); (P.R.-F.); (B.M.-M.); (P.C.-d.-B.); (J.D.)
| | | |
Collapse
|
6
|
Abohashrh M, Ahmad I, Alam MM, Beg MMA, Alshahrani MY, Irfan S, Verma AK, Alshaghdali K, Saeed M. Assessment of IL-12, mRNA expression, vitamin-D level, and their correlation among the Mycobacterium tuberculosis cases. Saudi J Biol Sci 2022; 29:992-997. [PMID: 35197768 PMCID: PMC8847913 DOI: 10.1016/j.sjbs.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/28/2021] [Accepted: 10/03/2021] [Indexed: 10/26/2022] Open
|
7
|
Dorjravdan M, Kouda K, Boldoo T, Dambaa N, Sovd T, Nakama C, Nishiyama T. Association between household solid fuel use and tuberculosis: cross-sectional data from the Mongolian National Tuberculosis Prevalence Survey. Environ Health Prev Med 2021; 26:76. [PMID: 34372757 PMCID: PMC8353728 DOI: 10.1186/s12199-021-00996-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/07/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) and indoor air pollution (IAP) are equally critical public health issues in the developing world. Mongolia is experiencing the double burden of TB and IAP due to solid fuel combustion. However, no study has assessed the relationship between household solid fuel use and TB in Mongolia. The present study aimed to assess the association between household solid fuel use and TB based on data from the Mongolian National Tuberculosis Prevalence Survey (MNTP Survey). METHOD The MNTP Survey was a nationally representative population-based cross-sectional survey targeting households in Mongolia from 2014 to 2015, with the aim of evaluating the prevalence of TB. The survey adopted a multistage cluster sampling design in accordance with the World Health Organization prevalence survey guidelines. Clusters with at least 500 residents were selected by random sampling. A sample size of 98 clusters with 54,100 participants was estimated to be required for the survey, and 41,450 participants were included in the final analysis of the present study. A structured questionnaire was used to collect information on environmental and individual factors related to TB. Physical examination, chest X-ray, and sputum examinations were also performed to diagnose TB. RESULTS The use of solid fuels for heating (adjusted odds ratio (aOR): 1.5; 95% confidence interval (CI): 1.1-2.1), male gender (aOR: 2.2; 95% CI: 1.6-3.2), divorced or widowed (aOR: 2.6; 95% CI: 1.7-3.8), daily smoker (aOR: 1.8; 95% CI: 1.3-2.5), contact with an active TB case (aOR: 1.7; 95% CI: 1.2-2.3), being underweight (aOR: 3.7; 95% CI: 2.4-5.7), and previous history of TB (aOR: 4.3; 95% CI: 3.0-6.1) were significantly associated with bacteriologically confirmed TB after adjusting for confounding variables. CONCLUSION The use of solid fuels for heating was significantly associated with active TB in Mongolian adults. Increased public awareness is needed on the use of household solid fuels, a source of IAP.
Collapse
Affiliation(s)
- Munkhjargal Dorjravdan
- grid.410783.90000 0001 2172 5041Department of Hygiene and Public Health, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, Osaka, 573-1010 Japan
| | - Katsuyasu Kouda
- grid.410783.90000 0001 2172 5041Department of Hygiene and Public Health, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, Osaka, 573-1010 Japan
| | - Tsolmon Boldoo
- Tuberculosis Surveillance and Research Department, National Center for Communicable Disease, Nam Yan Ju Street, Bayanzurkh district, Ulaanbaatar, 13701 Mongolia
| | - Naranzul Dambaa
- Tuberculosis Surveillance and Research Department, National Center for Communicable Disease, Nam Yan Ju Street, Bayanzurkh district, Ulaanbaatar, 13701 Mongolia
| | - Tugsdelger Sovd
- grid.416786.a0000 0004 0587 0574Swiss Tropical and Public Health Institute, Socinstrasse 57, CH-4051 Basel, Switzerland
| | - Chikako Nakama
- grid.410783.90000 0001 2172 5041Department of Hygiene and Public Health, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, Osaka, 573-1010 Japan
| | - Toshimasa Nishiyama
- grid.410783.90000 0001 2172 5041Department of Hygiene and Public Health, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, Osaka, 573-1010 Japan
| |
Collapse
|
8
|
Ferdous T, Siddiqi K, Semple S, Fairhurst C, Dobson R, Mdege N, Marshall AM, Abdullah SM, Huque R. Smoking behaviours and indoor air quality: a comparative analysis of smoking-permitted versus smoke-free homes in Dhaka, Bangladesh. Tob Control 2020; 31:444-451. [PMID: 33328266 DOI: 10.1136/tobaccocontrol-2020-055969] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 09/12/2020] [Accepted: 10/07/2020] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Exposure to secondhand smoke (SHS) is a health risk to non-smokers. Indoor particulate matter (PM2.5) is associated with SHS exposure and is used as a proxy measure. However, PM2.5 is non-specific and influenced by a number of environmental factors, which are subject to geographical variation. The nature of association between SHS exposure and indoor PM2.5-studied primarily in high-income countries (HICs) context-may not be globally applicable. We set out to explore this association in a low/middle-income country setting, Dhaka, Bangladesh. METHODS A cross-sectional study was conducted among households with at least one resident smoker. We inquired whether smoking was permitted inside the home (smoking-permitted homes, SPH) or not (smoke-free homes, SFH), and measured indoor PM2.5 concentrations using a low-cost instrument (Dylos DC1700) for at least 22 hours. We describe and compare SPH and SFH and use multiple linear regression to evaluate which variables are associated with PM2.5 level among all households. RESULTS We surveyed 1746 households between April and August 2018; 967 (55%) were SPH and 779 (45%) were SFH. The difference between PM2.5 values for SFH (median 27 µg/m3, IQR 25) and SPH (median 32 µg/m3, IQR 31) was 5 µg/m3 (p<0.001). Lead participant's education level, being a non-smoker, having outdoor space and smoke-free rule at home and not using kerosene oil for cooking were significantly associated with lower PM2.5. CONCLUSIONS We found a small but significant difference between PM2.5 concentrations in SPH compared with SFH in Dhaka, Bangladesh-a value much lower than observed in HICs.
Collapse
Affiliation(s)
- Tarana Ferdous
- Epidemiology research, ARK Foundation, Dhaka, Bangladesh
| | - Kamran Siddiqi
- Institute of Health Sciences, University of York, York, North Yorkshire, UK
| | - Sean Semple
- Institute of Social Marketing, University of Stirling Institute for Social Marketing, Stirling, UK
| | - Caroline Fairhurst
- York Trials Unit, Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Ruaraidh Dobson
- G10 Pathfoot Building Stirling Campus, University of Stirling Institute for Social Marketing, Stirling, UK
| | - Noreen Mdege
- Institute of Health Sciences, University of York, York, North Yorkshire, UK
| | | | - S M Abdullah
- Economics, University of Dhaka, Dhaka, Dhaka District, Bangladesh.,Health Economics research, ARK Foundation, Dhaka, Bangladesh
| | - Rumana Huque
- Economics, University of Dhaka, Dhaka, Dhaka District, Bangladesh.,Health Economics research, ARK Foundation, Dhaka, Bangladesh
| |
Collapse
|
9
|
Ibironke O, Carranza C, Sarkar S, Torres M, Choi HT, Nwoko J, Black K, Quintana-Belmares R, Osornio-Vargas Á, Ohman-Strickland P, Schwander S. Urban Air Pollution Particulates Suppress Human T-Cell Responses to Mycobacterium Tuberculosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16214112. [PMID: 31731429 PMCID: PMC6862251 DOI: 10.3390/ijerph16214112] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 01/18/2023]
Abstract
Tuberculosis (TB) and air pollution both contribute significantly to the global burden of disease. Epidemiological studies show that exposure to household and urban air pollution increase the risk of new infections with Mycobacterium tuberculosis (M.tb) and the development of TB in persons infected with M.tb and alter treatment outcomes. There is increasing evidence that particulate matter (PM) exposure weakens protective antimycobacterial host immunity. Mechanisms by which exposure to urban PM may adversely affect M.tb-specific human T cell functions have not been studied. We, therefore, explored the effects of urban air pollution PM2.5 (aerodynamic diameters ≤2.5µm) on M.tb-specific T cell functions in human peripheral blood mononuclear cells (PBMC). PM2.5 exposure decreased the capacity of PBMC to control the growth of M.tb and the M.tb-induced expression of CD69, an early surface activation marker expressed on CD3+ T cells. PM2.5 exposure also decreased the production of IFN-γ in CD3+, TNF-α in CD3+ and CD14+ M.tb-infected PBMC, and the M.tb-induced expression of T-box transcription factor TBX21 (T-bet). In contrast, PM2.5 exposure increased the expression of anti-inflammatory cytokine IL-10 in CD3+ and CD14+ PBMC. Taken together, PM2.5 exposure of PBMC prior to infection with M.tb impairs critical antimycobacterial T cell immune functions.
Collapse
Affiliation(s)
| | - Claudia Carranza
- Department of Microbiology, National Institute of Respiratory Diseases (INER), Mexico City 1408, Mexico; (C.C.); (M.T.)
| | - Srijata Sarkar
- Environmental and Occupational Health Sciences Institute, Rutgers, Piscataway, NJ 08854, USA; (S.S.); (H.T.C.); (K.B.)
| | - Martha Torres
- Department of Microbiology, National Institute of Respiratory Diseases (INER), Mexico City 1408, Mexico; (C.C.); (M.T.)
| | - Hyejeong Theresa Choi
- Environmental and Occupational Health Sciences Institute, Rutgers, Piscataway, NJ 08854, USA; (S.S.); (H.T.C.); (K.B.)
| | - Joyce Nwoko
- Department of Environmental and Occupational Health, Rutgers School of Public Health, Piscataway, NJ 08854, USA;
| | - Kathleen Black
- Environmental and Occupational Health Sciences Institute, Rutgers, Piscataway, NJ 08854, USA; (S.S.); (H.T.C.); (K.B.)
| | | | | | - Pamela Ohman-Strickland
- Department of Biostatistics Rutgers University School of Public Health, Piscataway, NJ 08854, USA;
| | - Stephan Schwander
- Environmental and Occupational Health Sciences Institute, Rutgers, Piscataway, NJ 08854, USA; (S.S.); (H.T.C.); (K.B.)
- Department of Environmental and Occupational Health, Rutgers School of Public Health, Piscataway, NJ 08854, USA;
- Department of Urban-Global Public Health, Rutgers University School of Public Health, Newark, NJ 07102, USA
- Correspondence:
| |
Collapse
|
10
|
Azimi M, Feng F, Zhou C. Air pollution inequality and health inequality in China: An empirical study. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:11962-11974. [PMID: 30825123 DOI: 10.1007/s11356-019-04599-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 02/18/2019] [Indexed: 05/17/2023]
Abstract
China's residents experience unequal exposure to air pollution in different regions, and the corresponding health consequences have increased remarkably. To ensure sustainable development, China should monitor health inequality and its potential determinants. This study empirically examines the health inequalities (represented by perinatal and tuberculosis mortalities) caused by air pollution inequalities (represented by SO2 and NOx emissions) from 31 Chinese provinces in the period 2006 to 2015, using the generalized method of moments (GMM) and quantile regression (QR). The GMM results reveal a strong positive relationship between SO2/NOx emission inequality and tuberculosis mortality inequality. In contrast, the QR results show that perinatal mortality inequality is closely related to emission inequality across all percentiles for SO2 emission and at the 75th percentile for NOx emission. Our findings help policymakers to identify health disparities and be mindful of air pollution inequality as a factor in the elimination of health inequality.
Collapse
Affiliation(s)
- Mohaddeseh Azimi
- School of Management, University of Science and Technology of China, Hefei, 230026, China.
| | - Feng Feng
- School of Management, University of Science and Technology of China, Hefei, 230026, China.
| | - Chongyang Zhou
- School of Management, University of Science and Technology of China, Hefei, 230026, China
| |
Collapse
|
11
|
Baindara P. Host-directed therapies to combat tuberculosis and associated non-communicable diseases. Microb Pathog 2019; 130:156-168. [PMID: 30876870 DOI: 10.1016/j.micpath.2019.03.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 03/03/2019] [Accepted: 03/04/2019] [Indexed: 12/22/2022]
Abstract
Mycobacterium tuberculosis (Mtb) has coevolved with a human host to evade and exploit the immune system in multiple ways. Mtb is an enormously successful human pathogen that can remain undetected in hosts for decades without causing clinical disease. While tuberculosis (TB) represents a perfect prototype of host-pathogen interaction, it remains a major challenge to develop new therapies to combat mycobacterial infections. Additionally, recent studies emphasize on comorbidity of TB with different non-communicable diseases (NCDs), highlighting the impact of demographic and lifestyle changes on the global burden of TB. In the recent past, host-directed therapies have emerged as a novel and promising approach to treating TB. Drugs modulating host responses are likely to avoid the development of bacterial resistance which is a major public health concern for TB treatment. Interestingly, many of these drugs also form treatment strategies for non-communicable diseases. In general, technological advances along with novel host-directed therapies may open an exciting and promising research area, which can eventually deliver effective TB treatment as well as curtail the emergent synergy with NCDs.
Collapse
Affiliation(s)
- Piyush Baindara
- Department of Microbiology and Immunology, University of Arkansas for Medical Sciences, Little Rock, USA.
| |
Collapse
|
12
|
Mdege N, Fairhurst C, Ferdous T, Hewitt C, Huque R, Jackson C, Kellar I, Parrott S, Semple S, Sheikh A, Swami S, Siddiqi K. Muslim Communities Learning About Second-hand Smoke in Bangladesh (MCLASS II): study protocol for a cluster randomised controlled trial of a community-based smoke-free homes intervention, with or without Indoor Air Quality feedback. Trials 2019; 20:11. [PMID: 30611292 PMCID: PMC6321715 DOI: 10.1186/s13063-018-3100-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 12/04/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Second-hand smoke (SHS) is a serious health hazard costing 890,000 lives a year globally. Women and children in many economically developing countries are worst affected as smoke-free laws are only partially implemented and homes remain a major source of SHS exposure. There is limited evidence on interventions designed to reduce SHS exposure in homes, especially in community settings. Following a successful pilot, a community-based approach to promote smoke-free homes in Bangladesh, a country with a strong commitment to smoke-free environments but with high levels of SHS exposure, will be evaluated. The study aims to assess the effectiveness and cost-effectiveness of a community-based intervention, Muslims for better Health (M4bH), with or without Indoor Air Quality (IAQ) feedback, in reducing non-smokers' exposure to SHS in the home. METHODS/DESIGN Based on behaviour-change theories, M4bH and IAQ feedback are designed to discourage people from smoking indoors. M4bH consists of a set of messages couched within mainstream Islamic discourse, delivered weekly by faith leaders (imams and khatibs) in mosques over 12 weeks (one message each week). The messages address key determinants of current smoking behaviours including lack of knowledge and misconceptions on specific harms associated with SHS exposure. IAQ feedback consists of personalised information on IAQ measured by a particulate matter (PM2.5) monitor within the home. Following adaptation of M4bH and IAQ feedback for the Bangladeshi context, a three-arm cluster randomised controlled trial will be conducted in Dhaka. Forty-five mosques and 1800 households, with at least one smoker and one non-smoker, will be recruited. Mosques will be randomised to: M4bH and IAQ feedback; M4bH alone; or usual services only. The primary outcome is 24-h mean household concentration of indoor fine particulate matter (PM2.5) at 12 months post randomisation. Secondary outcomes are 24-h mean household PM2.5 at 3 months post randomisation, frequency and severity of respiratory symptoms, health care service use and quality of life. A cost-effectiveness analysis and process evaluation will also be conducted. DISCUSSION The MCLASS II trial will test the potential of a community-based intervention to reduce second-hand smoke exposure at home and improve lung health among non-smokers in Bangladesh and beyond. TRIAL REGISTRATION ISRCTN, ISRCTN49975452 . Registered on 11 January 2018.
Collapse
Affiliation(s)
- Noreen Mdege
- Department of Health Sciences, Faculty of Sciences, University of York, York, YO10 5DD UK
| | - Caroline Fairhurst
- York Trials Unit, Department of Health Sciences, Faculty of Sciences, University of York, York, YO10 5DD UK
| | - Tarana Ferdous
- ARK Foundation, Suite C-3, C-4, House number 06, Road 109, Dhaka, 1212 Bangladesh
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, Faculty of Sciences, University of York, York, YO10 5DD UK
| | - Rumana Huque
- ARK Foundation, Suite C-3, C-4, House number 06, Road 109, Dhaka, 1212 Bangladesh
- Department of Economics, Dhaka University, Dhaka, Bangladesh
| | - Cath Jackson
- Valid Research Ltd, Sandown House, Sandbeck Way, Wetherby, LS22 7DN UK
| | - Ian Kellar
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9JT UK
| | - Steve Parrott
- Department of Health Sciences, Faculty of Sciences, University of York, York, YO10 5DD UK
| | - Sean Semple
- Institute for Social Marketing, University of Stirling, Stirling, FK9 4LA UK
| | - Aziz Sheikh
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, EH8 9AG UK
| | - Shilpi Swami
- Department of Health Sciences, Faculty of Sciences, University of York, York, YO10 5DD UK
| | - Kamran Siddiqi
- Department of Health Sciences, Faculty of Sciences, University of York, York, YO10 5DD UK
- Hull York Medical School, University of York, Heslington, York, YO10 5DD UK
| |
Collapse
|
13
|
Bai X, Aerts SL, Verma D, Ordway DJ, Chan ED. Epidemiologic Evidence of and Potential Mechanisms by Which Second-Hand Smoke Causes Predisposition to Latent and Active Tuberculosis. Immune Netw 2018; 18:e22. [PMID: 29984040 PMCID: PMC6026693 DOI: 10.4110/in.2018.18.e22] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/15/2018] [Accepted: 06/16/2018] [Indexed: 12/13/2022] Open
Abstract
Many studies have linked cigarette smoke (CS) exposure and tuberculosis (TB) infection and disease although much fewer have studied second-hand smoke (SHS) exposure. Our goal is to review the epidemiologic link between SHS and TB as well as to summarize the effects SHS and direct CS on various immune cells relevant for TB. PubMed searches were performed using the key words "tuberculosis" with "cigarette," "tobacco," or "second-hand smoke." The bibliography of relevant papers were examined for additional relevant publications. Relatively few studies associate SHS exposure with TB infection and active disease. Both SHS and direct CS can alter various components of host immunity resulting in increased vulnerability to TB. While the epidemiologic link of these 2 health maladies is robust, more definitive, mechanistic studies are required to prove that SHS and direct CS actually cause increased susceptibility to TB.
Collapse
Affiliation(s)
- Xiyuan Bai
- Department of Medicine, Denver Veterans Affairs Medical Center, University of Colorado Anschutz Medical Center, Denver, CO 80045, USA
- Department of Medicine and Office of Academic Affairs, National Jewish Health, Denver, CO 80206, USA
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Denver, CO 80045, USA
| | - Shanae L. Aerts
- Department of Medicine and Office of Academic Affairs, National Jewish Health, Denver, CO 80206, USA
| | - Deepshikha Verma
- Department of Microbiology, Immunology, and Pathology, Mycobacteria Research Laboratories, Colorado State University, Fort Collins, CO 80523, USA
| | - Diane J. Ordway
- Department of Microbiology, Immunology, and Pathology, Mycobacteria Research Laboratories, Colorado State University, Fort Collins, CO 80523, USA
| | - Edward D. Chan
- Department of Medicine, Denver Veterans Affairs Medical Center, University of Colorado Anschutz Medical Center, Denver, CO 80045, USA
- Department of Medicine and Office of Academic Affairs, National Jewish Health, Denver, CO 80206, USA
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Denver, CO 80045, USA
| |
Collapse
|
14
|
Chiang CY, Bam TS. Should tobacco control intervention be implemented into tuberculosis control program? Expert Rev Respir Med 2018; 12:541-543. [PMID: 29799762 DOI: 10.1080/17476348.2018.1481394] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Chen-Yuan Chiang
- a Department of Tuberculosis and HIV , International Union Against Tuberculosis and Lung Disease , Paris , France.,b Division of Pulmonary Medicine , Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University , Taipei , Taiwan.,c Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine , College of Medicine, Taipei Medical University , Taipei , Taiwan
| | - Tara Singh Bam
- d Department of Tobacco Control, Tuberculosis and HIV , International Union Against Tuberculosis and Lung Disease , Paris , France
| |
Collapse
|
15
|
Yew WW, Yoshiyama T, Leung CC, Chan DP. Epidemiological, clinical and mechanistic perspectives of tuberculosis in older people. Respirology 2018; 23:567-575. [PMID: 29607596 DOI: 10.1111/resp.13303] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 02/25/2018] [Accepted: 03/14/2018] [Indexed: 12/18/2022]
Abstract
With the ageing population globally, tuberculosis (TB) in older people becomes a major clinical and public health challenge. In many Asian countries, especially those located in the eastern and southeastern parts of the continent, geriatric TB is a significant problem. TB in the older patients is more difficult to diagnose in the early course of disease, and has poorer treatment outcomes, largely as increased failure and death. More drug-induced adverse reactions are also experienced by this population during TB therapy. Oxidative stress and mitochondrial dysfunction are now well recognized to be associated with the ageing process, and it is likely that the cellular and molecular perturbations interact inextricably with the immunological dysfunction biophysiologically inherent to ageing. These underlying mechanistic bases putatively contribute to the development of TB in the geriatric population and worsen the disease outcomes, especially when the TB is compounded by co-morbid conditions such as smoking and diabetes mellitus. Unravelling these mechanisms further would yield knowledge that might potentially help to prevent reactivated TB in older people, and also to better manage the established disease with drug regimens and other new therapeutic strategies. In addition, addressing the social elements associated with geriatric TB is also imperative in the relief of individual patient suffering and improvement of overall disease control.
Collapse
Affiliation(s)
- Wing W Yew
- Stanley Ho Centre for Emerging Infectious Diseases, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Takashi Yoshiyama
- Japan Anti Tuberculosis Association, The Research Institute of Tuberculosis and Fukujuji Hospital, Tokyo, Japan
| | - Chi C Leung
- Department of Health, Tuberculosis and Chest Service, Centre for Health Protection, Hong Kong
| | - Denise P Chan
- Stanley Ho Centre for Emerging Infectious Diseases, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| |
Collapse
|
16
|
Malekinejad M, Parriott A, Viitanen AP, Horvath H, Marks SM, Kahn JG. Yield of community-based tuberculosis targeted testing and treatment in foreign-born populations in the United States: A systematic review. PLoS One 2017; 12:e0180707. [PMID: 28786991 PMCID: PMC5546677 DOI: 10.1371/journal.pone.0180707] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 06/20/2017] [Indexed: 11/25/2022] Open
Abstract
Objective To synthesize outputs and outcomes of community-based tuberculosis targeted testing and treatment (TTT) programs in foreign-born populations (FBP) in the United States (US). Methods We systematically searched five bibliographic databases and other key resources. Two reviewers independently applied eligibility criteria to screen citations and extracted data from included studies. We excluded studies that contained <50% FBP participants or that examined steps only after diagnosis of latent TB infection (LTBI). We stratified studies as majority FBP (50–90%) and predominantly FBP (>90%). We used random-effects meta-analytic models to calculate pooled proportions and 95% confidence intervals (CI) for community-based TTT cascade steps (e.g., recruited, tested and treated), and used them to create two hypothetical cascades for 100 individuals. Results Fifteen studies conducted in 10 US states met inclusion criteria. Studies were heterogeneous in recruitment strategies and mostly recruited participants born in Latin America. Of 100 hypothetical participants (predominantly FBP) reached by community-based TTT, 40.4 (95% CI 28.6 to 50.1) would have valid test results, 15.7 (95% CI 9.9 to 21.8) would test positive, and 3.6 (95% CI 1.4 to 6.0) would complete LTBI treatment. Likewise, of 100 hypothetical participants (majority FBP) reached, 77.9 (95% CI 54.0 to 92.1) would have valid test results, 26.5 (95% CI 18.0 to 33.5) would test positive, and 5.4 (95% CI 2.1 to 9.0) would complete LTBI treatment. Of those with valid test results, pooled proportions of LTBI test positive for predominantly FBP and majority FBP were 38.9% (95% CI 28.6 to 49.8) and 34.3% (95% CI 29.3 to 39.5), respectively. Conclusions We observed high attrition throughout the care cascade in FBP participating in LTBI community-based TTT studies. Few studies included cascade steps prior to LTBI diagnosis, limiting our review findings. Moreover, Asia-born populations in the US are substantially underrepresented in the FBP community-based TTT literature.
Collapse
Affiliation(s)
- Mohsen Malekinejad
- Phillip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California, United States of America
- Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
- The Consortium for the Assessment of Prevention Economics (CAPE), University of California, San Francisco, San Francisco, California, United States of America
- * E-mail:
| | - Andrea Parriott
- Phillip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California, United States of America
- The Consortium for the Assessment of Prevention Economics (CAPE), University of California, San Francisco, San Francisco, California, United States of America
| | - Amanda P. Viitanen
- Phillip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California, United States of America
- The Consortium for the Assessment of Prevention Economics (CAPE), University of California, San Francisco, San Francisco, California, United States of America
| | - Hacsi Horvath
- Phillip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California, United States of America
- Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
- The Consortium for the Assessment of Prevention Economics (CAPE), University of California, San Francisco, San Francisco, California, United States of America
| | - Suzanne M. Marks
- Centers for Disease Control and Prevention, Division of Tuberculosis Elimination, Atlanta, Georgia, United States of America
| | - James G. Kahn
- Phillip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California, United States of America
- Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
- The Consortium for the Assessment of Prevention Economics (CAPE), University of California, San Francisco, San Francisco, California, United States of America
| |
Collapse
|
17
|
SmokeHaz: Systematic Reviews and Meta-analyses of the Effects of Smoking on Respiratory Health. Chest 2016; 150:164-79. [PMID: 27102185 DOI: 10.1016/j.chest.2016.03.060] [Citation(s) in RCA: 143] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 03/11/2016] [Accepted: 03/30/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Smoking tobacco increases the risk of respiratory disease in adults and children, but communicating the magnitude of these effects in a scientific manner that is accessible and usable by the public and policymakers presents a challenge. We have therefore summarized scientific data on the impact of smoking on respiratory diseases to provide the content for a unique resource, SmokeHaz. METHODS We conducted systematic reviews and meta-analyses of longitudinal studies (published to 2013) identified from electronic databases, gray literature, and experts. Random effect meta-analyses were used to pool the findings. RESULTS We included 216 articles. Among adult smokers, we confirmed substantially increased risks of lung cancer (risk ratio (RR), 10.92; 95% CI, 8.28-14.40; 34 studies), COPD (RR, 4.01; 95% CI, 3.18-5.05; 22 studies), and asthma (RR, 1.61; 95% CI, 1.07-2.42; eight studies). Exposure to passive smoke significantly increased the risk of lung cancer in adult nonsmokers and increased the risks of asthma, wheeze, lower respiratory infections, and reduced lung function in children. Smoking significantly increased the risk of sleep apnea and asthma exacerbations in adult and pregnant populations, and active and passive smoking increased the risk of tuberculosis. CONCLUSIONS These findings have been translated into easily digestible content and published on the SmokeHaz website.
Collapse
|
18
|
Underner M, Perriot J, Peiffer G, Meurice JC, Dautzenberg B. Tabagisme et observance du traitement antituberculeux. Rev Mal Respir 2016; 33:128-44. [PMID: 26777112 DOI: 10.1016/j.rmr.2015.08.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 08/31/2015] [Indexed: 02/08/2023]
|
19
|
Lai TC, Chiang CY, Wu CF, Yang SL, Liu DP, Chan CC, Lin HH. Ambient air pollution and risk of tuberculosis: a cohort study. Occup Environ Med 2015; 73:56-61. [DOI: 10.1136/oemed-2015-102995] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 09/23/2015] [Indexed: 12/17/2022]
|
20
|
Siddiqi K, Huque R, Jackson C, Parrott S, Dogar O, Shah S, Thomson H, Sheikh A. Children Learning About Secondhand Smoke (CLASS II): protocol of a pilot cluster randomised controlled trial. BMJ Open 2015; 5:e008749. [PMID: 26307620 PMCID: PMC4550726 DOI: 10.1136/bmjopen-2015-008749] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Exposure to secondhand smoke (SHS) increases children's risk of acquiring chest and ear infections, tuberculosis, meningitis and asthma. Smoking bans in public places (where implemented) have significantly reduced adults' exposure to SHS. However, for children, homes remain the most likely place for them to be exposed to SHS. Additional measures are therefore required to protect children from SHS. In a feasibility study in Dhaka, Bangladesh, we have shown that a school-based smoke-free intervention (SFI) was successful in encouraging children to negotiate and implement smoking restrictions in homes. We will now conduct a pilot trial to inform plans to undertake a cluster randomised controlled trial (RCT) investigating the effectiveness and cost-effectiveness of SFI in reducing children's exposure to SHS. METHODS AND ANALYSIS We plan to recruit 12 primary schools in Dhaka, Bangladesh. From these schools, we will recruit approximately 360 schoolchildren in year 5 (10-12 years old), that is, 30 per school. SFI consists of six interactive educational activities aimed at increasing pupils' knowledge about SHS and related harms, motivating them to act, providing skills to negotiate with adults to persuade them not to smoke inside homes and helping families to 'sign-up' to a voluntary contract to make their homes smoke-free. Children in the control arm will receive the usual education. We will estimate: recruitment and attrition rates, acceptability, fidelity to SFI, effect size, intracluster correlation coefficient, cost of intervention and adverse events. Our primary outcome will consist of SHS exposure in children measured by salivary cotinine. Secondary outcomes will include respiratory symptoms, lung function tests, healthcare contacts, school attendance, smoking uptake, quality of life and academic performance. ETHICS AND DISSEMINATION The trial has received ethics approval from the Research Governance Committee at the University of York. Findings will help us plan for the definitive trial. TRIAL REGISTRATION NUMBER ISRCTN68690577.
Collapse
Affiliation(s)
- Kamran Siddiqi
- Department of Health Sciences, The University of York, York, UK
| | | | - Cath Jackson
- Department of Health Sciences, The University of York, York, UK
| | - Steve Parrott
- Department of Health Sciences, The University of York, York, UK
| | - Omara Dogar
- Department of Health Sciences, The University of York, York, UK
| | - Sarwat Shah
- Department of Health Sciences, The University of York, York, UK
| | | | - Aziz Sheikh
- Centre for Medical Informatics, Usher Institute of Population Heath Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| |
Collapse
|
21
|
Wei X, Zou G, Chong MK, Xu L. An intervention of active TB case finding among smokers attending routine primary care facilities in China: an exploratory study. Trans R Soc Trop Med Hyg 2015; 109:545-52. [PMID: 26246249 DOI: 10.1093/trstmh/trv063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 07/15/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Smoking is an important risk factor of TB. However, no studies have been conducted to identify TB cases from smokers. We assessed the process and initial impact of active case finding among smokers at primary care facilities in a setting with high smoking rates and TB burden. METHODS A prospective quasi-experimental study was conducted in para-urban communities in Yunnan China between September 2013 and June 2014. Smokers attending primary care facilities in the intervention group were prescribed chest X-rays if they had diabetes or TB symptoms, or were elders or close contacts of TB patients. Those with X-rays suggestive of TB were referred to TB dispensaries for diagnosis. Passive case finding was practiced in the control group. RESULTS In the intervention group, we screened 471 smokers with high risks of TB, of whom 73% took chest X-ray examinations. Eight TB cases were diagnosed, reflecting a 1.7% yield rate of all screened smokers. Smokers with diabetes (OR 6.003, 95% CI 1.057-34.075) were more likely to have TB compared with those without. In total, the intervention group reported significantly higher TB notification rate compared with the control group (38.6 vs 22.9 per 100 000, p=0.016). CONCLUSIONS Active case finding among smokers with high risks of TB was feasible and contributed to improved notification rates.
Collapse
Affiliation(s)
- Xiaolin Wei
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Guangyan Zou
- COMDIS Health Services Delivery Research Consortium, China Programme, University of Leeds, Shenzhen, China
| | - Marc Kc Chong
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Lin Xu
- Institute of Yunnan Tuberculosis Control, Yunnan Center for Disease Control and Prevention, Kunming, China
| |
Collapse
|
22
|
Second-hand smoke and the risk of tuberculosis: a systematic review and a meta-analysis. Epidemiol Infect 2015; 143:3158-72. [DOI: 10.1017/s0950268815001235] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
SUMMARYThere is limited evidence and lack of consensus whether second-hand smoke (SHS) increases risk of tuberculosis (TB), which has substantial implications for unrestricted smoking indoors and TB control policies. We aimed to establish the association between SHS and the risk of acquiring and worsening of TB in non-smokers. We identified 428 articles in the initial search and 12 comparative epidemiological studies met our inclusion criteria. Exposure to SHS was found to have a higher risk of TB infection [risk ratio (RR) 1·19, 95% confidence interval (CI) 0·90–1·57] compared to non-exposure; however, this did not reach statistical significance. There was marked variability (I2 = 74%, P = 0·0008) between studies’ results, which could be explained by the differences in the diagnostic criteria used. Exposure to SHS was found to be statistically significantly associated (RR 1·59, 95% CI 1·11–2·27) with the risk of TB disease. There was significant heterogeneity (I2 = 77%, P = 0·0006) between studies’ results, which was sourced to the internal characteristics of the studies rather than combining different study designs. We did not find any studies for SHS and TB treatment-related outcomes. Thus, we conclude that SHS exposure may increase the risk of acquiring TB infection and progression to TB disease; however, the evidence remains scanty and weak.
Collapse
|
23
|
Patra J, Bhatia M, Suraweera W, Morris SK, Patra C, Gupta PC, Jha P. Exposure to second-hand smoke and the risk of tuberculosis in children and adults: a systematic review and meta-analysis of 18 observational studies. PLoS Med 2015; 12:e1001835; discussion e1001835. [PMID: 26035557 PMCID: PMC4452762 DOI: 10.1371/journal.pmed.1001835] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 04/23/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND According to WHO Global Health Estimates, tuberculosis (TB) is among the top ten causes of global mortality and ranks second after cardiovascular disease in most high-burden regions. In this systematic review and meta-analysis, we investigated the role of second-hand smoke (SHS) exposure as a risk factor for TB among children and adults. METHODS AND FINDINGS We performed a systematic literature search of PubMed, Embase, Scopus, Web of Science, and Google Scholar up to August 31, 2014. Our a priori inclusion criteria encompassed only original studies where latent TB infection (LTBI) and active TB disease were diagnosed microbiologically, clinically, histologically, or radiologically. Effect estimates were pooled using fixed- and random-effects models. We identified 18 eligible studies, with 30,757 children and 44,432 adult non-smokers, containing SHS exposure and TB outcome data for inclusion in the meta-analysis. Twelve studies assessed children and eight studies assessed adult non-smokers; two studies assessed both populations. Summary relative risk (RR) of LTBI associated with SHS exposure in children was similar to the overall effect size, with high heterogeneity (pooled RR 1.64, 95% CI 1.00-2.83). Children showed a more than 3-fold increased risk of SHS-associated active TB (pooled RR 3.41, 95% CI 1.81-6.45), which was higher than the risk in adults exposed to SHS (summary RR 1.32, 95% CI 1.04-1.68). Positive and significant exposure-response relationships were observed among children under 5 y (RR 5.88, 95% CI 2.09-16.54), children exposed to SHS through any parent (RR 4.20, 95% CI 1.92-9.20), and children living under the most crowded household conditions (RR 5.53, 95% CI 2.36-12.98). Associations for LTBI and active TB disease remained significant after adjustment for age, biomass fuel (BMF) use, and presence of a TB patient in the household, although the meta-analysis was limited to a subset of studies that adjusted for these variables. There was a loss of association with increased risk of LTBI (but not active TB) after adjustment for socioeconomic status (SES) and study quality. The major limitation of this analysis is the high heterogeneity in outcomes among studies of pediatric cases of LTBI and TB disease. CONCLUSIONS We found that SHS exposure is associated with an increase in the relative risk of LTBI and active TB after controlling for age, BMF use, and contact with a TB patient, and there was no significant association of SHS exposure with LTBI after adjustment for SES and study quality. Given the high heterogeneity among the primary studies, our analysis may not show sufficient evidence to confirm an association. In addition, considering that the TB burden is highest in countries with increasing SHS exposure, it is important to confirm these results with higher quality studies. Research in this area may have important implications for TB and tobacco control programs, especially for children in settings with high SHS exposure and TB burden.
Collapse
Affiliation(s)
- Jayadeep Patra
- Centre for Global Health Research, St Michael’s Hospital, Toronto, Ontario, Canada
- Dalla-Lana School of Public Health, University of Toronto, Ontario, Toronto, Canada
- * E-mail:
| | - Mehak Bhatia
- Centre for Global Health Research, St Michael’s Hospital, Toronto, Ontario, Canada
- Dalla-Lana School of Public Health, University of Toronto, Ontario, Toronto, Canada
| | - Wilson Suraweera
- Centre for Global Health Research, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Shaun K. Morris
- Division of Infectious Diseases, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Cyril Patra
- School of Public Health, University of Memphis, Memphis, Tennessee, United States of America
| | | | - Prabhat Jha
- Centre for Global Health Research, St Michael’s Hospital, Toronto, Ontario, Canada
- Dalla-Lana School of Public Health, University of Toronto, Ontario, Toronto, Canada
| |
Collapse
|
24
|
Jiménez-Ruiz CA, Andreas S, Lewis KE, Tonnesen P, van Schayck CP, Hajek P, Tonstad S, Dautzenberg B, Fletcher M, Masefield S, Powell P, Hering T, Nardini S, Tonia T, Gratziou C. Statement on smoking cessation in COPD and other pulmonary diseases and in smokers with comorbidities who find it difficult to quit. Eur Respir J 2015; 46:61-79. [PMID: 25882805 DOI: 10.1183/09031936.00092614] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 12/24/2014] [Indexed: 12/18/2022]
Abstract
Chronic obstructive pulmonary disease (COPD), lung cancer, asthma and pulmonary tuberculosis are common pulmonary diseases that are caused or worsened by tobacco smoking. Growing observational evidence suggests that symptoms and prognosis of these conditions improve upon smoking cessation. Despite increasing numbers of (small) randomised controlled trials suggesting intensive smoking cessation treatments work in people with pulmonary diseases many patients are not given specific advice on the benefits or referred for intensive cessation treatments and, therefore, continue smoking.This is a qualitative review regarding smoking cessation in patients with COPD and other pulmonary disorders, written by a group of European Respiratory Society experts. We describe the epidemiological links between smoking and pulmonary disorders, the evidence for benefits of stopping smoking, how best to assess tobacco dependence and what interventions currently work best to help pulmonary patients quit. Finally, we describe characteristics and management of any "hardcore" smoker who finds it difficult to quit with standard approaches.
Collapse
Affiliation(s)
| | - Stefan Andreas
- Lungenfachklinik Immenhausen and Pneumology, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Keir E Lewis
- Dept of Respiratory Medicine, Prince Philip Hospital and Swansea College of Medicine, Swansea, UK
| | - Philip Tonnesen
- Dept of Sleep Medicine, Glostrup Hospital, Glostrup, Denmark
| | - C P van Schayck
- Care and Public Health Research Institute (Caphri), Maastricht University, Maastricht, The Netherlands
| | - Peter Hajek
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Serena Tonstad
- Section for Preventive Cardiology, Oslo University Hospital, Oslo, Norway
| | | | | | | | | | | | - Stefano Nardini
- Pulmonary and TB Unit, Ospedale Civile, Vittorio Veneto, Italy
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Christina Gratziou
- University Centre for Research and Smoking Cessation, Evgenidio Hospital, Medical School, Athens University, Athens, Greece
| |
Collapse
|
25
|
Air pollution particulate matter alters antimycobacterial respiratory epithelium innate immunity. Infect Immun 2015; 83:2507-17. [PMID: 25847963 DOI: 10.1128/iai.03018-14] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 03/26/2015] [Indexed: 01/10/2023] Open
Abstract
Inhalation exposure to indoor air pollutants and cigarette smoke increases the risk of developing tuberculosis (TB). Whether exposure to ambient air pollution particulate matter (PM) alters protective human host immune responses against Mycobacterium tuberculosis has been little studied. Here, we examined the effect of PM from Iztapalapa, a municipality of Mexico City, with aerodynamic diameters below 2.5 μm (PM2.5) and 10 μm (PM10) on innate antimycobacterial immune responses in human alveolar type II epithelial cells of the A549 cell line. Exposure to PM2.5 or PM10 deregulated the ability of the A549 cells to express the antimicrobial peptides human β-defensin 2 (HBD-2) and HBD-3 upon infection with M. tuberculosis and increased intracellular M. tuberculosis growth (as measured by CFU count). The observed modulation of antibacterial responsiveness by PM exposure was associated with the induction of senescence in PM-exposed A549 cells and was unrelated to PM-mediated loss of cell viability. Thus, the induction of senescence and downregulation of HBD-2 and HBD-3 expression in respiratory PM-exposed epithelial cells leading to enhanced M. tuberculosis growth represent mechanisms by which exposure to air pollution PM may increase the risk of M. tuberculosis infection and the development of TB.
Collapse
|
26
|
Bishwakarma R, Kinney WH, Honda JR, Mya J, Strand MJ, Gangavelli A, Bai X, Ordway DJ, Iseman MD, Chan ED. Epidemiologic link between tuberculosis and cigarette/biomass smoke exposure: Limitations despite the vast literature. Respirology 2015; 20:556-68. [PMID: 25808744 DOI: 10.1111/resp.12515] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 01/04/2015] [Accepted: 01/26/2015] [Indexed: 11/29/2022]
Abstract
The geographic overlap between the prevalence of cigarette smoke (CS) exposure and tuberculosis (TB) in the world is striking. In recent years, relatively large number of studies has linked cigarette or biomass fuel smoke exposure and various aspects of TB. Our goals are to summarize the significance of the known published studies, graphically represent reports that quantified the association and discuss their potential limitations. PubMed searches were performed using the key words 'tuberculosis' with 'cigarette', 'tobacco', 'smoke' or 'biomass fuel smoke.' The references of relevant articles were examined for additional pertinent papers. A large number of mostly case-control and cross-sectional studies significantly associate both direct and second-hand smoke exposure with tuberculous infection, active TB, and/or more severe and lethal TB. Fewer link biomass fuel smoke exposure and TB. While a number of studies interpreted the association with multivariate analysis, other confounders are often not accounted for in these analyses. It is also important to emphasize that these retrospective studies can only show an association and not any causal link. We further explored the possibility that even if CS exposure is a risk factor for TB, several mechanisms may be responsible. Numerous studies associate cigarette and biomass smoke exposure with TB but the mechanism(s) remains largely unknown. While the associative link of these two health maladies is well established, more definitive, mechanistic studies are needed to cement the effect of smoke exposure on TB pathogenesis and to utilize this knowledge in empowering public health policies.
Collapse
Affiliation(s)
- Raju Bishwakarma
- Departments of Medicine and Academic Affairs, National Jewish Health, Denver, Colorado, USA; Department of Medicine, University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
O'Leary SM, Coleman MM, Chew WM, Morrow C, McLaughlin AM, Gleeson LE, O'Sullivan MP, Keane J. Cigarette smoking impairs human pulmonary immunity to Mycobacterium tuberculosis. Am J Respir Crit Care Med 2015; 190:1430-6. [PMID: 25390734 DOI: 10.1164/rccm.201407-1385oc] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Cigarette smoking is linked to important aspects of tuberculosis, such as susceptibility to infection, disease reactivation, mortality, transmission, and persistent infectiousness. The mechanistic basis for this remains poorly understood. OBJECTIVES To compare the functional impairment seen in human alveolar macrophages (AM) from nonsmokers, smokers, and ex-smokers after infection with Mycobacterium tuberculosis (Mtb). METHODS AM were acquired at bronchoscopy, and number and viability from smoking donors were compared with nonsmoking donors. AM were challenged in vitro with Mtb and intracellular bacterial viability was measured. Cytokine secretion was measured 24 hours postinfection by ELISA. Previously we determined the frequency of CD4(+)FoxP3(+) T cells in the presence or absence of allogeneic AM, and data were reanalyzed to separate the patient subjects according to smoking status. MEASUREMENTS AND MAIN RESULTS There were significantly more AM from smokers compared with nonsmokers or ex-smokers (P < 0.01). AM from smokers could not control intracellular Mtb growth. Nonsmokers' AM generated significantly more tumor necrosis factor (TNF)-α, IFN-γ, and IL-1β after Mtb infection compared with uninfected AM (P < 0.05). However, Mtb-infected AM from smokers did not secrete significantly more TNF-α, IFN-γ, and IL-1β compared with uninfected smokers' AM. AM taken from ex-smokers also failed to secrete significantly increased TNF-α, IFN-γ, and IL-1β after Mtb infection. Both smokers' and nonsmokers' AM induced FoxP3(+) T regulatory cell phenotype responses in allogeneic admixed T cells (>4.8 fold; P < 0.05). Even after Mtb infection, AM continued to drive this regulatory phenotype. CONCLUSIONS In smokers, the pulmonary compartment has a number of macrophage-specific immune impairments that provide some mechanistic explanations whereby cigarette smoking renders a patient susceptible to tuberculosis infection and disease.
Collapse
Affiliation(s)
- Seónadh M O'Leary
- 1 Department of Clinical Medicine, Institute of Molecular Medicine, Trinity College Dublin, Dublin, Ireland; and
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Schooling CM, Chan WM, Leung SL, Lam TH, Lee SY, Shen C, Leung JY, Leung GM. Cohort Profile: Hong Kong Department of Health Elderly Health Service Cohort. Int J Epidemiol 2014; 45:64-72. [PMID: 25480143 DOI: 10.1093/ije/dyu227] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2014] [Indexed: 01/26/2023] Open
Abstract
The Department of Health Elderly Health Service Cohort in Hong Kong was set up to promote understanding of ageing in a global context, to exploit the role of Hong Kong as a sentinel for populations currently experiencing very rapid economic development, to provide a developed non-Western 'social laboratory' where empirically derived hypotheses can be tested and to leverage the different patterns of common chronic diseases between East and West to generate novel hypotheses about their determinants. The initial cohort enrolled from July 1998 to the end of December 2001 includes 66 820 people aged 65 years or older, forming about 9% of the population of this age. A comprehensive health assessment was made at enrollment and then repeated regularly on an ongoing basis. The health assessment included a comprehensive assessment of lifestyle, social circumstances, physical health and mental health, including an assessment of cognition and depressive symptoms. Health services use and deaths have been obtained by record linkage and confirmed, where necessary, by telephone interview. Currently, the data are not publicly available; we would welcome collaborations and research proposals.
Collapse
Affiliation(s)
- C M Schooling
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China and
| | - W M Chan
- Department of Health, Government of Hong Kong SAR, China
| | - S L Leung
- Department of Health, Government of Hong Kong SAR, China
| | - T H Lam
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China and
| | - S Y Lee
- Department of Health, Government of Hong Kong SAR, China
| | - C Shen
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China and
| | - J Y Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China and
| | - G M Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China and
| |
Collapse
|
29
|
Biraro IA, Egesa M, Toulza F, Levin J, Cose S, Joloba M, Smith S, Dockrell HM, Katamba A, Elliott AM. Impact of co-infections and BCG immunisation on immune responses among household contacts of tuberculosis patients in a Ugandan cohort. PLoS One 2014; 9:e111517. [PMID: 25372043 PMCID: PMC4221037 DOI: 10.1371/journal.pone.0111517] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 09/30/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Tuberculosis incidence in resource poor countries remains high. We hypothesized that immune modulating co-infections such as helminths, malaria, and HIV increase susceptibility to latent tuberculosis infection (LTBI), thereby contributing to maintaining the tuberculosis epidemic. METHODS Adults with sputum-positive tuberculosis (index cases) and their eligible household contacts (HHCs) were recruited to a cohort study between May 2011 and January 2012. HHCs were investigated for helminths, malaria, and HIV at enrolment. HHCs were tested using the QuantiFERON-TB Gold In-Tube (QFN) assay at enrolment and six months later. Overnight whole blood culture supernatants from baseline QFN assays were analyzed for cytokine responses using an 11-plex Luminex assay. Associations between outcomes (LTBI or cytokine responses) and exposures (co-infections and other risk factors) were examined using multivariable logistic and linear regression models. RESULTS We enrolled 101 index cases and 291 HHCs. Among HHCs, baseline prevalence of helminths was 9% (25/291), malaria 16% (47/291), HIV 6% (16/291), and LTBI 65% (179/277). Adjusting for other risk factors and household clustering, there was no association between LTBI and any co-infection at baseline or at six months: adjusted odds ratio (95% confidence interval (CI); p-value) at baseline for any helminth, 1.01 (0.39-2.66; 0.96); hookworm, 2.81 (0.56-14.14; 0.20); malaria, 1.06 (0.48-2.35; 0.87); HIV, 0.74 (0.22-2.47; 0.63). HHCs with LTBI had elevated cytokine responses to tuberculosis antigens but co-infections had little effect on cytokine responses. Exploring other risk factors, Th1 cytokines among LTBI-positive HHCs with BCG scars were greatly reduced compared to those without scars: (adjusted geometric mean ratio) IFNγ 0.20 (0.09-0.42), <0.0001; IL-2 0.34 (0.20-0.59), <0.0001; and TNFα 0.36 (0.16-0.79), 0.01. CONCLUSIONS We found no evidence that co-infections increase the risk of LTBI, or influence the cytokine response profile among those with LTBI. Prior BCG exposure may reduce Th1 cytokine responses in LTBI.
Collapse
Affiliation(s)
- Irene A. Biraro
- College of Health Sciences, Makerere University, Kampala, Uganda
- * E-mail:
| | - Moses Egesa
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Frederic Toulza
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jonathan Levin
- Medical Research Council/Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Stephen Cose
- Medical Research Council/Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe, Uganda
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Moses Joloba
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Steven Smith
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Hazel M. Dockrell
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Achilles Katamba
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Alison M. Elliott
- Medical Research Council/Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe, Uganda
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
30
|
Leung CC, Yew WW, Chan CK, Chang KC, Law WS, Lee SN, Tai LB, Leung ECC, Au RKF, Huang SS, Tam CM. Smoking adversely affects treatment response, outcome and relapse in tuberculosis. Eur Respir J 2014; 45:738-45. [PMID: 25359352 DOI: 10.1183/09031936.00114214] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The impact of smoking on tuberculosis outcome was evaluated in a territory-wide treatment programme. 16,345 consecutive patients undergoing chemotherapy for active tuberculosis in government chest clinics in Hong Kong from 2001 to 2003 were followed up prospectively for 2 years for treatment outcome and subsequently tracked through the territory-wide tuberculosis notification registry for relapse until the end of 2012. Smoking was associated with more extensive lung disease, lung cavitation and positive sputum smear and culture at the baseline. In both current smokers and ex-smokers, sputum smears and cultures were significantly more likely to remain positive after 2 months of treatment. Both categories of smokers were significantly less likely to achieve cure or treatment completion within 2 years. Overall, 16.7% of unsuccessful treatment outcomes were attributable to smoking, with the key contributor being default in current smokers and death in ex-smokers. Among successful treatment completers, there was a clear gradient (hazard ratios of 1.00, 1.33 and 1.63) of relapse risk from never-smokers to ex-smokers and current smokers, with an overall population attributable risk of 19.4% (current smokers: 12.2%; ex-smokers: 7.2%). Smoking adversely affects baseline disease severity, bacteriological response, treatment outcome and relapse in tuberculosis. Smoking cessation likely reduces relapse and secondary transmission.
Collapse
Affiliation(s)
- Chi C Leung
- TB and Chest Service, Dept of Health, Hong Kong, China
| | - Wing W Yew
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China
| | - Chi K Chan
- TB and Chest Service, Dept of Health, Hong Kong, China
| | - Kwok C Chang
- TB and Chest Service, Dept of Health, Hong Kong, China
| | - Wing S Law
- TB and Chest Service, Dept of Health, Hong Kong, China
| | - Shuk N Lee
- TB and Chest Service, Dept of Health, Hong Kong, China
| | - Lai B Tai
- TB and Chest Service, Dept of Health, Hong Kong, China
| | | | - Ronald K F Au
- TB and Chest Service, Dept of Health, Hong Kong, China
| | - Shan S Huang
- TB and Chest Service, Dept of Health, Hong Kong, China
| | - Cheuk M Tam
- TB and Chest Service, Dept of Health, Hong Kong, China
| |
Collapse
|
31
|
Chen M, Deng J, Su C, Li J, Wang M, Abuaku BK, Hu S, Tan H, Wen SW. Impact of passive smoking, cooking with solid fuel exposure, and MBL/MASP-2 gene polymorphism upon susceptibility to tuberculosis. Int J Infect Dis 2014; 29:1-6. [PMID: 25312983 DOI: 10.1016/j.ijid.2014.08.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 07/15/2014] [Accepted: 08/16/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND To explore the impact of passive smoking, cooking with solid fuel, mannose-binding lectin (MBL) gene, MBL-associated serine proteases 2 (MASP-2) gene, and gene-environment interactions on the susceptibility to tuberculosis (TB) in non-smokers. METHODS A total of 205 TB patients and 216 healthy controls were recruited to participate in this case-control study. PCR with sequence-specific primers (PCR-SSP) technology was leveraged to genotype rs7096206 of MBL genes and rs2273346 and rs6695096 of MASP-2 genes. Demographic data and information on exposures of participants were collected. Unconditioned logistic regression analysis was conducted to identify associations between the various factors and TB, and marginal structural linear odds models were used to estimate the interactions. RESULTS Passive smoking and cooking with solid fuel were associated with the risk of TB, with odds ratios (OR) of 1.58 and 2.93, respectively (p<0.05). Genotype CG at rs7096206 of MBL genes (OR 2.02) and genotype TC at rs6695096 of MASP-2 genes (OR 1.67) were more prevalent in the TB patients than in healthy controls (p<0.05). The relative excess risk of interaction (RERI) between rs7096206 of MBL genes and passive smoking or cooking with solid fuel exposure was 1.86 (95% confidence interval (CI) 0.59-3.16) and 2.66 (95% CI 1.85-3.47), respectively. The RERI between rs6695096 of MASP-2 genes and cooking with solid fuel exposure was 3.70 (95% CI 2.63-4.78), which was also a positive interaction. However, the RERI between rs6695096 of MASP-2 genes and passive smoking was not statistically significant. CONCLUSIONS Passive smoking, cooking with solid fuel, and polymorphisms of MBL (rs7096206) and MASP-2 (rs6695096) genes were associated with susceptibility to TB in non-smokers, and there were gene-environment interactions among them. Further studies are needed to explore details of the mechanisms of association.
Collapse
Affiliation(s)
- Mengshi Chen
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan 410008, PR China; Hunan Children's Hospital, Changsha, Hunan, PR China
| | - Jing Deng
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan 410008, PR China
| | - Congxu Su
- Yueyanglou Center for Disease Control and Prevention, Yueyang, Hunan, PR China
| | - Jun Li
- Hunan Provincial Tumor Hospital, Changsha, Hunan, PR China
| | - Mian Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan 410008, PR China
| | - Benjamin Kwaku Abuaku
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan 410008, PR China
| | - ShiMin Hu
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan 410008, PR China
| | - Hongzhuan Tan
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan 410008, PR China.
| | - Shi Wu Wen
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan 410008, PR China; Department of Obstetrics and Gynecology, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada; Department of Epidemiology and Community Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
| |
Collapse
|
32
|
Zhu B, Wu X, Wang X, Zheng Q, Sun G. The Association Between Passive Smoking and Type 2 Diabetes. Asia Pac J Public Health 2014; 26:226-37. [PMID: 24824522 DOI: 10.1177/1010539514531041] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The number of people with diabetes has been exponentially increasing. A number of reports in the literature have suggested that exposure to passive smoke may play a key role in the development of diabetes; however, the association has not been jointly summarized yet. In this meta-analysis, 2 databases were searched to identify studies, and the references of these studies were scanned for further studies. Fourteen studies on the relationship between passive smoking and diabetes were included. After all the studies were pooled, the results showed that passive smoking was significantly associated with an increased risk of type 2 diabetes in a random model. The subgroup analysis results were consistent with overall results regardless of type of study design, age, gender, adjustment of dependent variables, area, or study quality. Sensitivity analysis indicated that the overall results were reliable. There was no publication bias observed in the selected studies.
Collapse
Affiliation(s)
- Bo Zhu
- China Medical University, Shenyang, China
- Liaoning Academy of Safety Science, Shenyang, China
| | - Xiaomei Wu
- The First Hospital of China Medical University, Shenyang, China
| | - Xin Wang
- Liaoning Academy of Safety Science, Shenyang, China
| | | | - Guifan Sun
- China Medical University, Shenyang, China
| |
Collapse
|
33
|
Prognostic factors in tuberculosis related mortalities in hospitalized patients. Tuberc Res Treat 2014; 2014:624671. [PMID: 24895532 PMCID: PMC4033512 DOI: 10.1155/2014/624671] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 04/13/2014] [Indexed: 01/09/2023] Open
Abstract
Setting. The study was undertaken at the Department of Pulmonology at a public, tertiary care centre in Karachi, Pakistan. Objectives. To evaluate factors concerned with in-hospital deaths in patients admitted with pulmonary tuberculosis (TB). Design. A retrospective case-control audit was performed for 120 patients hospitalised with pulmonary TB. Sixty of those discharged after treatment were compared to sixty who did not survive. Radiological findings, clinical indicators, and laboratory values were compared between the two groups to identify factors related to poor prognosis. Results. Factors concerned with in-hospital mortality listed late presentation of disease (P < 0.01), noncompliance to antituberculosis therapy (P < 0.01), smoking (P < 0.01), longer duration of illness prior to treatment (P < 0.01), and low body weight (P < 0.01). Most deaths occurred during the first week of admission (P < 0.01) indicating late referrals as significant. Immunocompromised status and multi-drug resistance were not implicated in higher mortality. Conclusions. Poor prognosis was associated with noncompliance to therapy resulting in longer duration of illness, late patient referrals to care centres, and development of complications. Early diagnosis, timely referrals, and monitored compliance may help reduce mortality. Adherence to a more radically effective treatment regimen is required to eliminate TB early during disease onset.
Collapse
|
34
|
Abstract
Particle exposures increase the risk for human infections. Particles can deposit in the nose, pharynx, larynx, trachea, bronchi, and distal lung and, accordingly, the respiratory tract is the system most frequently infected after such exposure; however, meningitis also occurs. Cigarette smoking, burning of biomass, dust storms, mining, agricultural work, environmental tobacco smoke (ETS), wood stoves, traffic-related emissions, gas stoves, and ambient air pollution are all particle-related exposures associated with an increased risk for respiratory infections. In addition, cigarette smoking, burning of biomass, dust storms, mining, and ETS can result in an elevated risk for tuberculosis, atypical mycobacterial infections, and meningitis. One of the mechanisms for particle-related infections includes an accumulation of iron by surface functional groups of particulate matter (PM). Since elevations in metal availability are common to every particle exposure, all PM potentially contributes to these infections. Therefore, exposures to wood stove emissions, diesel exhaust, and air pollution particles are predicted to increase the incidence and prevalence of tuberculosis, atypical mycobacterial infections, and meningitis, albeit these elevations are likely to be small and detectable only in large population studies. Since iron accumulation correlates with the presence of surface functional groups and dependent metal coordination by the PM, the risk for infection continues as long as the particle is retained. Subsequently, it is expected that the cessation of exposure will diminish, but not totally reverse, the elevated risk for infection.
Collapse
Affiliation(s)
- A J Ghio
- National Health and Environmental Effects Research Laboratory, US EPA, Research Triangle Park, NC, 27711, USA,
| |
Collapse
|
35
|
Masumoto S, Yamamoto T, Ohkado A, Yoshimatsu S, Querri AG, Kamiya Y. Factors associated with health-related quality of life among pulmonary tuberculosis patients in Manila, the Philippines. Qual Life Res 2013; 23:1523-33. [DOI: 10.1007/s11136-013-0571-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2013] [Indexed: 11/24/2022]
|
36
|
Safdar N, Zahid R, Shah S, Cameron I, Fatima R, Qureshi H, Siddiqi K. TB patients learning about second hand smoke (TBLASS): a pilot individual randomised controlled trial. SPRINGERPLUS 2013; 2:556. [PMID: 24255850 PMCID: PMC3824698 DOI: 10.1186/2193-1801-2-556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 10/17/2013] [Indexed: 11/12/2022]
Abstract
Background Living with a smoker is a key determinant of exposure to Second Hand Smoke (SHS) and its exposure mainly occurs at home. Exposure to SHS from tobacco in the household predisposes to the development of tuberculosis (TB) and outcome of the disease gets worse. We aim to develop and evaluate a behavioural intervention 'Smoke Free Homes’ (SFH) for TB patients that encourages them to negotiate a smoke free environment within their homes. Methods and design The pilot individual randomised controlled trial of SFH will inform the design of a future definitive trial. We will first develop SFH intervention using taxonomy of behaviour change techniques aimed at encouraging families of non-smoking TB patients to implement smoking restrictions at home following a logic model of the intervention. This will be followed by conducting a pilot randomised controlled trial of intervention within the context of routine TB control programme. The eligible non-smoking TB patients will be randomised and allocated to one of the two trial arms consisting of “individual based care” and “individual based care” plus “supplementary support”. We aim to recruit 150 newly registered pulmonary TB patients from two selected TB centres with 75 cases in each arm. The Primary outcome measure will be SFH of non-smoker TB patient by validating through 'Urine Cotinine’ test. We will also determine qualitatively the barriers and key drivers to the creation of smoke free homes followed by developing a definitive trial. Discussion The male to female distribution of TB cases in Pakistan is almost equal whereas, tobacco use among males is much high as compared to females in Pakistan. This reflects a strong possibility that women health can be affected by men behaviour. Appropriate storage, restricted access and disposal arrangements for participant’s personal details will be implemented. All ethical issues will be addressed. There will be no extra burden, financial or otherwise, on the participants. They will not receive any financial incentive to participate in the study. Trial registration Trial Registration Number: ISRCTN83630841
Collapse
Affiliation(s)
- Nauman Safdar
- Social and Health Inequalities Network, 862, St 13-C, E-11/4, Islamabad, 44000 Pakistan
| | | | | | | | | | | | | |
Collapse
|
37
|
Zafar Ullah AN, Huque R, Akter S, Nasreen S, Akter H, Thomson H, Cameron I, Newell JN, Siddiqi K. Children's exposure to second-hand smoke at home in Bangladesh: a community survey. BMJ Open 2013; 3:e003059. [PMID: 24227868 PMCID: PMC3831095 DOI: 10.1136/bmjopen-2013-003059] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES In Bangladesh, second-hand smoke (SHS) is recognised as a principal source of indoor air pollution and a major public health problem. However, we know little about the extent to which people are aware of the risks of second-hand smoking, or restrict smoking indoors or in the presence of children. We report findings of a community survey exploring these questions. DESIGN AND SETTING A total of 722 households were surveyed in urban and rural settings, using a multistage cluster random sampling approach and a semistructured questionnaire. In addition, we used qualitative methods to further explore the determinants of smoking-related behaviours inside homes. FINDINGS 55% of households in our sample had at least one regular smoker. Smoking indoors was common. In 30% of households, smoking occurred in the presence of children, exposing nearly 40% of children to SHS. Overall, we found a lack of awareness about the harms associated with second-hand smoking. CONCLUSIONS Our study highlights that a sizeable proportion of children and non-smokers are exposed to SHS at homes in Bangladesh, posing a significant and grave public health problem. In the absence of any impetus to legislate against smoking in private places, an educational approach is recommended to change smoking practices at home. Such a shift toward voluntary smoking restrictions at home would require behaviour change among smokers and support from non-smoking family members.
Collapse
Affiliation(s)
- Abu Naser Zafar Ullah
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Lin HH, Chiang YT, Chuang JH, Yang SL, Chang HY, Ezzati M, Murray M. Exposure to secondhand smoke and risk of tuberculosis: prospective cohort study. PLoS One 2013; 8:e77333. [PMID: 24204811 PMCID: PMC3808396 DOI: 10.1371/journal.pone.0077333] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 08/30/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Prospective evidence on the association between secondhand-smoke exposure and tuberculosis is limited. METHODS We included 23,827 never smokers from two rounds (2001 and 2005) of Taiwan National Health Interview Survey. Information on exposure to secondhand smoke at home as well as other sociodemographic and behavioral factors was collected through in-person interview. The participants were prospectively followed for incidence of tuberculosis through cross-matching the survey database to the national tuberculosis registry of Taiwan. RESULTS A total of 85 cases of active tuberculosis were identified after a median follow-up of 7.0 years. The prevalence of exposure to secondhand smoke at home was 41.8% in the study population. In the multivariable Cox proportional hazards analysis, secondhand smoke was not associated with active tuberculosis (adjusted hazard ratio [HR], 1.03; 95% CI, 0.64 to 1.64). In the subgroup analysis, the association between secondhand smoke and tuberculosis decreased with increasing age; the adjusted HR for those <18, > = 18 and <40, > = 40 and <60, and > = 60 years old was 8.48 (0.77 to 93.56), 2.29 (0.75 to 7.01), 1.33 (0.58 to 3.01), and 0.66 (0.35 to 1.23) respectively. Results from extensive sensitivity analyses suggested that potential misclassification of secondhand-smoke exposure would not substantially affect the observed associations. CONCLUSIONS The results from this prospective cohort study did not support an overall association between secondhand smoke and tuberculosis. However, the finding that adolescents might be particularly susceptible to secondhand smoke's effect warrants further investigation.
Collapse
Affiliation(s)
- Hsien-Ho Lin
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Ting Chiang
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | | | - Shiang-Lin Yang
- Centers for Disease Control, Department of Health, Taipei, Taiwan
| | - Hsing-Yi Chang
- Institute of Population Health Science, National Health Research Institute, Miaoli, Taiwan
| | - Majid Ezzati
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, United Kingdom
| | - Megan Murray
- Department of Epidemiology, Harvard School of Public Health, Boston, United States of America
| |
Collapse
|
39
|
Jurcev-Savicevic A, Mulic R, Ban B, Kozul K, Bacun-Ivcek L, Valic J, Popijac-Cesar G, Marinovic-Dunatov S, Gotovac M, Simunovic A. Risk factors for pulmonary tuberculosis in Croatia: a matched case-control study. BMC Public Health 2013; 13:991. [PMID: 24144113 PMCID: PMC4015441 DOI: 10.1186/1471-2458-13-991] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 10/11/2013] [Indexed: 01/29/2023] Open
Abstract
Background Mycobacterium tuberculosis is a necessary, but not sufficient, cause of tuberculosis. A number of studies have addressed the issue of risk factors for tuberculosis development. Croatia is a European country with an incidence rate of 14/100 000 which is slowly decreasing. The aim of this study is to evaluate the potential demographic, socioeconomic, behavioural and biological risk factors for tuberculosis in Croatia in comparison to other high-income, low-incidence European countries. Methods A total of 300 tuberculosis patients were matched for age, sex and county of residence to 300 controls randomly selected from general practitioners’ registers. They were interviewed and their medical records were evaluated for variables broadly described as potential risk factors. Results In multiple logistic regression, the following factors were significant: parents born in a particular neighbouring county (Bosnia and Herzegovina) (OR = 3.90, 95% CI 2.01-7.58), the lowest level of education (OR = 3.44, 95% CI 1.39-8.50), poor household equipment (OR = 4.72, 95% CI 1.51-14.76), unemployment (OR = 2.69, 95% CI 1.18-6.16), contact with tuberculosis (OR = 2.19, 95% CI 1.27-3.77), former (OR = 2.27, 95% CI 1.19-4.33) and current smoking habits (OR = 2.35, 95% CI 1.27-4.36), diabetes (OR = 2.38, 95% CI 1.05-5.38), a malignant disease (OR = 5.79, 95% CI 1.49-22.42), being underweight in the previous year (OR = 13.57, 95% CI 1.21-152.38). Conclusion In our study, the identified risk groups for tuberculosis reflect a complex interaction between socioeconomic conditions, lifestyle and non-communicable diseases. Interventions focused on poverty will undoubtedly be useful, but not sufficient. Tuberculosis control would benefit from a combination of broad public health activities aimed at the prevention and control of risky lifestyles and non-communicable diseases, interventions outside the health sector, and efforts to constantly improve the Croatian national tuberculosis programme.
Collapse
|
40
|
Wampande EM, Mupere E, Debanne SM, Asiimwe BB, Nsereko M, Mayanja H, Eisenach K, Kaplan G, Boom HW, Gagneux S, Joloba ML. Long-term dominance of Mycobacterium tuberculosis Uganda family in peri-urban Kampala-Uganda is not associated with cavitary disease. BMC Infect Dis 2013; 13:484. [PMID: 24134504 PMCID: PMC3853102 DOI: 10.1186/1471-2334-13-484] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 10/07/2013] [Indexed: 11/12/2022] Open
Abstract
Background Previous studies have shown that Mycobacterium tuberculosis (MTB) Uganda family, a sub-lineage of the MTB Lineage 4, is the main cause of tuberculosis (TB) in Uganda. Using a well characterized patient population, this study sought to determine whether there are clinical and patient characteristics associated with the success of the MTB Uganda family in Kampala. Methods A total of 1,746 MTB clinical isolates collected from1992-2009 in a household contact study were genotyped. Genotyping was performed using Single Nucleotide Polymorphic (SNP) markers specific for the MTB Uganda family, other Lineage 4 strains, and Lineage 3, respectively. Out of 1,746 isolates, 1,213 were from patients with detailed clinical data. These data were used to seek associations between MTB lineage/sub-lineage and patient phenotypes. Results Three MTB lineages were found to dominate the MTB population in Kampala during the last two decades. Overall, MTB Uganda accounted for 63% (1,092/1,746) of all cases, followed by other Lineage 4 strains accounting for 22% (394/1,746), and Lineage 3 for 11% (187/1,746) of cases, respectively. Seventy-three (4 %) strains remained unclassified. Our longitudinal data showed that MTB Uganda family occurred at the highest frequency during the whole study period, followed by other Lineage 4 strains and Lineage 3. To explore whether the long-term success of MTB Uganda family was due to increased virulence, we used cavitary disease as a proxy, as this form of TB is the most transmissible. Multivariate analysis revealed that even though cavitary disease was associated with known risk factors such as smoking (adjusted odds ratio (aOR) 4.8, 95% confidence interval (CI) 3.33-6.84) and low income (aOR 2.1, 95% CI 1.47-3.01), no association was found between MTB lineage and cavitary TB. Conclusion The MTB Uganda family has been dominating in Kampala for the last 18 years, but this long-term success is not due to increased virulence as defined by cavitary disease.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Moses L Joloba
- Department of Medical Microbiology, College of Health Sciences, Makerere University, Kampala, Uganda.
| |
Collapse
|
41
|
|
42
|
Millet JP, Moreno A, Fina L, del Baño L, Orcau A, de Olalla PG, Caylà JA. Factors that influence current tuberculosis epidemiology. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 22 Suppl 4:539-48. [PMID: 22565801 PMCID: PMC3691414 DOI: 10.1007/s00586-012-2334-8] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 04/17/2012] [Indexed: 11/30/2022]
Abstract
According to WHO estimates, in 2010 there were 8.8 million new cases of tuberculosis (TB) and 1.5 million deaths. TB has been classically associated with poverty, overcrowding and malnutrition. Low income countries and deprived areas, within big cities in developed countries, present the highest TB incidences and TB mortality rates. These are the settings where immigration, important social inequalities, HIV infection and drug or alcohol abuse may coexist, all factors strongly associated with TB. In spite of the political, economical, research and community efforts, TB remains a major global health problem worldwide. Moreover, in this new century, new challenges such as multidrug-resistance extension, migration to big cities and the new treatments with anti-tumour necrosis alpha factor for inflammatory diseases have emerged and threaten the decreasing trend in the global number of TB cases in the last years. We must also be aware about the impact that smoking and diabetes pandemics may be having on the incidence of TB. The existence of a good TB Prevention and Control Program is essential to fight against TB. The coordination among clinicians, microbiologists, epidemiologists and others, and the link between surveillance, control and research should always be a priority for a TB Program. Each city and country should define their needs according to the epidemiological situation. Local TB control programs will have to adapt to any new challenge that arises in order to respond to the needs of their population.
Collapse
Affiliation(s)
- Juan-Pablo Millet
- />Epidemiology Service, Public Health Agency of Barcelona, Plaza Lesseps, 1, 08023 Barcelona, Spain
- />CIBER de Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain
- />Tuberculosis Investigation Unit of Barcelona (UiTB), Barcelona, Spain
| | - Antonio Moreno
- />Epidemiology Service, Public Health Agency of Barcelona, Plaza Lesseps, 1, 08023 Barcelona, Spain
- />CIBER de Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain
- />Tuberculosis Investigation Unit of Barcelona (UiTB), Barcelona, Spain
| | - Laia Fina
- />Epidemiology Service, Public Health Agency of Barcelona, Plaza Lesseps, 1, 08023 Barcelona, Spain
- />CIBER de Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain
- />Tuberculosis Investigation Unit of Barcelona (UiTB), Barcelona, Spain
| | - Lucía del Baño
- />Epidemiology Service, Public Health Agency of Barcelona, Plaza Lesseps, 1, 08023 Barcelona, Spain
- />CIBER de Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain
- />Tuberculosis Investigation Unit of Barcelona (UiTB), Barcelona, Spain
| | - Angels Orcau
- />Epidemiology Service, Public Health Agency of Barcelona, Plaza Lesseps, 1, 08023 Barcelona, Spain
- />CIBER de Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain
- />Tuberculosis Investigation Unit of Barcelona (UiTB), Barcelona, Spain
| | - Patricia García de Olalla
- />Epidemiology Service, Public Health Agency of Barcelona, Plaza Lesseps, 1, 08023 Barcelona, Spain
- />CIBER de Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain
- />Tuberculosis Investigation Unit of Barcelona (UiTB), Barcelona, Spain
| | - Joan A. Caylà
- />Epidemiology Service, Public Health Agency of Barcelona, Plaza Lesseps, 1, 08023 Barcelona, Spain
- />CIBER de Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain
- />Tuberculosis Investigation Unit of Barcelona (UiTB), Barcelona, Spain
| |
Collapse
|
43
|
Feldman C, Anderson R. Cigarette smoking and mechanisms of susceptibility to infections of the respiratory tract and other organ systems. J Infect 2013; 67:169-84. [PMID: 23707875 DOI: 10.1016/j.jinf.2013.05.004] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 05/08/2013] [Accepted: 05/14/2013] [Indexed: 01/04/2023]
Abstract
The predisposition of cigarette smokers for development of oral and respiratory infections caused by microbial pathogens is well recognised, with those infected with the human immunodeficiency virus (HIV) at particularly high risk. Smoking cigarettes has a suppressive effect on the protective functions of airway epithelium, alveolar macrophages, dendritic cells, natural killer (NK) cells and adaptive immune mechanisms, in the setting of chronic systemic activation of neutrophils. Cigarette smoke also has a direct effect on microbial pathogens to promote the likelihood of infective disease, specifically promotion of microbial virulence and antibiotic resistance. In addition to interactions between smoking and HIV infection, a number of specific infections/clinical syndromes have been associated epidemiologically with cigarette smoking, including those of the upper and lower respiratory tract, gastrointestinal tract, central nervous and other organ systems. Smoking cessation benefits patients in many ways, including reduction of the risk of infectious disease.
Collapse
Affiliation(s)
- Charles Feldman
- Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital, South Africa.
| | | |
Collapse
|
44
|
Bonacci RA, Cruz-Hervert LP, García-García L, Reynales-Shigematsu LM, Ferreyra-Reyes L, Bobadilla-del-Valle M, Canizales-Quintero S, Ferreira-Guerrero E, Báez-Saldaña R, Téllez-Vázquez N, Mongua-Rodríguez N, Montero-Campos R, Delgado-Sánchez G, Martínez-Gamboa RA, Cano-Arellano B, Sifuentes-Osornio J, de León AP. Impact of cigarette smoking on rates and clinical prognosis of pulmonary tuberculosis in Southern Mexico. J Infect 2013; 66:303-12. [PMID: 22982014 PMCID: PMC3543482 DOI: 10.1016/j.jinf.2012.09.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Revised: 09/07/2012] [Accepted: 09/09/2012] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To examine the relationship between cigarette smoking and incidence and mortality rates of pulmonary tuberculosis (TB) and treatment outcomes. MATERIALS From 1995 to 2010, we analyzed data from 1062 patients with TB and from 2001 to 2004, 2951 contacts in Southern Mexico. Patients with acid-fast bacilli or Mycobacterium tuberculosis in sputum samples underwent epidemiological, clinical and mycobacteriological evaluation and received treatment by the local DOTS program. RESULTS Consumers of 1-10 (LS) or 11 or more (HS) cigarettes per day incidence (1.75 and 11.79) and mortality (HS, 17.74) smoker-non-smoker rate ratios were significantly higher for smokers. Smoker population was more likely to experience unfavorable treatment outcomes (HS, adjusted OR 2.36) and retreatment (LS and HS, adjusted hazard ratio (HR) 2.14 and 2.37). Contacts that smoked had a higher probability of developing active TB (HR 2.38) during follow up. CONCLUSIONS Results indicate the need of incorporating smoking prevention and cessation, especially among men, into international TB control strategies.
Collapse
Affiliation(s)
- Robert A. Bonacci
- Instituto Nacional de Salud Pública, Av. Universidad # 655, Col. Sta. María Ahuacatitlán, Cuernavaca, Morelos, México, 62100
- Department of Microbiology, The Ohio State University, W. Lane Ave., Columbus, Ohio, USA, 43210
| | - Luis Pablo Cruz-Hervert
- Instituto Nacional de Salud Pública, Av. Universidad # 655, Col. Sta. María Ahuacatitlán, Cuernavaca, Morelos, México, 62100
| | - Lourdes García-García
- Instituto Nacional de Salud Pública, Av. Universidad # 655, Col. Sta. María Ahuacatitlán, Cuernavaca, Morelos, México, 62100
| | - Luz Myriam Reynales-Shigematsu
- Instituto Nacional de Salud Pública, Av. Universidad # 655, Col. Sta. María Ahuacatitlán, Cuernavaca, Morelos, México, 62100
| | - Leticia Ferreyra-Reyes
- Instituto Nacional de Salud Pública, Av. Universidad # 655, Col. Sta. María Ahuacatitlán, Cuernavaca, Morelos, México, 62100
| | - Miriam Bobadilla-del-Valle
- Instituto Nacional de Ciencias Médicas y de Nutrición Salvador Zubirán (INCMNSZ) Vasco de Quiroga 15, Col. Belisario Domínguez Sección 16, Ciudad de México, Distrito Federal México, D.F., México,14000
| | - Sergio Canizales-Quintero
- Instituto Nacional de Salud Pública, Av. Universidad # 655, Col. Sta. María Ahuacatitlán, Cuernavaca, Morelos, México, 62100
| | - Elizabeth Ferreira-Guerrero
- Instituto Nacional de Salud Pública, Av. Universidad # 655, Col. Sta. María Ahuacatitlán, Cuernavaca, Morelos, México, 62100
| | - Renata Báez-Saldaña
- Instituto Nacional de Salud Pública, Av. Universidad # 655, Col. Sta. María Ahuacatitlán, Cuernavaca, Morelos, México, 62100
| | - Norma Téllez-Vázquez
- Instituto Nacional de Salud Pública, Av. Universidad # 655, Col. Sta. María Ahuacatitlán, Cuernavaca, Morelos, México, 62100
| | - Norma Mongua-Rodríguez
- Instituto Nacional de Salud Pública, Av. Universidad # 655, Col. Sta. María Ahuacatitlán, Cuernavaca, Morelos, México, 62100
| | - Rogelio Montero-Campos
- Instituto Nacional de Salud Pública, Av. Universidad # 655, Col. Sta. María Ahuacatitlán, Cuernavaca, Morelos, México, 62100
| | - Guadalupe Delgado-Sánchez
- Instituto Nacional de Salud Pública, Av. Universidad # 655, Col. Sta. María Ahuacatitlán, Cuernavaca, Morelos, México, 62100
| | - Rosa Areli Martínez-Gamboa
- Instituto Nacional de Ciencias Médicas y de Nutrición Salvador Zubirán (INCMNSZ) Vasco de Quiroga 15, Col. Belisario Domínguez Sección 16, Ciudad de México, Distrito Federal México, D.F., México,14000
| | - Bulmaro Cano-Arellano
- Instituto Nacional de Salud Pública, Av. Universidad # 655, Col. Sta. María Ahuacatitlán, Cuernavaca, Morelos, México, 62100
| | - José Sifuentes-Osornio
- Instituto Nacional de Ciencias Médicas y de Nutrición Salvador Zubirán (INCMNSZ) Vasco de Quiroga 15, Col. Belisario Domínguez Sección 16, Ciudad de México, Distrito Federal México, D.F., México,14000
| | - Alfredo Ponce de León
- Instituto Nacional de Ciencias Médicas y de Nutrición Salvador Zubirán (INCMNSZ) Vasco de Quiroga 15, Col. Belisario Domínguez Sección 16, Ciudad de México, Distrito Federal México, D.F., México,14000
| |
Collapse
|
45
|
Continuous and discontinuous cigarette smoke exposure differentially affects protective Th1 immunity against pulmonary tuberculosis. PLoS One 2013; 8:e59185. [PMID: 23527127 PMCID: PMC3602464 DOI: 10.1371/journal.pone.0059185] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 02/12/2013] [Indexed: 11/19/2022] Open
Abstract
Pulmonary tuberculosis (TB), caused by Mycobacterium tuberculosis, is the leading cause of death due to a bacterial pathogen. Emerging epidemiologic evidence suggests that the leading risk factor associated with TB mortality is cigarette smoke exposure. Despite this, it remains poorly understood what is the effect of cigarette smoke exposure on anti-TB immunity and whether its potential detrimental effect can be reversed by cigarette smoking cessation. In our current study, we have investigated the impact of both continuous and discontinuous cigarette smoke exposure on the development of anti-mycobacterial type 1 immunity in murine models. We find that while continuous cigarette smoke exposure severely impairs type 1 immunity in the lung, a short-term smoking cessation allows rapid restoration of anti-mycobacterial immunity. The ability of continuous cigarette smoke exposure to dampen type 1 protective immunity is attributed locally to its affects on innate immune cells in the lung. Continuous cigarette smoke exposure locally, by not systemically, impairs APC accumulation and their production of TNF, IL-12, and RANTES, blunts the recruitment of CD4+IFN-γ+ T cells to the lung, and weakens the formation of granuloma. On the other hand, smoking cessation was found to help restore type 1 immunity by rapidly improving the functionality of lung APCs, enhancing the recruitment of CD4+IFN-γ+ T cells to the lung, and promoting the formation of granuloma. Our study for the first time demonstrates that continuous, but not discontinuous, cigarette smoke exposure severely impedes the lung expression of anti-TB Th1 immunity via inhibiting innate immune activation and lung T cell recruitment. Our findings thus suggest cigarette smoking cessation to be beneficial to the control of pulmonary TB.
Collapse
|
46
|
Kent BD, Sulaiman I, Nicholson TT, Lane SJ, Moloney ED. Acute pulmonary admissions following implementation of a national workplace smoking ban. Chest 2013; 142:673-679. [PMID: 22383660 DOI: 10.1378/chest.11-2757] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The implementation of workplace smoking bans has contributed to a significant reduction in the incidence of acute coronary syndrome admissions, but their influence on adult acute pulmonary disease admissions is unclear. We sought to assess the impact of a national smoking ban on nationwide admissions of individuals of working age with acute pulmonary illness. METHODS Data relating to emergency hospital admissions of subjects aged 20 to 70 years preceding and succeeding the implementation of the Irish smoking ban were obtained from a central registry. Population, weather, pollution, and influenza data were obtained from the relevant authorities. Poisson regression analysis was used to assess adjusted risk of emergency hospital admission following implementation of the smoking ban. RESULTS Overall admissions with pulmonary illness decreased from 439 per 100,000 population per annum to 396 per 100,000 population per annum following the ban (unadjusted relative risk [RR], 0.91; 95% CI, 0.83-0.99; P = .048). This persisted following adjustment for confounding factors (adjusted RR, 0.85; 95% CI, 0.72-0.99; P = .04) and was most marked among younger age groups and in admissions due to asthma (adjusted RR, 0.60; 95% CI, 0.39-0.91; P = .016). Admissions with acute coronary syndromes (adjusted RR, 0.82; 95% CI, 0.70-0.97; P = .02), but not stroke (adjusted RR, 0.93; 95% CI, 0.73-1.20; P = .60), were also reduced. CONCLUSIONS The implementation of a nationwide workplace smoking ban is associated with a decline in admissions with acute pulmonary disease among specific age groups and an overall reduction in asthma admissions. This may result from reduced exposure of vulnerable individuals to environmental tobacco smoke, emphasizing the potential benefit of legislation reducing second-hand smoke exposure.
Collapse
Affiliation(s)
- Brian D Kent
- Department of Respiratory Medicine, Adelaide and Meath Hospital, Dublin, Ireland; Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland.
| | - Imran Sulaiman
- Department of Respiratory Medicine, Adelaide and Meath Hospital, Dublin, Ireland
| | - Trevor T Nicholson
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland
| | - Stephen J Lane
- Department of Respiratory Medicine, Adelaide and Meath Hospital, Dublin, Ireland
| | - Edward D Moloney
- Department of Respiratory Medicine, Adelaide and Meath Hospital, Dublin, Ireland
| |
Collapse
|
47
|
Underner M, Perriot J. Tabac et tuberculose. Presse Med 2012; 41:1171-80. [PMID: 22465718 DOI: 10.1016/j.lpm.2012.02.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 02/16/2012] [Accepted: 02/20/2012] [Indexed: 02/08/2023] Open
|
48
|
Barnoya J, Navas-Acien A. Protecting the world from secondhand tobacco smoke exposure: where do we stand and where do we go from here? Nicotine Tob Res 2012; 15:789-804. [PMID: 23072872 DOI: 10.1093/ntr/nts200] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Article 8 of the Framework Convention on Tobacco Control mandates all signatory countries to "protect citizens from exposure to tobacco smoke in workplaces, public transport and indoor public places." Even though there has been great progress in the implementation of Article 8, still most of the world population remains exposed to secondhand smoke (SHS). In this article, we sought to summarize the research that supports Article 8, where do we stand, and current research gaps and future directions. DISCUSSION Secondhand smoke is an established cause of heart disease and several types of cancer. Additional research is needed to reach final conclusions for diseases where evidence is only suggestive of causality. The only solution to SHS exposure in public places is banning smoking indoors. Research on the gaming industry and nightclubs, particularly in developing countries, needs to be disseminated to support their inclusion in smoke-free laws. Aside from indoor bans, additional research is needed for outdoor and multiunit housing bans and in support of measures that protect children and other vulnerable populations. The impact of smoke-free laws on other health outcomes, besides heart disease and respiratory outcomes, is another area where further research is needed. Thirdhand smoke assessment and health effects are also likely to be a topic of further research. As new tobacco products emerge, evaluating SHS exposure and effects will be vital. CONCLUSIONS Furthering research in support of Article 8 can contribute to reach the final goal of protecting everyone from SHS exposure.
Collapse
Affiliation(s)
- Joaquin Barnoya
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, MO 63110, USA.
| | | |
Collapse
|
49
|
Remais JV, Zeng G, Li G, Tian L, Engelgau MM. Convergence of non-communicable and infectious diseases in low- and middle-income countries. Int J Epidemiol 2012; 42:221-7. [PMID: 23064501 DOI: 10.1093/ije/dys135] [Citation(s) in RCA: 135] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The convergence of non-communicable disease (NCD) and infectious disease (ID) in low- and middle-income countries (LMICs) presents new challenges and new opportunities to enact responsive changes in policy and research. Most LMICs have significant dual disease burdens of NCDs such as cardiovascular disease, diabetes and cancer, and IDs including tuberculosis, HIV/AIDS and parasitic diseases. A combined strategy is needed in surveillance and disease control; yet, experts, institutions and policies that support prevention and control of these two overarching disease categories have limited interaction and alignment. NCDs and IDs share common features, such as long-term care needs and overlapping high-risk populations, and there are also notable direct interactions, such as the association between certain IDs and cancers, as well as evidence of increased susceptibility to IDs in individuals with NCDs. Enhanced simultaneous surveillance of NCD and ID comorbidity in LMIC populations would generate the empirical data needed to better understand the dual burden, and to target coordinated care. Where IDs and NCDs are endemic, focusing on vulnerable populations by strengthening social protections and improving access to health services is crucial, as is the re-alignment of efforts to combine NCD and ID screening, treatment programmes, and the assessment of their impact. Integrating public health activities for ID and NCD should extend beyond health care services to prevention, which is widely seen as crucial to successful NCD and ID control campaigns alike. The convergence of NCD and ID in LMICs has the potential to overstretch already strained health systems. With some LMICs now focused on major health system reforms, a unique opportunity is available to address NCD and ID challenges with newfound urgency and novel approaches.
Collapse
Affiliation(s)
- Justin V Remais
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
| | | | | | | | | |
Collapse
|
50
|
|