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Background and aims: Reported associations between previous incarceration and the risk of overdose‐related death are substantially heterogeneous, and previous studies are limited by an inability to control for confounding factors in risk assessment. This study investigated the associations of overdose‐related death with previous incarceration and the number or cumulative duration of previous incarcerations, and individual or neighborhood characteristics that may potentially modify the associations. Design and setting: A cohort study using a 20% random sample of residents in British Columbia, Canada. Participants: A total of 765 690 people aged 23 years or older at baseline as of 1 January 2015. Mean age was 50 years; 49% were males. Measurements Previous incarcerations that occurred during the 5‐year exposure period (January 2010 to December 2014) were identified using provincial incarceration records. Overdose‐related deaths that occurred during the 3‐year follow‐up period (January 2015 to December 2017) were identified using linked administrative health data. Baseline individual and neighborhood characteristics were retrieved from the provincial health insurance data. Findings In the cohort, 5743 people had an incarceration history during the exposure period, and 634 people died from drug overdose during the follow‐up period. The mortality rate was 897 and 22 per 100 000 person‐years for people who did and did not have an incarceration history, respectively. After adjusting for baseline individual and neighborhood characteristics (without any interaction term), people who had an incarceration history were 4.04 times (95% confidence interval 3.23–5.06) more likely to die from drug overdose compared with people without an incarceration history. The association was stronger for females, people without diagnoses of substance use disorder and people without dispensation of opioids for pain or benzodiazepines (P < 0.001 for each interaction term). There was no discernible linear trend between the number or cumulative duration of previous incarcerations and the risk of overdose‐related death. Conclusions: Previous incarceration appears to be a major risk factor for overdose‐related death. [ABSTRACT FROM AUTHOR]

Abstract Background Whether inhaled corticosteroids suppress airway inflammation in chronic obstructive pulmonary disease (COPD) remains controversial. We sought to determine the effects of inhaled corticosteroids on sputum indices of inflammation in stable COPD. Methods We searched MEDLINE, EMBASE, CINAHL, and the Cochrane Databases for randomized, controlled clinical trials that used induced sputum to evaluate the effect of inhaled corticosteroids in stable COPD. For each chosen study, we calculated the mean differences in the concentrations of sputum cells before and after treatment in both intervention and control groups. These values were then converted into standardized mean differences to accommodate the differences in patient selection, clinical treatment, and biochemical procedures that were employed across original studies. If significant heterogeneity was present (p < 0.10), then a random effects model was used to pool the original data. In the absence of significant heterogeneity, a fixed effects model was used. Results We identified six original studies that met the inclusion criteria (N = 162 participants). In studies with higher cumulative dose (≥ 60 mg) or longer duration of therapy (≥ 6 weeks), inhaled corticosteroids were uniformly effective in reducing the total cell, neutrophil, and lymphocyte counts. In contrast, studies with lower cumulative dose (< 60 mg) or shorter duration of therapy (< 6 weeks) did not demonstrate a favorable effect of inhaled corticosteroids on these sputum indices. Conclusions Our study suggests that prolonged therapy with inhaled corticosteroids is effective in reducing airway inflammation in stable COPD.

Objectives: Bilateral high-frequency hearing loss is an indicator for chronic exposure to loud noise. This study aimed to examine the association between bilateral high-frequency hearing loss and the presence of coronary heart disease (CHD).Methods: This study included 5223 participants aged 20-69 years who participated in the audiometry examination of the National Health and Nutrition Examination Survey 1999-2004. Bilateral high-frequency hearing loss was defined as the average high-frequency (3, 4 and 6 kHz) hearing threshold ≥25 dB in both ears. CHD was defined as self-reported diagnoses by doctors or other health professionals.Results: Compared with those with normal high-frequency hearing, participants with bilateral high-frequency hearing loss were more likely to have CHD (OR 1.91; 95% CI 1.28 to 2.85) after adjustment for various covariates. This association was particularly strong for currently employed workers who were exposed to loud occupational noise (OR 4.23; 95% CI 1.32 to 13.55). For this subgroup, there was no significant association of CHD with unilateral high-frequency hearing loss, and unilateral or bilateral low-frequency hearing loss. Furthermore, there was no significant association of CHD with any types of hearing loss for participants who were not exposed to loud noise. Stratified analyses for participants exposed to loud noise showed that the observed association was particularly strong for those who were less than 50 years of age, less educated and current smokers.Conclusions: On the basis of an objective indicator for personal chronic exposure to loud noise, this study confirmed that exposure to loud occupational noise is associated with the presence of CHD. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to determine associations between cigarette smoking and the existence of headache in a nationally representative sample, with attention to differences in effect estimates between mentholated and non-mentholated cigarettes smoking., Methods: We examined cross-sectional associations between cigarette smoking and headache in 8,399 adults who participated in the National Health and Nutrition Examination Survey (NHANES) 1999-2004. The existence of headache was determined by an affirmative response to the question "During the past 3 months, did you have severe headaches or migraines?" Further refinement of headache diagnosis was not possible. We used logistic regression models to examine the association between cigarette smoking and headache., Results: The current study included 8,399 participants aged 20 years and over, including 68% (n = 5491) never smokers and 32% (n = 2548) current smokers. Among the current smokers, 24% (n = 739) smoked menthol cigarettes, and 76% (n = 1719) smoked non-menthol cigarettes. Compared with never smokers, after adjustment for potential confounding factors, current smokers were more likely to have headache (OR: 1.38; 95% CI: 1.17-1.62; P < .001). With the increase of both the number of cigarettes smoked daily and pack-years of smoking, the likelihood of having headache was significantly increased compared with never smokers (P for linear trend < .001). Compared with non-mentholated smokers, mentholated smokers were not more likely to have headache (P = .302)., Conclusions: Based on a nationally representative sample, we found that cigarette smoking was associated with headache in an exposure-response manner. Mentholated cigarette smokers were not more likely to have headache compared to non-mentholated cigarette smokers., (© 2016 American Headache Society.)

Chronic obstructive pulmonary disease (COPD) affects over 5% of the adult population and is the only major cause of death in the United States where morbidity and mortality are increasing. Clinically, COPD is characterized by irreversible airflow obstruction and airway inflammation that eventually lead to dyspnea, cough and sputum production. Long-acting beta(2)-agonists (LABAs) are effective in reducing patient symptoms through their bronchodilatory action on airway smooth muscle. More importantly, when LABAs are given in conjunction with inhaled corticosteroids, they appear to provide added benefits for patients. While the mechanisms for this observation are not entirely clear, there is emerging evidence to indicate that LABAs and corticosteroids attenuate different but complementary components of the inflammatory cascade related to COPD. Moreover, LABAs and corticosteroids may beneficially interact to prevent downregulation of beta(2)-receptors in airway cells (and thereby preventing tachyphylaxis) and to facilitate translocation of glucocorticoid receptors into the nucleus of inflammatory cells (thereby, amplifying the anti-inflammatory activity of the corticosteroid). Regardless of the mechanism, several large, high-quality randomized controlled clinical trials indicate that combination therapy of LABA with inhaled corticosteroids improves patient symptoms, and reduces exacerbations by a third (compared to placebo). More importantly, combination therapy produces superior health outcomes than mono-therapy with inhaled corticosteroids or LABA, suggesting added clinical benefits of these two compounds in COPD. This article will present a comprehensive overview of the currently available clinical evidence for the use of combination therapy as well as the potential mechanisms of their actions in COPD.

Objective: To identify the prevalence, distribution, current status of awareness and control of hypertension in Chinese adult population., Methods: A cross-sectional survey was conducted in mainland of China in 2000 - 2001 as a part of work coordinated with InterASIA Program. A total of 15,838 nationally representative subjects aged 35 to 74 were selected with multistage cluster sampling. Measurement of blood pressure was taken for all of them with three readings in a mercuric-column sphygmomanometer after resting for five minutes. Standard structured questionnaire was used to collect their histories and treatment and prevention for hypertension. A case of hypertension was defined as any person with systolic blood pressure equal to or greater than 140 mmHg, or with diastolic blood pressure equal to or greater than 90 mmHg, or being administered with antihypertensive agents., Results: A total of 15,838 adults aged 35 - 74 years were included in this survey. Overall, the prevalence of hypertension was 27.2%, representing 130 million persons with hypertension nationwide as estimated. Age-specific prevalence of hypertension was 10.7%, 26.8%, 38.9% and 50.2% for women and 17.4%, 28.2%, 40.7% and 47.3% for men aged 35 - 44, 45 - 54, 55 - 64 and 65 - 74 years, respectively. Among hypertensive patients, 44.7% were aware of their high blood pressure, 28.2% were taking antihypertensive medication, and 8.1% achieved their blood pressure under control (< 140/90 mm Hg). All these data indicated that percentages of awareness, treatment and control of hypertension increased by 86.2%, 92.6% and 145.4%, respectively in the past ten years, as compared with the data in 1991., Conclusions: In the past ten years, percentages of awareness, treatment and control of hypertension in Chinese adults increased significantly, who had a relatively high prevalence of hypertension, but lower awareness and much lower percentages of treatment and control of hypertension. It is urgently needed to improve prevention, detection and treatment for hypertension in adults.