Barker pioneered the novel idea that common chronic diseases result not only from bad genes and an unhealthy lifestyle, but also from alterations in the intrauterine and early postnatal environment. 1 The timing of these alterations, either during a "critical" period of growth and maturation or accumulating over longer intervals, can have a permanent effect on the organism. The impact of birth weight, maternal habitus, nutrition, and smoking, and the role of the placenta on developmental programming of metabolic syndrome, obesity, hypertension, and organ development have been well-studied. More recent studies have suggested that developmental programming on the background of preterm birth may be far more important than suboptimal intrauterine growth. In the US, about 10%-12% of births occur before 37 completed weeks of postmenstrual age. 2 Worldwide rates vary. Today, more than 95% of these "preterm infants" survive to adulthood in most industrialized nations owing to remarkable advances in perinatal, neonatal, and pediatric care. 3-6 Survival may come at the expense of future adverse health and social risks characterized by failure to achieve optimal development or more rapid rates of decline in cardiovascular, pulmonary, and renal function or "accelerated aging." 7 Individuals born preterm are at an increased risk for type 2 diabetes, cardiovascular and cerebrovascular diseases, hypertension, chronic kidney disease, asthma and pulmonary function abnormalities, and neurocognitive and psychosocial disorders and poorer social adaptation. 8-12 Even a modest increase (eg, 10%-20%) in risk for these chronic conditions can translate into a substantial population burden. Because of this, the US National Institutes of Health convened a conference of multidisciplinary experts to elucidate the evidence for the epidemiologic, public health, and societal burden of diseases among those born preterm, to review potential mechanisms and to consider future research priorities. An understanding of these areas is crucial for developing prevention and treatment strategies. This report summarizes the key concepts discussed at the conference, and poses many unanswered questions that may serve to guide future research endeavors in each domain (Table). Epidemiology and Preterm Outcomes Much of our knowledge about individuals born preterm has come from prospective birth cohort studies of large populations. Although longitudinal cohort studies have many advantages, there are significant challenges, such as the long duration of follow-up (and need for long-term funding) necessary to provide meaningful associations, lack of information on confounders, changes in classification of diseases and outcomes over time, and loss to follow-up. With a few exceptions, our knowledge of the longer term outcomes of preterm birth comes from cohorts born outside of the US 13-15 who were followed through adulthood. A Swedish study of 679 981 singleton live births between 1973 and 1979, examined the association between preterm birth and allcause and cause-s...
There is a substantial burden of chronic respiratory diseases, including chronic obstructive pulmonary disease (COPD), in lowand middle-income countries (LMICs). LMICs have particular challenges in delivering cost-effective prevention, diagnosis, and management of COPD. Optimal care can be supported by effective implementation of guidelines. This American Thoracic Society workshop considered challenges to implementation of COPD guidelines in LMICs. We make 10 specific recommendations: 1) relevant organizations should provide LMIC-specific COPD management guidance; 2) patient and professional organizations must persuade policy-makers of the importance of lung function testing programs in LMICs; 3) healthcare education and training should emphasize the early-life origins of COPD; 4) urgent action is required by governments to reduce airborne exposures, including exposures to tobacco smoke and indoor and outdoor air pollution; 5) guidance for COPD in LMICs should explicitly link across Essential Medicine Lists and the World Health Organization package of essential noncommunicable disease interventions for primary health care in low-resource settings and should consider availability, affordability, sustainability, and cost-effective use of medicines; 6) the pharmaceutical industry should work to make effective COPD and tobacco-dependence medicines globally accessible and affordable; 7) implementation of locally adapted, cost-effective pulmonary rehabilitation programs should be an international priority; 8) the World Health Organization Global Action Plan for the Prevention and Control of Noncommunicable Diseases should specify how improvements in respiratory health will be achieved; 9) research funders should increase the proportion of funding allocated to COPD in LMICs; and 10) the respiratory community should leverage the skills and enthusiasm of earliercareer clinicians and researchers to improve global respiratory health.
Objectives: Despite bearing a substantial burden of respiratory diseases, low- and middle-income countries in Africa contribute little to the research literature. Since 2007, the Pan African Thoracic Society’s Methods in Epidemiologic, Clinical, and Operations Research (PATS-MECOR) program has been working to strengthen capacity in lung health research in Africa. The aim of this study was to assess the research productivity of previous PATS-MECOR participants. Materials and Methods: A systematic review of publications attributed to past PATS-MECOR participants up until 2018 was carried out using a systematic search strategy based on their names on PubMed database. Results: A total of 210 participants drawn from 21 African countries attended PATS-MECOR between 2007 and 2016, of which more than three-quarters (76.7%) had ever published. Of the total 1673 included publications, 303 (12.7%) had multiple course attendees as coauthors. The median publication per published participant was 5 (IQR 2–13) articles. The percentages of the first author, second authors, or last authors publications were 371 (22.2%), 239 (14.3%), and 99 (5.9%), respectively. The top three journals published in were PLOS One 108 (6.6%), Lancet 80 (4.9%), and the International Journal of Tuberculosis and Lung Disease 52 (3.2%). The median citation of their publications was 11 (4–26). There was approximately a double-fold rise in the publication output of participants in their 1st year following attendance to PATS-MECOR compared to the year before the course (123, 68.0% vs. 58, 32.0%). Conclusion: The PATS-MECOR training program has been successful in research capacity building for African investigators as evidenced by a growing publication track record. There is a need to ensure sustainability and for increased collaboration and networking among the trained critical mass of researchers in the continent.
The PATS began at the prompting of several past presidents of the American Thoracic Society (ATS) who pointed out that Africa had a huge burden of respiratory disease, mostly undescribed, with few respiratory physicians and no representation at the Forum of International Respiratory Societies (FIRS). PATS began as a virtual society at a time when that was unusual, with a website and a journal -the African Journal of Respiratory Medicine which has now been replaced by the Journal of the PATS. It was evident very early that this was not enough -the engine rooms of Africa, namely, the bright talented young physicians in each country, had to be mobilized to describe the burden of disease, find research solutions, and advocate for change and implementation. All African regions needed to come together to make a difference, by studying and working together. THE METHODS IN THE EPIDEMIOLOGIC, CLINICAL, AND OPERATIONS RESEARCH (MECOR) MODELThe ATS's MECOR program was chosen as the model. ATS MECOR started in Latin America in 1995 as the International Epidemiology Programme with the overall goal of improving global lung health by increasing the capacity for doing high-quality research that addresses the needs of low-and middle-income countries. [1] The name change to the MECOR program occurred in 2004 and reflected a program expansion and the introduction of courses at multiple levels. The program was developed as a ladder so that students could move up through sequential courses toward mastery of study design and data analysis. PATS MECOR BEGINS AND THRIVESThe PATS's MECOR program (PATS MECOR) was the first MECOR program outside of Latin America and was started in 2007 with the same goal, specifically of improving lung health in the African continent. The target audience for PATS MECOR was and remains clinical and academicThis is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
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