Frank E. Speizer

Bio: Frank E. Speizer is an academic researcher from Brigham and Women's Hospital. The author has contributed to research in topics: Relative risk & Risk factor. The author has an hindex of 193, co-authored 636 publications receiving 135891 citations. Previous affiliations of Frank E. Speizer include Medical Research Council & Beth Israel Deaconess Medical Center.

Seasonal and allergenic predictors of bronchial responsiveness to distilled water.

Abstract: To evaluate a possible seasonal change in bronchial responsiveness and the relation of such change to atopy, we administered 2,537 bronchial challenge tests in winter and spring to a dynamic population cohort of children 7 to 10 yr of age. The bronchial challenge test consisted of 10 min of tidal inhalation of an aerosol of ultrasonically nebulized distilled water; the resulting percentage decrease in FEV1 (dFEV1%) was recorded. Atopy was determined on the basis of skin-test positivity (any wheal with a diameter greater than that obtained with a positive control) to seven allergens (cat dander, dog dander, house-dust mite, birch, raygrass, orchard grass, and Alternaria). Greater bronchial responsiveness in winter was independently and significantly predicted by a physician's diagnosis of asthma (difference in dFEV1%, 5.6; 95% confidence intervals [95% CI], 2.8 to 8.5; p = 0.0001) and by shortness of breath (difference in dFEV1%, 4.2; 95% CI, 2.1 to 6.3; p = 0.0001). These factors were also predictive of g...

Asia: Changing Times and Changing Problems

Abstract: Asia is currently experiencing rapid increases in industrialization, urbanization, and vehicularization As a result, emission trends (eg, energy, fuel, vehicle use), population trends (eg, degree of urbanization, urban population growth, city size), health trends (eg, age structure, background disease rates), and other important factors (eg, broad changes in regulatory approaches, improvements in control technology) will influence the extent to which exposure to air pollution affects the health of the Asian population over the next several decades Because the effects on air quality of recent, rapid development are clearly apparent in many of Asia’s cities and industrial areas, government decision makers, the private sector, and other local stakeholders are increasingly raising concerns about the health impacts of urban air pollution Major Asian cities, such as Shanghai (China), Delhi (India), Ho Chi Minh City (Vietnam), and Manila (Philippines), now experience annual average levels of respirable particles [particulate matter ≤ 10 μm in aerodynamic diameter (PM10)] in excess of the World Health Organization’s (WHO) newly revised world air quality guideline of 50 μg/m3 (WHO 2006) The health impacts in the region are already estimated to be substantial The WHO (2002) estimated that urban air pollution contributed to approximately 800,000 deaths and 64 million lost life-years worldwide in 2000, with two-thirds of these losses occurring in rapidly urbanizing countries of Asia These estimates were made using the results of US studies of long-term exposure to air pollution because such studies have not yet been conducted in the developing countries of Asia, where health, health care, exposure to pollution, and socioeconomic circumstances still differ markedly from the United States This contributes considerable uncertainty to these and other recent estimates of health impacts of air pollution (Cohen et al 2004) High-quality, credible science from locally relevant studies is essential to address the substantial air pollution challenges in Asia Such studies will be critical in helping decision makers decide which policies are most likely to result in public health benefits Although the number of published studies on the health effects of air pollution in Asia has grown nearly exponentially over the past quarter century, with > 400 reports in the peer-reviewed literature [Health Effects Institute (HEI) 2008], few coordinated, multicity time-series studies have been conducted comparable to the robust and consistent results in the United States and Europe (Katsouyanni et al 2001; Samet et al 2000) The Public Health and Air Pollution in Asia (PAPA) studies in Hong Kong, Shanghai, and Wuhan, China, and Bangkok, Thailand, published in this issue of Environmental Health Perspectives (Kan et al 2008; Qian et al 2008; Vichit-Vadakan et al 2008; Wong et al 2008a, 2008b), comprise the first coordinated multicity analyses of air pollution and daily mortality in Asia These studies, designed and conducted by local investigators in concert with local air pollution and public health officials and international experts, explored key aspects of the epidemiology of exposure to air pollution in each location, providing additional insight about how factors such as weather (particularly high temperatures) and social class might modify the air pollution relative risk Although clearly relevant to contemporary Asian conditions, these results also have global relevance The studies were conducted using the same types of mortality and air pollution data used in time-series studies throughout the world, and with methodologic rigor that matches or exceeds that of most published studies, including formal quality control in the form of detailed standard operating procedures for data collection and analysis, and external quality assurance audits of the data overseen by the funding organization These studies also benefited from recent efforts to strengthen and refine methods for the analysis of time-series data; as a result they are on a par methodologically with the most recent US and European analyses (HEI 2003) These five studies provide a relatively consistent, if limited, picture of the acute mortality impact of current ambient particulate air pollution in several large metropolitan areas in East and Southeast Asia Wong et al (2008b) report that a 10-μg/m3 increase in PM10 level was associated with a 06% (95% confidence interval, 03–09) increase in daily rates of all natural-cause mortality, estimates comparable to or greater than those reported in US and European multi-city studies Interestingly, these proportional increases in mortality are seen at levels of exposure several times higher than those in most large Western cities (mean levels, 516–1418 μg/m3), and in each city except Shanghai, the pattern of the exposure–response functions appear linear over a fairly large range of ambient concentrations up to and sometimes > 100 μg/m3 Although only four cities were studied, these results may begin to allay concerns regarding the generalizability of the results of the substantial, but largely Western, literature on the effects of short-term exposure to air pollution The results, which are broadly consistent with previous research (HEI 2004), suggest that neither genetic factors nor longer-term exposure to highly polluted air substantially modify the effect of short-term exposure on daily mortality rates in major cities in developing Asia This provides support for the notion, implicit in the approach taken in the WHO’s world air quality guidelines (Krzyzanowski and Cohen 2008), that incremental improvements in air quality would be expected to improve health, even in areas with relatively high ambient concentrations Health impacts in cities in developing countries of Asia result from exposures to a mixture of pollutants, particles, and gases, which are derived in large measure from combustion sources (Harrison 2006; Wong et al 2008b) This is, of course, no different from in Europe and North America, but the specific sources and their proportional contributions are different, with open burning of biomass and solid waste materials, combustion of lower-quality fuels including coal, and two- and three-wheeled vehicles contributing a larger share in Asia Time–activity patterns, building characteristics, and proximity of susceptible populations to pollution sources also differ in ways that may affect human exposure and health effects (Janssen and Mehta 2006) Our current knowledge of these issues is rudimentary, and additional research is clearly needed to inform effective and sustainable control strategies From past experience in the West and current evidence in Asia, substantial increases in the combustion of fossil fuels for power generation and transportation in developing Asia will have important consequences for human health and environmental quality in Asia and beyond Effective approaches to pollution control and reduction do exist, and investment in these approaches need not necessarily impede economic growth Therefore, developing countries of Asia may be able to avoid increased environmental degradation and associated health impacts while reducing poverty and providing economic security for their populations (Center for Science and the Environment 2006) Thirty million people currently live in the four cities studied, so even the small proportional increases in daily mortality rates imply large numbers of excess deaths That said, air pollution is but one of many factors that affect the health of people in developing Asia, and, unfortunately, not even the most important one (Ezzati et al 2002) Nonetheless, the substantial health impacts of exposure to air pollution should be of concern to public health policy makers faced with difficult decisions in transportation and energy policy Given current predictions of even more accelerated urbanization in the regions, there will be an increasing need for more extensive monitoring of urban air quality designed to support health effects studies and impact assessments, and a corresponding need for more highly trained professionals in air quality monitoring, exposure assessment, and environmental epidemiology Strategic planning for future research is also needed Although our ability to draw firm conclusions from results in four cities is limited, the methods of Wong et al (2008b) can be replicated in additional cities across the regions In some cases, nonmortality outcomes, such as hospital admissions, may also be addressed, enabling policy makers to better quantify the health impacts of air pollution However, while time-series studies such as the PAPA studies will continue to be important potential drivers of environmental and public policy, additional study designs, such as cohort studies—similar to the US American Cancer Society (Pope et al 2002) and Six Cities (Laden et al 2006) studies—are needed in Asian populations to estimate effects of long-term exposure on annual average mortality and life expectancy, the metrics that may be the most meaningful and policy relevant to decision makers These kinds of studies will require the building of multidisciplinary teams of investigators, with adequate long-term commitment of resources to work in collaboration with governmental officials, their industrial counterparts, and local stakeholders The PAPA program is one model of how such resources can be brought together to support such an effort

The Six-City Study: Examples of Problems in Analysis of the Data

Abstract: This paper presents some of the results from cross-sectional analyses and studies during air pollution alerts obtained as a part of the Six-City Study, a longitudinal study of the respiratory effects of air pollution. These analyses illustrate some of the limitations and uncertainties of epidemiologic studies. For example, an earlier report noted increased respiratory illness rates for children living in homes where gas was used for cooking. A later analysis did not confirm this. Reasons for this are explored by using different criteria and variables to be controlled for. The results illustrate that the strength of the association between cooking fuel and illness was sensitive to the definitions of the variables and the number of subjects and city cohorts. Similar examples are presented for illness rates for four respiratory diseases: asthma, bronchitis, illness before age 2 and illness last winter. These examples of cross-sectional analyses emphasize the ambiguities of studies of possible health effects of air pollution exposures close to the present ambient air quality standards.

Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary.

Abstract: Chronic obstructive pulmonary disease (COPD) remains a major public health problem. It is the fourth leading cause of chronic morbidity and mortality in the United States, and is projected to rank fifth in 2020 in burden of disease worldwide, according to a study published by the World Bank/World Health Organization. Yet, COPD remains relatively unknown or ignored by the public as well as public health and government officials. In 1998, in an effort to bring more attention to COPD, its management, and its prevention, a committed group of scientists encouraged the U.S. National Heart, Lung, and Blood Institute and the World Health Organization to form the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Among the important objectives of GOLD are to increase awareness of COPD and to help the millions of people who suffer from this disease and die prematurely of it or its complications. The first step in the GOLD program was to prepare a consensus report, Global Strategy for the Diagnosis, Management, and Prevention of COPD, published in 2001. The present, newly revised document follows the same format as the original consensus report, but has been updated to reflect the many publications on COPD that have appeared. GOLD national leaders, a network of international experts, have initiated investigations of the causes and prevalence of COPD in their countries, and developed innovative approaches for the dissemination and implementation of COPD management guidelines. We appreciate the enormous amount of work the GOLD national leaders have done on behalf of their patients with COPD. Despite the achievements in the 5 years since the GOLD report was originally published, considerable additional work is ahead of us if we are to control this major public health problem. The GOLD initiative will continue to bring COPD to the attention of governments, public health officials, health care workers, and the general public, but a concerted effort by all involved in health care will be necessary.

Risks and benefits of estrogen plus progestin in healthy postmenopausal women: Principal results from the Women's Health Initiative randomized controlled trial

Abstract: Context Despite decades of accumulated observational evidence, the balance of risks and benefits for hormone use in healthy postmenopausal women remains uncertain Objective To assess the major health benefits and risks of the most commonly used combined hormone preparation in the United States Design Estrogen plus progestin component of the Women's Health Initiative, a randomized controlled primary prevention trial (planned duration, 85 years) in which 16608 postmenopausal women aged 50-79 years with an intact uterus at baseline were recruited by 40 US clinical centers in 1993-1998 Interventions Participants received conjugated equine estrogens, 0625 mg/d, plus medroxyprogesterone acetate, 25 mg/d, in 1 tablet (n = 8506) or placebo (n = 8102) Main outcomes measures The primary outcome was coronary heart disease (CHD) (nonfatal myocardial infarction and CHD death), with invasive breast cancer as the primary adverse outcome A global index summarizing the balance of risks and benefits included the 2 primary outcomes plus stroke, pulmonary embolism (PE), endometrial cancer, colorectal cancer, hip fracture, and death due to other causes Results On May 31, 2002, after a mean of 52 years of follow-up, the data and safety monitoring board recommended stopping the trial of estrogen plus progestin vs placebo because the test statistic for invasive breast cancer exceeded the stopping boundary for this adverse effect and the global index statistic supported risks exceeding benefits This report includes data on the major clinical outcomes through April 30, 2002 Estimated hazard ratios (HRs) (nominal 95% confidence intervals [CIs]) were as follows: CHD, 129 (102-163) with 286 cases; breast cancer, 126 (100-159) with 290 cases; stroke, 141 (107-185) with 212 cases; PE, 213 (139-325) with 101 cases; colorectal cancer, 063 (043-092) with 112 cases; endometrial cancer, 083 (047-147) with 47 cases; hip fracture, 066 (045-098) with 106 cases; and death due to other causes, 092 (074-114) with 331 cases Corresponding HRs (nominal 95% CIs) for composite outcomes were 122 (109-136) for total cardiovascular disease (arterial and venous disease), 103 (090-117) for total cancer, 076 (069-085) for combined fractures, 098 (082-118) for total mortality, and 115 (103-128) for the global index Absolute excess risks per 10 000 person-years attributable to estrogen plus progestin were 7 more CHD events, 8 more strokes, 8 more PEs, and 8 more invasive breast cancers, while absolute risk reductions per 10 000 person-years were 6 fewer colorectal cancers and 5 fewer hip fractures The absolute excess risk of events included in the global index was 19 per 10 000 person-years Conclusions Overall health risks exceeded benefits from use of combined estrogen plus progestin for an average 52-year follow-up among healthy postmenopausal US women All-cause mortality was not affected during the trial The risk-benefit profile found in this trial is not consistent with the requirements for a viable intervention for primary prevention of chronic diseases, and the results indicate that this regimen should not be initiated or continued for primary prevention of CHD

2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).

Abstract: ABCD : Appropriate Blood pressure Control in Diabetes ABI : ankle–brachial index ABPM : ambulatory blood pressure monitoring ACCESS : Acute Candesartan Cilexetil Therapy in Stroke Survival ACCOMPLISH : Avoiding Cardiovascular Events in Combination Therapy in Patients Living with Systolic Hypertension ACCORD : Action to Control Cardiovascular Risk in Diabetes ACE : angiotensin-converting enzyme ACTIVE I : Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events ADVANCE : Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation AHEAD : Action for HEAlth in Diabetes ALLHAT : Antihypertensive and Lipid-Lowering Treatment to Prevent Heart ATtack ALTITUDE : ALiskiren Trial In Type 2 Diabetes Using Cardio-renal Endpoints ANTIPAF : ANgioTensin II Antagonist In Paroxysmal Atrial Fibrillation APOLLO : A Randomized Controlled Trial of Aliskiren in the Prevention of Major Cardiovascular Events in Elderly People ARB : angiotensin receptor blocker ARIC : Atherosclerosis Risk In Communities ARR : aldosterone renin ratio ASCOT : Anglo-Scandinavian Cardiac Outcomes Trial ASCOT-LLA : Anglo-Scandinavian Cardiac Outcomes Trial—Lipid Lowering Arm ASTRAL : Angioplasty and STenting for Renal Artery Lesions A-V : atrioventricular BB : beta-blocker BMI : body mass index BP : blood pressure BSA : body surface area CA : calcium antagonist CABG : coronary artery bypass graft CAPPP : CAPtopril Prevention Project CAPRAF : CAndesartan in the Prevention of Relapsing Atrial Fibrillation CHD : coronary heart disease CHHIPS : Controlling Hypertension and Hypertension Immediately Post-Stroke CKD : chronic kidney disease CKD-EPI : Chronic Kidney Disease—EPIdemiology collaboration CONVINCE : Controlled ONset Verapamil INvestigation of CV Endpoints CT : computed tomography CV : cardiovascular CVD : cardiovascular disease D : diuretic DASH : Dietary Approaches to Stop Hypertension DBP : diastolic blood pressure DCCT : Diabetes Control and Complications Study DIRECT : DIabetic REtinopathy Candesartan Trials DM : diabetes mellitus DPP-4 : dipeptidyl peptidase 4 EAS : European Atherosclerosis Society EASD : European Association for the Study of Diabetes ECG : electrocardiogram EF : ejection fraction eGFR : estimated glomerular filtration rate ELSA : European Lacidipine Study on Atherosclerosis ESC : European Society of Cardiology ESH : European Society of Hypertension ESRD : end-stage renal disease EXPLOR : Amlodipine–Valsartan Combination Decreases Central Systolic Blood Pressure more Effectively than the Amlodipine–Atenolol Combination FDA : U.S. Food and Drug Administration FEVER : Felodipine EVent Reduction study GISSI-AF : Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico-Atrial Fibrillation HbA1c : glycated haemoglobin HBPM : home blood pressure monitoring HOPE : Heart Outcomes Prevention Evaluation HOT : Hypertension Optimal Treatment HRT : hormone replacement therapy HT : hypertension HYVET : HYpertension in the Very Elderly Trial IMT : intima-media thickness I-PRESERVE : Irbesartan in Heart Failure with Preserved Systolic Function INTERHEART : Effect of Potentially Modifiable Risk Factors associated with Myocardial Infarction in 52 Countries INVEST : INternational VErapamil SR/T Trandolapril ISH : Isolated systolic hypertension JNC : Joint National Committee JUPITER : Justification for the Use of Statins in Primary Prevention: an Intervention Trial Evaluating Rosuvastatin LAVi : left atrial volume index LIFE : Losartan Intervention For Endpoint Reduction in Hypertensives LV : left ventricle/left ventricular LVH : left ventricular hypertrophy LVM : left ventricular mass MDRD : Modification of Diet in Renal Disease MRFIT : Multiple Risk Factor Intervention Trial MRI : magnetic resonance imaging NORDIL : The Nordic Diltiazem Intervention study OC : oral contraceptive OD : organ damage ONTARGET : ONgoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial PAD : peripheral artery disease PATHS : Prevention And Treatment of Hypertension Study PCI : percutaneous coronary intervention PPAR : peroxisome proliferator-activated receptor PREVEND : Prevention of REnal and Vascular ENdstage Disease PROFESS : Prevention Regimen for Effectively Avoiding Secondary Strokes PROGRESS : Perindopril Protection Against Recurrent Stroke Study PWV : pulse wave velocity QALY : Quality adjusted life years RAA : renin-angiotensin-aldosterone RAS : renin-angiotensin system RCT : randomized controlled trials RF : risk factor ROADMAP : Randomized Olmesartan And Diabetes MicroAlbuminuria Prevention SBP : systolic blood pressure SCAST : Angiotensin-Receptor Blocker Candesartan for Treatment of Acute STroke SCOPE : Study on COgnition and Prognosis in the Elderly SCORE : Systematic COronary Risk Evaluation SHEP : Systolic Hypertension in the Elderly Program STOP : Swedish Trials in Old Patients with Hypertension STOP-2 : The second Swedish Trial in Old Patients with Hypertension SYSTCHINA : SYSTolic Hypertension in the Elderly: Chinese trial SYSTEUR : SYSTolic Hypertension in Europe TIA : transient ischaemic attack TOHP : Trials Of Hypertension Prevention TRANSCEND : Telmisartan Randomised AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease UKPDS : United Kingdom Prospective Diabetes Study VADT : Veterans' Affairs Diabetes Trial VALUE : Valsartan Antihypertensive Long-term Use Evaluation WHO : World Health Organization ### 1.1 Principles The 2013 guidelines on hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology …

Standardisation of spirometry

Abstract: [⇓][1] SERIES “ATS/ERS TASK FORCE: STANDARDISATION OF LUNG FUNCTION TESTING” Edited by V. Brusasco, R. Crapo and G. Viegi Number 2 in this Series [1]: #F13