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  • 1
    Language: English
    In: Expert Review of Anti-infective Therapy, 01 July 2011, Vol.9(7), pp.759-762
    Keywords: Bacterial Pneumonia ; HIV/AIDS ; Smoking ; Smoking Cessation ; Medicine
    ISSN: 1478-7210
    E-ISSN: 1744-8336
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  • 2
    In: Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences, 2012, Vol. 67A(3), pp.276-291
    Description: Pulmonary disease prevalence increases with age and contributes to morbidity and mortality in older patients. Dyspnea in older patients is often ascribed to multiple etiologies such as medical comorbidities and deconditioning. Common pulmonary disorders are frequently overlooked as contributors to dyspnea in older patients. In addition to negative impacts on morbidity and mortality, quality of life is reduced in older patients with uncontrolled, undertreated pulmonary symptoms. The purpose of this review is to discuss the epidemiology of common pulmonary diseases, namely pneumonia, chronic obstructive pulmonary disease, asthma, lung cancer, and idiopathic pulmonary fibrosis in older patients. We will review common clinical presentations for these diseases and highlight differences between younger and older patients. We will also briefly discuss risk factors, treatment, and mortality associated with these diseases. Finally, we will address the relationship between comorbidities, pulmonary symptoms, and quality of life in older patients with pulmonary diseases.
    Keywords: Pulmonary Diseases ; Older Persons ; Dyspnea ; Comorbidity ; Quality Of Life
    ISSN: 1079-5006
    E-ISSN: 1758-535X
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  • 3
    In: AIDS, 2013, Vol.27(8), pp.1345-1347
    Keywords: HIV Infections -- Physiopathology ; Lung -- Physiopathology ; Lung Diseases, Obstructive -- Physiopathology ; Respiratory Tract Diseases -- Physiopathology;
    ISSN: 0269-9370
    E-ISSN: 14735571
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  • 4
    Language: English
    In: Chest, May 2013, Vol.143(5), pp.1312-1320
    Description: COPD and hypertension both increase the risk of congestive heart failure (CHF). Current clinical trials do not inform the selection of combination antihypertensive therapy among patients with COPD. We performed a comparative effectiveness study to investigate whether choice of dual agent antihypertensive therapy is associated with risk of hospitalization for CHF among patients with these two conditions. We identified a cohort of 7,104 patients with COPD and hypertension receiving care within Veterans Administration hospitals between January 2001 and December 2006, with follow-up through April 2009. We included only patients prescribed two antihypertensive medications. We used Cox proportional hazard models for statistical analysis. Compared with β-blockers plus an angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker, patients prescribed a thiazide diuretic plus a β-blocker (adjusted hazard ratio [HR], 0.49; 95% CI, 0.32-0.75), a thiazide plus an angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker (adjusted HR, 0.50; 95% CI, 0.35-0.71), and a thiazide plus a calcium channel blocker (adjusted HR, 0.55; 95% CI, 0.35-0.88) had a significantly lower risk of hospitalization for CHF. After stratification by history of CHF, we found that this association was isolated to patients without a history of CHF. Adjustment for patient characteristics and comorbidities had a small effect on risk of hospitalization. Choice of antihypertensive medication combination had no significant association with risk of COPD exacerbation. Among patients with comorbid hypertension and COPD requiring two antihypertensive agents, combination therapy that includes a thiazide diuretic was associated with a significantly lower risk of hospitalization for CHF among patients without a history of CHF.
    Keywords: Medicine
    ISSN: 0012-3692
    E-ISSN: 1931-3543
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  • 5
    Language: English
    In: 2012, Vol.7(11), p.e49050
    Description: Evidence of an association between cigarette smoking and latent tuberculosis infection (LTBI) is based on studies in special populations and/or from high prevalence settings. We sought to evaluate the association between LTBI and smoking in a low prevalence TB setting using population-based data from the National Health and Nutrition Examination Survey (NHANES). ; In 1999–2000, NHANES assessed LTBI (defined as a tuberculin skin test measurement ≥10 mm) in participants, and those ≥20 years of age were queried regarding their tobacco use and serum cotinine was measured. We evaluated the association of LTBI with self-reported smoking history and smoking intensity in multivariable logistic regression models that adjusted for known confounders (gender, age, birthplace, race/ethnicity, poverty, education, history of BCG vaccination, and history of household exposure to tuberculosis disease). ; Estimated LTBI prevalence was 5.3% among those ≥20 years of age. The LTBI prevalence among never smokers, current smokers, and former smokers was 4.1%, 6.6%, and 6.2%, respectively. In a multivariable model, current smoking was associated with LTBI (OR 1.8; 95% CI, 1.1–2.9). The association between smoking and LTBI was strongest for Mexican-American and black individuals. In multivariate analysis stratified by race/ethnicity, cigarette packs per day among Mexican-American smokers and cotinine levels among black smokers, were significantly associated with LTBI. ; In the large, representative, population-based NHANES sample, smoking was independently associated with significantly increased risks of LTBI. In certain populations, a greater risk of LTBI corresponded with increased smoking exposure.
    Keywords: Research Article ; Medicine ; Public Health And Epidemiology ; Infectious Diseases ; Respiratory Medicine
    E-ISSN: 1932-6203
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  • 6
    Language: English
    In: Emerging infectious diseases, June 2011, Vol.17(6), pp.1140-3
    Description: To the Editor: In the United States during spring and fall of 2009, pandemic (H1N1) 2009 influenza A virus resulted in 2 major outbreaks of disease. Initial reports identified immunosuppression, including HIV infection, as a risk factor for the development of severe influenza (1–5). Subsequent reports did not confirm this association, but the number of HIV-infected patients in these studies was small (6,7). We describe the clinical course of pandemic (H1N1) 2009 in HIV-infected persons in a US hospital.
    Keywords: Influenza A Virus, H1n1 Subtype ; Pandemics ; HIV Infections -- Complications ; Influenza, Human -- Complications
    ISSN: 10806040
    E-ISSN: 1080-6059
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  • 7
    Language: English
    In: PLoS ONE, 01 January 2016, Vol.11(2), p.e0149687
    Description: INTRODUCTION:Pulmonary vascular endothelial activation has been implicated in acute respiratory distress syndrome (ARDS), yet little is known about the presence and role of endothelial activation markers in the alveolar space in ARDS. We hypothesized that endothelial activation biomarkers would...
    Keywords: Sciences (General)
    E-ISSN: 1932-6203
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  • 8
    Language: English
    In: BMC Medical Informatics and Decision Making, Dec 20, 2010, Vol.10, p.75
    Description: Background Advance directives (AD) may promote preference-concordant care yet are absent in many patients with Chronic Obstructive Pulmonary Disease (COPD). In order to begin to inform AD discussions between clinicians and COPD patients, we constructed a decision tree to estimate the impact of alternative AD decisions on both quality and quantity of life (quality adjusted life years, QALYs). Methods Two aspects of the AD were considered, Do Not Intubate (DNI; i.e., no invasive mechanical ventilation) and Full Code (i.e., may use invasive mechanical ventilation). Model parameters were based on published estimates. Our model follows hypothetical patients with COPD to evaluate the effect of underlying COPD severity and of hypothetical patient-specific preferences (about long-term institutionalization and complications from invasive mechanical ventilation) on the recommended AD. Results Our theoretical model recommends endorsing the Full Code advance directive for patients who do not have strong preferences against having a potential complication from intubation (ETT complications) or being discharged to a long-term ECF. However, our model recommends endorsing the DNI advance directive for patients who do have strong preferences against having potential complications of intubation and are were willing to tradeoff substantial amounts of time alive to avoid ETT complications or permanent institutionalization. Our theoretical model also recommends endorsing the DNI advance directive for patients who have a higher probability of having complications from invasive ventilation (ETT). Conclusions Our model suggests that AD decisions are sensitive to patient preferences about long-term institutionalization and potential complications of therapy, particularly in patients with severe COPD. Future work will elicit actual patient preferences about complications of invasive mechanical ventilation, and incorporate our model into a clinical decision support to be used for actual COPD patients facing AD decisions.
    Keywords: Chronic Obstructive Lung Disease -- Care And Treatment ; Chronic Obstructive Lung Disease -- Research ; Advance Directives (Medicine) -- Health Aspects ; Advance Directives (Medicine) -- Research ; Decision Making -- Usage
    ISSN: 1472-6947
    Source: Cengage Learning, Inc.
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  • 9
    Language: English
    In: BMC Medical Informatics and Decision Making, Dec 20, 2010, Vol.10, p.75
    Description: Background Advance directives (AD) may promote preference-concordant care yet are absent in many patients with Chronic Obstructive Pulmonary Disease (COPD). In order to begin to inform AD discussions between clinicians and COPD patients, we constructed a decision tree to estimate the impact of alternative AD decisions on both quality and quantity of life (quality adjusted life years, QALYs). Methods Two aspects of the AD were considered, Do Not Intubate (DNI; i.e., no invasive mechanical ventilation) and Full Code (i.e., may use invasive mechanical ventilation). Model parameters were based on published estimates. Our model follows hypothetical patients with COPD to evaluate the effect of underlying COPD severity and of hypothetical patient-specific preferences (about long-term institutionalization and complications from invasive mechanical ventilation) on the recommended AD. Results Our theoretical model recommends endorsing the Full Code advance directive for patients who do not have strong preferences against having a potential complication from intubation (ETT complications) or being discharged to a long-term ECF. However, our model recommends endorsing the DNI advance directive for patients who do have strong preferences against having potential complications of intubation and are were willing to tradeoff substantial amounts of time alive to avoid ETT complications or permanent institutionalization. Our theoretical model also recommends endorsing the DNI advance directive for patients who have a higher probability of having complications from invasive ventilation (ETT). Conclusions Our model suggests that AD decisions are sensitive to patient preferences about long-term institutionalization and potential complications of therapy, particularly in patients with severe COPD. Future work will elicit actual patient preferences about complications of invasive mechanical ventilation, and incorporate our model into a clinical decision support to be used for actual COPD patients facing AD decisions.
    Keywords: Chronic Obstructive Lung Disease -- Care And Treatment ; Chronic Obstructive Lung Disease -- Research ; Advance Directives (Medicine) -- Health Aspects ; Advance Directives (Medicine) -- Research ; Decision Making -- Usage
    ISSN: 1472-6947
    Source: Cengage Learning, Inc.
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  • 10
    In: AIDS, 2016, Vol.30(2), pp.273-291
    Description: OBJECTIVE:: The burden of cancer among persons living with HIV/AIDS (PLWHA) is substantial and increasing. We assessed the prevalence of modifiable cancer risk factors among adult PLWHA in Western high-income countries since 2000. DESIGN:: Meta-analysis. METHODS:: We searched PubMed to identify articles published in 2011–2013 reporting prevalence of smoking, alcohol consumption, overweight/obesity, and infection with human papillomavirus (HPV), hepatitis C virus (HCV) and hepatitis B virus (HBV) among PLWHA. We conducted random effects meta-analyses of prevalence for each risk factor, including estimation of overall, sex-specific, and HIV-transmission-group-specific prevalence. We compared prevalence in PLWHA with published prevalence estimates in US adults. RESULTS:: The meta-analysis included 113 publications. Overall summary prevalence estimates were current smoking, 54% [95% confidence interval (CI) 49–59%] versus 20–23% in US adults; cervical high-risk HPV infection, 46% (95% CI 34–58%) versus 29% in US females; oral high-risk HPV infection, 16% (95% CI 10–23%) versus 4% in US adults; anal high-risk HPV infection (men who have sex with men), 68% (95% CI 57–79%), with no comparison estimate available; chronic HCV infection, 26% (95% CI 21–30%) versus 0.9% in US adults; and HBV infection, 5% (95% CI 4–5%) versus 0.3% in US adults. Overweight/obesity prevalence (53%; 95% CI 46–59%) was below that of US adults (68%). Meta-analysis of alcohol consumption prevalence was impeded by varying assessment methods. Overall, we observed considerable study heterogeneity in prevalence estimates. CONCLUSION:: Prevalence of smoking and oncogenic virus infections continues to be extraordinarily high among PLWHA, indicating a vital need for risk factor reduction efforts.
    Keywords: Obesity ; Acquired Immune Deficiency Syndrome ; Cancer ; Smoking ; Body Weight ; Reviews ; Risk Factors ; Chronic Infection ; Alcohols ; Risk Groups ; Cervix ; Ethanol ; Sex ; Obesity ; Alcohol ; Smoking ; Health Risks ; Acquired Immune Deficiency Syndrome ; Human Immunodeficiency Virus ; Risk Factors ; Hepatitis B ; Homosexuality ; Hepatitis C ; Infection ; Cancer ; Lentivirus ; Hepatitis C Virus ; Hepatitis B Virus ; Retroviridae ; Papillomaviridae ; Human Papillomavirus ; Natural Disasters/Civil Defense/Emergency Management ; AIDS and HIV ; Cancer Immunology ; Acquired Immunodeficiency Syndrome ; Cancer Prevention ; Cancer Risk Factors ; High-Income Countries ; HIV Infections ; Neoplasms;
    ISSN: 0269-9370
    E-ISSN: 14735571
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