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D Teculescu

Publications and source records attributed to D Teculescu.

At least 19 recordsLinked to original sources

Occupational status and sleep-disordered breathing in a sample of French males.

Sleep-disordered breathing (SDB) and lower socio-professional status have in common a series of risk factors for ill health such as sedentary lifestyle, weight excess, heavy alcohol and tobacco consumption. We hypothesised that SDB will be more prevalent in lower socio-professional groups. A total of 496 male middle aged subjects (23-66 years) were tested with a protocol including a self-completed structured sleep questionnaire (translation of the Madison sleep cohort study form), anthropometry (including neck, waist and hip girth) and a simple, non-invasive nose-throat examination by a specialist physician. The subjects were classified according to the 10 major groups of the ISCO-88 classification (International Labour Office). Our sampling base did not contain subjects in the major groups 1 (senior officials, legislators), 6 (fishery and agricultural workers), and zero (armed forces), thus these groups were not represented in the analysis. To improve the power of the statistical analysis, groups 3 and 4, 5 and 7, 8 and 9 were merged, the analysis thus including four categories. The differences in demographic data were negligible; as expected, smoking was more prevalent in low socio-occupational groups (difference non-significant). A history of chronic bronchitis was more frequent in low socio-occupational groups, while a low physical job labour was more frequent in higher occupational groups. We did not find any differences in the prevalence of sleep-related respiratory disturbances (snoring, sleep apnoeas). This first study of the possible association between socio-occupational factors and sleep disordered breathing was negative, but we believe further studies, on larger samples, with a more homogeneous distribution of social groups are warranted.

Adult↗

Prevalence of habitual snoring in a sample of French males. Role of "minor" nose-throat abnormalities.

BACKGROUND: No data on snoring prevalence obtained with a standard questionnaire exist for France. Major nose-throat abnormalities have been demonstrated in cases with obstructive sleep apnea; evidence of "minor" abnormalities in community studies is scarce. OBJECTIVES: The first objective of our study was to estimate the prevalence of habitual snoring in a sample of middle-aged active males in France. The second objective was to test the hypothesis that "minor" nose-throat abnormalities could be associated with habitual snoring in a field survey. METHODS: Three hundred thirty-four male employees of a local university volunteered for the study (93.6% of those contacted by mail); 300 returned a sleep questionnaire. The protocol also included anthropometry and a noninvasive nose-throat examination. RESULTS: Complete data were obtained in 299 subjects aged 23-63 years. When "habitual snorers" (= 32%) were compared with never-snorers, significant differences were found for all anthropometric variables, except height. In univariate analysis, habitual snoring was associated with a large number of variables, including a large soft palate, a large uvula, and altered nose patency. A logistic regression model retained 8 factors independently associated with snoring: age, neck circumference, tobacco consumption, breathing pauses during sleep, not feeling rested during the day, need for coffee to stay awake, blocked or running nose at night and a large soft palate. CONCLUSIONS: The prevalence of habitual snoring in this sample of middle-aged French males was 32%. We confirmed the significant association of habitual snoring with age, weight excess, and tobacco smoking, and identified two further factors: blocked nose at night and a large soft palate.

Adolescent↗

Age and bronchial hyperresponsiveness are associated with failure to perform the single breath N2 test in a rural female population.

Because some authors have reported high rates of failure in performing the single breath N2 (SBN2) test in rural areas, the present study aimed at evaluating its acceptability in a female population, unfamiliar with lung function testing, in a rural area of northeastern France. Two hundred ninety-eight women from a rural area volunteered for a preventive medicine examination (91.6% of those invited); four of them were excluded for clinical reasons, and six (2%) were unable to perform spirometry. The protocol included completion of a questionnaire, spirometry with a bronchial reactivity test, skin prick test, and the SBN2 test utilizing a computerized assembly. Although failures caused by the apparatus were few (n = 7, 2.4%) 96 of 281 women (34.1%) were unable to produce two valid SBN2 tests in a series of six attempts. Compared with the group who succeeded in the test (n = 185), women who failed were older and had a higher prevalence of bronchial hyperresponsiveness. Logistic regression confirmed the independent association of these two variables with an inability to perform. We conclude that in a female population completely unfamiliar with lung function testing the SBN2 test has a high rate of failure associated with higher age and the presence of bronchial hyperresponsiveness.

Adolescent↗

Dose-response slope of forced oscillation and forced expiratory parameters in bronchial challenge testing.

In population studies, the provocative dose (PD) of bronchoconstrictor causing a significant decrement in lung function cannot be calculated for most subjects. Dose-response curves for carbachol were examined to determine whether this relationship can be summarized by means of a continuous index likely to be calculable for all subjects, namely the two-point dose response slope (DRS) of mean resistance (Rm) and resistance at 10 Hz (R10) measured by the forced oscillation technique (FOT). Five doses of carbachol (320 microg each) were inhaled by 71 patients referred for investigation of asthma (n=16), chronic cough (n=15), nasal polyposis (n=8), chronic rhinitis (n=8), dyspnoea (n=8), urticaria (n=5), post-anaphylactic shock (n=4) and miscellaneous conditions (n=7). FOT resistance and forced expiratory volume in one second (FEV1) were measured in close succession. The PD of carbachol leading to a fall in FEV1 > or = 20% (PD20) or a rise in Rm or R10 > or = 47% (PD47,Rm and PD47,R10) were calculated by interpolation. DRS for FEV1 (DRSFEV1), Rm (DRSRm) and R10 (DRSR10) were obtained as the percentage change at last dose divided by the total dose of carbachol. The sensitivity (Se) and specificity (Sp) of DRSRm, DRS10 delta%Rm and delta%R10 in detecting spirometric bronchial hyperresponsiveness (BHR, fall in FEV1 > or = 20%) were assessed by receiver operating characteristic (ROC) curves. There were 23 (32%) "spirometric" reactors. PD20 correlated strongly with DRSFEV1 (r=-0.962; p=0.0001); PD47,Rm correlated significantly with DRSRm (r=-0.648; p=0.0001) and PD47,R10 with DRSR10 (r=-0.552; p=0.0001). DRSFEV1 correlated significantly with both DRSRm (r=0.700; p=0.0001) and DRSR10 (r=0.784; p=0.0001). The Se and Sp of the various FOT indices to correctly detect spirometric BHR were as follows: DRSRm: Se=91.3%, Sp=81.2%; DRSR10: Se=91.3%, Sp=95.8%; delta%Rm: Se=86.9%, Sp=52.1%; and delta%R10: Se=91.3%, Sp=58.3%. Dose-response slopes of indices of forced oscillation technique resistance, especially the dose-response slope of resistance at 10Hz are proposed as simple quantitative indices of bronchial responsiveness which can be calculated for all subjects and that may be useful in occupational epidemiology.

Adult↗

Can snoring induce or worsen obstructive sleep apnea?

Snoring and sleep apneas are breathing disorders intimately associated during sleep. Most snorers are 'simple' or 'nonapneic', as the prevalence of snoring is much higher than that of sleep apneas. The vibrations transmitted to the pharyngeal structures by snoring span a large range of frequencies, while the energy transmitted may reach high values. A deleterious effect of these vibrations can therefore be considered. In 1983 a group of investigators from Bologna described five cases of heavy snorers of increasing severity, suggesting that they correspond to the natural history of 'heavy snorers' disease'. The present article reviews the data published since 1983 in favor of this hypothesis: anatomic lesions of the upper airway mucosa, pharyngeal muscles and nerves, and clinical observations in snorers. The conclusion stresses the absence of ultimate proof in favor of this attractive hypothesis: we lack the demonstration of a significant increase of the incidence of sleep apnea in a group of nonapneic snorers in a longitudinal follow-up study.

Female↗

Can the evolution to pneumoconiosis be suspected in coal miners? A longitudinal study.

To assess whether the evolution to pneumoconiosis may be suspected in coal miners, we conducted a 4-yr longitudinal study of 80 dust-exposed miners with chest X-ray findings classified 0/1 or 1/0 according to the International Labor Organization (ILO) classification (exposed to coal mine dust, suspected of pneumoconiosis [ES group]) and two control groups having normal X-rays. The first of these latter two groups included 80 miners with similar exposure to that of the first group (exposure with normal X-rays [EN]), whereas the second group consisted of markedly less exposed miners (no exposure with normal X-rays [NN]). The protocol comprised a questionnaire on respiratory symptoms and smoking, assessment of cumulative coal-mine-dust exposure, X-rays, computed tomographic (CT) scans, and lung-function tests. The study was conducted in 1990 and 1994 by the same medical team. At the end of the follow-up, 24 members of the ES group had worsened X-ray findings, and 10 of them had X-ray findings classified as 1/1 or greater. In the EN and NN groups, six and one subjects, respectively, had worsened X-ray findings. At the first examination, subjects who developed pneumoconiosis had significantly lower values for FEV1/FVC ratio, maximum midexpiratory flow (MMEF), and maximal forced expiratory flow at 25% of vital capacity (FEF25%), and higher CT-scan micronodule scores. This latter score and FEF25% were significantly associated with the evolution to pneumoconiosis in the ES group, and scanner micronodule score and MMEF were significantly associated with this in all three groups combined. Worsening findings on X-ray and change to pneumoconiosis must be controlled in coal miners. The findings in this study offer the possibility of identifying miners who especially need follow-up and monitoring.

Adult↗

[An epidemiologic study of sleep-disordered breathing in the male population of Lorraine: preliminary results].

The prevalence of sleep-disordered breathing (SDB) was evaluated in a male population sample of Lorraine (university staff), with a protocol including a self-completed standardized questionnaire, anthropometry (including neck, waist and hip circumferences) and non-invasive ear, nose, and throat examination. Among 357 subjects present in the institution at the moment of the survey, 334 (93.6%) accepted to participate, and 300 (84%) returned the questionnaires. The anthropometric results corresponded to the French normative values according to gender and age. We chose a value of 32 as limit of the body mass index (BMI) between weight excess and obesity; this limit was exceeded by 7.2% of the subjects. The mean age of the sample was 44.8 (SD 10.1) years; the waist-to-hip ratio was of 0.907 +/- 0.053. The ENT examination found a high prevalence of nasal septum deviations (52.6%), of soft palate (25.2%), and uvula (42%) abnormalities; 32.1% of the subjects had experienced amygdalectomy. The non-responses to the questionnaire were infrequent (less than 2%), except for the questions regarding a history of hypertension (2.6%), weight fluctuations the last 5 years (7.6%), and the number of years in school (12%). The questionnaire included, for each question, the optional answer "don't know"; this answer was chosen for the questions concerning the duration of snoring (37.1%), stopping breathing during sleep (12.7%) and the parental history of narcolepsy (18.7 and 20.7%) and sleep apnoea (33.7 and 36.4%). 5.7% of the subjects declared sleep apnoeas at least once per week: 16.1% had unrefreshing sleep; 10.6% admitted to excessive daytime sleepiness; 41.9% were habitual snorers. These results indicate a prevalence of SDB in our sample which is comparable to the figures obtained in other European studies. Further analysis of our data will indicate if, besides weight excess and its troncular distribution, cigarette smoking and respiratory symptoms, the "minor" ENT abnormalities play a role in the pathogenesis of SDB.

Adult↗

The single-breath nitrogen test in coal miners: factors associated with failure to perform.

The single-breath nitrogen washout (SBN2) test was used, along with spirometry, in the baseline examination of a longitudinal study in a cohort of active coal miners from North-eastern France. The procedure was computerized, allowing the technician to coach and encourage the subject, and excluding computation errors. While all miners performed satisfactory spirometry, a significant number were unable to meet the National Heart and Lung Institute recommendation concerning a 10% agreement of vital capacities. When the limits were set at +/-12%, 57 miners (24.2%) were still classified as failing to perform. When compared to those who succeeded, those failing proved to be significantly older, had more cumulated dust exposure, a higher prevalence of chronic cough and sputum, and a trend for more micronodulation on the chest radiographs. The ventilatory function did not differ between the two groups. These results confirm previous data on spirometric test failure concerning older age and respiratory symptoms, extending them to the SBN2 test. The present study further indicates that dust exposure and roentgenologic pneumoconiosis nodulation are associated with failure to perform the SBN2 test.

Adult↗

[Respiratory disorders during sleep].

Sleep-disordered breathing includes snoring, upper airway resistance syndrome, sleep hypopneas and apneas, and is a borderline pathology between several disciplines (neurology, pneumology, cardiology, oto-rhino-laryngology, etc.). The common element is an abnormal increase in upper airway resistance during sleep. In mild cases, this increase accelerates airflow and induces vibrations of the pharyngeal structures (snoring); in severe cases the airway is occluded and airflow ceases (obstructive apnea). Sleep apnea syndrome (SAS) is present in 4% of males and 2% females in the general population. The risk factors are an age above 50, male sex, weight excess, presence of respiratory symptoms, tobacco smoking, alcohol consumption, use of hypnotic drugs... Snoring is much more frequent than sleep apnea, present in up to 50% of males aged 50 yr or more; most snorers do not have apneas ("simple" snorers). Apneas end with a micro-arousal; this sleep disruption explains the excess daytime sleepiness of patients with SAS. The daytime sleepiness is responsible for the increased rate of accidents (traffic, domestic, work...) in SAS patients. The second effect of apneas is desaturation, leading to heart rhythm abnormalities, coronary or cerebrovascular accidents, pulmonary vasoconstriction, systemic hypertension, etc. Screening for SAS is justified by its prevalence, by the potentially severe consequences and by the existence of an efficacious treatment: continuous positive airway pressure.

Aged↗

Forced oscillation technique (FOT): a new tool for epidemiology of occupational lung diseases?

The aim of this study was to evaluate the usefulness of the forced oscillation technique (FOT) in the assessment of occupation-related airway changes. The forced oscillation technique and conventional lung function tests were applied in 80 underground coalface workers, aged 35-48 yrs, with chest roentgenogram films classified 0/1 or 1/0 according to the International Labour Office (ILO) classification (G group), and two control groups matched for age and smoking habits. The first control group, was made up of face-workers having normal chest radiographs, whilst the second comprised underground non-face-workers with normal chest radiographs. Spirometric, plethysmographic and transfer factor of the lungs for carbon monoxide single-breath (TL,CO,sb) indices revealed no significant differences between the three groups. As regards the forced oscillation technique, a higher value of resistance/frequency slope (Pa.L-1.s2) was found in the G group compared with the control groups; 2.11 vs 1.06 in the face-workers, and 1.58 in the underground workers. In all three groups, the forced oscillation technique indices (mean resistance (R), resistance at zero frequency (RO), resistance/frequency slope (S), and resonant frequency (fo)) were found to be higher in subjects having a decreased forced expiratory volume in one second (FEV1) (< or = 90% predicted) or a mildly obstructive pattern of ventilatory function, even though this did not reach statistical significance in each of the groups. These findings together with the feasibility and acceptability of the forced oscillation technique would suggest that it may be a suitable tool for epidemiological studies of occupational respiratory diseases.

Adult↗

Tracheal wheezes during methacholine airway challenge (MAC) in workers exposed to occupational hazards.

Methacholine airway challenge (MAC) is a simple and useful means to assess bronchial hyperreactivity in workers exposed to various occupational hazards. Recently, wheeze detection by tracheal auscultation has been proposed as an indicator of bronchial responsiveness during bronchial provocation test in children. Our aim was to examine the relationship between the appearance of wheezes and the concurrent changes in forced expiratory volume in one second (FEV1) observed during MAC test in adults. Three cumulative doses of a methacholine solution (100 micrograms, 500 micrograms and 1500 micrograms) were inhaled by 45 workers with occupational exposure to flour dust. Spirometry was done using an electronic spirometer. Tracheal sounds were recorded with an electronic stethoscope placed over the anterior cervical triangle, 2 cm above the sternal notch. The amplified sounds were stored on magnetic tape, band-pass filtered (50-2000 Hz), and digitized at a sampling rate of 4096 Hz into a GenRad Vibration Control System. Wheezes were detected by fast Fourier transform (FFT) analysis and their presence compared to a 20% fall in FEV1. A positive MAC test by spirometry was found in 12 subjects whereas wheezes were identified in 14 subjects. Among the wheezing subjects, nine had a positive MAC test (range of fall in FEV1 = 20.6 to 42.3%) and five had a negative one (range of fall in FEV1 = 3.6 to 16.9%). Moreover, no wheezes were found in the remaining three subjects with a positive MAC test (range of fall in FEV1 = 20.7 to 27.4%). Taking a 20% fall in FEV1 as reference, wheezes were 75% sensitive and 84.8% specific to detect airflow obstruction. In conclusion, since it carries a significant although small false-negative rate, the acoustic technique based upon wheeze detection cannot, at the present time, fully replace spirometry during airway challenge testing in subjects with suspected asthma.

Adult↗

[Respiratory symptoms and function of coal miners presenting radiological pulmonary abnormalities].

Respiratory symptoms and lung function of 80 coal workers suspected of pneumoconiosis (pulmonary X-rays classified 0/1 or 1/0 according to International Labour Organisation classification) who worked for at least 10 years at face work (Ts) were studied in comparison with two control groups matched by age (+/- 2 years), height (+/- 5 cm), weight (+/- 10 kg) and smoking habits: the Tn group constituted by 80 coal workers who worked for at least 10 years at face work with normal pulmonary X-rays, and the HTn group constituted by 80 underground miners who worked mainly out of face work with normal pulmonary X-rays. The frequencies of cough, expectoration, chronic bronchitis or dyspnoea were significantly higher in Ts group than in the two others. The one-second forced expiratory volume to vital capacity ratio (FEV1/VC) was lower, closing volume to vital capacity (CV/VC) or to total lung capacity ratios (CV/TLC) were higher in Ts group than in the control groups. Unexpectedly, vital capacity (VC), one-second forced expiratory volume (FEV1), total lung capacity (TLC), compliance, diffusing capacity (DLCO) referred to alveolar volume (VA) were higher. In Ts group, the small rounded opacities were noted in the top part of the lung (56.9%), the irregular ones were distributed on the entire lung (65.5%). There were no relation between the category of small opacities and respiratory symptoms or lung function.

Adult↗

[Estimation of static lung volumes by nitrogen washout method. Single breath of oxygen].

Total lung capacity (TLC) and residual volume (RV) estimations were obtained from single-breath nitrogen washouts in 96 male and 77 female healthy never-smokers with normal spirometry from a non-polluted rural area in north-east France. TLC depended on height (both sexes) and diminished slightly with age in males, with the body-mass index (kg/m2) in females. RV increased with age in both sexes and with weight in males. The RV/TLC ratio was related only to age. When compared with values obtained using multiple-breath helium dilution, our results yielded lower predicted values. The test depends heavily on the subject's co-operation, and errors are frequent if a standard procedure is not observed. This method cannot thus be recommended for routine use in patients with respiratory diseases.

Adult↗

[Radioimmunoassay of urinary cotinine: variability of measurements, identification of exposed subjects].

Urinary cotinine was assessed by a radioimmune assay (RIA) in a random subsample of 63 (out of 285) children aged 5 to 6 from 10 kindergartens in Nancy (N-E France). The result was adjusted for urine concentration by expressing cotinine per mg creatinine. The correlation between two successive determinations was excellent (r = 0.989) and the difference between the two mean values was minimal and non-significant (121.4 +/- 25.9 vs 121.0 +/- 25.0). Expressed in percentage of their mean, the difference between two determinations was on average 8.2%. The urinary cotinine determinations allowed a satisfactory separation of children exposed vs unexposed to parental tobacco smoke.

Child↗

Mortality of iron miners in Lorraine (France): relations between lung function and respiratory symptoms and subsequent mortality.

An increased mortality from lung and stomach cancer was found in previous studies on Lorraine iron miners. A detailed analysis, however, was not possible due to the lack of data for survivors. In this study the cohort included 1178 workers selected at random from all the 5300 working miners aged between 35 and 55 at the start of the follow up period, which ranged from 1975 to 1985. Occupational exposures and tobacco consumption, lung function tests, and respiratory symptoms were assessed for each subject in 1975, 1980, and 1985. This study confirmed the excess of lung cancer (standardised mortality ratio (SMR) = 389, p < 0.001) and of stomach cancer (SMR = 273, p < 0.05). There was no excess of lung cancer in non-smokers and moderate smokers (< 20 pack-years) or the miners who worked only at the surface or underground for less than 20 years. A significant excess (SMR = 349, p < 0.001) was found in moderate smokers when they worked underground for between 20 and 29 years. Heavy smokers (over 30 pack-years) or subjects who worked underground for more than 30 years experienced a high risk: SMR = 478 (p < 0.001) for moderate smokers who worked underground for over 30 years; 588 (p < 0.001) for heavy smokers who worked underground for between 20 and 29 years; and 877 (p < 0.001) for heavy smokers who worked underground for over 30 years. This showed an interaction between smoking and occupational exposure. The excess mortality from lung cancer was because there were some subjects who died young (from 45 years old). Comparison with the results of a previous study showed that additional hazards produced by diesel engines and explosives increased the mortality from lung cancer. The SMR was higher than 400 (p < 0.001) from 45 years old instead of from 56 years. A relation was found between a decrease in vital capacity (VC), forced expiratory volume in one second (FEV1) and of FEV1/VC and mortality from all causes and from lung cancer in heavy smokers or men who had worked underground for more than 20 years. Respiratory symptoms were related to mortality from lung cancer among smokers (moderate and heavy) who worked underground for more than 20 years. It is considered that the risk of lung cancer in the Lorraine iron miners was mainly due to dust, diesel engines, and explosives although the role of low exposure to radon daughters could not be totally excluded.

Adult↗

Iron miners--a ten year follow-up.

1167 workers of Lorraine (France) iron mines, a random sample of 5600 workers aged 35 to 55 years, at work in 1975 constituted the initial cohort that was examined twice at 5-year intervals after the first examination. A questionnaire on respiratory symptoms and smoking habits (MRC questionnaire) plus questions on the work history of each participant was completed, vital capacity (VC), forced expiratory volume in one second (FEV1.0), residual volume (RV) and fractional uptake of CO (FuCO) were measured at the first examination and repeated five and ten years later. At the end of the ten year follow-up, 522 subjects were re-examined, 186 were lost to follow-up, 328 answered a mail questionnaire, and 111 had died. The total number of deaths was not different from that of the general population, but for lung cancer the standardized mortality ratio (SMR) was significantly increased (SMR = 3.7). For the miners re-examined, frequency of bronchitis and decrease of functional tests were more related to age and smoking habits than to occupation.

Adult↗

[Skin sensitivity to respiratory allergens in agricultural workers and wage-earners].

Prick tests were performed with "pneumallergerns" (mites, cereal dusts, animal dander, pollens, moulds--totalling 35 allergens) among 742 agricultural workers of the Meuse department (North East of France) as part of an epidemiological study on respiratory and immuno-allergological problems. Among those with positive skin tests, 47.9% had positive skin tests for mites, 22.4% for cereal dusts, 10.7% for animals, 12.7% for pollens and 7.8% for moulds. Polysensitization was frequent (19.5% of the population). When the skin test was positive for main house dust mites it frequently was positive for storage mites, too. Among vegetal dusts sensitization, soy bean allergy yielded the highest frequency (6.5%). As for animal sensitization, cow dander was the most frequently observed positive test. Sensitization to pollens and moulds was comparatively rare. This study shows the large frequency and diversity of "latent allergy" to pneumallergens among agricultural workers.

Agriculture↗