Showing papers by "Peymane Adab published in 2016"

Self-management of health care behaviors for COPD: a systematic review and meta-analysis

Abstract: AMT reports grants from University of Birmingham/ National Institute for Health Research (NIHR), during the conduct of the study; REJ was in receipt of an NIHR postdoctoral research fellowship (pdf/01/2008/023) during the conduct of the study; KJ, DAF, REJ, PA, and SJS are investigators on an NIHR SPCR funded trial of self-management for COPD; SJS reports that the University Hospitals of Leicester National Health Service trust holds the IP for a self-management manual for COPD. REJ was funded by NIHR Health Technology Assessment Programme (10/44/01). KJ is part-funded by the National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRC) West Midlands. SJS is part-funded by the CLAHRC-East Midlands. Malcolm Price was supported by funding from a multivariate meta-analysis grant from the MRC Methodology Research Programme (grant reference number: MR/ J013595/1).

Effect of obstructive sleep apnoea on diabetic retinopathy and maculopathy: a systematic review and meta-analysis

Abstract: AIMS To summarize the association between obstructive sleep apnoea and diabetic retinopathy and diabetic maculopathy, and to examine the effects of oxygen desaturation index, mean and minimum oxygen saturation and time spent with < 90% oxygen saturation on diabetic retinopathy and diabetic maculopathy. METHODS A systematic search was performed for papers published from inception to January 2014 in MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews using indexed terms and free text. Additional searches were carried out for grey literature. Two authors conducted the study selection and quality assessment. Data extraction was performed by the main author and checked by the other authors. RESULTS One cohort study and 15 cross-sectional studies were included for narrative synthesis and three for meta-analyses. There was no convincing evidence that obstructive sleep apnoea was associated with diabetic retinopathy, although some evidence suggested that obstructive sleep apnoea was associated with greater severity of diabetic retinopathy and advanced diabetic retinopathy in people with Type 2 diabetes. Only six studies examined the impact of obstructive sleep apnoea on diabetic maculopathy and our narrative review suggests there is an association in Type 2 diabetes. Oxygen desaturation index, mean oxygen saturation or time spent with < 90% oxygen saturation were not associated with diabetic retinopathy, and insufficient evidence was available to draw conclusions on their effects on diabetic maculopathy; however, there was evidence from both narrative synthesis and meta-analysis that minimum oxygen saturation had an impact on diabetic retinopathy (pooled odds ratio 0.91, 95% CI 0.87-0.95; I(2) = 0%). CONCLUSIONS There is a need for large cohort studies with long-term follow-up data to examine the long-term effects of obstructive sleep apnoea and other sleep variables on advanced retinal disease in diabetes.

Socioeconomic determinants of childhood obesity among primary school children in Guangzhou, China.

Abstract: Background Socioeconomic inequalities in childhood obesity prevalence differ according to a country’s stage of nutrition transition. The aim of this study was to determine which socioeconomic factors influence inequalities in obesity prevalence in Chinese primary school children living in an urban setting.

The Association between Obstructive Sleep Apnea on Diabetic Kidney Disease: A Systematic Review and Meta-Analysis.

Abstract: STUDY OBJECTIVE This systematic review aims to investigate the association between obstructive sleep apnea (OSA) and diabetic kidney disease (DKD). METHODS MeSH terms and free text searches were performed on MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews from inception to April 2015. Zetoc and OpenGrey databases were queried for grey literature, and lastly, hand searches were carried out. Study selection and quality assessment were conducted by two authors. One author carried out data extraction, which was checked by other authors. The relationships between apneahypopnea index (AHI), oxygen desaturation index (ODI), time spent under 90% oxygen saturation (%TST < 90), and minimum and mean oxygen saturation (O2) on DKD were examined. RESULTS Two longitudinal and ten cross-sectional studies were included for our narrative synthesis, and seven studies for meta-analysis. Studies that performed multi-variable analysis demonstrated significant associations between OSA (assessed using either apnea-hypopnea index or ODI) and DKD in type 2 diabetes mellitus (T2DM). This was confirmed by meta-analysis (pooled OR 1.73, 95% CI: 1.13-2.64). There was some evidence to suggest that %TST < 90 may have an association with DKD. There was insufficient evidence to conclude on the relationship between minimum and mean oxygen saturation on DKD. There was no evidence available on the associations between OSA and other respiratory parameters in type 1 diabetes mellitus populations. CONCLUSIONS There is moderate evidence that OSA is associated with DKD in patients with T2DM. Large prospective studies with long-term follow up are needed to assess the possible bi-directional mechanisms between OSA and DKD.

Cohort Profile: The Birmingham Chronic Obstructive Pulmonary Disease (COPD) Cohort Study.

Abstract: Chronic obstructive pulmonary disease (COPD) affects 5–10% of people worldwide, 1 is rising in prevalence 2 and is the third most common cause of death. 3 The annual burden of COPD regarding healthcare (mainly exacerbations resulting in emergency admissions) and societal (predominantly lost productivity) costs was estimated to be around $49.9 billion in the USA (2010 prices 4 ) and €48.4 billion in the EU (2011 prices 5 ). A substantial proportion of those with COPD are of working age, but there is some evidence that they have poorer employment history, 6 higher rate of sickness absence 7 and poorer work performance (presenteeism) 8 compared with the general population.

Relationship Between Weight Status and Health-Related Quality of Life in Chinese Primary School Children in Guangzhou: A Cross-Sectional Study

Abstract: To investigate the association between weight status and health-related quality of life (HRQOL) among pupils in Guangzhou, China. The study comprised 5781 children aged 8–12 years from 29 schools. Height and weight were objectively measured using standardized methods, and BMI z-score derived using the age and sex specific WHO reference 2007 for 5–19 years. Weight status was classified as underweight ( 1SD). HRQOL was measured by the self-report version of the Pediatric Quality of Life Inventory 4.0. After controlling for gender, age, school type, parental education, and family income, HRQOL scores were significantly lower in overweight/obese compared with healthy weight children only in the social functioning domain (β = −1.93, p = 0.001). Compared with healthy weight children, underweight children had significantly lower total (β = −1.47, p = 0.05) and physical summary scores (β = −2.18, p = 0.02). Subgroup analysis for gender indicated that compared to healthy weight, total (β = −1.96, p = 0.02), psychosocial (β = −2.40, p = 0.01), social functioning (β = −3.36, p = 0.001), and school functioning (β = −2.19, p = 0.03) scores were lower in overweight/obese girls, but not boys. On the other hand, being underweight was associated with lower physical functioning (β = −2.27, p = 0.047) in girls, and lower social functioning (β = −3.63, p = 0.01) in boys. The associations were mainly observed in children aged 10 and over, but were not significant in younger children. Children from private schools had generally lower HRQOL compared to those in public schools, but the associations with weight status were similar in both groups. The relationship between overweight/obesity and HRQOL in children in China is not as prominent as that seen in children in western or high-income countries. However, there appears to be gender and age differences, with more of an impact of overweight on HRQOL in girls and older children compared with boys and younger children. Underweight is also associated with lower HRQOL. Future intervention to prevent both obesity and undernutrition may have a positive impact on the HRQOL in children in China.

Changes in adiposity in an older Chinese population in rapid economic transition.

Abstract: Objective To examine the changes in body mass index (BMI) and waist circumference (WC) in Guangzhou, South China, which is probably experiencing the most rapid economic transition in history. Methods In this study, 17,786 Chinese aged 50+ years were recruited from 2003 to 2008 and followed up until 2012. BMI and WC were measured at two time points. Results During the mean follow-up of 3.6 years (median = 3, interquartile = 1), age-adjusted mean BMI increased only slightly. By contrast, mean WC increased sharply by 0.94 cm (95% confidence interval 0.93-0.94) annually in men and 1.29 cm (1.28-1.29) annually in women. In 77% of women and 69% of men, WC increased, and among them, the mean annual increase was 2.01 cm and 1.70 cm, respectively. Among healthy, never-smoking participants, the incidence of central obesity was 29.0% (36.4% in women and 14.2% in men). The incidence of general obesity was 1.9% and was similarly low in both men and women (2.1% vs. 1.8%). Conversely, 20.3% of individuals with general obesity became nonobese, and 12.8% of individuals with central obesity returned to normal. Conclusions Central obesity has risen sharply in this cohort. Such increases may have been greatly underestimated previously and should form the basis of an even stronger warning for regions undergoing economic transitions in China and elsewhere.

Adiposity and response to an obesity prevention intervention in Pakistani and Bangladeshi primary school boys and girls: a secondary analysis using the BEACHeS feasibility study

Abstract: Objectives As a secondary analysis of the BEACHeS study, we hypothesised there would be sex differences in Pakistani and Bangladeshi school children when examining adiposity and their response to an obesity intervention. Design The Birmingham healthy Eating and Active lifestyle for CHildren Study (BEACHeS) was designed as a Phase II feasibility study of a complex intervention. Setting 8 primary schools with predominantly South Asian children in Birmingham, UK Participants 1090 pupils (aged 5–7 years old) from school year 1 and 2 were allocated at school level to receive an intervention. A total of 574 were enrolled in the study with consent. We focused on the 466 children of Pakistani and Bangladeshi origin (50.6% boys). Intervention Delivered between 2007 and 2009, the 1-year obesity prevention intervention targeted school and family-based dietary and physical activities. Primary and secondary outcome measures and analysis Adiposity measures including skinfold thickness were compared by sex at baseline and follow-up. Gains in adiposity measures were compared between control and intervention arms in boys and in girls. Measures were compared using two-sample t tests and Wilcoxon-Mann-Whitney rank sum tests according to normality distribution. Results At baseline, girls had larger skinfold measures at all sites compared to boys although body mass index (BMI) was similar (eg, median subscapular skinfold 6.6 mm vs 5.7 mm; p Conclusions Our secondary analysis suggests differences in adiposity in Pakistani and Bangladeshi girls and boys and in the effect of the intervention reducing adiposity in girls. These preliminary findings indicate that including sex differences should be examined in future trials. Trial registration number ISRCTN51016370; Post-results.

Cultural adaptation of a children’s weight management programme for Bangladeshi and Pakistani families in the UK: a cluster-randomised feasibility study protocol

Abstract: Group-based children’s weight management programmes are widely available in the UK and evidence shows that these are effective in the short-term. No programmes have been specifically developed to meet the cultural requirements of UK minority ethnic communities. South Asian children are a high-risk group for obesity and its consequences; therefore, the study aim is to adapt an existing weight management programme for children aged 4-11 years and their families to ensure cultural relevance to Pakistani and Bangladeshi communities, and undertake a feasibility study of the adapted programme. Pakistani and Bangladeshi families of overweight children who have been offered the existing children’s weight management programme in Birmingham, UK, will be invited to interviews and focus groups to explore their experiences and views of the programme. These data, together with existing literature and service provider information, will inform adaptation of the programme to be more culturally relevant to these families. The feasibility study will employ a cluster-randomised design, and will assess success of programme adaptation and feasibility of programme delivery. Planned programmes will be randomised to be delivered as the adapted programme (intervention) or the standard programme (comparator) with a 2:1 ratio. The primary outcome will be the proportion of Pakistani and Bangladeshi families completing the adapted programme. To assess recruitment, retention and data collection methods to inform a future trial, we aim to recruit 80 participants. A range of assessments will be undertaken with participants pre-, post- and 6-months post-intervention. This study addresses the identified need to provide children’s weight management programmes that are suitable for minority ethnic communities. Whilst the focus of the intervention adaptation is on Pakistani and Bangladeshi communities, the programme will be developed to be flexibly delivered to meet the cultural needs of communities of all ethnic compositions. The feasibility study will directly compare the adapted and existing weight management programmes, and will enable a comprehensive evaluation of the success of the adaptation. Essential information will also be gathered to inform the design and sample size calculation of a future trial to evaluate intervention effectiveness. ISRCTN81798055 , registered: 13/05/2014.

Predicting risk of undiagnosed COPD in primary care:: Development and validation of the TargetCOPD model

Abstract: Background: Previous prediction models for assessing risk of undiagnosed COPD used data from routine diagnoses, which may be inaccurate because of under- and misdiagnosis. We developed and externally validated a primary care-based model using data from a unique case finding trial. Methods: Patients aged 40-79 years with no prior diagnosis of COPD received a screening questionnaire either by post or opportunistically at primary care attendances through a large case finding trial based in primary care in the West Midlands, UK. Those reporting chronic respiratory symptoms were assessed with spirometry. COPD was defined as presence of respiratory symptoms and post-bronchodilator FEV 1 /FVC Results: A model containing age, smoking status, dyspnoea, and prescriptions of salbutamol and antibiotics discriminated between patients with and without undiagnosed COPD (validation c-statistic 0.74 [95% CI 0.68 to 0.80]). A cut-point of ≥7.5% predicted risk to prompt referral for diagnostic assessment had a sensitivity of 68.8% (95% CI 57.3 to 78.9%) and specificity of 68.8% (95% CI 65.8.1 to 71.6%), requiring 7 diagnostic assessments (95% CI 6 to 10) to identify 1 patient with undiagnosed COPD. Conclusion: We have developed and externally validated a readily applicable risk model for undiagnosed COPD using routine data from electronic health records in primary care.

Prevalence and characteristics of low oxygen saturation (SpO2) in a primary care COPD cohort

Abstract: Introduction: Long-term oxygen therapy (LTOT) reduces mortality and improves function in patients with COPD. Guidelines for prescribing oxygen therapy vary; however, all agree that (LTOT) should be considered in patients at risk of developing hypoxemia. Aims and objectives: To describe prevalence of low SpO2 at rest, post-exercise and self-reported LTOT use amongst primary care COPD patients. Methods: Baseline data for existing COPD patients (n=1558) from the Birmingham COPD Cohort study were used to describe clinical and demographic characteristics by SpO2 level. “Low SpO2” was defined as ≤92% at rest. We also reported the number of patients experiencing ≥4% SpO2 drop post-exercise, which was a one-minute sit-to-stand test. Results: 159 (11%) patients had ≤92% resting SpO2. Patients with low SpO2 were more likely to be ever-smokers (p After exercise, 92 (8%) desaturated >4%, from their resting SpO2; the majority of whom, 64 (70%) had normal SpO2 at baseline. Conclusion: Within a primary care COPD population, patients with lower SpO2 were more likely to report worse breathlessness, lower exercise capacity, a history of smoking and be obese. Around 13% of patients in this cohort may benefit from LTOT use.

A cluster-randomised controlled trial to assess the effectiveness and cost-effectiveness of a childhood obesity prevention programme delivered through schools, targeting 6-7 year old children

Abstract: Background: There is some evidence that school-based interventions are effective in preventing childhood obesity. However, longer term outcomes, equity of effects and cost-effectiveness of interventions have not been assessed. The aim of this trial is to assess the clinical and cost-effectiveness of a multi-component intervention programme targeting the school and family environment through primary schools, in preventing obesity in 6–7 year old children, compared to usual practice. Methods: This cluster randomised controlled trial is set in 54 primary schools within the West Midlands, UK, including a multi-ethnic, socioeconomically diverse population of children aged 6–7 years. The 12-month intervention consists of healthy diet and physical activity promotion. These include: activities to increase time spent doing physical activity within the school day, participation in the ‘Villa Vitality’ programme (a programme that is delivered by an iconic sporting institution (Aston Villa Football Club), which provides interactive learning opportunities for physical activity and healthy eating), healthy cooking skills workshops in school time for parents and children, and provision of information to families signposting local leisure opportunities. The primary (clinical) outcome is the difference in body mass index (BMI) z-scores between arms at 3 and 18 months post-intervention completion. Cost per Quality Adjusted Life Year (QALY) will also be assessed. The sample size estimate (1000 children split across 50 schools at follow-up) is based on 90% power to detect differences in BMI z-score of 0.25 (estimated ICC ≤ 0.04), assuming a correlation between baseline and follow-up BMI z-score of 0.9. Treatment effects will be examined using mixed model ANCOVA. Primary analysis will adjust for baseline BMI z-score, and secondary analysis will adjust for pre-specified baseline school and child level covariates. (Continued on next page) * Correspondence: p.adab@bham.ac.uk; E.R.Lancashire@bham.ac.uk Health & Population Sciences, University of Birmingham, B15 2TT Birmingham, UK Full list of author information is available at the end of the article © 2015 Adab et al.; licensee BioMed Central. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Adab et al. BMC Public Health (2015) 15:488 DOI 10.1186/s12889-015-1800-8

Using the ADO score in primary care to target pulmonary rehabilitation to patients at high risk of hospital admission

Abstract: Introduction: COPD admissions cost the English NHS £200m/yr. Pulmonary rehabilitation (PR) is effective in reducing admissions, but referral /uptake rates are low. With limited capacity/resources it would be ideal to focus on those with highest risk of admission. Multicomponent prognostic scores predict admissions and could be used to guide management Aims and objectives: Use existing data to model effects of targeting pulmonary rehabilitation referral to patients at highest risk Methods: Data from two primary care COPD cohorts (THIN(n=5930) and BLISS(n=1065)) were used to describe risk of acute respiratory admission in 1 year by baseline ADO score, and effect estimates from published literature applied to model the benefits of targeting PR to a high risk group Results: Patients with ADO score > 9 formed 40% of the COPD primary care population, but were responsible for 63% of emergency respiratory admissions and 72% of associated bed-days. 87% of this high-risk group had MRC score > 3, but only 17% reported ever attending PR (8% in the last year). Assuming PR attendance in this high risk group can be increased by an extra 50%, and PR reduces admission risk by 60%, overall acute COPD admissions could be reduced by 19% (19,000)/yr, equating to ∼ £38m reduction in annual admission costs. Conclusion: Improving PR uptake in high risk groups has great potential for reducing admissions.