The aim of the present study was to analyse the risk of rehospitalisation in patients with chronic obstructive pulmonary disease and associated risk factors.This prospective study included 416 patients from a university hospital in each of the five Nordic countries. Data included demographic information, spirometry, comorbidity and 12 month followup for 406 patients. The hospital anxiety and depression scale and St. George's Respiratory Questionnaire (SGRQ) were applied to all patients.The number of patients that had a re-admission within 12 months was 246 (60.6%). Patients that had a re-admission had lower lung function and health status. A low forced expiratory volume in one second (FEV1) and health status were independent predictors for re-admission. Hazard ratio (HR; 95% CI) was 0.82 (0.74-0.90) per 10% increase of the predicted FEV1 and 1.06 (1.02-1.10) per 4 units increase in total SGRQ score. The risk of rehospitalisation was also increased in subjects with anxiety (HR 1.76 (1.16-2.68)) and in subjects with low health status (total SGRQ score .60 units). When comparing the different subscales in the SGRQ, the closest relation between the risk of rehospitalisation was seen with the activity scale (HR 1.07 (1.03-1.11) per 4 unit increase).In patients with low health status, anxiety is an important risk factor for rehospitalisation. This may be important for patient treatment and warrants further studies. KEYWORDS: Anxiety, chronic obstructive pulmonary disease, depression, health status, rehospitalisation, risk factors C hronic obstructive pulmonary disease (COPD) is associated with intermittent exacerbations characterised by acute deterioration in the symptoms of chronic dyspnoea, cough and sputum production. Hospitalisations because of acute exacerbations are an important part of the care of patients with COPD. Multiple studies have been conducted in order to identify risk factors for COPD hospitalisations and there is also an increasing interest in modifying the risk factors in order to reduce the rate of rehospitalisation [5]. Risk factors that have been identified in previous studies are as follows: 1) low lung function [4,6,7]; 2) increasing age [7]; 3) poor quality of life [1,8,9]; 4) low physical function [4,8]; 5) history of frequent past exacerbations [1]; 6) history of previous admissions [4,6]; 7) under prescription of long-term oxygen therapy [6]; 8) hypercapnoea; and 9) pulmonary hypertension [10]. Interventions that decrease the risk of hospitalisations in COPD patients include vaccinations for influenza [11], smoking cessation [12] and pulmonary rehabilitation [13]. A study by DAHLÉ N and JANSON [14] found that anxiety and depression were related to a higher risk of relapse in patients with asthma and COPD that were admitted for emergency treatment. There is, however, limited data available regarding the level of anxiety and depression and the risk for hospital re-admission for COPD. There is also a lack of data on re-admission rates of COPD from Northern Europe and many previous s...

Attention-deficit/hyperactivity disorder occurs more often than expected before unprovoked seizures, suggesting a common antecedent for both conditions.

No abstract

Airway epithelial cells are unresponsive to endotoxin (lipopolysaccharide (LPS)) exposure under normal conditions. This study demonstrates that respiratory syncytial virus (RSV) infection results in increased sensitivity to this environmental exposure. Infection with RSV results in increased expression of Toll-like receptor (TLR) 4 mRNA, protein, and increased TLR4 membrane localization. This permits significantly enhanced LPS binding to the epithelial monolayer that is blocked by disruption of the Golgi. The increased TLR4 results in an LPS-induced inflammatory response as demonstrated by increased mitogen-activated protein (MAP) kinase activity, IL-8 production, and tumor necrosis factor ␣ production. RSV infection also allowed for tumor necrosis factor ␣ production subsequent to TLR4 cross-linking with an immobilized antibody. These data suggest that RSV infection sensitizes airway epithelium to a subsequent environmental exposure (LPS) by altered expression and membrane localization of TLR4. The increased interaction between airway epithelial cells and LPS has the potential to profoundly alter airway inflammation.The ability of cells to respond to microbial motifs depends on expression of a family of Type I transmembrane receptors, Toll-like receptors (TLRs) 1 (1-9). Recent evidence in intestinal epithelial cells suggests that cells that are in constant contact with pathogenic microbes and other environmental exposures express some of the TLRs at very low levels (10 -12). More particularly, these studies suggest that in intestinal epithelial cells, TLR4 is in low abundance, localized in the Golgi, and not present on the plasma membrane. The airway epithelium is another region that is in constant contact with multiple pathogen-related antigens and other environmental agents. These exposures, with the exception of significant pathogen load or an immunosuppressed host, do not normally elicit an immunological response. A recent study by Tsutsumi-Ishii and Nagaoka (13) suggests that the intestinal epithelial cell lack of TLR4 is also true of airway epithelial cells. They found no surface expression of TLR4 and a lack of LPS responsiveness (13).The relative tolerance to foreign antigens that is demonstrated by normal airway epithelial cells is altered in people with asthma and after RSV infection. Asthma and RSV infection are characterized by non-specific responses to both infectious agents and environmental exposures that include heightened inflammatory responses and hyper-responsive airways. The factors that predispose a particular individual to developing asthma are for the most part unclear. One early exposure that has been linked to the subsequent development of asthma is a severe infection with RSV during the first year of life (14 -16). The correlation is especially clear if the RSV infection results in hospitalization for bronchiolitis and other respiratory complications (15,17).RSV is found ubiquitously in the environment. Serious illness, however, is for the most part found only in very young children an...

Background:Never smokers comprise a substantial proportion of patients with COPD. Their characteristics and possible risk factors in this population are not yet well defined.Methods:We analyzed data from 14 countries that participated in the international, population-based Burden of Obstructive Lung Disease (BOLD) study. Participants were aged ≥ 40 years and completed postbronchodilator spirometry testing plus questionnaires about respiratory symptoms, health status, and exposure to COPD risk factors. A diagnosis of COPD was based on the postbronchodilator FEV1/FVC ratio, according to current GOLD (Global Initiative for Obstructive Lung Disease) guidelines. In addition to this, the lower limit of normal (LLN) was evaluated as an alternative threshold for the FEV1/FVC ratio.Results:Among 4,291 never smokers, 6.6% met criteria for mild (GOLD stage I) COPD, and 5.6% met criteria for moderate to very severe (GOLD stage II+) COPD. Although never smokers were less likely to have COPD and had less severe COPD than ever smokers, never smokers nonetheless comprised 23.3% (240/1,031) of those classified with GOLD stage II+ COPD. This proportion was similar, 20.5% (171/832), even when the LLN was used as a threshold for the FEV1/FVC ratio. Predictors of COPD in never smokers include age, education, occupational exposure, childhood respiratory diseases, and BMI alterations.Conclusion:This multicenter international study confirms previous evidence that never smokers comprise a substantial proportion of individuals with COPD. Our data suggest that, in addition to increased age, a prior diagnosis of asthma and, among women, lower education levels are associated with an increased risk for COPD among never smokers.

Summary:Purpose: Few population-based studies of longterm survival in people with seizures or epilepsy have been made.Methods: Between January 1, 1960 and December 31, 1964, we identified 224 incidence cases of unprovoked seizures in Iceland and determined survivorship status and date of death for the cases as of January 1, 1996. We compared survivorship with that expected based on data from age-/sex-specific life tables from the country for 196 1-1 990 and calculated the standardized mortality ratio (SMR).Results: By 30 years after diagnosis, there were 45 deaths among patients with unprovoked seizures as compared with an expected 28 deaths [standardized mortality ratio (SMR) 1.6; 95% confidence interval (CI) 1.2-2.21. Patients with unprovoked seizures of unknown etiology did not have a significant increase in mortality overall (SMR 1.3, 95% CI 0.8-1.9) or in any time interval. For patients with remote symptomatic unprovoked seizures, mortality was increased (SMR 2.3, 95% CI 1.4-3.5). This increase was attributable to excess mortality for the first 15 years after diagnosis (SMR 4.1, 95% CI 2.4-6.6), and SMR was not different after that time.Conclusions: Survivorship was decreased for the population of patients with unprovoked seizures. The increased mortality was primarily due to excess mortality in patients with remote symptomatic seizures, occurring in the first 15 years after diagnosis. Overall mortality for idiopathic unprovoked seizures was not significantly increased. Key Words: EpidemiologyEpilepsy-Seizures-Mortality-Iceland-Long-term survival.Epilepsy can often influence the life expectancy of the persons affected and several medical conditions associated with seizures are also associated with increased mortality. Decreased long-term survival of selected populations (clinical series, holders of life insurance policies) with epilepsy has been reported in several studies and increased mortality has been reported in most of them. Only one population-based study (1) of mortality and long-term survival is available. We wished to determine long-term survival in a population-based incidence cohort of patients with unprovoked seizures. MATERIALS AND METHODSIndex cases were the 224 inhabitants of Iceland first diagnosed with unprovoked seizures (single, 15; recurrent, 209) during the 5-year period from 1960 through ~~

Mortality was high after COPD admission, with older age, decreased lung function, lower health status and diabetes the most important risk factors. Treatment with inhaled corticosteroids and long-acting bronchodilators may be associated with lower mortality in patients with COPD.

The present study confirms findings of other recent studies of incidence in Western Countries.