SummaryFracture probabilities derived from the surrogate FRAX model for Armenia were compared to those from the model based on regional estimates of the incidence of hip fracture. Disparities between the surrogate and authentic FRAX models indicate the importance of developing country-specific FRAX models. Despite large differences between models, differences in the rank order of fracture probabilities were minimal.ObjectiveArmenia has relied on a surrogate FRAX model based on the fracture epidemiology of Romania. This paper describes the epidemiology of fragility fractures in Armenia used to create an Armenia-specific FRAX model with an aim of comparing this new model with the surrogate model.MethodsWe carried out a population-based study in two regions of Armenia (Ararat and Vayots Dzor representing approximately 11% of the country’s population). We aimed to identify all low-energy fractures: retrospectively from hospital registers in 2011–2012 and prospectively in 2013 with the inclusion of primary care sources.ResultsThe differences in incidence between the surveys with and without data from primary care suggested that 44% of patients sustaining a hip fracture did not receive specialized medical care. A similar proportion of forearm and humeral fractures did not come to hospital attention (48 and 49%, respectively). Only 57.7% of patients sustaining a hip fracture were hospitalized. In 2013, hip fracture incidence at the age of 50 years or more was 201/100,000 for women and 136/100,000 for men, and age- and sex-specific rates were incorporated into the new “authentic” FRAX model for Armenia. Compared to the surrogate model, the authentic model gave lower 10-year fracture probabilities in men and women aged less than 70 years but substantially higher above this age. Notwithstanding, there were very close correlations in fracture probabilities between the surrogate and authentic models (> 0.99) so that the revisions had little impact on the rank order of risk.ConclusionA substantial proportion of major osteoporotic fractures in Armenia do not come to hospital attention. The disparities between surrogate and authentic FRAX models indicate the importance of developing country-specific FRAX models. Despite large differences between models, differences in the rank order of fracture probabilities were minimal.
Background: The prevalence of chronic obstructive pulmonary disease (COPD) varies in different countries, while the cut-off for airflow obstruction (AO) is still contested. No COPD prevalence data based on the Global Lung Initiative (GLI) 2012 equations are available in Russia. Objectives: This study aims to assess AO prevalence by the GLI lower limit of normal (GLI-LLN) and the fixed cut-off, to identify AO risk factors and to assess the diagnostic value of respiratory symptoms in north-western Russia. Methods: In a north-western Russian population-based sample of 2,974 adults aged 35-70 years, data on socio-demographics, smoking, occupational exposures and respiratory symptoms were collected, and spirometry was performed before and after bronchodilator (BD) administration. Results: The AO prevalence was 6.8% (95% CI 5.8-7.9) based on the fixed and 4.8% (95% CI 3.9-5.7) based on the GLI-LLN cut-off. 22.5% of the participants with post-BD AO had a positive bronchodilator test, and 1% showed a paradoxical BD response. Of the environmental factors studied, only smoking was independently associated with AO (odds ratio 2.47, 95% CI 1.60-3.82). The positive predictive value of respiratory symptoms for AO was 11% based on the fixed and 8% based on the GLI-LLN cut-off. Conclusions: In a sample of adults in north-western Russia, the AO prevalence by the GLI-LLN cut-off was lower than that by the fixed cut-off. The predictive value of respiratory symptoms was low.
A hallmark of the diagnosis of chronic obstructive pulmonary disease (COPD) is the measurement of post-bronchodilator (post-BD) airflow obstruction (AO) by spirometry, but spirometry is not enough for the provision of a clinical diagnosis. In the majority of previous epidemiological studies, COPD diagnosis has been based on spirometry and a few clinical characteristics. The aim of our study was to identify outcomes in patients newly diagnosed with airflow obstruction (AO) based on a diagnostic work-up conducted as part of a population-based cross-sectional study in North-Western Russia. Spirometry was performed before (pre-BD) and after BD administration, and AO was defined using the FEV1/FVC <0.70 and FEV1/FVC
BackgroundSmoking remains a leading health risk factor among Europeans. Tobacco, together with other factors, will lead to an expansive epidemic of chronic diseases, including COPD, among the working population in Russia. The general aim of the RESearch on the PrEvalence and the diagnosis of COPD and its Tobacco-related etiology (RESPECT) study is to gain a better understanding of the prevalence, pathogenesis and symptoms of COPD.Methods/DesignThe RESPECT study is a prospective, population-based cohort study of subjects aged 35–70 years in two north-west regions of the Russian Federation (Saint Petersburg and Arkhangelsk). The study includes three components: a cross-sectional study (prevalence), a case-control study and a cohort study (diagnostic). An investigator who interviewed the patient completed three questionnaires. Spirometry, including a reversibility test, was offered to all participants. Individuals displaying forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) < 0.7 and/or FEV1/FVC < the lower limit of normal before and/or after bronchodilation were included in a follow-up study and were examined by a pulmonologist using a standardized comprehensive examination protocol. A future case-control study of two matched groups of patients (heavy smokers with COPD versus heavy smokers without COPD) will provide information on which factors (biomarkers, including pneumoproteins, in serum and induced sputum) are related to tobacco-induced COPD.DiscussionIn total, 3133 individuals (2122 from St. Petersburg and 1012 from Arkhangelsk) aged 35–70 years agreed to participate in this study and met the inclusion criteria. In total, 2974 participants met the quality criteria for spirometry, and 2388 reversibility tests were performed. A cohort of newly defined obstructive pulmonary disease patients (247 persons) was established for follow-up investigation.The RESPECT study will provide information regarding the prevalence of COPD in the north-west region of the Russian Federation. Moreover, the comprehensive RESPECT database will enable us to explore new research questions, provide novel insight into the risk factors and different phenotypes of COPD, and contribute to an improved understanding of the reasons why some heavy smokers develop the disease whereas others do not.Clinical trial registrationNCT02307799 (the release date: 12/01/2014)
Background: We organized this study in order to investigate differences in serum inflammatory profiles and circulating serum pneumoproteins between smokers with and without chronic obstructive pulmonary disease (COPD). Methods: Patients aged 35-70 years with COPD and a smoking history ≥10 pack-years (cases, n=38) and 38 participants with the same smoking history without COPD (controls) were included in a comparative study conducted as part of a population-based cross-sectional study with 2,388 individuals in northwestern Russia. Cases and controls were matched for age and smoking history. Airflow obstruction (AO) was defined using forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) <0.70 and/or FEV1/FVC < lower limit of the normal cut-off values. Patients at risk for COPD were reassessed using a standardized diagnostic work-up protocol. Several parameters, among which four inflammatory biomarkers [the highsensitivity C-reactive protein (hs-CRP), interleukin (IL)-6, IL-8, and tumor necrosis factor-α (TNF-α) levels] and two pneumoproteins [surfactant protein D (SP-D) and Clara cell secretory protein 16 (CC16)], were measured in the peripheral blood. Systemic inflammation was defined as at least 2 or more elevated biomarker levels. Results: Out of all smokers, 57.9% with normal spirometry and 36.8% with COPD did not have systemic inflammation, whereas 44.7% of the patients with COPD and 5.3% of the patients without AO demonstrated at least two elevated biomarker levels. No difference in age, gender, and smoking history, environmental and occupational exposure was found between the non-inflamed and the inflamed smokers.Of all risk factors studied, only COPD was associated with systemic inflammation [odds ratio (OR) 11.42, 95% confidence interval (CI): 2.13-58.84].Conclusions: Our study describes the systemic inflammatory network pattern associated with COPD and how it differs from the pattern in smokers with normal lung function. Systemic inflammation is not present in all smokers with COPD; in contrast, some non-obstructed smokers are characterized by systemic inflammation. From this perspective, smoking itself could be seen as a disease and studied accordingly.Trial registration: NCT02307799.
© Коллектив авторов, 2015 г.В статье представлен анализ распространенности пассивного курения, профессиональных факторов риска, воздействия продуктов сгорания биомасс в быту, являющихся факторами риска хронической об-структивной болезни легких (ХОБЛ) среди населения Санкт-Петербурга 35-70 лет на основании резуль-татов первого этапа эпидемиологического исследования RESPECT (RESearch on the PrEvalence and the diagnosis of COPD and its Tobacco-related aetiology). Выявлена высокая распространенность бытового пассивного воздействия табака среди лиц старше 35 лет, которые более 10 лет подвергались воздействию табака в детском и подростковом возрасте. Их доля составила 43,5% (95% ДИ 41,4-45,7%). Распростра-ненность пассивного воздействия табака в быту среди лиц старше 18 лет более 10 лет составила 32,8% (95% ДИ 30,8-34,9%). Среди них женщины достоверно чаще подвергались вторичному воздействию таба-ка в быту, чем мужчины (36,9 и 23,9% соответственно, р < 0,001). Мужчины, напротив, достоверно чаще, чем женщины подвергались пассивному курению на работе (25,0 и 11,6% соответственно, р < 0,001). До-ля никогда не куривших участников, подвергавшихся пассивному курению более 1 часа в течение послед-ней недели перед опросом, составила 22,4%. Никогда не курившие лица с высшим образованием достовер-но реже подвергались где-либо (дома или на работе) вторичному воздействию табачного дыма (ОШ = 0,59, 95% ДИ 0,44-0,80). Более четверти участников подвергались воздействию профессиональных факторов риска: 27,5% лиц -пыли на производстве более 1 года (95% ДИ 25,5-29,6%); 23,7% -газов или химиче-ских паров/дымов (95% ДИ 21,8-25,7%).Ключевые слова: ХОБЛ, эпидемиологическое исследование, пассивное курение, профессиональные факторы риска, биомасса, распространенность.There is an analysis of the prevalence of passive smoking, occupational hazards, exposure to biomass smoke in the home as a risk factors for chronic obstructive pulmonary disease (COPD) among the population aged 35-70 years of St. Petersburg on the basis of the results of the first phase of an epidemiological study RESPECT (RESearch on the PrEvalence and the diagnosis of COPD and its Tobacco-related aetiology). High prevalence of passive smoking was found among persons those aged older than 35 years, who are exposed to over 10 years in childhood and adolescence. They were accounted 43,5% (95% CI 41,4-45,7%). Overall, the prevalence of second-hand smoke among people older than 18 years more than 10 years was found 32,8% (95% CI 30,8-34,9%). Among them, women were significantly more exposed to the secondary effects of tobacco in the home than men (36,9 and 23,9%, respectively, p < 0,001). In opposite, men significantly more often than women exposed to environmental tobacco smoke at work (25,0 and 11,6%, respectively, p < 0,001). The proportion of participants who had never smoked, exposed to passive smoking more than 1 hour per week during the last week before the survey, was 22,4%. Never smoked persons with higher education less exposed anywhere (home or work) second-hand smoke (...
© Коллектив авторов, 2014 г.В статье представлен анализ распространенности курения как основного фактора риска хронической обструктивной болезни легких (ХОБЛ) среди населения Санкт-Петербурга на основании результатов первого этапа эпидемиологического исследования RESPECT (RESearch on the PrEvalence and the diagnosis of COPD and its Tobacco-related aetiology). В случайную выборку вошли 2121 человек в возрасте 35-70 лет, наблюдаемых врачами общей практики в 10 поликлиниках Санкт-Петербурга. Отклик составил 72,7% (n = 2121 из 2917 чел.). Изучена распространенность курения, его связь с социально-демо гра-фическими характеристиками. Установлено, что курили в момент исследования 30,6% (46,8% мужчин и 23,2% женщин) и курили в прошлом 18,5% (26,5% мужчин и 14,9% женщин) участников. Индекс куре ния (ИК) курильщиков составил в среднем 23,1 пачко-лет, бывших курильщиков -14,2 пачко-лет. 48,5% ку-рильщиков и 28,8% бывших курильщиков курили интенсивно (ИК более 20 пачко-лет). Из всех возрастных групп наиболее высокая доля курящих (41,9%) была обнаружена среди лиц в возрасте от 55 до 64 лет. Получена достоверная зависимость наличия факта курения от уровня образования и дохода. Лица с выс-шим образованием курили меньше, чем лица без него (44,7 и 51,9% соответственно, р < 0,001). Шанс быть курящим достоверно ниже у лиц с высшим образованием, чем у лиц без него (ОШ = 0,75; 95% ДИ = 0,63-0,89). Среди лиц с низким доходом курящих было достоверно больше, чем среди лиц с высоким уровнем дохода (63,4% и 36,8% соответственно, р < 0,05). Выявлено, что высокий доход связан с более низким шансом интенсивного курения (ИК > 20 пачко-лет) среди когда-либо куривших лиц по сравнению с таки-ми же лицами с низким доходом (ОШ = 0,66; 95% ДИ = 0,51-0,85).Полученные данные свидетельствуют о высокой распространенности курения среди жителей Санкт-Петербурга в возрасте 35-70 лет.Ключевые слова: ХОБЛ, эпидемиологическое исследование, табакокурение, распространенность.There is an analysis of the prevalence of smoking as a major risk factor for chronic obstructive pulmonary disease (COPD) among the population of St. Petersburg on the basis of the results of the first phase of an epidemiological study RESPECT (RESearch on the PrEvalence and the diagnosis of COPD and its Tobaccorelated aetiology). 2121 persons aged 35-70 years were randomly chosen from the lists of 10 primary care centers in St. Petersburg. The response rate was 72,7% (n = 2121 of 2917). The prevalence of smoking and its relationship with socio-demographic characteristics were studied. Overall, 30,6% currently smoked (46,8% men and 23,2% women), 18,5% was ex-smoked (26,5% men and 14,9% women). The average smoking history was 23,1 pack/years, ex-smokers -14,2 pack-years. 48,5% of smokers and 28,8% of ex-smokers smoked more than 20 pack-years. The highest percentage of smokers (41,9%) was found among those aged 55 to 64 years. It was found the relationships between the rate of smoking and level of education. The prevalence of smoking among persons with higher education was lower than among ...
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