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Association between smoke-free legislation and hospitalizations for cardiac, cerebrovascular, and respiratory diseases: a meta-analysis.

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Association between smoke-free legislation and hospitalizations for cardiac, cerebrovascular, and respiratory diseases: a meta-analysis.

Circulation. 2012 Oct 30;126(18):2177-83

Authors: Tan CE, Glantz SA

Abstract
BACKGROUND: Secondhand smoke causes cardiovascular and respiratory disease. Smoke-free legislation is associated with a lower risk of hospitalization and death from these diseases.
METHODS AND RESULTS: Random-effects meta-analysis was conducted by law comprehensiveness to determine the relationship between smoke-free legislation and hospital admission or death from cardiac, cerebrovascular, and respiratory diseases. Studies were identified by using a systematic search for studies published before November 30, 2011 with the use of the Science Citation Index, Google Scholar, PubMed, and Embase and references in identified articles. Change in hospital admissions (or deaths) in the presence of a smoke-free law, duration of follow-up, and law comprehensiveness (workplaces only; workplaces and restaurants; or workplaces, restaurants, and bars) were recorded. Forty-five studies of 33 smoke-free laws with median follow-up of 24 months (range, 2-57 months) were included. Comprehensive smoke-free legislation was associated with significantly lower rates of hospital admissions (or deaths) for all 4 diagnostic groups: coronary events (relative risk, 0.848; 95% confidence interval 0.816-0.881), other heart disease (relative risk, 0.610; 95% confidence interval, 0.440-0.847), cerebrovascular accidents (relative risk, 0.840; 95% confidence interval, 0.753-0.936), and respiratory disease (relative risk, 0.760; 95% confidence interval, 0.682-0.846). The difference in risk following comprehensive smoke-free laws does not change with longer follow-up. More comprehensive laws were associated with larger changes in risk.
CONCLUSIONS: Smoke-free legislation was associated with a lower risk of smoking-related cardiac, cerebrovascular, and respiratory diseases, with more comprehensive laws associated with greater changes in risk.

PMID: 23109514 [PubMed - in process]

Effectiveness of Interventions in Reducing Antibiotic Use for Upper Respiratory Infections in Ambulatory Care Practices.

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Effectiveness of Interventions in Reducing Antibiotic Use for Upper Respiratory Infections in Ambulatory Care Practices.

Popul Health Manag. 2012 Oct 31;

Authors: Vinnard C, Linkin DR, Localio AR, Leonard CE, Teal VL, Fishman NO, Hennessy S

Abstract
Abstract The objective was to evaluate the effect of separate interventions on antimicrobial prescribing for uncomplicated upper respiratory tract infections. The authors conducted a quasi-experimental pre-post study with concurrent control groups for each intervention. Academic detailing led to a significant reduction in unnecessary antibiotic prescribing. However, there was no significant change in antibiotic prescribing in response to educational mailings to providers or to provider involvement in patient mailings. Organizations that seek to reduce inappropriate use of antibiotics should use proven approaches, even when they are more expensive. (Population Health Management 2012;XX:xxx-xxx).

PMID: 23113630 [PubMed - as supplied by publisher]

Anxiety and depression symptoms in patients with sleep-disordered breathing.

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INTRODUCTION: Information concerning the frequency of anxiety and depression symptoms in patients with sleep-disordered breathing (SDB) is controversial. Hence, the objectives of this study were to: determine the frequency of anxiety and depression symptoms in patients with SDB; explore whether the frequency of anxiety and depression symptoms rises with increasing parameters of SDB severity; and investigate the factors potentially associated with anxiety and depression. MATERIALS AND METHODOLOGY: Data was collected from consecutive adult patients referred to the National Institute of Respiratory Diseases' Sleep Medicine Unit from October 2008 to October 2009. SDB diagnoses were established using standard polysomnography or simplified respiratory polygraphy. All patients routinely completed the Hospital Anxiety and Depression Scale (HADS) on their first visit to the Sleep Medicine Unit. RESULTS: 382 patients with SDB were included. Mean age was 50.8±13.6 years, 62% were male. Anxiety symptoms were acknowledged by 71 patients (18.5%), while 29 (7.6%) had depression symptoms, and 116 (30.4%) had symptoms of anxiety plus depression. Patients who reported anxiety and depression symptoms scored higher on the Epworth Sleepiness Scale (ESS, 16±7) than those with no symptoms (11±6) (p<0.0001). Patients with symptoms of anxiety plus depression also had higher BMIs (36 ± 8 K/m(2)) than patients with SDB without anxiety or depression. No other differences were observed, not even with respect to the parameters of the severity of their SDB. CONCLUSIONS: Our results support the recommendation that due to their high frequency and potential importance for long-term adherence to CPAP, anxiety and depression symptoms should be included in the routine evaluation of all adults with SDB.

Sport and infectious risk: A systematic review of the literature over 20 years.

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The development of sports activities promoted as a health factor should not hide the increased risk for diseases, more particularly infections.

A review of articles made over the last 20 years was made with a descriptive epidemiological purpose. The most marked risk is skin infection with methicillin-resistant community acquired Staphylococcus aureus (27.4% of the articles), followed by Tinea corporis and capitis (13.7%), and leptospirosis (11.7%). The risk of blood-borne infection seems low, and articles are rare (3.9%). The risk of disease with respiratory transmission (measles, meningococcal meningitis) must be taken into account. The effect of physical activity on the immune system depends on the type and duration of the work out: it seems to be beneficial for a workout of a moderate intensity, and deleterious for a sustained acute work out, or a period of intensive training. These periods of protection or susceptibility to infections are described as "open window" and "J curve". The only recommendations for prevention of sport-related infections arise from the frequency of skin infections and the severity of blood-borne infections. These recommendations are published by American and international sports authorities. The specificity of athletes' management is due to imperatives of competitiveness (maintaining physical performance) and the necessity of temporary eviction from sports, in case of contagiousness. The athletes must make sure their recommended vaccinations are up-to-date.

Dendritic cells, viruses, and the development of atopic disease.

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Dendritic cells are important residents of the lung environment. They have been associated with asthma and other inflammatory diseases of the airways. In addition to their antigen-presenting functions, dendritic cells have the ability to modulate the lung environment to promote atopic disease. While it has long been known that respiratory viral infections associate with the development and exacerbation of atopic diseases, the exact mechanisms have been unclear.

Recent studies have begun to show the critical importance of the dendritic cell in this process. This paper focuses on these data demonstrating how different populations of dendritic cells are capable of bridging the adaptive and innate immune systems, ultimately leading to the translation of viral illness into atopic disease.

 

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