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Search Results: 1 - 10 of 20833 matches for " Jean Bourbeau "
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Canadian mortality in perspective: a comparison with the United States and other developed countries
Bourbeau, Robert
Canadian Studies in Population , 2002,
Abstract: English The purposes of this paper is to compare mortality patterns in Canada to theUnited States and to other industrialised countries to give support to the existence of a "NorthAmerican Mortality Pattern" (NAMP), and to try to explain this pattern in the context of the specificfeatures of Canadian society. Using data from the WHO mortality database for total and cause-specificmortality, we applied a decomposition method to explain the changes in mortality rate ratios duringthe 1950-1995 period. Our findings show that Canada has experienced a general increase of itsmortality rate ratios compared to other developed countries. There is no evidence that the NAMP fitsfor Canada. In fact, Canadian mortality below age 65 is quite comparable to mortality in otherdeveloped countries. However there is a contrasting low mortality level for the oldest-old(80+). French Cet article a pour but de comparer le profil de la mortalité canadienne à celui des états-Unis et de plusieurs pays développés afin de vérifier l'existence d'un " profil nord américain de la mortalité ", et de tenter de l'expliquer dans le contexte particulier de la société canadienne. Nous avons utilisé les données de la banque de l'OMS sur la mortalité selon l'age et la cause de décès pour tenter d'interpréter, à l'aide d'un modèle de décomposition, les changements relatifs de la mortalité canadienne au cours de la période 1950 à 1995. Le Canada a connu une détérioration générale de ses taux de mortalité relativement aux autres pays développés. Le Canada présente un profil de mortalité distinct des états-Unis, sauf pour une caractéristique commune, la plus faible mortalité aux grands ages (80 ans et plus.)
The impact of obesity on walking and cycling performance and response to pulmonary rehabilitation in COPD
Francesco Sava, Louis Laviolette, Sarah Bernard, Marie-Josée Breton, Jean Bourbeau, Fran?ois Maltais
BMC Pulmonary Medicine , 2010, DOI: 10.1186/1471-2466-10-55
Abstract: 261 patients with COPD were divided into three groups: normal body mass index (BMI), overweight and obese. Baseline and post rehabilitation pulmonary function, 6-min walking test (6MWT), endurance time during a constant workrate exercise test (CET) and St. George's Respiratory Questionnaire (SGRQ) scores were compared between all three classes of BMI.At baseline, obese and overweight patients had less severe airflow obstruction compared to normal BMI patients. There was no baseline difference in CET performance or SGRQ scores across BMI classes and 6MWT was reduced in the presence of obesity (p < 0.01). Compared to baseline, post-rehabilitation 6MWT, CET performance and SGRQ scores improved significantly in each group (p < 0.01), but 6MWT was still significantly lower in the presence of obesity.Walking, but not cycling performance was worse in obese patients. This difference was maintained post rehabilitation despite significant improvements. Weight excess may counterbalance the effect of a better preserved respiratory function in the performance of daily activities such as walking. However, obesity and overweight did not influence the magnitude of improvement after pulmonary rehabilitation.Chronic obstructive pulmonary disease (COPD) is associated with dyspnea and exercise intolerance, two major impediments to quality of life. Although low body weight[1] and muscle wasting[2] have traditionally been the focus of nutritional management in COPD, recent data indicate that obesity is becoming frequent in this disease[3]. On one hand, a high body mass index (BMI) appears to convey a survival advantage to patients with COPD[1,4]. On the other hand, obesity by itself may compromise lung function[5], decrease exercise tolerance particularly during weight bearing activities[6,7], and quality of life[8], leading to greater disability[9,10].The effects of obesity in combination with COPD on exercise tolerance and dyspnea have received little attention. In one study, obese pat
Relationship between FEV1 change and patient-reported outcomes in randomised trials of inhaled bronchodilators for stable COPD: a systematic review
Marie Westwood, Jean Bourbeau, Paul W Jones, Annamaria Cerulli, Gorana Capkun-Niggli, Gill Worthy
Respiratory Research , 2011, DOI: 10.1186/1465-9921-12-40
Abstract: Six databases (to October 2009) were searched to identify studies with long-acting bronchodilator therapy reporting FEV1 and health status, dyspnoea or exacerbations. Mean and standard deviations of treatment effects were extracted for each arm of each study. Relationships between changes in trough FEV1 and outcomes were assessed using correlations and random-effects regression modelling. The primary outcome was St George's Respiratory Questionnaire (SGRQ) total score.Thirty-six studies (≥3 months) were included. Twenty-two studies (23,654 patients) with 49 treatment arms each contributing one data point provided SGRQ data. Change in trough FEV1 and change in SGRQ total score were negatively correlated (r = -0.46, p < 0.001); greater increases in FEV1 were associated with greater reductions (improvements) in SGRQ. The correlation strengthened with increasing study duration from 3 to 12 months. Regression modelling indicated that 100 mL increase in FEV1 (change at which patients are more likely to report improvement) was associated with a statistically significant reduction in SGRQ of 2.5 (95% CI 1.9, 3.1), while a clinically relevant SGRQ change (4.0) was associated with 160.6 (95% CI 129.0, 211.6) mL increase in FEV1. The association between change in FEV1 and other patient-reported outcomes was generally weak.Our analyses indicate, at a study level, that improvement in mean trough FEV1 is associated with proportional improvements in health status.Chronic obstructive pulmonary disease (COPD) is a complex, chronic condition, which is characterised by progressive airflow limitation that is not fully reversible. The major symptoms of COPD, such as dyspnoea, cough and sputum production, are disabling and have substantial impact on both patients' health status and the health care system [1,2]. Although treatment involves several approaches, bronchodilator medications are central to the management of COPD, improving both lung function and symptoms [1].The complex nature
CD8 positive T cells express IL-17 in patients with chronic obstructive pulmonary disease
Ying Chang, Jessica Nadigel, Nicholas Boulais, Jean Bourbeau, Fran?ois Maltais, David H Eidelman, Qutayba Hamid
Respiratory Research , 2011, DOI: 10.1186/1465-9921-12-43
Abstract: Bronchoscopic biopsies of the airway were obtained from 16 COPD subjects (GOLD stage 1-4) and 15 control subjects. Paraffin sections were used for the investigation of IL-17A and IL-17F expression in the airways by immunohistochemistry, and frozen sections were used for the immunofluorescence double staining of IL-17A or IL-17F paired with CD4 or CD8. In order to confirm the expression of IL-17A and IL-17F at the mRNA level, a quantitative RT-PCR was performed on the total mRNA extracted from entire section or CD8 positive cells selected by laser capture microdissection.IL-17F immunoreactivity was significantly higher in the bronchial biopsies of COPD patients compared to control subjects (P < 0.0001). In the submucosa, the absolute number of both IL-17A and IL-17F positive cells was higher in COPD patients (P < 0.0001). After adjusting for the total number of cells in the submucosa, we still found that more cells were positive for both IL-17A (P < 0.0001) and IL-17F (P < 0.0001) in COPD patients compared to controls. The mRNA expression of IL-17A and IL-17F in airways of COPD patients was confirmed by RT-PCR. The expression of IL-17A and IL-17F was co-localized with not only CD4 but also CD8, which was further confirmed by RT-PCR on laser capture microdissection selected CD8 positive cells.These findings support the notion that Th17 cytokines could play important roles in the pathogenesis of COPD, raising the possibility of using this mechanism as the basis for novel therapeutic approaches.Chronic obstructive pulmonary disease (COPD), a progressive and irreversible chronic inflammatory disease of the lung caused predominantly by cigarette smoking, is one of the most important causes of mortality globally [1]. The inflammatory response in the lungs of COPD patients has been found to be strongly linked to tissue destruction and alveolar airspace enlargement, which lead to disease progression [2].The inflammatory response reflects both the innate immune response to ci
Cigarette smoke increases TLR4 and TLR9 expression and induces cytokine production from CD8+ T cells in chronic obstructive pulmonary disease
Jessica Nadigel, David Préfontaine, Carolyn J Baglole, Fran?ois Maltais, Jean Bourbeau, David H Eidelman, Qutayba Hamid
Respiratory Research , 2011, DOI: 10.1186/1465-9921-12-149
Abstract: Endobronchial biopsies and peripheral blood were obtained from COPD patients and control subjects. TLR4 and TLR9 expression was assessed by immunostaining of lung tissue and flow cytometry of the peripheral blood. CD8+ T cells isolated from peripheral blood were treated with or without cigarette smoke condensate (CSC) as well as TLR4 and TLR9 inhibitors. PCR and western blotting were used to determine TLR4 and TLR9 expression, while cytokine secretion from these cells was detected using electrochemiluminescence technology.No difference was observed in the overall expression of TLR4 and TLR9 in the lung tissue and peripheral blood of COPD patients compared to control subjects. However, COPD patients had increased TLR4 and TLR9 expression on lung CD8+ T cells. Exposure of CD8+ T cells to CSC resulted in an increase of TLR4 and TLR9 protein expression. CSC exposure also caused the activation of CD8+ T cells, resulting in the production of IL-1β, IL-6, IL-10, IL-12p70, TNFα and IFNγ. Furthermore, inhibition of TLR4 or TLR9 significantly attenuated the production of TNFα and IL-10.Our results demonstrate increased expression of TLR4 and TLR9 on lung CD8+ T cells in COPD. CD8+ T cells exposed to CSC increased TLR4 and TLR9 levels and increased cytokine production. These results provide a new perspective on the role of CD8+ T cells in COPD.Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide [1], with more than 80% of COPD cases caused by cigarette smoking [2]. Chronic inflammation observed in COPD is characterized by pro-inflammatory cytokine production and recruitment of several cell types to the lungs, including cells of the innate immune response, such as neutrophils and macrophages [3], as well as those of adaptive immune response, namely T and B lymphocytes [4,5]. CD8+ T cells are regarded as a hallmark cell of COPD, and are increased in both the central [6] and peripheral [7] airways of COPD patients. CD8+ T cells foun
Changes in the age-at-death distribution in four low mortality countries: A nonparametric approach
Nadine Ouellette,Robert Bourbeau
Demographic Research , 2011,
Abstract: Since the beginning of the twentieth century, important transformations have occurred in the age-at-death distribution within human populations. We propose a flexible nonparametric smoothing approach based on P-splines to refine the monitoring of these changes. Using data from the Human Mortality Database for four low mortality countries, namely Canada (1921-2007), France (1920-2009), Japan (1947-2009), and the USA (1945-2007), we find that the general scenario of compression of mortality no longer describes appropriately some of the recent adult mortality trends recorded. Indeed, reductions in the variability of age at death above the mode have stopped since the early 1990s in Japan and since the early 2000s for Canadian, US, and French women, while their respective modal age at death continued to increase. These findings provide additional support to the shifting mortality scenario, using an alternative method free from any assumption on the shape of the age-at-death distribution.
Mortality statistics for the oldest-old
Bourbeau Robert,Lebel André
Demographic Research , 2000,
Abstract: The main purposes of this paper is to evaluate the quality of Canadian data among the oldest-old (80+) over the 1951-1995 period, and to compare estimations of Canadian probabilities of death based on the extinct generation method with those of other developed countries in order to ascertain whether Canada experiences a distinct low mortality profile. The evaluation of the data quality suggests that Canadian data are quite good up to the age of 100, and that the main problems concern the centenarians (overstatement of age at death and errors in census age declarations). International comparisons on the basis of two mortality indicators for the 80-99 age-interval lead to the same conclusion: Canadian mortality is lower than in most European countries. The best match is still with the United States.
How do COPD patients respond to exacerbations?
Jaap CA Trappenburg, David Schaap, Evelyn M Monninkhof, Jean Bourbeau, Gerdien H de Weert-van Oene, Theo JM Verheij, Jan-Willem J Lammers, Augustinus JP Schrijvers
BMC Pulmonary Medicine , 2011, DOI: 10.1186/1471-2466-11-43
Abstract: In a multicentre observational study, 121 patients (age 67 ± 11 years, FEV1pred. 48 ± 19) were followed for 6 weeks by daily diary symptom recording. Three types of action were assessed daily: planning periods of rest, breathing techniques and/or sputum clearing (type-A), increased bronchodilator use (type-B) and contacting a healthcare provider (type-C).Type-A action was taken in 70.7%, type-B in 62.7% and type C in 17.3% of exacerbations (n = 75). Smokers were less likely to take type-A and B actions. Type-C actions were associated with more severe airflow limitation and increased number of hospital admissions in the last year.Our study shows that most patients are willing to take timely self-management actions during exacerbations. Future research is needed to determine whether the low incidence of contacting a healthcare provider is due to a lack of self-management or healthcare accessibility.Chronic obstructive pulmonary disease (COPD) is characterised by a progressive decline in respiratory function, exercise capacity and health status [1]. This underlying disease state is interrupted by episodes of acute worsening in respiratory symptoms. If these deteriorations are beyond individual day-to-day variability, these are defined as exacerbations [2]. It is widely recognized that acute exacerbations play a central role in COPD-related morbidity and mortality [1]. Exacerbations are associated with marked physiologic deterioration that may affect disease progression by accelerating reductions in forced expiratory volume in 1 s (FEV1) [3,4], have a significant negative effect on the individual's health-related quality of life (HRQoL) [5,6] and generate an increasing burden on health services and economic costs [7]. Several studies have shown that almost 50% of exacerbations remain unreported and subsequently do not receive adequate treatment [8-10]. Although unreported exacerbations are often considered to be mild, recent studies have shown that these exacerbations m
Detecting exacerbations using the Clinical COPD Questionnaire
Jaap CA Trappenburg, Irene Touwen, Gerdien H de Weert-van Oene, Jean Bourbeau, Evelyn M Monninkhof, Theo JM Verheij, Jan-Willem J Lammers, Augustinus JP Schrijvers
Health and Quality of Life Outcomes , 2010, DOI: 10.1186/1477-7525-8-102
Abstract: The Clinical COPD Questionnaire (CCQ) is a short questionnaire with great evaluative properties in measuring health status. The current explorative study evaluates the discriminative properties of weekly CCQ assessment in detecting exacerbations.In a multicentre prospective cohort study, 121 patients, age 67.4 ± 10.5 years, FEV1 47.7 ± 18.5% pred were followed for 6 weeks by daily diary card recording and weekly CCQ assessment. Weeks were retrospectively labeled as stable or exacerbation (onset) weeks using the Anthonisen symptom diary-card algorithm. Change in CCQ total scores are significantly higher in exacerbation-onset weeks, 0.35 ± 0.69 compared to -0.04 ± 0.37 in stable weeks (p < 0.001). Performance of the Δ CCQ total score discriminating between stable and exacerbation onset weeks was sufficient (area under the ROC curve 0.75). At a cut off point of 0.2, sensitivity was 62.5 (50.3-73.4), specificity 82.0 (79.3-84.4), and a positive and negative predictive value of 43.5 (35.0-51.0) and 90.8 (87.8-93.5), respectively. Using this cut off point, 22 (out of 38) unreported exacerbations were detected while 39 stable patients would have been false positively 'contacted'.Weekly CCQ assessment is a promising, low burden method to detect unreported exacerbations. Further research is needed to validate discriminative performance and practical implications of the CCQ in detecting exacerbations in daily care.Chronic Obstructive Pulmonary Disease (COPD) is a progressive chronic disease, characterized by an irreversible decline in lung function, exercise capacity and health status. The natural history of COPD is interrupted by exacerbations: episodes of worsening symptoms and signs, accelerating lung function decline [1,2] and responsible for decreased health related quality of life (HRQoL)[3,4], increased mortality [5,6] and health-care costs[7,8].Irrespective of the definition of exacerbation used, the clinical diagnosis points to an acute clinical worsening that may ne
Action Plan to enhance self-management and early detection of exacerbations in COPD patients; a multicenter RCT
Jaap CA Trappenburg, Lieselotte Koevoets, Gerdien H de Weert-van Oene, Evelyn M Monninkhof, Jean Bourbeau, Thierry Troosters, Theo JM Verheij, Jan-Willem J Lammers, Augustinus JP Schrijvers
BMC Pulmonary Medicine , 2009, DOI: 10.1186/1471-2466-9-52
Abstract: The current multicenter, single-blind RCT with a follow-up period of 6 months, evaluates the hypothesis that individualized AP's reduce exacerbation recovery time. Patients are included from regular respiratory nurse clinics and allocated to either usual care or the AP intervention. The AP provides individualized treatment prescriptions (pharmaceutical and non-pharmaceutical) related to a color coded symptom status (reinforcement at 1 and 4 months). Although usually not possible in self-management trials, we ensured blinding of patients, using a modified informed consent procedure in which patients give consent to postponed information. Exacerbations in both study arms are defined using the Anthonisen symptom diary-card algorithm. The Clinical COPD Questionnaire (CCQ) is assessed every 3-days. CCQ-recovery time of an exacerbation is the primary study outcome. Additionally, healthcare utilization, anxiety, depression, treatment delay, and self-efficacy are assessed at baseline and 6 months. We aim at including 245 COPD patients from 7 hospitals and 5 general practices to capture the a-priori sample size of at least 73 exacerbations per study arm.This RCT identifies if an AP is an effective component of self-management in patients with COPD and clearly differentiates from existing studies in its design, outcome measures and generalizability of the results considering that the study is carried out in multiple sites including general practices.NCT00879281Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation that is not fully reversible. This airflow limitation is usually progressive and associated with an abnormal response to noxious particles or gases [1]. COPD is a major cause of morbidity and mortality throughout the world[2]. Its stable state is interrupted by periods of worsening symptoms which vary in severity and frequency both during the course of a patient's illness and between patients. Depending on aetiology and severity, these p
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