COPD is the third leading cause of death in the United States and is the sixth leading cause of death for low-to middle income countries (Downs & Appel, 2006; GOLD, 2011). COPD is a largely preventable disease due to the lifestyle factors that heavily contribute to disease onset and severity. Although traditionally COPD research has focused on health outcomes related to risk factors, compliance, comorbid psychological and physical conditions, and treatment interventions, a growing body of research suggests religious and spiritual factors may play an equally important role in health outcomes for several medical conditions, including pulmonary disease. However, studies of this kind have not specifically examined COPD nor have they examined the role of religious and spiritual beliefs in COPD management among ethnic minority patients. As such, the current study aimed to examine whether spiritual ethnic minority patients with COPD hold religious fatalistic attitudes and less active religious problem solving . A sample of 35 ethnic minority patients from the Louis. B. Stokes Cleveland VA Medical Center (LSCVAMC) Outpatient Pulmonary Clinic in Cleveland, OH. were recruited to participate in the study. Due to the acknowledgeable limitations of the present study, results are preliminary but convey associations between religious health fatalistic beliefs and religious problem solving approaches. Implications and areas of future study are discussed.

No description available.

Hospital readmission is prevalent among people with chronic obstructive pulmonary disease (COPD), particularly among older people in Hong Kong. Evidence shows that hospital readmissions exert a considerable impact on patients. Studies in this area primarily identify various associative factors based on the perspectives of health professionals. However, these factors are inadequate in illustrating the needs of older people and in illuminating the phenomenon of hospital readmissions. A thorough understanding of the issue can be achieved if the related experiences are interpreted from the perspective of the patients and in terms of their context. Understanding of their experiences has paramount significance in uncovering the unmet needs of patients and in informing the provision of healthcare services. Yet, there is a dearth of studies unfolding the experiences of Chinese older people. / This study aimed to explore and describe the lived experience of hospital readmissions of Chinese older people with COPD and to identify Chinese socio-cultural influences on the experience. Understanding was acquired through descriptive phenomenology. Twenty-two Chinese older people aged 62 to 89 were recruited by purposive sampling. They had been readmitted 4 to 14 times in the previous year. The older people were interviewed once during their hospitalization, and their readmission experiences were elicited from these unstructured interviews. Narrative descriptions were analyzed using the phenomenological method described by Giorgi (1985). / The general structure of the lived experience of hospital readmissions of Chinese older people with COPD reveals that older people refrain from unnecessary readmissions because they regard hospital care as the last resort in relieving breathlessness. When their breathlessness becomes intolerable, they perceive the urgency of surviving the distress. Craving for survival, they seek hospital readmission, which provides them immediate relief from the imminent threat. After being readmitted to a hospital, they feel powerless when their need for hospital care is disregarded by their doctors. Considering themselves as demanding to their families in daily lives, older people remain conscious of relieving their burden during their periods of hospital readmission because they regard this as the only opportunity to relieve their burden. Older people come to realize hospital readmissions are unavoidable after they put every effort to refrain from it but hospital care remains necessary. They further rationalize hospital readmissions as inevitable and resign themselves to it because of their perception of aging, doctors’ accounts of COPD, experience with and knowledge of the disease, and belief in fate. This acceptance of the inevitability of hospital readmissions precipitates an attitudinal shift toward the belief of living for the moment. Their past experiences inspire them to be satisfied with the current state of living and engage the present. This positive outlook enables them to embrace the experiences of hospital readmissions into their lives. Six invariant constituents emerged from the lived experience. The constituent “refraining from unnecessary readmissions” describes how older people manage their diseases in relation to hospital readmissions. “Craving for survival” explains why they seek hospital readmissions. “Feeling being disregarded and powerless” and “being conscious of relieving burden to families” characterize their experience of hospital readmissions. “Resigning to hospital readmissions” illustrates how they understand the recurrence of this phenomenon and “living for the moment” illuminates how they live with their experiences. / A deep understanding of hospital readmissions is embodied in the experiences of older people. The findings emphasize that hospital readmissions among Chinese older people are complex experiences shaped by their sociocultural context. The meanings of hospital readmissions to older people are influenced by their assumption of a submissive patient role, collectivism, external attribution style, and past life experiences. Although older people appear to accept and cope well with hospital readmissions, this study uncovers their needs as they move to and fro the hospital and home. The findings of this study offer implications in promoting the wellness of Chinese older people as they go through this revolving door. / 再次住院在患有慢性阻塞性肺病人士中相當普遍，尤其是在中國老年患者。研究證據顯示再次住院對病人有很大的影響。現有的研究偏重於從醫務人員角度尋找不同的關聯因素，但該些因素並不足以反映老年人的需要以及解釋再次住院的現象。只有透過病人的觀點以及結合他們的背景來闡釋這些相關經驗，才能作出深入了解。了解病人的再次住院經驗有助於找出病人的需要以及指引醫療服務的提供。然而，有關中國老年人再次住院經驗的探討相當缺乏。 / 是次研究目的是探討和描述患有慢性阻塞性肺病的中國老年人再次住院的體驗，以及認識中國社會文化對再次住院經驗的影響。研究採用描述現象學方法。研究以立意抽樣方式選取了22名62至89歲的中國老年人。他們在去年入院次數為4至14次。這些老年人在住院期間均接受一次非結構式訪談以了解他們的再次住院經驗。這些敘述性描寫再按 Giorgi (1985) 的現象學方法作出分析。 / 患有慢性阻塞性肺病中國老年人再次住院的體驗的通用結構顯示他們避免不必要的再次住院，因為他們將住院護理視為紓緩呼吸困難的最後方法。當他們的呼吸困難惡化至無法忍受，他們會感受到從危病中活下來的迫切性。因著渴望生存的意識，他們尋求再次住院以即時消除緊迫的生命威脅。再次入院後，對於醫生漠視其住院護理的需要，他們感到無力。由於考慮到他們在日常生活中對家人的需求頗多，老年人以再次住院其間來減輕家庭負擔，因他們視這其間為唯一能減輕家庭負擔的機會。儘管老年人盡能力以避免再次入院，但他們依然需要住院護理，老年人逐漸意識到再次住院為無可避免。由於老年人對於老化的感知、醫生對慢性阻塞性肺病的解明、患病經驗和對疾病的相關知識以及相信命運的看法，他們更將再次住院合理化為無可避免並順從。接受再次住院為無可避免促成他們的態度轉變為活在當下。過去的經驗令他們對目前的生活感到滿意並希望活在當下。這個正面想法令他們將再次住院接納為生活的一部份。六個不變組成要素呈現於老年人的再次住院體驗當中。組成要素「避免不必要的再次住院」描述老年人如何管理慢性阻塞性肺病以避免再次住院。「渴望生存」解釋了他們尋求再次住院的原因。「感到被忽略和無力」以及「減輕家庭負擔的意識」敘述了他們再次住院的經驗。「順從再次住院」說明了他們對再次住院現象發生的理解，而「活在當下」說明了他們如何接納再次住院經驗。 / 對於再次住院的深入了解具體表現於老年人的經驗當中。是次研究結果強調，老年人再次住院是由他們的社會文化背景塑造而成的複雜經驗。對於老年人而言，再次住院的意義受到他們對順從性病人角色的假設、集體主義觀念、外部歸因以及過往的生活經驗所影響。雖然老年人似乎接受並適應再次住院，是次研究發現了他們在這現象中的需要。研究結果對於促進再次住院的中國老年人的健康帶來新的啟示。 / Tang, Wing Ki. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2015. / Includes bibliographical references (leaves 342-393). / Abstracts also in Chinese. / Title from PDF title page (viewed on 05, October, 2016). / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only.

The problem of this study is to determine the vitamin B-6 status of patients who have chronic obstructive pulmonary disease (COPD). Erythrocyte aspartate transaminase assay was the method for measuring vitamin B-6 status. The vitamin B-6 status was examined in thirty subjects (ten COPD subjects and twenty control subjects). An unpaired t-test was used to compare the vitamin B-6 status of the COPD group versus the control group. Four determinants (percentage stimulation, ratio of basal to stimulated activity, basal activity, and stimulated activity) were used to determine vitamin B-6 status in both groups of subjects. Percentage stimulation and ratio of basal to stimulated activity were not significantly different (control group versus COPD group) at the .05 level. However, two of ten COPD subjects had values for percentage stimulation that were two standard deviations above the mean, indicating a poor B-6 status. In contrast, basal activity and stimulated activity of erythrocyte aspartate transaminase were found to be significantly lower at the .05 level in the COPD group than the control group. Therefore, the COPD subjects as a group had some biochemical characteristics of a lower level of vitamin B-6 than the controls.

Orientador: Irma de Godoy / Coorientador: Susana Erico Tanni Minamoto / Coorientador: Camila Renata Corrêa / Banca: José Antonio Baddini Martinez / Banca: Mariana Gobbo Braz / Banca: Oliver Augusto Nascimento / Banca: Ângela Victoriano de Campos Soares / Resumo: Foi realizado estudo transversal para avaliar e comparar a associação entre estresse oxidativo e estado inflamatório e suas relações com a força muscular, a massa muscular sistêmica, a capacidade funcional de exercício e o estado geral de saúde em tabagistas, pacientes com doença pulmonar obstrutiva crônica (DPOC) leve/moderado e controles não tabagistas. Foram avaliados 32 tabagistas ativos (carga tabágica >10 anos/maço) sem DPOC, 32 pacientes com DPOC leve/moderado [tabagistas ativos ou ex-tabagistas (carga tabágica >10 anos/maço)] e 32 indivíduos não tabagistas. Todos os indivíduos foram submetidos à avaliação clínica e do estado tabágico, espirometria pré e pósbroncodilatador, oximetria de pulso e as concentrações de mediadores inflamatórios [proteína C-reativa (PCR), interleucina (IL) 6, receptores do fator de necrose tumoral alfa (TNFR1 e TNFR2)] e indicadores de estresse oxidativo [produtos finais de glicação avançada (AGEs) e receptor solúvel do produto final de glicação (sRAGE)] foram avaliadas no soro. Foi realizada avaliação da composição do corpo por bioimpedância, da força muscular periférica por dinamometria, da capacidade funcional de exercício (distância percorrida em seis minutos) e da avaliação do estado geral de saúde, por meio do Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) e da Escala Hospitalar de Ansiedade e Depressão (HAD). Tabagistas (p<0,001) e pacientes com DPOC (p<0,001) apresentaram valores superiores de AGEs quando comparados aos controles. Não houve diferença estatisticamente significante entre tabagistas e pacientes com DPOC. As concentrações de sRAGE não diferiram entre os grupos (p=0,92). Tabagistas (p=0,01) e pacientes com DPOC (p=0,01) apresentaram valores superiores da PCR em comparação aos controles, sem diferenças nas demais comparações. As concentrações de IL6 (p=0,07) e TNFR1 (p=0,07) não diferiram entre os grupos. Os valores... / Abstract: The aim of this study was to evaluate the association between oxidative stress and inflammatory markers and their relationship with muscle strength, systemic muscle mass, exercise capacity, quality of life in smokers, mild/moderate COPD patients and nonsmokers controls. Were evaluated 32 active smokers (smoking history> 10 pack/years) without COPD, 32 mild/moderate COPD patients [current smokers or former smokers (smoking history> 10 pack/years) and 32 nonsmokers. All individuals underwent to medical and smoking status evaluations, spirometry pre and post-bronchodilator and pulse oximetry. The concentration of inflammatory mediators [C-reactive protein (CRP), interleukin (IL) 6, and tumor necrosis factor-alpha receptors (TNFR1 and TNFR2)] and indicators of oxidative stress [advanced glycation end-products (AGEs) and soluble receptors for advanced glycation end-products (sRAGE)] were measured in serum. We assessed body composition by bioimpedance, peripheral muscle strength by dynamometry, exercise capacity (six minutes walk distance) and the health status through the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and the Hospital Anxiety and Depression Scale (HAD). Smokers (p<0.001) and COPD patients (p<0.001) had higher values of AGEs when compared to controls there was no statistically significant difference between smokers and COPD patients. The sRAGE concentrations did not differ between groups (p=0.92). Smokers (p=0.01) and patients with COPD (p=0.01) showed higher values of CRP compared to controls, there was no statistical significant difference between smokers and COPD groups. The concentrations of IL-6 (p=0.07) and TNFR1 (p=0.07) did not differ between groups. Regarding concentrations of TNFR2, COPD patients showed higher values when compared to smokers (p=0.004) and controls (p=0.004). We identified positive association of smoking (p=0.04), CRP (p=0.03) and IL6 (p=0.03) with the concentrations of AGEs. The ... / Doutor

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 6 uppsatser.

Chan, Wai Kiu. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 233-256). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract and appendix also in Chinese.

O propósito da presente investigação foi avaliar o papel da atividade física no desenvolvimento de enfisema induzido por papaína em ratos. Para tanto, ratos Wistar foram randomicamente divididos em quatro grupos (n = 10 para cada grupo) que receberam, respectivamente, infusão intra-traqueal de papaína (6 mg em 1 mL de NaCl 0,9%) ou veículo e foram submetidos ou não ao protocolo de exercício em uma esteira ergométrica. Os ratos exercitaram-se a 13,3 m/min, 6 dias por semana, durante 9 semanas (o tempo de exercício foi aumentado gradualmente, de 10 a 35 min). Foram medidas a elastância e a resistência do sistema respiratório (Ers e Rrs, respectivamente), o peso e tamanho do coração, volume das câmaras cardíacas, diâmetro médio das fibras cardíacas e diâmetro alveolar médio. Após 9 semanas de atividade física não houve diferença para os valores de Ers e Rrs entre os quatro grupos experimentais. Houve um aumento estatisticamente significativo do peso do coração preenchido por solução de formaldeído nos grupos de animais submetidos à atividade física comparados aos grupos de animais sedentários (P = 0,007). Não houve diferenças significativas entre os dois grupos que fizeram exercício físico (tendo ou não recebido papaína) ou entre os dois grupos sedentários. O volume das câmaras cardíacas direita e esquerda não foram diferentes entre os diferentes grupos. O diâmetro médio das fibras do ventrículo esquerdo foi significativamente maior nos grupos submetidos à atividade física quando comparados aos grupos sedentários (P = 0,006). O diâmetro alveolar médio foi significativamente maior em ratos que receberam papaína quando comparados aos ratos que receberam salina intratraqueal (P = 0,025). Entretanto o diâmetro alveolar médio foi significativamente maior nos animais que receberam instilação intratraqueal de papaína e que foram submetidos à atividade física, quando comparados aos animais que foram instilados com papaína, mas não foram submetidos ao condicionamento físico. Concluímos que a atividade física pode aumentar à lesão alveolar induzida pela infusão de papaína / The purpose of the present study was to evaluate the role of exercise training on the development of papain-induced emphysema in rats. Wistar rats were randomly assigned to four groups (n = 10 for each group) that received, respectively, intratracheal infusion of papain (6 mg in 1 mL NaCl 0.9%) or vehicle and were submitted or not to a protocol of exercise on a treadmill. Rats exercised at 13.3 m/min, 6 days per week, for 9 weeks (increasing exercise time, from 10 to 35 min). We measured respiratory system elastance (Ers) and resistance (Rrs), the size and weight of the heart and mean alveolar diameter (Lm). After 9 weeks of exercise training, there were no differences in Rrs and Ers values among the four experimental groups. There was a significant increase in the heart weight filled with formaldehyde solute in animals submitted to exercise training compared to the sedentary groups (P = 0.007). There were no differences between the two groups submitted to exercise training (receiving or not papaine) or between the sedentary groups. There were no differences in cardiac chambers volume between all groups. The left ventricule fibers mean diameter was significantly greater in rats submitted to exercise training compared to sedentary rats (P = 0.006). Lm was significantly greater in rats that received papain compared to saline-infused rats (P = 0.025). However, Lm was significantly greater in papain + exercise rats compared to rats that received papain and were not submitted to exercise. We conclude that exercise training can increase alveolar damage induced by papain infusion

O propósito da presente investigação foi avaliar o papel da atividade física no desenvolvimento de enfisema induzido por papaína em ratos. Para tanto, ratos Wistar foram randomicamente divididos em quatro grupos (n = 10 para cada grupo) que receberam, respectivamente, infusão intra-traqueal de papaína (6 mg em 1 mL de NaCl 0,9%) ou veículo e foram submetidos ou não ao protocolo de exercício em uma esteira ergométrica. Os ratos exercitaram-se a 13,3 m/min, 6 dias por semana, durante 9 semanas (o tempo de exercício foi aumentado gradualmente, de 10 a 35 min). Foram medidas a elastância e a resistência do sistema respiratório (Ers e Rrs, respectivamente), o peso e tamanho do coração, volume das câmaras cardíacas, diâmetro médio das fibras cardíacas e diâmetro alveolar médio. Após 9 semanas de atividade física não houve diferença para os valores de Ers e Rrs entre os quatro grupos experimentais. Houve um aumento estatisticamente significativo do peso do coração preenchido por solução de formaldeído nos grupos de animais submetidos à atividade física comparados aos grupos de animais sedentários (P = 0,007). Não houve diferenças significativas entre os dois grupos que fizeram exercício físico (tendo ou não recebido papaína) ou entre os dois grupos sedentários. O volume das câmaras cardíacas direita e esquerda não foram diferentes entre os diferentes grupos. O diâmetro médio das fibras do ventrículo esquerdo foi significativamente maior nos grupos submetidos à atividade física quando comparados aos grupos sedentários (P = 0,006). O diâmetro alveolar médio foi significativamente maior em ratos que receberam papaína quando comparados aos ratos que receberam salina intratraqueal (P = 0,025). Entretanto o diâmetro alveolar médio foi significativamente maior nos animais que receberam instilação intratraqueal de papaína e que foram submetidos à atividade física, quando comparados aos animais que foram instilados com papaína, mas não foram submetidos ao condicionamento físico. Concluímos que a atividade física pode aumentar à lesão alveolar induzida pela infusão de papaína / The purpose of the present study was to evaluate the role of exercise training on the development of papain-induced emphysema in rats. Wistar rats were randomly assigned to four groups (n = 10 for each group) that received, respectively, intratracheal infusion of papain (6 mg in 1 mL NaCl 0.9%) or vehicle and were submitted or not to a protocol of exercise on a treadmill. Rats exercised at 13.3 m/min, 6 days per week, for 9 weeks (increasing exercise time, from 10 to 35 min). We measured respiratory system elastance (Ers) and resistance (Rrs), the size and weight of the heart and mean alveolar diameter (Lm). After 9 weeks of exercise training, there were no differences in Rrs and Ers values among the four experimental groups. There was a significant increase in the heart weight filled with formaldehyde solute in animals submitted to exercise training compared to the sedentary groups (P = 0.007). There were no differences between the two groups submitted to exercise training (receiving or not papaine) or between the sedentary groups. There were no differences in cardiac chambers volume between all groups. The left ventricule fibers mean diameter was significantly greater in rats submitted to exercise training compared to sedentary rats (P = 0.006). Lm was significantly greater in rats that received papain compared to saline-infused rats (P = 0.025). However, Lm was significantly greater in papain + exercise rats compared to rats that received papain and were not submitted to exercise. We conclude that exercise training can increase alveolar damage induced by papain infusion

Lau Yin Kei. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (leaves 58-79). / Abstracts in English and Chinese. / Acknowledgement --- p.I / Abstract --- p.IV / Abstract in Chinese --- p.VI / Abbreviations --- p.VIII / Introduction --- p.1 / Chapter 1.1 --- Prevalence of COPD and asthma in Hong Kong --- p.1 / Chapter 1.2 --- Players in pathogenesis of COPD --- p.2 / Chapter 1.3 --- Players in pathogenesis of asthma --- p.4 / Chapter 1.4 --- The use of exhaled breath condensate in previous studies --- p.6 / Chapter 1. 5 --- Brief overview of chemokines --- p.8 / Chapter 1.6 --- Objective of this study --- p.12 / Materials and methods --- p.14 / Chapter 2.1 --- Study population --- p.14 / Chapter 2.1.1 --- Patients with COPD and control subjects --- p.14 / Chapter 2.1.2 --- Patients with asthma and control subjects --- p.15 / Chapter 2.2 --- Lung function --- p.15 / Chapter 2.3 --- Dyspnoea score measurement of patients with COPD --- p.16 / Chapter 2.4 --- Classification of patients and asthma severity --- p.16 / Chapter 2.5 --- Skin prick test and blood tests --- p.16 / Chapter 2.6 --- Collection of exhaled breath condensate --- p.17 / Chapter 2.7 --- Measurement of constituent in EBC --- p.17 / Chapter 2.7.1 --- "Measurement of 8-isoprostane, MCP-1 and GROα in patients with COPD and the corresponding control subjects" --- p.17 / Chapter 2.7.2 --- Measurement of eotaxin and MDC of patients with asthma and the corresponding control subjects --- p.18 / Chapter 2.8 --- Reproducibility of exhaled breath constituent --- p.18 / Chapter 2.8.1 --- "Assessment of reproducibility of the exhaled MCP-1, GROα and8- isoprostane measurements" --- p.19 / Chapter 2.8.2 --- Assessment of reproducibility of the exhaled eotaxin and MDC measurement --- p.19 / Chapter 2.9 --- Statistical analysis --- p.19 / Results --- p.21 / Chapter 3.1 --- Patients with COPD and corresponding control subjects --- p.21 / Chapter 3.2 --- Patients with asthma and corresponding control subjects --- p.28 / Discussion --- p.36 / Chapter 4.1 --- "Exhaled 8-isoprostane, GRO-α and MCP-1 of patients with COPD and corresponding control subjects" --- p.36 / Chapter 4.2 --- Exhaled eotaxin and MDC from patients with asthma and corresponding control subjects --- p.43 / Chapter 4.3 --- Technical aspects of EBC assessment --- p.49 / Future prospect --- p.54 / Conclusion --- p.56 / References --- p.58 / Tables and Figures / Table 1. Demographics of the COPD and control subjects --- p.22 / Figure 1. The level of 8-isoprostane in the exhaled breath condensate of COPD and control subjects --- p.23 / Figure 2. The level of GROa in the exhaled breath condensate of COPD and control subjects --- p.25 / "Figure 3 Bland and Altman's Plot of the repeatability of 8-isoprostane, GROa and MCP-1 in the exhaled breath condensate of normal controls" --- p.27 / Table2. Clinical and physiological details of the subjects --- p.29 / Figure 4. Level of eotaxin in exhaled breath condensate of asthma and control subjects --- p.30 / Figure 5 Level of MDC in exhaled breath condensate of asthma and control subjects --- p.31 / Table 3. Levels of eotaxin and MDC in exhaled breath condensate of asthma subjects on different dose of inhaled corticosteroids --- p.33 / Figure 6. Relationship between exhaled breath condensate level of MDC and total serum IgE level --- p.35