Assessment of Global Lung Function Initiative (GLI) reference equations for diffusing capacity in relation to respiratory burden in the Swedish CArdioPulmonary bioImage Study (SCAPIS).

The Global Lung Function Initiative (GLI) has recently published international reference values for diffusing capacity of the lung for carbon monoxide (D LCO). Lower limit of normal (LLN), i.e. the 5th percentile, usually defines impaired D LCO We examined if the GLI LLN for D LCO differs from the LLN in a Swedish population of healthy, never-smoking individuals and how any such differences affect identification of subjects with respiratory burden.Spirometry, D LCO, chest high-resolution computed tomography (HRCT) and questionnaires were obtained from the first 15 040 participants, aged 50-64 years, of the Swedish CArdioPulmonary bioImage Study (SCAPIS). Both GLI reference values and the lambda-mu-sigma (LMS) method were used to define the LLN in asymptomatic never-smokers without respiratory disease (n=4903, of which 2329 were women).Both the median and LLN for D LCO from SCAPIS were above the median and LLN from the GLI (p<0.05). The prevalence of D LCO GLI LLN but GLI LLN but GLI LLN and >SCAPIS LLN). No differences were found with regard to physician-diagnosed asthma.The GLI LLN for D LCO is lower than the estimated LLN in healthy, never-smoking, middle-aged Swedish adults. Individuals with D LCO above the GLI LLN but below the SCAPIS LLN had, to a larger extent, an increased respiratory burden. This suggests clinical implications for choosing an adequate LLN for studied populations.

Data-driven questionnaire-based cluster analysis of asthma in Swedish adults.

The aim of this study was to identify asthma phenotypes through cluster analysis. Cluster analysis was performed using self-reported characteristics from a cohort of 1291 Swedish asthma patients. Disease burden was measured using the Asthma Control Test (ACT), the mini Asthma Quality of Life Questionnaire (mini-AQLQ), exacerbation frequency and asthma severity. Validation was performed in 748 individuals from the same geographical region. Three clusters; early onset predominantly female, adult onset predominantly female and adult onset predominantly male, were identified. Early onset predominantly female asthma had a higher burden of disease, the highest exacerbation frequency and use of inhaled corticosteroids. Adult onset predominantly male asthma had the highest mean score of ACT and mini-AQLQ, the lowest exacerbation frequency and higher proportion of subjects with mild asthma. These clusters, based on information from clinical questionnaire data, might be useful in primary care settings where the access to spirometry and biomarkers is limited.

Effect of tobacco control policies on the Swedish smoking quitline using intervention time-series analysis.

OBJECTIVES: To coherently examine the responsiveness of the Swedish National Tobacco Quitline (SNTQ) to different types of anti-smoking policies over an extended period of calendar time. DESIGN: Quasi-experimental design with an intervention time-series analysis based on 19 years series of data collected between January 1999 and August 2017 (224 months). Statistical inference on calling rates and rate ratios was obtained using intervention time-series models (Poisson regression and transfer functions). PARTICIPANTS: A total of 179 851 phone calls to the SNTQ. INTERVENTIONS: Recent application of the 2014/40/ European Union (EU) Tobacco Products Directive in 2016. Historical interventions such as a campaign on passive smoking in January 2001; introduction of larger text warnings on cigarette packages since September 2002; banning smoking in restaurants since June 2005; and tobacco tax increase by 10% since January 2012. OUTCOME MEASURE: Calling rates to the SNTQ expressed per 100 000 smokers. SETTING: Sweden. RESULTS: The introduction of large pictorial warnings together with text warnings on cigarette packages (May 2016) was associated with a 35% increase in SNTQ calling rate (95% CI 1.16 to 1.57). The campaign on passive smoking (Jan 2001) was associated with a 61% higher calling rate (95% CI 1.06 to 2.45). Larger text warnings on cigarette packs (Sept 2002) conferred a 28% increment in the calling rate (95% CI 1.15 to 1.42); and prohibition to smoke in restaurants (Jun 2005) was associated with a 15% increase in the calling rate (95% CI 1.01 to 1.30). The 10% tobacco tax increase (Jan 2012) was associated with a 3% higher calling rate (95% CI 0.90 to 1.19). CONCLUSIONS: Within an overall decreasing trend of daily smoking in Sweden, we found that the recent introduction of pictorial warnings together with text warnings and referral text had a discernible positive impact on the calling rates to the smoking quitline. We were also able to detect a likely impact of earlier nationwide interventions.

[Risk Assessment for Malaria Transmission in the Border Area of Yunnan Province].

Objective: To assess the malaria transmission risk in the border area of Yunnan Province and provide evidence for adjustment of malaria intervention and elimination strategies. Method: Data concerning malaria prevalence, vector distribution, and institutional intervention capacity were collected in 197 towns of 20 counties in the border area of Yunnan Province during 2012-2014. The malaria transmission potential index （TPI）, intervention capacity index (ICI) and malaria risk index (MRI) were calculated for each town, based on the criteria formulated by a professional committee. The towns were categorized according to the indices aforementioned. The risk map was created with GIS software. Results: Based on the TPI, the 197 towns comprised of 2 grade-I towns (including Nabang in Yingjiang and Banlao in Cangyuan) with high transmission potential, 11 grade-II towns with moderate transmission potential and 184 grade-III towns with low transmission potential. Based on the ICI, the 197 towns comprised of 4 grade-III towns (including Zhongke in Ximen, Zhonghe and Diantan in Tengchong, and Menghan in Jinghong) with a weak control capacity, 20 grade-II towns with a moderate control capacity and 173 grade-I towns with a strong control capacity. Based on the MRI, the 197 towns comprised of 2 grade-I towns (including Nabang in Yingjiang, and Banlao in Cangyuan) with a high transmission risk level, 12 grade-II towns with a moderate level and 183 grade-III towns with a low level distributed in 20 counties. Conclusion: The grade I or II towns with moderate and high transmission risk constitute <5% of the 197 towns in the border area, suggesting a relatively low level of malaria transmission risk in most counties.

Mekong malaria. II. Update of malaria, multi-drug resistance and economic development in the Mekong region of Southeast Asia.

In an expansion of the first Mekong Malaria monograph published in 1999, this second monograph updates the malaria database in the countries comprising the Mekong region of Southeast Asia. The update adds another 3 years' information to cover cumulative data from the 6 Mekong countries (Cambodia, China/Yunnan, Lao PDR, Myanmar, Thailand, Viet Nam) for the six-year period 1999-2001. The objective is to generate a more comprehensive regional perspective in what is a global epicenter of drug resistant falciparum malaria, in order to improve malaria control on a regional basis in the context of social and economic change. The further application of geographical information systems (GIS) to the analysis has underscored the overall asymmetry of disease patterns in the region, with increased emphasis on population mobility in disease spread. Of great importance is the continuing expansion of resistance of P. falciparum to antimalarial drugs in common use and the increasing employment of differing drug combinations as a result. The variation in drug policy among the 6 countries still represents a major obstacle to the institution of region-wide restrictions on drug misuse. An important step forward has been the establishment of 36 sentinel sites throughout the 6 countries, with the objective of standardizing the drug monitoring process; while not all sentinel sites are fully operational yet, the initial implementation has already given encouraging results in relation to disease monitoring. Some decreases in malaria mortality have been recorded. The disease patterns delineated by GIS are particularly instructive when focused on inter-country distribution, which is where more local collaborative effort can be made to rationalize resource utilization and policy development. Placing disease data in the context of socio-economic trends within and between countries serves to further identify the needs and the potential for placing emphasis on resource rationalization on a regional basis. Despite the difficulties, the 6-year time frame represented in this monograph gives confidence that the now well established collaboration is becoming a major factor in improving malaria control on a regional basis and hopefully redressing to a substantial degree the key problem of spread of drug resistance regionally and eventually globally.