Screening for impaired pulmonary function using peak expiratory flow: Performance of different interpretation strategies.

BACKGROUND: Spirometry is the gold standard for diagnosis of impaired pulmonary function, but is often unavailable in resource-constrained settings. Some authors have suggested using peak expiratory flow (PEF) to screen for impaired pulmonary function when spirometry is unavailable, but with no consensus on how to define abnormally low PEF. Strategies have included cutoffs based on absolute value of PEF, PEF in percent predicted, PEF Z-score, PEF × height-2, and gender-specific cutoffs of absolute PEF. The objective of this paper is to determine the PEF interpretation strategy with the highest predictive ability for low pulmonary function, with spirometry as the gold standard. METHODS: We analyzed data on individuals aged 40-79 years in the United States National Health and Nutrition Examination Survey 2007-2012. 6,144 individuals fulfilled inclusion criteria for the main analysis. For each PEF interpretation strategy, we calculated the area under the receiver operating curve (AUC) for the detection of low pulmonary function (defined by FEV1 Z-score < -1.645, < -2, < -2.5 or < -3). RESULTS: The AUC was substantially and statistically significantly higher for PEF in percent predicted and PEF Z-score than for absolute value and PEF × height-2, including after stratification by gender. There was no difference in AUC between PEF in percent predicted and PEF Z-score. CONCLUSION: If using PEF to screen adults aged 40 years or older for impaired pulmonary function defined by low FEV1 Z-score, basing cutoffs on PEF in percent predicted or PEF Z-score may result in improved predictive ability. As percent predicted is a mathematically simpler term than Z-score, it may be preferable to use cutoffs based on PEF in percent predicted.

[Christmas article: Do Christmas hats and reindeer antlers provide the same anonymity in photos of persons as black bars covering the eyes? A randomized controlled study].

INTRODUCTION In medical literature, attempts are often made to de-identify facial photos using black bars across the eyes, but the effectiveness is probably limited. I hypothesized that compared to the original photo the relative risk of recognition is > 50% when such techniques are employed. METHODS Randomized controlled trial among 33 participants, who each completed an electronic questionnaire showing 24 facial photographs of Danish politicians and had to provide the name of each politician in free text. The photographs were either unmodified or had been covered by small black bars, large black bars, T-shapes, Christmas hats or reindeer antlers and nose. A pseudo-random number generator assigned each participant to one of six questionnaires, which had the same photos in the same order, and always had four photos with each kind of modification (unmodified, T-shape etc.). Across the six questionnaires, each photo appeared once with each type of modification. The relative risk of recognition was calculated using a generalized linear model adjusted for the order of presentation of the photos. Confidence intervals were derived by bootstrapping to account for the interdependence of observations. The analysis protocol was published before data collection began. RESULTS The relative risk of identification was approximately 1 and statistically significantly different from 0.5 for all methods, with the original photos as reference. CONCLUSION Attempts to de-identify facial photos using bars and similar are ineffective and should be discouraged. Funding: none. Trial registration: none.

Precision and accuracy of FEV1 measurements from the Vitalograph copd-6 mini-spirometer in a healthy Ugandan population.

OBJECTIVE: Evaluate the accuracy and precision of the copd-6 mini-spirometer for FEV1 in a rural Ugandan population. METHODS: In a cross-sectional study, 171 smallholder farmers performed spirometry with copd-6, and a diagnostic-quality spirometer. RESULTS AND DISCUSSION: The copd-6 underestimated FEV1 at low flows and overestimated FEV1 at high flows. Across all participants, the device slightly overestimated FEV1 by 0.04 [0.02; 0.06] L. Calibration data showed similar patterns. CONCLUSION: The copd-6 could be considered as an affordable tool for research on lung function impairment in resource-constrained settings. However, further validation in a study population with obstructive lung disease is needed.

Organophosphate and carbamate insecticide exposure is related to lung function change among smallholder farmers: a prospective study.

INTRODUCTION AND AIM: Exposure to some insecticides may cause airway obstruction, but existing evidence is limited by cross-sectional designs and inadequate confounder control. We investigated the relation between organophosphate and carbamate insecticides and pulmonary function in a prospective study accounting for important confounders. METHODS: In a cohort of 364 smallholder farmers in Uganda (69% women), participants underwent pre-bronchodilator spirometry at baseline (September/October 2018) and at two follow-up visits (November/December 2018 and January/February 2019). Exposure to carbamate and organophosphate insecticides was assessed using haemoglobin-adjusted erythrocyte acetylcholinesterase (AChE/Hb). Less than 3% of participants were lost to follow-up. We calculated Z-scores for FEV1, FVC and FEV1/FVC using the Global Lung Function Initiative equations. Data were analysed in linear mixed and fixed effect models accounting for family relationships and repeated measures of exposure and outcome. RESULTS: Low AChE/Hb was significantly associated with low FEV1 Z-score in both unadjusted and adjusted analyses. Compared with individuals with AChE/Hb 25.90 U/g (50th percentile, reference), those with lower AChE/Hb 24.50 U/g (35th percentile) had mean FEV1 Z-score 0.045 (0.003 to 0.087) lower, and persons with higher AChE/Hb 27.30 U/g (65th percentile) had a mean FEV1 Z-score 0.043 (-0.002 to 0.087) higher compared with the reference. Similar, but numerically smaller and statistically non-significant effects were seen for Z-scores of FVC and FEV1/FVC. CONCLUSION: Exposure to organophosphate and carbamate insecticides may lead to lung function decline. Our results add to the growing evidence of health effects in relation to exposure to organophosphate and carbamate insecticides, underlining the importance of minimising exposure.

HemoDownloader: Open source software utility to extract data from HemoCue HbA1c 501 devices in epidemiological studies of diabetes mellitus.

Diabetes mellitus is a serious disease with increasing global prevalence. Point-of-care analysis of glycated hemoglobin A (HbA1c) holds promise as a diagnostic test for diabetes mellitus in epidemiological studies in challenging environments with limited access to centralized biochemical labs. The HemoCue HbA1c 501 device can be used for point-of-care determination of HbA1c, but its usability in epidemiological studies is limited by its inability to export results in digital format. We have developed the open source HemoDownloader software to overcome this limitation of the device. HemoDownloader has an easy-to-use graphical user interface and can export data from HemoCue HbA1c 501 to standard spreadsheet file formats. The program has the potential to improve data collection and management in epidemiological studies of diabetes mellitus.

Exposure to cholinesterase inhibiting insecticides and blood glucose level in a population of Ugandan smallholder farmers.

OBJECTIVES: The risk of diabetes mellitus may be elevated among persons exposed to some pesticides, including cholinesterase-inhibiting insecticides (organophosphates and carbamates). The objective of this study was to investigate how acetylcholinesterase activity was associated with mean blood glucose levels among smallholder farmers in Uganda. METHODS: We conducted a short-term follow-up study among 364 smallholder farmers in Uganda. Participants were examined three times from September 2018 to February 2019. At each visit, we measured glycosylated haemoglobin A (HbA1c) as a measure of long-term average blood glucose levels. Exposure to organophosphate and carbamate insecticides was quantified using erythrocyte acetylcholinesterase normalised by haemoglobin (AChE/Hb). For a subgroup of participants, fasting plasma glucose (FPG) was also available. We analysed HbA1c and FPG versus AChE/Hb in linear mixed and fixed effect models adjusting for age, sex, physical activity level, and consumption of fruits and vegetables, alcohol and tobacco. RESULTS: Contrary to our hypothesis, our mixed effect models showed significant correlation between low AChE/Hb and low HbA1c. Adjusted mean HbA1c was 0.74 (95% CI 0.17 to 1.31) mmol/mol lower for subjects with AChE/Hb=24.3 U/g (35th percentile) compared with subjects with AChE/Hb=25.8 U/g (50th percentile). Similar results were demonstrated for FPG. Fixed effect models showed less clear correlations for between-phase changes in AChE/Hb and HbA1c. CONCLUSIONS: Our results do not clearly support a causal link between exposure to cholinesterase-inhibiting insecticides and elevated blood glucose levels (expressed as HbA1c and FPG), but results should be interpreted with caution due to the risk of reverse causality.

Pesticide exposure and diabetes mellitus in a semi-urban Nepali population: a cross-sectional study.

OBJECTIVE: Epidemiological studies suggest exposure to pesticides to be related to risk of diabetes mellitus. The objective of the present study was to assess the association between pesticide use and diabetes mellitus in a semi-urban population in Nepal. METHODS: We conducted a nested cross-sectional study on pesticides and diabetes mellitus in a population-based cohort from the former Lekhnath Municipality, Nepal. 2643 persons were invited, and 2310 persons participated (response rate 87.4%). All participants were tested for fasting plasma glucose. Diabetes mellitus was defined as either fasting plasma glucose (FPG) ≥ 7.0 mmol/L (126 mg/dL) or self-reported diagnosis of diabetes mellitus. Exposure to pesticides was determined by questionnaire. For the exposed persons, three exposure metrics (years of exposure, weeks of exposure per year and hours of exposure per week) were categorized and used to model exposure-response relationships. RESULTS: Although 62% of participants reported to be exposed to pesticides, the frequency and intensity of pesticide usage was low. Contrary to our hypothesis, we found lower odds of diabetes mellitus among persons reporting any pesticide use compared to those reporting no use of pesticides-adjusted odds ratio with 95% CI = 0.68 [0.52; 0.90]. However, we found no clear exposure-response relationships between pesticide exposure and neither diabetes mellitus nor FPG, and few and inconsistent associations were seen between pesticide exposure and symptoms of acute pesticide intoxication. CONCLUSIONS: The apparently lower odds of diabetes mellitus among pesticide-exposed persons in this population are probably due to residual confounding. Our results do not seem to support an association between pesticide exposure and diabetes mellitus in this low-exposed population dominated by subsistence farmers, although results should be interpreted with caution in light of the study limitations.

The burden and correlates of multiple cardiometabolic risk factors in a semi-urban population of Nepal: a community-based cross-sectional study.

This study assessed the burden and correlates of three cardiometabolic risk factors, (hypertension, diabetes, and overweight/obesity), and their possible clustering patterns in a semi-urban population of Nepal. Data were obtained from a community-based management of non-communicable disease in Nepal (COBIN) Wave II study, which included 2,310 adults aged 25-64 years in a semi-urban area of Pokhara Metropolitan City of Nepal, using the World Health Organization-STEPS questionnaire. Unadjusted and adjusted binary logistic regression models were used to study the correlates of the individual risk factors and their clustering. The prevalence of hypertension, diabetes, and overweight/obesity was 34.5%, 11.7%, and 52.9%, respectively. In total, 68.2% of the participants had at least one risk factor and many participants had two risks in combination: 6.8% for 'hypertension and diabetes', 7.4% for 'diabetes and overweight/obesity' and 21.4% for 'hypertension and overweight/obesity'. In total, 4.7% had all three risk factors. Janajati ethnicity (1.4-2.1 times), male gender (1.5 times) and family history of diabetes (1.4-3.4 times) were associated with presence of individual risk factors. Similarly, Janajati ethnicity (aOR: 4.31, 95% CI: 2.53-7.32), current smoking (aOR: 4.81, 95% CI: 2.27-10.21), and family history of diabetes (aOR: 4.60, 95% CI: 2.67-7.91) were associated with presence of all three risk factors. Our study found a high prevalence of all single and combined cardiometabolic risk factors in Nepal. It underlines the need to manage risk factors in aggregate and plan prevention activities targeting multiple risk factors.

Exposure to neuroactive non-organochlorine insecticides, and diabetes mellitus and related metabolic disturbances: Protocol for a systematic review and meta-analysis.

OBJECTIVES: To assess whether exposure to specific classes of neuroactive non-organochlorine insecticides is associated with diabetes mellitus or related metabolic traits. METHODS: Eligibility criteria: Any type of epidemiological and human exposure studies providing an exposure contrast to neuroactive non-organochlorine insecticides and a measure of association to diabetes mellitus or related metabolic traits. We will include published peer-reviewed studies in both English and non-English language. INFORMATION SOURCES: Articles will be located in the NCBI PubMed, Embase, Scopus, Web of Science and LILACS databases, supplemented with manual searching of reference lists and articles citing the included studies. Risk of bias assessment: Risk of bias in individual studies will be assessed using tools from the Navigation Guide systematic review methodology, while the risk of bias at the outcome level will be assessed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidelines. Data synthesis and analysis: When studies are sufficiently similar in population, exposure, comparator and effect estimate to meaningfully allow quantitative synthesis, we will perform meta-analysis. Otherwise, results will be summarized qualitatively. FUNDING: The authors are paid employees of their respective institutions. MRHH is a Ph.D. student working under grants from Aarhus University and the National Research Centre for the Working Environment. REGISTRATION: PROSPERO CRD42017068861.

Correction: Awareness, prevalence, treatment, and control of type 2 diabetes in a semi-urban area of Nepal: Findings from a cross-sectional study conducted as a part of COBIN-D trial.

[This corrects the article DOI: 10.1371/journal.pone.0206491.].

Awareness, prevalence, treatment, and control of type 2 diabetes in a semi-urban area of Nepal: Findings from a cross-sectional study conducted as a part of COBIN-D trial.

BACKGROUND: Type 2 diabetes is an escalating public health problem in Nepal. The current study aims to assess the prevalence, associated factors, awareness, treatment, and control of type 2 diabetes in a semi-urban area of Nepal. METHODS: A population-based cross-sectional survey was conducted including 2,310 adults aged 25 years or above from a semi-urban area of Lekhnath Municipality of Nepal, during October 2016 to April 2017 using the World Health Organization (WHO) STEPS approach. Data on demographics, behavioral risk factors, blood pressure, anthropometric measurements (weight, height, waist and hip circumference), and fasting blood glucose were collected by face-to-face interviews during a door-to-door visit. Participants were considered to have type 2 diabetes if they had previously been diagnosed by a physician and/or were on antidiabetic medications and/or had fasting blood glucose ≥ 7.0 mmol/L. Participants were classified as being aware of their diabetes conditions if they had earlier been told that they had type 2 diabetes. Treatment of diabetes among those aware was if participants received any kind of medication treatment or counseling, and control of diabetes among those treated was defined as fasting blood glucose level was <7.0 mmol/L. Odds Ratio (OR) with 95% Confidence Interval (CI) was used to determine the strength of association. RESULTS: The prevalence of type 2 diabetes was 11.7% (95% CI: 10.5-13.1). Among type 2 diabetes participants, 65% were aware of their disease, 94% of those who were aware received treatment, and 21% of the treated subjects had their diabetes under control. Factors significantly associated with type 2 diabetes were older age (OR = 3.2 for age group 45-54 years, OR = 3.8 for age group 55-64 years), Janajati ethnicity (OR = 1.4), abdominal obesity (OR = 2.3), being overweight or obese (OR = 1.4), and hypertension (OR = 2.0), while protective factors included being a female (OR = 0.4), medium physical activity (OR = 0.3), high physical activity (OR = 0.2), and not having family history of diabetes (OR = 0.3). CONCLUSIONS: The study revealed a high prevalence of type 2 diabetes among adults. Older age, male gender, Janajati ethnicity, abdominal obesity, overweight or obesity, hypertension, low physical activity, and family history of diabetes were associated with type 2 diabetes. Immediate public health and individual measures are warranted to reduce further burden of type 2 diabetes.

Neurological Deficits After Long-term Pyrethroid Exposure.

Pyrethroid pesticides have been suggested to be a cause of Parkinson disease and other neurodegenerative diseases. To investigate this, a cross-sectional study was conducted among 120 Bolivian public health vector program spray men, primarily exposed to pyrethroids. Pesticide exposure and central nervous system (CNS) symptoms were determined by a structured interview, whereas neuromotor and neurocognitive performance was assessed using the computerized Behavioral Assessment and Research System and CATSYS system. Individuals exposed to higher levels reported significantly more CNS symptoms (adjusted odds ratio per quintile of cumulative exposure = 2.01 [1.22-3.31]). There was no association seen between pyrethroid exposure and neuromotor performance. Higher spraying intensity was associated with significantly worse neurocognitive performance in structural equation models (adjusted ß per quintile = -0.405 [-0.660 to -0.150]), and workers only exposed to pyrethroids performed worse than workers also exposed to other pesticides (adjusted ß = -1.344 [-2.224 to -0.464]). Chronic pyrethroid exposure may cause deterioration in neurocognitive performance, and exposure control is recommended.