| 1. |
- Bornelöv, Susanne, et al.
(författare)
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Rule-Based Models of the Interplay between Genetic and Environmental Factors in Childhood Allergy
- 2013
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 8:11, s. e80080-
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Tidskriftsartikel (refereegranskat)abstract
- Both genetic and environmental factors are important for the development of allergic diseases. However, a detailed understanding of how such factors act together is lacking. To elucidate the interplay between genetic and environmental factors in allergic diseases, we used a novel bioinformatics approach that combines feature selection and machine learning. In two materials, PARSIFAL (a European cross-sectional study of 3113 children) and BAMSE (a Swedish birth-cohort including 2033 children), genetic variants as well as environmental and lifestyle factors were evaluated for their contribution to allergic phenotypes. Monte Carlo feature selection and rule based models were used to identify and rank rules describing how combinations of genetic and environmental factors affect the risk of allergic diseases. Novel interactions between genes were suggested and replicated, such as between ORMDL3 and RORA, where certain genotype combinations gave odds ratios for current asthma of 2.1 (95% CI 1.2-3.6) and 3.2 (95% CI 2.0-5.0) in the BAMSE and PARSIFAL children, respectively. Several combinations of environmental factors appeared to be important for the development of allergic disease in children. For example, use of baby formula and antibiotics early in life was associated with an odds ratio of 7.4 (95% CI 4.5-12.0) of developing asthma. Furthermore, genetic variants together with environmental factors seemed to play a role for allergic diseases, such as the use of antibiotics early in life and COL29A1 variants for asthma, and farm living and NPSR1 variants for allergic eczema. Overall, combinations of environmental and life style factors appeared more frequently in the models than combinations solely involving genes. In conclusion, a new bioinformatics approach is described for analyzing complex data, including extensive genetic and environmental information. Interactions identified with this approach could provide useful hints for further in-depth studies of etiological mechanisms and may also strengthen the basis for risk assessment and prevention.
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| 2. |
- Covaciu, Corina, et al.
(författare)
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Childhood Allergies Affect Health-Related Quality of Life
- 2013
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Ingår i: Journal of Asthma. - : Informa UK Limited. - 0277-0903 .- 1532-4303. ; 50:5, s. 522-528
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Tidskriftsartikel (refereegranskat)abstract
- Objective. The majority of studies investigating the effects of allergy on the children's health-related quality of life (HRQoL) address one particular allergic disease, using a disease-specific HRQoL instrument. This work aims to assess the comparative impact on HRQoL of several allergic conditions of childhood (asthma, rhinitis, eczema, and food hypersensitivity) in a large, population-based sample of Swedish 8-year-olds. Methods. Data were obtained from a Swedish birth cohort (BAMSE). At the 8-year follow-up, parents of 3236 children completed the standardized generic HRQoL instrument EQ-5D and reported on the children's symptoms of asthma, rhinitis, eczema, and food hypersensitivity. Information on allergic sensitization and lung function was available for a sub-sample of the children (n = 2370 and 2425, respectively). Results. Children in the study population had a median EQ visual analog scale (VAS) of 98 (Inter Quartile Range, IQR, 90-100). The median EQ VAS was significantly lower in children with allergic diseases. Children with asthma had the lowest median EQ VAS (90, IQR 85-98) and reported the highest prevalence of problems of "pain or discomfort" (18.2%, compared to 5.5% in children without asthma). Frequent wheezing and effort-induced wheezing were associated with high prevalence of problems of "anxiety or depression" (23.3% and 15.4%, respectively). Conclusions. Swedish 8-year-olds enjoy a good HRQoL, which though is significantly impacted by allergic diseases and particularly by asthma. Asthma symptoms are important determinants of HRQoL and symptom control should be a major goal in asthma management.
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| 3. |
- Mooe, Thomas, et al.
(författare)
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The NAILED stroke risk factor trial (Nurse based Age independent Intervention to Limit Evolution of Disease after stroke) : study protocol for a randomized controlled trial
- 2013
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Ingår i: Trials. - : Springer Science and Business Media LLC. - 1745-6215. ; 14, s. 5-
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Tidskriftsartikel (refereegranskat)abstract
- Background: Secondary prevention after stroke and transient ischemic attack (TIA) is essential in order to reduce morbidity and mortality. Secondary stroke prevention studies have, however, been fairly small, or performed as clinical trials with non-representative patient selection. Long-term follow-up data is also limited. A nurse-led follow-up for risk factor improvement may be effective but the evidence is limited. The aims of this study are to perform an adequately sized, nurse-led, long-term secondary preventive follow-up with a population-based inclusion of stroke and TIA patients. The focus will be on blood pressure and lipid control as well as tobacco use and physical activity. Methods: A randomized, controlled, long-term, population-based trial with two parallel groups. The patients will be included during the initial hospital stay. Important outcome variables are sitting systolic and diastolic blood pressure, LDL cholesterol and total cholesterol. Outcomes will be measured after 12, 24 and 36 months of follow-up. Trained nurses will manage the intervention group with a focus on reaching set treatment goals as soon as possible. The control group will receive usual care. At least 200 patients will be included in each group, in order to reliably detect a difference in mean systolic blood pressure of 5 mmHg. This sample size is also adequate for detection of clinically meaningful group differences in the other outcomes. Discussion: This study will test the hypothesis that a nurse-led, long-term follow-up after stroke with a focus on reaching set treatment goals as soon as possible, is an effective secondary preventive method. If proven effective, this method could be implemented in general practice at a low cost.
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| 4. |
- Neuman, Åsa, et al.
(författare)
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Infant wheeze, comorbidities and school age asthma
- 2014
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Ingår i: Pediatric Allergy and Immunology. - : Wiley. - 0905-6157 .- 1399-3038. ; 25:4, s. 380-386
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Tidskriftsartikel (refereegranskat)abstract
- Background: Factors associated with early onset of wheeze have been described, but there is limited knowledge on which of these infant wheezers who will have developed asthma in school age. The aim was to identify clinical risk factors for asthma in the 8-yr-old children that wheezed during infancy in a population-based setting. Methods: Three thousand two hundred and fifty-one children from a population-based birth cohort followed prospectively from infancy until age 8 yr were included in the study. Data were analyzed using multivariate logistic regression analysis. Results: Parents reported any wheeze episode before age 2 yr in 823 subjects (25%). Infant wheezers had an almost fourfold risk of asthma at age 8 [adjusted odds ratio (aOR) 3.68, 95% CI 2.74-4.96], equivalent to an asthma prevalence of 14% compared with 4% among non-wheezers (p < 0.001). After adjustments for sex, exposure to tobacco smoke and indoor dampness/mould, allergic heredity (aOR 1.53, 95% CI 1.02-2.30), increased frequency of wheeze (aOR 3.41, 95% CI 2.09-5.56 for children with >= 3 episodes compared with <= 2 episodes during the first 2 yr of life), infant eczema (aOR 2.31, 95% CI 1.52-3.49), and recurrent abdominal pain (aOR 2.33, 95% CI 1.30-4.16) remained risk factors for school age asthma in the infant wheezing group. Conclusions: Among infant wheezers, allergic heredity, increased severity of wheeze, infant eczema, and recurrent abdominal pain were independent risk factors for asthma at age 8 yr. Among children with three or four of these risk factors, 38% had asthma at school age.
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| 5. |
- Neuman, Åsa, et al.
(författare)
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Maternal Smoking in Pregnancy and Asthma in Preschool Children A Pooled Analysis of Eight Birth Cohorts
- 2012
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Ingår i: American Journal of Respiratory and Critical Care Medicine. - 1073-449X .- 1535-4970. ; 186:10, s. 1037-1043
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Tidskriftsartikel (refereegranskat)abstract
- Rationale: Although epidemiological studies suggest that exposure to maternal smoking during fetal and early life increases the risk of childhood wheezing and asthma, previous studies were not able to differentiate the effects of prenatal from postnatal exposure. Objectives: To assess the effect of exposure to maternal smoking only during pregnancy on wheeze and asthma among preschool-age children. Methods: A pooled analysis was performed based on individual participant data from eight European birth cohorts. Cohort-specific effects of maternal smoking during pregnancy, but not during the first year, on wheeze and asthma at 4 to 6 years of age were estimated using logistic regression and then combined using a random effects model. Adjustments were made for sex, parental education, parental asthma, birth weight, and siblings. Measurements and Main Results: Among the 21,600 children included in the analysis, 735 children (3.4%) were exposed to maternal smoking exclusively during pregnancy but not in the first year after birth. In the pooled analysis, maternal smoking only during pregnancy was associated with wheeze and asthma at 4 to 6 years of age, with adjusted odds ratios of 1.39 (95% confidence interval, 1.08-1.77) and 1.65 (95% confidence interval, 1.18-2.31), respectively. The likelihood to develop wheeze and asthma increased statistically significantly in a linear dose-dependent manner in relation to maternal daily cigarette consumption during the first trimester of pregnancy. Conclusions: Maternal smoking during pregnancy appears to increase the risk of wheeze and asthma among children who are not exposed to maternal smoking after birth.
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| 6. |
- Thacher, Jesse D., et al.
(författare)
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Pre- and Postnatal Exposure to Parental Smoking and Allergic Disease Through Adolescence
- 2014
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Ingår i: Pediatrics. - : American Academy of Pediatrics (AAP). - 0031-4005 .- 1098-4275. ; 134:3, s. 428-434
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To examine the role of prenatal and postnatal second-hand tobacco smoke (SHS) exposure on asthma, rhinitis, and eczema development up to 16 years of age. METHODS: A birth cohort of 4089 children was followed for 16 years. Information on parental smoking habits, lifestyle factors, and symptoms of allergic disease was gathered using repeated parental questionnaires. Generalized estimating equations assessed the overall and age-specific associations between SHS exposure and allergic disease at ages 1 to 16 years. RESULTS: Exposure to SHS in utero was associated with an overall elevated risk of developing asthma up to 16 years (odds ratio [OR] = 1.45; 95% confidence interval [CI], 1.15-1.83) but not for rhinitis or eczema. After additional adjustment for parental smoking throughout childhood, excess overall risks for asthma remained statistically significant. Moreover, a dose-dependent pattern with SHS was observed. Exposure to SHS during infancy was associated with an overall elevated risk of asthma (OR = 1.23; 95% CI, 1.01-1.51), rhinitis (OR = 1.18; 95% CI, 1.01-1.39), and eczema (OR = 1.26; 95% CI, 1.09-1.45) up to 16 years. When age-specific associations were examined, the elevated risks related to SHS exposure in utero or during infancy were mostly confined to early childhood for asthma and rhinitis, whereas the excess risk of eczema appeared greatest at later ages. CONCLUSIONS: Our findings indicate that early SHS exposure, in utero or during infancy, influences the development of allergic disease up to adolescence. Excess risks for asthma and rhinitis were seen primarily in early childhood, whereas those for eczema occurred at later ages.
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