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Search Results: 1 - 10 of 6452 matches for " Yelin Edward "
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Risk factors for hospitalization among adults with asthma: the influence of sociodemographic factors and asthma severity
Eisner Mark,Katz Patricia,Yelin Edward,Shiboski Stephen
Respiratory Research , 2001,
Abstract: Background The morbidity and mortality from asthma have markedly increased since the late 1970s. The hospitalization rate, an important marker of asthma severity, remains substantial. Methods 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. Results 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). Conclusion 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.
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
Work life of persons with asthma, rhinitis, and COPD: A study using a national, population-based sample
Edward Yelin, Patricia Katz, John Balmes, Laura Trupin, Gillian Earnest, Mark Eisner, Paul Blanc
Journal of Occupational Medicine and Toxicology , 2006, DOI: 10.1186/1745-6673-1-2
Abstract: Persons ages 55 to 75 reporting a physician's diagnosis of COPD, asthma, or rhinitis as well as those without any of these conditions were identified by random-digit dialing (RDD) in the continental U.S and administered a structured survey. We used Kaplan-Meier life table analysis to estimate the duration of work life among persons with and without the three conditions and Cox proportional hazard regression to examine the role of demographic and work characteristics in the proportion leaving employment in each time interval.Persons with COPD, asthma, and rhinitis were no less likely than the remainder of the population to have ever worked, but those with COPD were less likely to be working when interviewed or as of age 65, whichever came first. As of age 55, only 62 percent of persons with COPD continued to work versus 72 and 78 percent of persons with asthma and rhinitis, respectively. Persons with COPD, asthma, and rhinitis all had an elevated risk of leaving work prior to age 65 relative to those without chronic conditions, with and without adjustment for demographic and work characteristics.COPD and to a lesser extent asthma and rhinitis were associated with a substantially shortened work life, an effect not due to demographic and work characteristics.The impact of chronic respiratory conditions on employment even when work is not a cause of these conditions has been the subject of a growing literature. Most of the studies have concerned the impact of asthma [1-18], although a few concern other discrete respiratory conditions, including allergic rhinitis [14,19], cystic fibrosis [20], and chronic bronchitis [17].The vast majority of studies have used clinical samples, with the attendant risk that the work disability rate will be overestimated since persons sampled in clinical environments are more likely to have severe disease [21]. Recently there have been several studies that use population-based sampling frames [2,10,14,16,17,22-24]. However, each of these st
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
Kafka y el ocaso de la metáfora animal: Notas sobre la voz narradora en "Investigaciones de un perro"
Yelin,Julieta;
Anclajes , 2011,
Abstract: franz kafka's animal stories are contemporary with the first philosophic questionings of the so-called metaphysics of subjectivity. this paper proposes an examination of that synchronism through an analysis of the narrative voice in the story "investigations of a dog". we start, on one hand, from the hypothesis that, in this story, it is possible to find a particular way of thinking about animals and animality, one that is linked to the task of taking the animal metaphor apart; and, on the other hand, from the idea that this thought enables a dialogue with the reflections of post-humanist philosophy, that is oriented towards the creation of a non-anthropocentric theoretical perspective.
Kafka y el ocaso de la metáfora animal: Notas sobre la voz narradora en "Investigaciones de un perro" Kafka, and the Decline of the Animal Metaphor: Notes on the Narrative Voice in "Investigations of a Dog"
Julieta Yelin
Anclajes , 2011,
Abstract: Los relatos de animales de Franz Kafka son contemporáneos del surgimiento de los primeros cuestionamientos a la denominada metafísica de la subjetividad. El presente artículo propone explorar esa contemporaneidad a través de un análisis de las formas que asume la voz narradora en el relato "Investigaciones de un perro". Partimos, por un lado, de la hipótesis de que es posible hallar en él un modo singular de pensar los animales y la animalidad, y de que ese modo está ligado a un trabajo de desarticulación de la metáfora animal; y por otro, de la idea de que dicho pensamiento dialoga con las reflexiones de la filosofía posthumanista, orientada a la creación de una perspectiva teórica no antropocéntrica. Franz Kafka's animal stories are contemporary with the first philosophic questionings of the so-called metaphysics of subjectivity. This paper proposes an examination of that synchronism through an analysis of the narrative voice in the story "Investigations of a Dog". We start, on one hand, from the hypothesis that, in this story, it is possible to find a particular way of thinking about animals and animality, one that is linked to the task of taking the animal metaphor apart; and, on the other hand, from the idea that this thought enables a dialogue with the reflections of Post-humanist philosophy, that is oriented towards the creation of a non-anthropocentric theoretical perspective.
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
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