Publications by authors named "Arjun B Chatterjee"

22 Publications

  • Page 1 of 1

Preoperative Sleep Questionnaires Identify Medical Emergency Team Activation in Older Adults.

J Am Med Dir Assoc 2019 10 11;20(10):1340-1343.e2. Epub 2019 Jun 11.

Department of Internal Medicine, Section of Pulmonary, Critical Care and Allergy and Immunologic Diseases, Wake Forest School of Medicine, Winston-Salem, NC.

Patients with obstructive sleep apnea (OSA) have increased postoperative complications that are important for patient safety and healthcare utilization. Questionnaires help identify patients at risk for OSA; however, among older adults who preoperatively self-administered OSA questionnaires, the frequency of postoperative Medical Emergency Team Activation (META), rapid response, code blue, code stroke, is unknown.

Objectives: Identify whether having OSA questionnaires completed by patients is feasible in the preoperative clinic. Determine the frequency of META among older patients at risk for OSA.

Design And Intervention: Cohort of prospective patients independently completed 2 OSA questionnaires in a preoperative clinic, STOP-Bang (SB) and ISNORED (IS). Observers blinded to questionnaire responses recorded incidence of META.

Setting And Participants: Of the 898 consecutive patients approached in the preoperative assessment clinic and surgical navigation center, 575 (64%) consented and completed the questionnaires in <5 minutes and were included in the analysis.

Measures: Sleep questionnaire responses and frequency of inpatient postoperative META.

Results: With an affirmative response to ≥3 questions on either questionnaire, 65% of patients enrolled were at risk for OSA. Of these, 3.1% sustained an META. In patients at risk for OSA, META occurred in 7.6% (SB+) and 7.2% (IS+) vs 2.5% (SB+) and 1.7% (IS+) for low risk. METAs were disproportionately higher among patients aged ≥65 years (6.3% vs 1.7%; P < .018), American Society of Anesthesiologists (ASA) physical status class ≥3, and IS+. All patients with META positively answered ≥3 of 15 components of the 2 questionnaires.

Conclusions/implications: Preoperative, self-administration of SB and IS questionnaires is feasible. Overall, 65% of those with affirmative responses to ≥3 questions were at risk for OSA and associated with a disproportionate number of postoperative META in older patients. Additionally, risk of OSA identified by preoperative sleep questionnaires was associated with postoperative META among older adults. Use of clinical tools and OSA questionnaires may improve preoperative identification of META in this population.
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http://dx.doi.org/10.1016/j.jamda.2019.04.024DOI Listing
October 2019

An obstructive sleep apnea primer: What the practicing allergist needs to know.

Ann Allergy Asthma Immunol 2017 Mar;118(3):259-268

Division of Pulmonary, Critical Care Medicine, Allergy and Immunology, Department of Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina; W. G. (Bill) Hefner Veterans Affairs Medical Center, Salisbury, North Carolina. Electronic address:

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http://dx.doi.org/10.1016/j.anai.2016.07.033DOI Listing
March 2017

Bronchoscopy Safety in Patients With Chronic Obstructive Lung Disease.

J Bronchology Interv Pulmonol 2017 Apr;24(2):98-103

*Department of Pulmonary/Critical Care, Wake Forest Baptist Health†Salem Chest Specialists, Winston Salem, NC.

Background: Flexible bronchoscopy is a safe and minimally invasive diagnostic tool used by pulmonologists, but few studies have prospectively compared outcomes in patients with objectively defined obstructive lung disease to those without obstruction.

Methods: We determined whether complications in patients undergoing moderate sedation bronchoscopy differ in those without obstruction compared with chronic obstructive pulmonary disease (COPD). We prospectively followed all patients undergoing moderate sedation bronchoscopy in an inpatient or outpatient setting.

Results: Over 12 months, data were collected prospectively in 258 patients. A total o 151 patients had pulmonary function testing with classification of COPD according to GOLD Criteria. Sixty-seven of those patients (44%) had COPD: 6 mild (9%), 29 moderate (42%), 27 severe (41%), and 5 very severe (8%). COPD patients were more likely to receive outpatient inhaled corticosteroids and long-acting bronchodilators and anticholinergics (P<0.001) as would be clinically appropriate. Among all patients with COPD, there were 13% minor complications and 5% major complications, with no deaths. Respiratory complications occurred more often in patients with severe to very severe COPD (22%) compared with patients without COPD (6%) (P=0.018). When adjusted for age, body mass index, and use of home oxygen, this difference was still significant (P=0.045).

Conclusion: Bronchoscopy is generally safe with few complications in most patients with COPD. Patients with objectively confirmed severe to very severe COPD had more frequent respiratory complications than patients without COPD. The risks were not prohibitively high, but should be taken into consideration for COPD patients undergoing moderate sedation flexible bronchoscopy.
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http://dx.doi.org/10.1097/LBR.0000000000000333DOI Listing
April 2017

Sedation for Bronchoscopy and Complications in Obese Patients.

Respiration 2016 6;92(3):158-65. Epub 2016 Sep 6.

Salem Chest Specialists, Winston-Salem, N.C., USA.

Background: Bronchoscopy is a safe and minimally invasive diagnostic tool, but no studies have reported prospectively on sedation and outcomes in patients with objectively defined obesity.

Objectives: The purpose of the study is to determine if obese patients require more sedation or had more procedural complications during bronchoscopy under moderate sedation than non-obese patients.

Methods: We evaluated complications and sedation requirements in non-obese versus obese patients, defined by multiple criteria including body mass index (BMI), neck circumference, abdominal height, and Mallampati scores.

Results: Data were collected prospectively in 258 patients undergoing bronchoscopy under moderate sedation. By varying criteria, there were the following proportions of obese patients: 30% by BMI >30, 39% by neck circumference >40 cm, and 35% by abdominal height >22 cm in males and >20 cm in females. Sedative and analgesic dosing was not clinically significantly higher in obese patients than in non-obese patients. There was no difference in complications or procedural success based on obesity criteria. Hemoglobin oxygen desaturations occurred more often during bronchoscopy in patients with increasing Mallampati scores (p = 0.04), but this had no effect on bronchoscopy time or successful completion of the procedure. A subset of patients with previous polysomnogram-proven obstructive sleep apnea were more likely to have earlier termination of their procedure (15.8%) than patients with no diagnosed sleep apnea (2.3%; p = 0.002).

Conclusion: In this prospective assessment of patients with obesity, we found neither clinically significant differences in sedation needs nor increases in complications in obese versus non-obese patients using a variety of indices of obesity.
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http://dx.doi.org/10.1159/000448250DOI Listing
September 2017

Age at asthma onset and asthma self-management education among adults in the United States.

J Asthma 2015 17;52(9):974-80. Epub 2015 Aug 17.

c Section on Pulmonary, Critical Care, Allergy, and Immunologic Diseases, Department of Internal Medicine, Wake Forest School of Medicine , Winston-Salem, NC , USA.

Objective: Asthma self-management education improves asthma-related outcomes. We conducted this analysis to evaluate variation in the percentages of adults with active asthma reporting components of asthma self-management education by age at asthma onset.

Methods: Data from 2011 to 2012 Asthma Call-back Surveys were used to estimate percentages of adults with active asthma reporting six components of asthma self-management education. Components of asthma self-management education include having been taught to what to do during an asthma attack and receiving an asthma action plan. Differences in the percentages of adults reporting each component and the average number of components reported across categories of age at asthma onset were estimated using linear regression, adjusted for age, education, race/ethnicity, sex, smoking status, and years since asthma onset.

Results: Overall, an estimated 76.4% of adults with active asthma were taught what to do during an asthma attack and 28.7% reported receiving an asthma action plan. Percentages reporting each asthma self-management education component declined with increasing age at asthma onset. Compared with the referent group of adults whose asthma onset occurred at 5-14 years of age, the percentage of adults reporting being taught what to do during an asthma attack was 10% lower among those whose asthma onset occurred at 65-93 years of age (95% CI: -18.0, -2.5) and the average number of components reported decreased monotonically across categories of age at asthma onset of 35 years and older.

Conclusions: Among adults with active asthma, reports of asthma self-management education decline with increasing age at asthma onset.
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http://dx.doi.org/10.3109/02770903.2015.1020389DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4674308PMC
April 2016

Authors' Reply.

Respiration 2015 7;90(2):174. Epub 2015 Jul 7.

Department of Pulmonary/Critical Care, Wake Forest Baptist Health, Winston-Salem, N.C., USA.

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http://dx.doi.org/10.1159/000435870DOI Listing
November 2015

Training in and experience with endobronchial ultrasound.

Respiration 2014 12;88(6):478-83. Epub 2014 Nov 12.

Department of Pulmonary/Critical Care, Wake Forest Baptist Health, Winston Salem, N.C., USA.

Background: Diagnosing mediastinal and hilar lymphadenopathy and staging lung cancer with endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) are on the rise, but uncertainty surrounds the optimal number of cases needed to achieve acceptable yields.

Objectives: To determine the threshold at which EBUS-TBNA reaches adequate yields among trainees and skilled bronchoscopists.

Methods: We reviewed all EBUS-TBNAs performed at our medical center since implementing the use of EBUS (n = 222).

Results: EBUS-TBNAs were performed in 222 patients (344 nodes). The percentage of adequate specimens sampled (diagnostic specimens or nodal tissue) rose from 66% in 2008 to 90% in 2012 (p < 0.01) and cancer yield improved from 34% in 2008 to 48% in 2012 (p < 0.01). Attending physicians who performed an average of more than 10 procedures per year had higher yields compared to those who performed fewer than 10 procedures per year (86 vs. 68%, p < 0.01). The yield of trainees also improved with every 10 procedures (79, 90 and 95%, p < 0.001) and that of attending physicians with experience (1-25 procedures: 78% yield, 26-50 procedures: 87% yield and 50+ procedures: 90% yield; p < 0.01). Among trainees, failure rates declined steadily.

Conclusion: EBUS-TBNA yield (malignant and benign) increases with increasing experience amongst experienced bronchoscopists and trainees as early as the first 20-25 procedures. Pulmonary trainees had a rapid decline in failure rates. These findings suggest that in an academic environment a minimum of 20-25 procedures is needed to achieve acceptable yields.
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http://dx.doi.org/10.1159/000368366DOI Listing
November 2015

The association of respiratory symptoms and indoor housing conditions among migrant farmworkers in eastern North Carolina.

J Agromedicine 2014 ;19(4):395-405

a Department of Public Health, Brody School of Medicine , East Carolina University , Greenville , North Carolina , USA.

Farm labor housing has been described as among the worst in the nation, oftentimes with poor and unsanitary indoor living conditions. The objective of this study was to evaluate the association between indoor environmental risk factors and respiratory health among migrant farmworker occupants (N = 352) living in employer-provided housing. A cross-sectional sample of adult Latino male farm laborers were administered a questionnaire to identify the prevalence of major respiratory symptoms. Self-reported and independent observations were made to evaluate environmental respiratory risk factors and indoor housing conditions, including but not limited to, the presence of cockroaches, rodents, pesticides, and visible signs of mold. Spirometry was performed to evaluate lung function using FEV1 (forced expiratory volume in 1 second), FVC (forced vital capacity), and FEV1 /FVC ratio. Bivariate analysis was applied to evaluate associations between respiratory symptoms and selected indoor environmental risk factors. Findings for respiratory health included prevalence of wheeze (11.4%), coughing up phlegm (17.3%), tightness of chest (16.8%), and runny or stuffy nose (34.4%). Respiratory risks identified inside the dwellings included the use of pesticides or bug sprays for cockroaches (31.5%), rat or mouse poison (19.5%), visible signs of water damage in the bathroom (22.5%), and mold in the sleeping room (11.1%). Spirometry values were normal for most occupants, although statistically significant associations were found between mold and coughing up phlegm when not having a cold (P = .0262); presence of mold and asthma (P = .0084); pesticides used in the home and tightness of chest (P = .0001); and use of tobacco and coughing up phlegm (P = .0131). Although causal inference can be difficult to establish from a cross-sectional study, findings from this study represents suggestive evidence that indoor environmental risk factors may be contributory factors for respiratory health problems among this vulnerable workgroup population.
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http://dx.doi.org/10.1080/1059924X.2014.947458DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4185398PMC
October 2015

Airway obstruction among Latino poultry processing workers in North Carolina.

Arch Environ Occup Health 2015 ;70(1):63-6

a Division of Public Health Sciences, Department of Epidemiology and Prevention, School of Medicine , Wake Forest University , Winston-Salem , North Carolina , USA.

This analysis was conducted to evaluate the prevalence of airway obstruction among Latino poultry processing workers. Data were collected from 279 poultry processing workers and 222 other manual laborers via spirometry and interviewer-administered questionnaires. Participants employed in poultry processing reported the activities they perform at work. Participants with forced expiratory volume in 1 second (FEV1) or FEV1/forced expiratory volume (FVC) below the lower limits of normal were categorized as having airway obstruction. Airway obstruction was identified in 13% of poultry processing workers and 12% of the comparison population. Among poultry processing workers, the highest prevalence of airway obstruction (21%) occurred among workers deboning chickens (prevalence ratio: 1.75; 95% confidence interval: 0.97, 3.15). These findings identify variations in the prevalence of airway obstruction across categories of work activities.
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http://dx.doi.org/10.1080/19338244.2013.787965DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4526130PMC
February 2015

Active asthma and the prevalence of physician-diagnosed COPD.

Lung 2014 Oct 21;192(5):693-700. Epub 2014 Jun 21.

Air Pollution and Respiratory Health Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mailstop F-60, Atlanta, GA, 30341, USA,

Introduction: Despite the considerable overlap of asthma and chronic obstructive pulmonary disease (COPD), the extent to which the two diagnoses are the manifestations of the same disease remains unresolved. We conducted these analyses to evaluate the role of active asthma in the prevalence of physician-diagnosed COPD.

Methods: From 2006 through 2010, 74,209 adults aged 18-99 years and with a history of asthma participated in the Behavioral Risk Factor Surveillance System (BRFSS) Asthma Call-back Survey and responded to interview-administered questionnaires via telephone. We used publicly available data from 71,639 (97%) participants to identify respondents with and without active manifestations of asthma and self-reported, physician-diagnosed COPD. We generated population-weighted estimates of physician-diagnosed COPD prevalence and conducted linear regression to estimate associations between active asthma status and the prevalence of COPD among current smokers, former smokers, and lifetime nonsmokers separately.

Results: Physician-diagnosed COPD was reported in an estimated 29% of the population with any history of asthma, including both active and inactive asthma. Age-specific prevalences of physician-diagnosed COPD were consistently higher among adults with active asthma than adults without active asthma. Compared to inactive asthma, active asthma was associated with an 8.3% [95% confidence interval (CI) 6.1, 10.5] higher prevalence of physician-diagnosed COPD among lifetime nonsmokers, a 20.6% (95% CI 18.0, 23.3) higher prevalence among former smokers, and a 26.7% (95% CI 22.5, 30.9) higher prevalence among current smokers.

Conclusions: Among adults with a history of asthma, active manifestations of asthma may play an important role in the epidemiology of COPD.
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http://dx.doi.org/10.1007/s00408-014-9609-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4514018PMC
October 2014

Reliability in reporting asthma history and age at asthma onset.

J Asthma 2014 Nov 15;51(9):956-63. Epub 2014 Jul 15.

Air Pollution and Respiratory Health Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention , Atlanta, GA , USA .

Background: Evaluation of the prevalence and incidence of asthma and research into its etiology often rely on self-reported information. We conducted this analysis to investigate reliability in reporting asthma history across categories of demographic and socio-economic characteristics.

Methods: We analyzed data from 3109 participants in the Coronary Artery Risk Development in Young Adults study, a longitudinal study of African-American and white adults. Responses to self-administered questionnaires completed at 15- and 20-year follow-up exams were used to evaluate agreement in reporting asthma history and age at diagnosis and assess variation in agreement across categories of demographic and health-related characteristics.

Results: A history of asthma was reported by 12% of participants at the 15-year exam and 11% of participants at the 20-year exam, with 97% agreement and an overall Kappa coefficient of 0.845 (95% confidence interval: 0.815-0.874). Kappa coefficients were higher among women than men and increased monotonically across categories of educational attainment. One-hundred eight participants (35%) reported exactly the same age at diagnosis at the two time points; for another 120 (39%), the difference in reported ages was ≤2 years. Age at asthma diagnosis reported at the 20-year exam was, on an average, 1 year (SD: 5.2) older than that reported at the 15-year exam.

Conclusions: Five-year reliability in self-reported asthma history is high, and variation in reporting age at diagnosis is low across categories of participant characteristics. Nevertheless, agreement in responses at two times does not guarantee that self-administered questionnaires are sensitive tools for detecting a true asthma history.
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http://dx.doi.org/10.3109/02770903.2014.930480DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4514017PMC
November 2014

Age at asthma onset and subsequent asthma outcomes among adults with active asthma.

Respir Med 2013 Dec 5;107(12):1829-36. Epub 2013 Oct 5.

Air Pollution and Respiratory Health Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mailstop F-60, Atlanta, GA 30341, USA. Electronic address:

Introduction: Little is known about the extent to which the age at which asthma first began influences respiratory health later in life. We conducted these analyses to examine the relationship between age at asthma onset and subsequent asthma-related outcomes.

Methods: We used data from 12,216 adults with asthma who participated in the 2010 Behavioral Risk Factor Surveillance System Asthma Call-back Survey to describe the distribution of age at asthma onset. Linear regression was used to estimate associations of age at asthma onset with asthma-related outcomes, including symptoms in the past 30 days and asthma-related emergency visits.

Results: Asthma onset before age 16 was reported by an estimated 42% of adults with active asthma, including 14% with onset at 5-9 years of age who reported experiencing any asthma symptoms on 21% of days in the past month. Compared to this group, the percentage of days in the past month with any asthma symptoms was 14.8% higher (95% confidence interval (CI): 5.4, 24.1) among those whose asthma onset occurred at <1 year. When age at onset occurred at 10 years or older there was little change in the prevalence of asthma-related emergency visits across age at onset categories.

Conclusion: Age at asthma onset may affect subsequent asthma-related outcomes.
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http://dx.doi.org/10.1016/j.rmed.2013.09.022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4512733PMC
December 2013

Conventional and endobronchial ultrasound-guided transbronchial needle aspiration: complementary procedures.

South Med J 2012 Dec;105(12):625-9

Department of Pulmonary/Critical Care, Wake Forest Baptist Health, Winston-Salem, NC 27157, USA.

Objective: The diagnosis of mediastinal and hilar lymphadenopathy and staging lung cancer with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) are on the rise. Most reports have demonstrated high yields with EBUS-TBNA and superiority of this procedure over conventional TBNA (cTBNA), but the relative roles of these procedures remain undefined. We present a comprehensive comparison of EBUS-TBNA to cTBNA.

Methods: We reviewed all of the bronchoscopies performed at our medical center from January 2009 through December 2010. We collected data on 82 EBUS-TBNAs and 209 cTBNAs performed. A cost analysis was subsequently performed.

Results: EBUS-TBNA was performed more often in patients with known prior cancer and suspicion of recurrence or staging compared with cTBNA (42% vs 18%, P < 0.001). cTBNA was more likely to be performed in patients suspected of having malignancy and needing diagnostic specimens (70% vs 46%, P = 0.009). The overall yield in which a diagnostic specimen or lymphoid tissue was obtained was not different in each group: EBUS 84% vs cTBNA 86% (P = 0.75). The cancer yield was 57% in cTBNAs compared with 44% in EBUS-TBNAs (P < 0.0001), with EBUS-TBNA more often targeting smaller nodes (mean 15 ± 7 mm vs 21 ± 11 mm; P < 0.0001) and paratracheal sites (67% vs 49%, P = 0.003). Per-procedure cost using a Medicare scale was higher for EBUS than it was for cTBNA ($1195 vs $808; P < 0.001).

Conclusions: EBUS-TBNA and cTBNA are complementary bronchoscopic procedures, and the appropriate diagnostic modality can be selected in a cost-effective manner based upon the primary indication for TBNA, lymph node size, and lymph node location.
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http://dx.doi.org/10.1097/SMJ.0b013e318273a749DOI Listing
December 2012

Association between housing quality and individual health characteristics on sleep quality among Latino farmworkers.

J Immigr Minor Health 2014 Apr;16(2):265-72

Department of Family and Community Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1084, USA,

Although poor sleep quality and associated sleep disorders are associated with increased risk of job injury and multiple mental and physical health problems, scant research has examined sleep quality among Latino farmworkers. Interviews were conducted with 371 male Latino farmworkers working in North Carolina during the 2010 agricultural season. Data on housing quality and sleep quality were collected. Access to air conditioning was significantly and positively associated with good sleep quality. This association remained when other housing characteristics and individual health indicators were controlled. Good sleep quality was associated with low levels of pain, depression, and anxiety. Poor sleep quality among Latino farmworkers was associated with poorer indicators of health. One important indicator of housing quality, air conditioning, was associated with better sleep quality. Further research is required to delineate how to improve the adequacy of farmworker housing to improve sleep quality and other health indicators.
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http://dx.doi.org/10.1007/s10903-012-9746-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3884040PMC
April 2014

Poultry processing work and respiratory health of Latino men and women in North Carolina.

J Occup Environ Med 2012 Feb;54(2):177-83

Departments of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.

Objective: To evaluate associations between poultry processing work and respiratory health among working Latino men and women in North Carolina.

Methods: Between May 2009 and November 2010, 402 poultry processing workers and 339 workers in a comparison population completed interviewer-administered questionnaires. Of these participants, 279 poultry processing workers and 222 workers in the comparison population also completed spirometry testing to provide measurements of forced expiratory volume in 1 second and forced vital capacity.

Results: Nine percent of poultry processing workers and 10% of workers in the comparison population reported current asthma. Relative to the comparison population, adjusted mean forced expiratory volume in 1 second and forced vital capacity were lower in the poultry processing population, particularly among men who reported sanitation job activities.

Conclusions: Despite the low prevalence of respiratory symptoms reported, poultry processing work may affect lung function.
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http://dx.doi.org/10.1097/JOM.0b013e31823d86f2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4527529PMC
February 2012

A cross-sectional exploration of excessive daytime sleepiness, depression, and musculoskeletal pain among migrant farmworkers.

J Agromedicine 2012 Jan;17(1):70-80

Department of Family and Community Medicine, and the Center for Worker Health, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.

In this study the authors estimated the prevalence of elevated daytime sleepiness, depressive symptoms, and musculoskeletal pain among Latino migrant farmworkers, and examined the relationship among these symptoms. Data are from a cross-sectional survey of migrant farmworkers (N = 300) conducted in eastern North Carolina in 2009. Eleven percent of Latino farmworkers reported elevated levels of daytime sleepiness, 28% reported elevated levels of depressive symptoms, and 5% reported moderate to severe musculoskeletal pain on a daily or weekly basis. Depressive symptoms and daytime sleepiness were positively associated. Depression and daytime sleepiness may increase risk of injury; further research regarding sleep issues is warranted.
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http://dx.doi.org/10.1080/1059924X.2012.626750DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3297680PMC
January 2012

Depressive symptoms and sleepiness among Latino farmworkers in eastern North Carolina.

J Agromedicine 2011 Oct;16(4):251-60

Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.

Depression and sleepiness are both risk factors for occupational accidents and unintentional injury. Relatively little is known about the experiences of these risk factors in the immigrant Latino farmworker population. This analysis uses prospective panel data from a sample of Latino farmworkers in eastern North Carolina that were collected at monthly intervals during the 2008 agricultural season to (1) describe depressive symptoms and daytime sleepiness among immigrant Latino farmworkers across the agricultural season; (2) delineate associations of depressive symptoms with sleepiness across time; and (3) determine whether depressive symptoms precede sleepiness, or if sleepiness precedes depressive symptoms. Results indicated that 45% of farmworkers experienced elevated depressive symptoms across the season, whereas 20% experienced elevated sleepiness. Elevated depressive symptoms were more common among farmworkers living in barracks, and less common among those living in trailers. Sleepiness was more common among women than men. There was no evidence that depressive symptoms contributed to sleepiness, or that sleepiness contributed to depressive symptoms. The pattern of results suggests that a substantial proportion of Latino farmworkers experience levels of depressive symptoms or sleepiness that places them at risk for occupational accident or unintentional injury. The results also suggest that depressive symptoms and sleepiness do not cause each other; rather, the association of depressive symptoms with sleepiness hints at the possibility of a common physiologic mechanism such as circadian disruption.
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http://dx.doi.org/10.1080/1059924X.2011.605722DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3286788PMC
October 2011

Job activities and respiratory symptoms among farmworkers in North Carolina.

Arch Environ Occup Health 2011 ;66(3):178-82

Department of Epidemiology and Prevention, Divisionof Public Health Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1063, USA.

Respiratory health is an important component of the ability to perform physically demanding work. The authors assessed respiratory symptom prevalence among Latino farmworkers engaged in crop production, and investigated work activities as risk factors for respiratory symptoms. During June to September 2008, 122 farmworkers completed up to 3 questionnaires. The authors estimated associations between work activities and wheezing symptoms using alternating logistic regression, controlling for age and smoking. At the first data collection, 29 (24%) farmworkers reported ever wheezing and 10 (8%) reported wheezing within the past month. Though not statistically significant, the odds of wheezing were elevated for individuals who reported performing tobacco-related work in the last 3 days. The odds were decreased among individuals who reported harvesting activities (odds ratio: 0.3, 95% confidence interval: 0.1, 1.0). Among Latino farmworkers, respiratory symptoms may be associated with work activities.
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http://dx.doi.org/10.1080/19338244.2010.539637DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3162367PMC
January 2012

Migrant farmworkers' housing conditions across an agricultural season in North Carolina.

Am J Ind Med 2011 Jul 28;54(7):533-44. Epub 2011 Feb 28.

Department of Family and Community Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.

Background: Several studies have documented poor housing conditions for farmworkers but none has focused on migrant farmworker housing, which is often provided as a condition of employment. Farmworker housing quality is regulated, but little documentation exists of compliance with regulations.

Methods: A 2007 survey of 43 randomly selected farmworker camps and a 2008 survey of 27 camps randomly selected from the 2007 sample documented housing conditions via interviewer administered questionnaire and housing checklist.

Results: Substandard conditions are common in migrant housing. All camps had at least one exterior housing problem; 93% had at least one interior problem. Housing conditions worsen across the agricultural season. Characteristics including no residents with H2A visa and 11 or more residents are associated with poorer conditions.

Conclusions: Housing standards are not adequately enforced. An increase in post-occupancy inspections and targeting camps with characteristics that place them at increased risk for substandard conditions are recommended.
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http://dx.doi.org/10.1002/ajim.20945DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3106132PMC
July 2011

Review: continuous positive airway pressure devices are effective and cost-effective for obstructive sleep apnoea.

Evid Based Med 2009 Oct;14(5):143

Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.

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http://dx.doi.org/10.1136/ebm.14.5.143DOI Listing
October 2009

Reproducibility of the 6-minute walk test for ambulatory oxygen prescription.

Respiration 2010 20;79(2):121-7. Epub 2009 May 20.

Section of Pulmonary, Critical Care, Allergy and Immunologic Diseases, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.

Background: Ambulatory oxygen is frequently prescribed for patients with chronic obstructive pulmonary disease (COPD) who have oxygen desaturation
Objective: The aim of this study was to establish the reproducibility of the 6MWT in determining the need for ambulatory oxygen prescription in stable COPD patients using the Centers for Medicare and Medicaid (CMS) criteria for ambulatory oxygen prescription.

Methods: The study was designed as a prospective observational study in an academic health center and associated pulmonary rehabilitation program. Eighty-eight COPD patients referred to pulmonary rehabilitation underwent continuous pulse oximetry while performing standard 6MWT on 3 separate days.

Results: Fifty-one (58%) of these patients desaturated by continuous pulse oximetry to an SpO(2) < or = 88% on a least one of the 6MWTs. Only 26 patients (30%) demonstrated consistency in meeting the criteria for ambulatory oxygen set forth by the CMS on all three 6MWT with a kappa statistic of 0.62. The percent agreement between 6MWTs for ambulatory oxygen prescription was 72% and the paired observation was 51%.

Conclusions: The 6MWT distance is simple and widely used as a consistent measure of functional capacity in patients with COPD; however, the 6MWT oxygen saturation has only modest reproducibility in determining the need for ambulatory oxygen in stable COPD patients undergoing pulmonary rehabilitation.
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http://dx.doi.org/10.1159/000220343DOI Listing
February 2010
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