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Search Results: 1 - 10 of 155621 matches for " Edward H Yelin "
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The impact of SHS exposure on health status and exacerbations among patients with COPD
Mark D Eisner,Carlos Iribarren,Edward H Yelin,Stephen Sidney
International Journal of COPD , 2009,
Abstract: Mark D Eisner1,3, Carlos Iribarren3, Edward H Yelin2, Stephen Sidney3, Patricia P Katz2, Gabriela Sanchez3, Paul D Blanc11Division of Occupational and Environmental Medicine and Division of Pulmonary and Critical Care Medicine; 2Institute for Health Policy Studies, Department of Medicine, University of California, San Francisco, CA, USA; 3Division of Research, Kaiser Permanente, Oakland, CA, USAAbstract: Secondhand smoke (SHS) is a major contributor to indoor air pollution. Because it contains respiratory irritants, it may adversely influence the clinical course of persons with chronic obstructive pulmonary disease (COPD). We used data from nonsmoking members of the FLOW cohort of COPD (n = 809) to elucidate the impact of SHS exposure on health status and exacerbations (requiring emergency department visits or hospitalization). SHS exposure was measured by a validated survey instrument (hours of exposure during the past week). Physical health status was measured by the SF-12 Physical Component Summary Score and disease-specific health-related quality of life (HRQL) by the Airways Questionnaire 20-R. Health care utilization for COPD was determined from Kaiser Permanente Northern California computerized databases. Compared to no SHS exposure, higher level SHS exposure was associated with poorer physical health status (mean score decrement 1.78 points; 95% confidence interval [CI] 3.48 to 0.074 points) after controlling for potential confounders. Higher level SHS exposure was also related to poorer disease-specific HRQL (mean score increment 0.63; 95% CI 0.016 to 1.25) and less distance walked during the Six-Minute Walk test (mean decrement 50 feet; 95% CI 102 to 1.9). Both lower level and higher level SHS exposure was related to increased risk of emergency department (ED) visits (hazard ratio [HR] 1.40; 95% CI 0.96 to 2.05 and HR 1.41; 95% CI 0.94 to 2.13). Lower level and higher level SHS exposure were associated with a greater risk of hospital-based care for COPD, which was a composite endpoint of either ED visits or hospitalizations for COPD (HR 1.52; 95% CI 1.06 to 2.18 and HR 1.40; 95% CI 0.94 to 2.10, respectively). In conclusion, SHS was associated with poorer health status and a greater risk of COPD exacerbation. COPD patients may comprise a vulnerable population for the health effects of SHS.Keywords: chronic obstructive pulmonary disease, chronic bronchitis, pulmonary emphysema, tobacco smoke pollution
Lifetime environmental tobacco smoke exposure and the risk of chronic obstructive pulmonary disease
Mark D Eisner, John Balmes, Patricia P Katz, Laura Trupin, Edward H Yelin, Paul D Blanc
Environmental Health , 2005, DOI: 10.1186/1476-069x-4-7
Abstract: Using data from a population-based sample of 2,113 U.S. adults aged 55 to 75 years, we examined the association between lifetime ETS exposure and the risk of developing COPD.Participants were recruited from all 48 contiguous U.S. states by random digit dialing. Lifetime ETS exposure was ascertained by structured telephone interview. We used a standard epidemiologic approach to define COPD based on a self-reported physician diagnosis of chronic bronchitis, emphysema, or COPD.Higher cumulative lifetime home and work exposure were associated with a greater risk of COPD. The highest quartile of lifetime home ETS exposure was associated with a greater risk of COPD, controlling for age, sex, race, personal smoking history, educational attainment, marital status, and occupational exposure to vapors, gas, dusts, or fumes during the longest held job (OR 1.55; 95% CI 1.09 to 2.21). The highest quartile of lifetime workplace ETS exposure was also related to a greater risk of COPD (OR 1.36; 95% CI 1.002 to 1.84). The population attributable fraction was 11% for the highest quartile of home ETS exposure and 7% for work exposure.ETS exposure may be an important cause of COPD. Consequently, public policies aimed at preventing public smoking may reduce the burden of COPD-related death and disability, both by reducing direct smoking and ETS exposure.COPD is a common disease, affecting 5–10% of the population of North America and Europe [1-3]. During the past two decades, death and disability from COPD have continued to increase worldwide [1,4]. Although direct cigarette smoking is the major cause of COPD, up to two cases out of ten cannot be explained solely by direct smoking [5]. Environmental tobacco smoke (ETS) exposure, which appears to cause new cases of asthma, could also cause COPD [6-8]. Because it contains potent airway irritants, ETS could lead to chronic airway irritation, inflammation, and obstruction [6,9]. The role of ETS exposure in causing COPD, however, has received
Risk factors for hospitalization among adults with asthma: the influence of sociodemographic factors and asthma severity
Mark D Eisner, Patricia P Katz, Edward H Yelin, Stephen C Shiboski, Paul D Blanc
Respiratory Research , 2000, DOI: 10.1186/rr37
Abstract: In adults with health care access, we prospectively studied 242 with asthma, aged 18–50 years, recruited from a random sample of allergy and pulmonary physician practices in Northern California to identify risk factors for subsequent hospitalization.Thirty-nine subjects (16%) reported hospitalization for asthma during the 18-month follow-up period. On controlling for asthma severity in multiple logistic regression analysis, non-white race (odds ratio [OR], 3.1; 95% confidence interval [CI], 1.1–8.8) and lower income (OR, 1.1 per $10,000 decrement; 95% CI, 0.9–1.3) were associated with a higher risk of asthma hospitalization. The severity-of-asthma score (OR, 3.4 per 5 points; 95%, CI 1.7–6.8) and recent asthma hospitalization (OR, 8.3; 95%, CI, 2.1–33.4) were also related to higher risk, after adjusting for demographic characteristics. Reliance on emergency department services for urgent asthma care was also associated with a greater likelihood of hospitalization (OR, 3.2; 95% CI, 1.0–9.8). In multivariate analysis not controlling for asthma severity, low income was even more strongly related to hospitalization (OR, 1.2 per $10,000 decrement; 95% CI, 1.02–1.4).In adult asthmatics with access to health care, non-white race, low income, and greater asthma severity were associated with a higher risk of hospitalization. Targeted interventions applied to high-risk asthma patients may reduce asthma morbidity and mortality.Asthma is a common condition in general medical practice, accounting for about 1% of all ambulatory visits in the USA [1]. The mortality rate from asthma has risen sharply since the late 1970s, which may reflect increasing disease severity [2]. The hospitalization rate, another population-level marker of asthma severity, remains substantial [2], generating nearly one-half of all US health care costs for asthma [3]. Hospitalization rates for asthma have actually increased in some demographic subgroups, such as young adults [2] and the urban poor [4], desp
The impact of SHS exposure on health status and exacerbations among patients with COPD
Mark D Eisner, Carlos Iribarren, Edward H Yelin, Stephen Sidney, et al.
International Journal of Chronic Obstructive Pulmonary Disease , 2009, DOI: http://dx.doi.org/10.2147/COPD.S4681
Abstract: ct of SHS exposure on health status and exacerbations among patients with COPD Original Research (3711) Total Article Views Authors: Mark D Eisner, Carlos Iribarren, Edward H Yelin, Stephen Sidney, et al. Published Date May 2009 Volume 2009:4 Pages 169 - 176 DOI: http://dx.doi.org/10.2147/COPD.S4681 Mark D Eisner1,3, Carlos Iribarren3, Edward H Yelin2, Stephen Sidney3, Patricia P Katz2, Gabriela Sanchez3, Paul D Blanc1 1Division of Occupational and Environmental Medicine and Division of Pulmonary and Critical Care Medicine; 2Institute for Health Policy Studies, Department of Medicine, University of California, San Francisco, CA, USA; 3Division of Research, Kaiser Permanente, Oakland, CA, USA Abstract: Secondhand smoke (SHS) is a major contributor to indoor air pollution. Because it contains respiratory irritants, it may adversely influence the clinical course of persons with chronic obstructive pulmonary disease (COPD). We used data from nonsmoking members of the FLOW cohort of COPD (n = 809) to elucidate the impact of SHS exposure on health status and exacerbations (requiring emergency department visits or hospitalization). SHS exposure was measured by a validated survey instrument (hours of exposure during the past week). Physical health status was measured by the SF-12 Physical Component Summary Score and disease-specific health-related quality of life (HRQL) by the Airways Questionnaire 20-R. Health care utilization for COPD was determined from Kaiser Permanente Northern California computerized databases. Compared to no SHS exposure, higher level SHS exposure was associated with poorer physical health status (mean score decrement 1.78 points; 95% confidence interval [CI] 3.48 to 0.074 points) after controlling for potential confounders. Higher level SHS exposure was also related to poorer disease-specific HRQL (mean score increment 0.63; 95% CI 0.016 to 1.25) and less distance walked during the Six-Minute Walk test (mean decrement 50 feet; 95% CI 102 to 1.9). Both lower level and higher level SHS exposure was related to increased risk of emergency department (ED) visits (hazard ratio [HR] 1.40; 95% CI 0.96 to 2.05 and HR 1.41; 95% CI 0.94 to 2.13). Lower level and higher level SHS exposure were associated with a greater risk of hospital-based care for COPD, which was a composite endpoint of either ED visits or hospitalizations for COPD (HR 1.52; 95% CI 1.06 to 2.18 and HR 1.40; 95% CI 0.94 to 2.10, respectively). In conclusion, SHS was associated with poorer health status and a greater risk of COPD exacerbation. COPD patients may comprise a vulnerable population for the health effects of SHS.
Socioeconomic gradients in tiotropium use among adults with COPD
Paul D Blanc,Mark D Eisner,Edward H Yelin,Gillian Earnest
International Journal of COPD , 2008,
Abstract: Paul D Blanc1,2,3, Mark D Eisner1,2, Edward H Yelin4,5, Gillian Earnest1, John R Balmes1,2, Steven E Gregorich6, Patricia P Katz4,51Division of Occupational and Environmental Medicine, 2Division of Pulmonary and Critical Care Medicine, 4Division of Rheumatology, 6Division of General Internal Medicine, Department of Medicine; 3Cardiovascular Research Institute; 5Institute for Health Policy Studies; University of California San Francisco, San Francisco, CA, USABackground: Inequalities in the use of new medications may contribute to health disparities. We analyzed socioeconomic gradients in the use of tiotropium for chronic obstructive pulmonary disease (COPD).Methods: In a cohort of adults with COPD aged ≥55 years identified through population-based sampling, we elicited questionnaire responses on demographics, socioeconomic status (SES; lower SES defined as high school education or less or annual household income
Directly measured secondhand smoke exposure and COPD health outcomes
Mark D Eisner, John Balmes, Edward H Yelin, Patricia P Katz, S Katherine Hammond, Neal Benowitz, Paul D Blanc
BMC Pulmonary Medicine , 2006, DOI: 10.1186/1471-2466-6-12
Abstract: We used data from two waves of a population-based multiwave U.S. cohort study of adults with COPD. 77 non-smoking respondents with a diagnosis of COPD completed direct SHS monitoring based on urine cotinine and a personal badge that measures nicotine. We evaluated the longitudinal impact of SHS exposure on validated measures of COPD severity, physical health status, quality of life (QOL), and dyspnea measured at one year follow-up.The highest level of SHS exposure, as measured by urine cotinine, was cross-sectionally associated with poorer COPD severity (mean score increment 4.7 pts; 95% CI 0.6 to 8.9) and dyspnea (1.0 pts; 95% CI 0.4 to 1.7) after controlling for covariates. In longitudinal analysis, the highest level of baseline cotinine was associated with worse COPD severity (4.7 points; 95% CI -0.1 to 9.4; p = 0.054), disease-specific QOL (2.9 pts; -0.16 to 5.9; p = 0.063), and dyspnea (0.9 pts; 95% CI 0.2 to 1.6 pts; p < 0.05), although the confidence intervals did not always exclude the no effect level.Directly measured SHS exposure appears to adversely influence health outcomes in COPD, independent of personal smoking. Because SHS is a modifiable risk factor, clinicians should assess SHS exposure in their patients and counsel its avoidance. In public health terms, the effects of SHS exposure on this vulnerable subpopulation provide a further rationale for laws prohibiting public smoking.Personal direct cigarette smoking is the most important single causal factor for developing COPD. The view that cigarette smoking is the sole meaningful factor in the epidemiology and natural history of COPD, however, is a misconception. Although direct cigarette smoking is the major cause of COPD, up to two cases out of ten cannot be attributable solely to this risk factor.[1] Other exposures, particularly secondhand smoke (SHS) exposure and occupational exposures, may be important in the development of COPD.[2-4] In terms of disease progression, other initiators of COPD bes
Self-management skills in adolescents with chronic rheumatic disease: A cross-sectional survey
Erica F Lawson, Aimee O Hersh, Mark A Applebaum, Edward H Yelin, Megumi J Okumura, Emily von Scheven
Pediatric Rheumatology , 2011, DOI: 10.1186/1546-0096-9-35
Abstract: Cross-sectional survey of 52 adolescent patients in the Pediatric Rheumatology Clinic at UCSF. Outcome measures were self-reported medication adherence, medication regimen knowledge and independence in health care tasks. Predictors of self-management included age, disease perception, self-care agency, demographics and self-reported health status. Bivariate associations were assessed using the Student's t-test, Wilcoxon rank sum test and Fisher exact test as appropriate. Independence in self-management tasks were compared between subjects age 13-16 and 17-20 using the chi-squared test.Subjects were age 13-20 years (mean 15.9); 79% were female. Diagnoses included juvenile idiopathic arthritis (44%), lupus (35%), and other rheumatic conditions (21%). Mean disease duration was 5.3 years (SD 4.0). Fifty four percent reported perfect adherence to medications, 40% reported 1-2 missed doses per week, and 6% reported missing 3 or more doses. The most common reason for missing medications was forgetfulness. Among health care tasks, there was an age-related increase in ability to fill prescriptions, schedule appointments, arrange transportation, ask questions of doctors, manage insurance, and recognize symptoms of illness. Ability to take medications as directed, keep a calendar of appointments, and maintain a personal medical file did not improve with age.This study suggests that adolescents with chronic rheumatic disease may need additional support to achieve independence in self-management.Children with special health care needs (CSHCN), which include children with chronic rheumatologic conditions, typically enter the health care system as passive participants, with parents assuming responsibility for the majority of their health care-related tasks. However, as pediatric patients age into adolescence and young adulthood, there is an expected shift in the burden of responsibility from parent to young adult. Young adults must learn to complete such tasks as scheduling appoint
Provision of preventive health care in systemic lupus erythematosus: data from a large observational cohort study
Jinoos Yazdany, Chris Tonner, Laura Trupin, Pantelis Panopalis, Joann Z Gillis, Aimee O Hersh, Laura J Julian, Patricia P Katz, Lindsey A Criswell, Edward H Yelin
Arthritis Research & Therapy , 2010, DOI: 10.1186/ar3011
Abstract: We compared preventive services reported by insured women with SLE enrolled in the University of California, San Francisco Lupus Outcomes Study (n = 685) to two representative samples derived from a statewide health interview survey, a general population sample (n = 18,013) and a sample with non-rheumatic chronic conditions (n = 4,515). In addition, using data from the cohort in both men and women (n = 742), we applied multivariate regression analyses to determine whether characteristics of individuals (for example, sociodemographic and disease factors), health systems (for example, number of visits, involvement of generalists or rheumatologists in care, type of health insurance) or neighborhoods (neighborhood poverty) influenced the receipt of services.The receipt of preventive care in SLE was similar to both comparison samples. For cancer surveillance, 70% of eligible respondents reported receipt of cervical cancer screening and mammography, and 62% reported colon cancer screening. For immunizations, 59% of eligible respondents reported influenza immunization, and 60% reported pneumococcal immunization. In multivariate regression analyses, several factors were associated with a lower likelihood of receiving preventive services, including younger age and lower educational attainment. We did not observe any effects by neighborhood poverty. A higher number of physician visits and involvement of generalist providers in care was associated with a higher likelihood of receiving most services.Although receipt of cancer screening procedures and immunizations in our cohort was comparable to the general population, we observed significant variability by sociodemographic factors such as age and educational attainment. Further research is needed to identify the physician, patient or health system factors contributing to this observed variation in order to develop effective quality improvement interventions.Over the last several decades, the prognosis of patients with systemic
Body composition and functional limitation in COPD
Mark D Eisner, Paul D Blanc, Steve Sidney, Edward H Yelin, Phenius V Lathon, Patricia P Katz, Irina Tolstykh, Lynn Ackerson, Carlos Iribarren
Respiratory Research , 2007, DOI: 10.1186/1465-9921-8-7
Abstract: We used bioelectrical impedance to estimate body composition in a cohort of 355 younger adults with COPD who had a broad spectrum of severity.Among women, a higher lean-to-fat ratio was associated with a lower risk of self-reported functional limitation after controlling for age, height, pulmonary function impairment, race, education, and smoking history (OR 0.45 per 0.50 increment in lean-to-fat ratio; 95% CI 0.28 to 0.74). Among men, a higher lean-to-fat ratio was associated with a greater distance walked in 6 minutes (mean difference 40 meters per 0.50 ratio increment; 95% CI 9 to 71 meters). In women, the lean-to-fat ratio was associated with an even greater distance walked (mean difference 162 meters per 0.50 increment; 95% CI 97 to 228 meters). In women, higher lean-to-fat ratio was also associated with better Short Physical Performance Battery Scores. In further analysis, the accumulation of greater fat mass, and not the loss of lean mass, was most strongly associated with functional limitation among both sexes.Body composition is an important non-pulmonary impairment that modulates the risk of functional limitation in COPD, even after taking pulmonary function into account. Body composition abnormalities may represent an important area for screening and preventive intervention in COPD.Chronic obstructive pulmonary disease (COPD) is a common chronic health condition, affecting 5–10% of the U.S. population [1,2]. Disability from COPD is substantial, and will likely increase in the U.S. and worldwide [3,4]. Despite these trends, the current understanding of how disability develops in COPD is limited. Although pulmonary function is the most important indicator of physiologic impairment in COPD [5,6], it is a paradoxically a weak predictor of functional limitations [7-9]. Functional limitations, which are decrements in basic physical actions (e.g., mobility, strength), are the key precursors to disability [10,11]. To elucidate the pathway to disability in COPD, w
An integrated model of environmental factors in adult asthma lung function and disease severity: a cross-sectional study
Laura Trupin, John R Balmes, Hubert Chen, Mark D Eisner, S Katharine Hammond, Patricia P Katz, Fred Lurmann, Patricia J Quinlan, Peter S Thorne, Edward H Yelin, Paul D Blanc
Environmental Health , 2010, DOI: 10.1186/1476-069x-9-24
Abstract: Data on 176 subjects with asthma and/or rhinitis were collected via telephone interviews for sociodemographic factors and asthma severity (scored on a 0-28 point range). Dust, indoor air quality, antigen-specific IgE antibodies, and lung function (percent predicted FEV1) were assessed through home visits. Neighborhood socioeconomic status, proximity to traffic, land use, and ambient air quality data were linked to the individual-level data via residential geocoding. Multiple linear regression separately tested the explanatory power of five groups of environmental factors for the outcomes, percent predicted FEV1 and asthma severity. Final models retained all variables statistically associated (p < 0.20) with each of the two outcomes.Mean FEV1 was 85.0 ± 18.6%; mean asthma severity score was 6.9 ± 5.6. Of 29 variables screened, 13 were retained in the final model of FEV1 (R2 = 0.30; p < 0.001) and 15 for severity (R2 = 0.16; p < 0.001), including factors from each of the five groups. Adding FEV1 as an independent variable to the severity model further increased its explanatory power (R2 = 0.25).Multivariate models covering a range of individual and environmental factors explained nearly a third of FEV1 variability and, taking into account lung function, one quarter of variability in asthma severity. These data support an integrated approach to modeling adult asthma outcomes, including both the physical and the social environment.The potential relationship of environmental factors to morbidity in asthma is highly complex and difficult to study. Environmental risk factors for developing asthma (such as ambient pollution, antigens, and indoor air quality) have been given considerable research attention, particularly in the onset of childhood disease. In contrast, the role of the environment in asthma severity and disease-related quality of life for those who have established asthma has been less well studied, particularly among adults.As importantly, studies of environme
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