Recurrent reactions to food among children at paediatric emergency departments: epidemiology of allergic disease

BACKGROUND

Knowledge about repeated food reactions in paediatric emergency departments (ED) is sparse.

OBJECTIVE

To investigate the incidence and potential risk factors for repeated ED visits for food-allergic reactions among children with a prior ED visit due to reactions to food.

METHODS

A total of 358 children with ED visits at paediatric hospitals in Stockholm due to reactions to foods during 2007 (index-reaction) were investigated in relation to recurrent reactions until 30 June 2010. Adjusted Cox proportional hazard models were used to compute relative risks (RR) and 95% confidence intervals (CI).

RESULTS

A total of 80 children had 116 ED revisits over a period of 873 patient-years, yielding an incidence rate of 9 per 100 patient-years. Known food allergy before the index ED visit in 2007 increased the risk for ED revisits (RR = 2.30, 95% CI 1.35-3.94). Likewise, prescription of adrenaline auto-injector before the index-reaction increased the risk (RR = 2.02, 95% CI 1.17-3.49). Twenty-one percent of the children had more severe reactions at the revisit, 38% less severe and 41% had reactions of comparable severity. However, among 44% of the children with comparable or less severe reaction at revisit, early treatment with adrenaline hampered the classification of change in severity.

CONCLUSIONS AND CLINICAL RELEVANCE

Previously known food allergy and prior prescription of adrenaline are significant risk factors for ED revisits among children with a prior ED visit due to reactions to food. Our results indicate that the severity of the index-reaction cannot be used to predict the severity of the relapse.

The effect of two endogenous retinoids on the mRNA expression profile in human primary keratinocytes, focusing on genes causing autosomal recessive congenital ichthyosis

Retinoids (natural forms and synthetic derivatives of vitamin A) are used as therapeutic agents for numerous skin diseases such as keratinization disorders (e.g. ichthyoses) and psoriasis. Two endogenous ligands for retinoic acid receptors exist, retinoic acid (atRA) and 3,4-didehydroretinoic acid (ddRA). In primary human epidermal keratinocytes many transcriptional targets for atRA are known, whereas the targets for ddRA are unknown. In an attempt to determine the targets, we compared the effect of atRA and ddRA on transcriptional profiles in undifferentiated and differentiating human primary keratinocytes. First, as expected, many genes were induced or suppressed in response to keratinocyte differentiation. Furthermore, the two retinoids affected substantially more genes in differentiated keratinocytes (>350) than in proliferating keratinocytes (≈20). In differentiating keratinocytes markers of cornification were suppressed suggesting a de-differentiating effect by the two retinoids. When comparing the expression profile of atRA to that of ddRA, no differently regulated genes were found. The array analysis also found that a minor number of miRNAs and a large number of non-coding transcripts were changed during differentiation and in response to the two retinoids. Furthermore, the expression of all, except one, genes known to cause autosomal recessive congenital ichthyosis (ARCI) were found to be induced by differentiation. These results comprehensively document that atRA and ddRA exert similar transcriptional changes in keratinocytes and also add new insights into the molecular mechanism influenced by retinoids in the epidermis. Furthermore, it suggests which ARCI patients could benefit from therapy with retinoids.

Use of antibiotics in infancy and childhood and risk of recurrent abdominal pain--a Swedish birth cohort study

BACKGROUND

The etiology of recurrent abdominal pain of functional origin (AP) is largely unknown. Antibiotic treatment influences the intestinal microbiota, and a few studies have indicated an increased risk of AP in adults after antibiotic treatment. Corresponding data in children are lacking. The aim of this study was to explore the association between antibiotic treatment during childhood and AP at 12 years.

METHODS

Two thousand seven hundred and thirty-two children from a Swedish, population-based birth cohort. Parents reported antibiotic use for the children between birth and 2 years. Antibiotic use between 9 and 12 years was collected from the Swedish Prescribed Drug Register. The children answered questionnaires regarding AP at age 12. We used logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for AP at 12 years as a function of antibiotic use.

KEY RESULTS

Antibiotic treatment between 9 and 12 years was not associated with AP at 12. Children who had received ≥3 courses, or broad-spectrum antibiotics between 9 and 12 years had an increased risk of AP at 12, but these associations failed to reach statistical significance. Antibiotic treatment during both the first and the second year of life increased the risk of AP in girls at 12 (OR 1.65; 95% CI: 1.09-2.49), but not in boys or the whole cohort.

CONCLUSIONS & INFERENCES

Antibiotic treatment does not seem to be a major risk factor for AP at 12 years. However, we cannot exclude that repeated courses, especially to infant girls, or use of broad-spectrum antibiotics between 9 and 12 years may be associated with an increased risk of AP.

The link between parental allergy and offspring allergic and nonallergic rhinitis

BACKGROUND

Parental allergy-related disease increases the risk for rhinitis, but it remains unknown how different phenotypes of parental allergy affect this risk. The aim of this study was to investigate how parental hay fever, asthma, and eczema affect the risk of allergic rhinitis (AR) and nonallergic rhinitis (NAR) at 8 years of age.

METHODS

Information on 2413 children from a population-based birth cohort was used combining questionnaire data and IgE to inhalant allergens. Logistic regression was used to estimate the association between parental allergy-related disease and AR and NAR. In addition, cluster analysis was used to search for latent phenotypes of heredity likely to be associated with AR and NAR.

RESULTS

At age 8 years, 13.8% of the children had AR, while 6.4% had NAR. Parental isolated hay fever increased the odds of AR (OR 2.2, 95% CI 1.6-3.2), whereas isolated asthma or eczema did not. The odds of NAR increased when one parent had two or more allergy-related diseases. In the cluster analysis, the highest proportion of AR, 37.5%, was seen in a cluster where both parents had hay fever and pollen allergy and that of NAR, 11.0%, in a cluster where one parent had hay fever, pollen allergy, and eczema.

CONCLUSIONS

Parental allergy-related disease may be an important risk factor for NAR as well as AR, and the risk is comparable for maternal and paternal allergy. Parental hay fever seems to be the dominating hereditary risk factor for AR.

Genome-wide association study of body mass index in 23 000 individuals with and without asthma

BACKGROUND

Both asthma and obesity are complex disorders that are influenced by environmental and genetic factors. Shared genetic factors between asthma and obesity have been proposed to partly explain epidemiological findings of co-morbidity between these conditions.

OBJECTIVE

To identify genetic variants that are associated with body mass index (BMI) in asthmatic children and adults, and to evaluate if there are differences between the genetics of BMI in asthmatics and healthy individuals.

METHODS

In total, 19 studies contributed with genome-wide analysis study (GWAS) data from more than 23 000 individuals with predominantly European descent, of whom 8165 are asthmatics.

RESULTS

We report associations between several DENND1B variants (P = 2.2 × 10(-7) for rs4915551) on chromosome 1q31 and BMI from a meta-analysis of GWAS data using 2691 asthmatic children (screening data). The top DENND1B single nucleotide polymorphisms(SNPs) were next evaluated in seven independent replication data sets comprising 2014 asthmatics, and rs4915551 was nominally replicated (P < 0.05) in two of the seven studies and of borderline significance in one (P = 0.059). However, strong evidence of effect heterogeneity was observed and overall, the association between rs4915551 and BMI was not significant in the total replication data set, P = 0.71. Using a random effects model, BMI was overall estimated to increase by 0.30 kg/m(2) (P = 0.01 for combined screening and replication data sets, N = 4705) per additional G allele of this DENND1BSNP. FTO was confirmed as an important gene for adult and childhood BMI regardless of asthma status.

CONCLUSIONS AND CLINICAL RELEVANCE

DENND1B was recently identified as an asthma susceptibility gene in a GWAS on children, and here, we find evidence that DENND1B variants may also be associated with BMI in asthmatic children. However, the association was overall not replicated in the independent data sets and the heterogeneous effect of DENND1B points to complex associations with the studied diseases that deserve further study.

Antioxidant intake and allergic disease in children

BACKGROUND

Antioxidant intake may reduce the risk of allergic disease by protecting against oxidative tissue damage. Major sources of antioxidants in the Western world are fruits, vegetables (vitamin C, β-carotene, α-tocopherol), meat and milk (selenium, magnesium, zinc). Children may exclude or eat less of some fruits and vegetables due to cross-reactivity between pollen and these foods, complicating assessment of causal relationships.

OBJECTIVE

To investigate the association between dietary antioxidant intake and allergic disease, taking potential reverse causation into account.

METHODS

Data on 2442 8-year-old children from the Swedish birth cohort study BAMSE were analysed. Children with completed parental questionnaires on exposures and health, including a food-frequency questionnaire and who provided a blood sample were included. Associations between antioxidant intake during the past year and current allergic disease were analysed using logistic regression.

RESULTS

An inverse association was observed between intake of β-carotene and rhinitis (OR(adj), highest vs. lowest quartile, 0.67, 95% CI 0.49-0.93). Magnesium intake was inversely related to asthma (OR(adj), 0.65, 95% CI 0.42-1.00) and atopic sensitisation (OR(adj), 0.78, 95% CI 0.61-1.00). Following exclusion of children who avoided certain fruits, vegetables or milk due to allergic symptoms (n = 285), the inverse association remained between magnesium intake and asthma (OR(adj), 0.58, 95% CI 0.35-0.98), whereas all other associations became non-significant.

CONCLUSION AND CLINICAL RELEVANCE

Diet modifications due to allergy may affect the antioxidant intake and needs to be considered when investigating the relationship between diet and allergic disease. Magnesium intake seems to have a protective effect on childhood asthma.

Glutathione-S-transferase P1, early exposure to mould in relation to respiratory and allergic health outcomes in children from six birth cohorts. A meta-analysis

BACKGROUND

There are conflicting study results regarding the association of exposure to visible mould and fungal components in house dust with respiratory and allergic diseases in children. It has been suggested that functional polymorphisms of the GSTP1 gene may influence the risk for allergic disorders through an impaired defence against oxidant injury.

METHODS

We examined in six birth cohorts of over 14 000 children whether the association between early exposure to reported mould at home in relation to respiratory and allergic diseases is modified by a single nucleotide polymorphism of the GSTP1 gene.

RESULTS

We observed a positive association of mould exposure with nasal symptoms (2-10 year) aOR: 1.19 (1.02-11.38). Further, there was a borderline significant increased risk of rhinoconjunctivitis (6-8 year) in children homozygous for the minor allele Val/Val, aOR: 1.25 (0.98-1.60). In stratified analyses, subjects homozygous for the minor allele and exposed to mould at home were at increased risk for early wheezing aOR: 1.34 (1.03-1.75), whereas the major allele may confer susceptibility for later nasal outcomes, (6-8 year) aOR: 1.20 (1.00-1.45) and (2-10 year) aOR: 1.30 (1.04-1.61), respectively. For none of the health outcomes studied, we found gene by environment interactions.

CONCLUSION

A genetic influence of the GSTP1 gene cannot be ruled out, but the magnitude of the effect is a matter of further research. In conclusion, the interplay between gene and environments is complex and remains subject of further study.

Transplantation of human embryonic retina to adult rat retina

Human embryonic retinas (postconceptional age 3-10 weeks) with or without retinal pigment epithelium were grafted to the retina of immuno-suppressed adult rat hosts. The development of the xenografts was followed up to 37 weeks of total age by histology and by immunohistochemistry for S-antigen. The donor tissue became rearranged in folded sheets with rosettes. The grafts developed approximately according to their intrinsic timetable, but with a developmental delay in the later stages. Occasionally, the grafts were well fused with the host retina. At 13 weeks of total age, the grafts contained areas of inner plexiform layer with presumptive ganglion cells, one neuroblastic layer, and cone precursor cells around rosettes. At 19 weeks, an outer plexiform layer and inner segments of the cones started to form. At 20 weeks, the first immunoreactivity for S-antigen was observed in photoreceptor precursors. Cone inner segments were clearly distinguishable at 28 weeks, and more S-antigen-positive rods were seen. At 31 weeks, rods were more differentiated, showing S-antigen-positive inner and outer segments. An inner limiting membrane with an apparent ganglion cell layer was only seen in one cograft of retina and retinal pigment epithelium at 37 weeks, indicating an important role of retinal pigment epithelium for graft differentiation. This study shows that human embryonic retina can be grafted to immuno-suppressed adult rat retina with long-term survival. A high degree of maturation can be obtained in the grafted tissue comparable to the layering of newborn human retina. It appears that most cell types develop. This model opens up possibilities for studying human retinal development with the goal of reaching a treatment for human degenerative retinal disorders.

Development and comorbidity of eczema, asthma and rhinitis to age 12: data from the BAMSE birth cohort

BACKGROUND

Allergy-related diseases are a public health issue, but knowledge on development and comorbidity among children is scarce. The aim was to study the development of eczema, asthma and rhinitis in relation to sex and parental allergy, in a population-based cohort, during childhood.

METHODS

At 1, 2, 4, 8 and 12 years, parental questionnaires were used to obtain data on allergy-related diseases. Complete data for all five follow-up occasions were available from 2916 children. Odds ratios for the risk of any allergy-related disease in relation to heredity and sex were calculated using generalized estimating equations.

RESULTS

At 12 years, 58% of the children had had eczema, asthma and/or rhinitis at some time. Disease turnover was high for all three diseases throughout the study. Comorbidity increased with age, and at 12 years, 7.5% of all the children were affected by at least two allergy-related diseases. Parental allergy was associated with increased comorbidity and more persistent disease and increased the risk of having any allergy-related disease (adjusted OR 1.76; 95% CI 1.57-1.97) up to 12 years. Male sex was associated with an increased risk throughout childhood. Boys and girls did not differ in disease persistence, and for comorbidity, the differences were minor.

CONCLUSIONS

Allergy-related diseases may affect a majority of children. Eczema, asthma and rhinitis develop dynamically throughout childhood, and allergic comorbidity is common. These findings indicate that allergy-related diseases should be neither seen nor studied as isolated entities.

Meta-analysis of mould and dampness exposure on asthma and allergy in eight European birth cohorts: an ENRIECO initiative

BACKGROUND

Several cross-sectional studies during the past 10 years have observed an increased risk of allergic outcomes for children living in damp or mouldy environments.

OBJECTIVE

The objective of this study was to investigate whether reported mould or dampness exposure in early life is associated with the development of allergic disorders in children from eight European birth cohorts.

METHODS

We analysed data from 31 742 children from eight ongoing European birth cohorts. Exposure to mould and allergic health outcomes were assessed by parental questionnaires at different time points. Meta-analyses with fixed- and random-effect models were applied. The number of the studies included in each analysis varied based on the outcome data available for each cohort.

RESULTS

Exposure to visible mould and/or dampness during first 2 years of life was associated with an increased risk of developing asthma: there was a significant association with early asthma symptoms in meta-analyses of four cohorts [0-2 years: adjusted odds ratios (aOR), 1.39 (95% CI, 1.05-1.84)] and with asthma later in childhood in six cohorts [6-8 years: aOR, 1.09 (95% CI, 0.90-1.32) and 3-10 years: aOR, 1.10 (95% CI, 0.90-1.34)]. A statistically significant association was observed in six cohorts with symptoms of allergic rhinitis at school age [6-8 years: aOR, 1.12 (1.02-1.23)] and at any time point between 3 and 10 years [aOR, 1.18 (1.09-1.28)].

CONCLUSION

These findings suggest that a mouldy home environment in early life is associated with an increased risk of asthma particularly in young children and allergic rhinitis symptoms in school-age children.

Analysis of the intestinal microbiota of oligosaccharide fed mice exhibiting reduced resistance to Salmonella infection

Certain indigestible carbohydrates, known as prebiotics, are claimed to be beneficial for gut health through a selective stimulation of certain gut microbes including bifidobacteria. However, stimulation of such microbes does not necessarily imply a preventive effect against pathogen infection. We recently demonstrated a reduced resistance to Salmonella infection in mice fed diets containing fructo-oligosaccharides (FOS) or xylo-oligosaccharides (XOS). In the present study, faecal and caecal samples from the same mice were analysed in order to study microbial changes potentially explaining the observed effects on the pathogenesis of Salmonella. Denaturing gradient gel electrophoresis revealed that the microbiota in faecal samples from mice fed FOS or XOS were different from faecal samples collected before the feeding trial as well as from faecal profiles generated from control animals. This difference was not seen for caecal profiles. Further analysis of faecal samples by real-time PCR demonstrated a significant increase in the Bacteroidetes phylum, the Bacteroides fragilis group and in Bifidobacterium spp. in mice fed FOS or XOS. The observed bifidogenic effect was more pronounced for XOS than for FOS. The Firmicutes phylum and the Clostridium coccoides group were reduced by both FOS and XOS. Surprisingly, no significant differences were detected between faecal samples collected before and after pathogen challenge in any of the groups. Furthermore, no effect of diets on caecal concentrations of short-chain fatty acids was recorded. In conclusion, diets supplemented with FOS or XOS induced a number of microbial changes in the faecal microbiota of mice. The observed effects of XOS were qualitatively similar to those of FOS, but the most prominent bifidogenic effect was seen for XOS. An increased level of bifidobacteria is thus not in itself preventive against Salmonella infection, since the same XOS or FOS-fed mice were previously reported to be more severely affected by Salmonella than control animals.

Antibiotic use in early life and development of allergic diseases: respiratory infection as the explanation

BACKGROUND

Early antibiotic use has been postulated to increase the development of allergic disease. Antibiotic use results from infection. Early infection may play a confounding role in the relationship between antibiotic use and allergic disease.

OBJECTIVE

We aimed to investigate the relationship between antibiotic use during the first year of life and the development of allergic diseases in a birth cohort study, and also to carefully address the confounding effect of early respiratory infection.

METHODS

Three thousand three hundred and six children were included in this study who participated in investigations at all occasions of 2 months, 1, 4 and 8 years of age. Data on antibiotic use and respiratory infections were collected at the age of 1 year. Diagnoses of allergic diseases at 4 and 8 years of age were derived from the follow-up questionnaires.

RESULTS

During the first year of life, 43% (n=1420) of the children received antibiotics and 32% (n=1046) of the children had at least one type of respiratory infection among pneumonia, bronchitis and otitis. In univariate logistic regression analysis and after adjustment for early life factors, antibiotic use during the first year of life was associated with wheeze, asthma, eczema and food hypersensitivity at 4 years of age. After adjustment for the above respiratory infections during the first year of life, only the associations with wheeze and asthma at age 4 years remained statistically significant. These associations became non-significant in a subgroup analysis in children without early allergic signs. At age 8 years, antibiotic use during the first year of life was significantly associated with wheeze and eczema after adjustment for early life factors. The significant associations at age 8 years faded away following further adjustment for the respiratory infections.

CONCLUSION

Our study indicated that the association between early antibiotic use and later allergic disease could at least partially be explained by early respiratory infection.

Hormonal concentrations in bitches with primary uterine inertia

Normal labor is accompanied by sequential changes in blood concentrations of prostaglandin F2alpha (measured as 15-ketodihydro-PGF2 alpha=PGFM), progesterone, estradiol, oxytocin, vasopressin, and of elevated cortisol levels. The aim of this study was to investigate hormone concentrations in dogs diagnosed with primary uterine inertia before and during treatment by cesarean section. The hypothesis was the dogs would have abnormally low plasma concentrations in one or several of the hormones involved in parturition. The study comprised seven bitches with total primary uterine inertia (dystocia group) treated with cesarean section and six healthy bitches (control group) subjected to planned cesarean section. Blood samples were taken before anesthesia, before surgery started, on delivery of the first puppy and on delivery of the last puppy. The progesterone:PGFM ratio in plasma was higher in the dystocia group than in the control group, but the serum estradiol concentration did not differ between groups. The plasma concentrations of oxytocin and vasopressin increased in both groups when the first puppies were delivered, but both hormones were more elevated in the control group than in the dystocia group on delivery of the last puppies. The plasma cortisol concentration increased to the same level in both groups. In conclusion, the ratio between progesterone and PGFM was higher and the oxytocin and vasopressin concentrations lower in the dystocia dogs than in the control dogs. The findings indicate that these hormones are involved in the pathophysiology of total primary uterine inertia in bitches.

Gestational diabetes mellitus in 13 dogs

BACKGROUND

There are few reports on the clinical appearance, prognosis, and risk factors for gestational diabetes mellitus (GDM) in dogs.

OBJECTIVE

To describe the clinical characteristics of GDM in dogs.

ANIMALS

Thirteen dogs with GDM.

METHODS

Retrospective study. Medical records were reviewed and owners and referring veterinarians were contacted for follow-up information.

RESULTS

Nordic Spitz breeds (11/13 dogs) were overrepresented in the case material. Diagnosis was established at a median of 50 days after mating (range, 32-64). Median glucose concentration at diagnosis was 340 mg/dL (18.9 mmol/L) (range, 203-587). One dog was euthanized at diagnosis, 5 bitches were treated with insulin until whelping, and in 7 dogs, pregnancy was terminated within 4 days of diagnosis. One dog died after surgery. Tight glycemic control was not achieved in any of the insulin-treated dogs during pregnancy. Diabetes mellitus (DM) resolved in 7 dogs at a median of 9 days after the end of their pregnancies and DM was permanent in 4 dogs. Puppy mortality was increased compared with offspring of healthy dams.

CONCLUSION

This report suggests that GDM affects mainly middle-aged bitches in the 2nd half of pregnancy with a breed predisposition toward Nordic Spitz breeds. GDM may resolve within days to weeks after pregnancy has ended. Further research is needed to investigate optimal treatment regimens for dogs with GDM and risk factors for unsuccessful outcome.

The protective effect of farm animal exposure on childhood allergy is modified by NPSR1 polymorphisms

BACKGROUND

Little is known about the asthma candidate gene neuropeptide S receptor 1 (NPSR1) in relation to environmental exposures, but recent evidences suggest its role as an effect modifier.

OBJECTIVES

To explore the interaction between NPSR1 polymorphisms and environmental exposures related to farming lifestyle and to study the in vitro effects of lipopolysaccharide (LPS) stimulation on NPSR1 expression levels.

METHODS

We studied 3113 children from PARSIFAL, a European cross-sectional study on environmental/lifestyle factors and childhood allergy, partly focused on children brought up on a farm. Information on exposures and outcomes was primarily obtained from parental questionnaires. Seven tagging polymorphisms were analysed in a conserved haplotype block of NPSR1. Multivariate logistic regression was used to evaluate a multiplicative model of interaction. NPSR1 protein and messenger RNA (mRNA) levels in monocytes were measured after LPS stimulation by fluorescence activated cell sorting (FACS) and quantitative real-time polymerase chain reaction (PCR).

RESULTS

A strong interaction was seen between current regular contact to farm animals and several NPSR1 polymorphisms, particularly rs323922 and rs324377 (p<0.005), with respect to allergic symptoms. Considering the timing of initiation of such current regular farm animal contact, significant interactions with these and two additional polymorphisms (SNP546333, rs740347) were revealed. In response to LPS, NPSR1-A protein levels in monocytes were upregulated (p = 0.002), as were NPSR1-A mRNA levels (p = 0.02).

CONCLUSIONS

The effect of farm animal contact on the development of allergic symptoms in children is modified by NPSR1 genetic background.

Molecular pathways associated with stress resilience and drug resistance in the chronic mild stress rat model of depression: a gene expression study

The current antidepressant drugs are ineffective in 30 to 40% of the treated patients; hence, the pathophysiology of the disease needs to be further elucidated. We used the chronic mild stress (CMS) paradigm to induce anhedonia, a core symptom of major depression, in rats. A fraction of the animals exposed to CMS is resistant to the development of anhedonia; they are CMS resilient. In the CMS-sensitive animals, the induced anhedonic state is reversed in 50% of the animals when treating with escitalopram, whereas the remaining animals are treatment resistant. We used the microarray and the real-time quantitative reverse transcription polymerase chain reaction technique, as well as the ingenuity pathway analysis software to identify the differential gene expression pathways, which are associated with the occurrence of the treatment resistance and the stress-resilient rats. In the hippocampus, we found a significant upregulation of apoptotic pathways in the treatment-resistant animals and significantly increased expression levels of genes involved in hippocampal signaling in the CMS-resilient rats. We hypothesize that sensitivity to the stress-induced anhedonia in rats is correlated with the impairment of hippocampal neurogenesis.

Stress sensitivity and resilience in the chronic mild stress rat model of depression; an in situ hybridization study

We used the validated chronic mild stress (CMS) paradigm to induce anhedonia, a core symptom of major depression, in rats. Thirty percent of animals exposed to CMS are resistant to the development of anhedonia, whereas the remaining are responsive, CMS resilient and CMS sensitive, respectively. We used in situ hybridization to elucidate the molecular mechanisms, which may be involved in the development of anhedonia during CMS. In the CA3 of the ventral hippocampus, we found upregulation of brain-derived neurotrophic factor (BDNF) mRNA in the CMS resilient group indicating protective role of BDNF in stress. Moreover, in the CA3 we found downregulation of vascular endothelial growth factor (VEGF) mRNA in the CMS sensitive group. Downregulation of VEGF suggests impaired hippocampal function, caused by loss of trophic factor neuroprotective support, as part of a previously uncharacterized mechanism for development of anhedonia. CMS induced anhedonia was not related to mRNA expression differences of the dopamine receptors D(1) and D(2), enkephalin, dynorphin, the NMDA receptor subtype NR2B in the ventral striatum, BDNF expression in the dentate gyrus, nor corticotrophin releasing hormone (CRH) and arginine vasopressin (AVP) in the paraventricular nucleus of the hypothalamus. In particular, HPA axis seems to be activated in the CMS resilient group suggesting other pathways protecting against stress sensitivity. We applied the restraint stress procedure to compare effects of a faster and simpler form of stress to CMS and found the latter to be more valid as rats probably easier adapt to restraint stress. Finally, we used the conditioned place preference model to demonstrate a clear tendency towards a distinct morphine induced behavioral difference between CMS resilient and CMS sensitive animals.

Alcoholic beverages and risk of renal cell cancer

Using a mailed questionnaire, we investigated the risk of renal cell cancer in relation to different types of alcoholic beverages, and to total ethanol in a large population-based case–control study among Swedish adults, including 855 cases and 1204 controls. Compared to non-drinkers, a total ethanol intake of >620 g month⁻¹ was significantly related to a decreased risk of renal cell cancer (odds ratio (OR) 0.6, 95% confidence interval (CI) 0.4–0.9; P-value for trend=0.03). The risk decreased 30–40% with drinking more than two glasses per week of red wine (OR 0.6, 95% CI 0.4–0.9), white wine (OR 0.7, 95% CI 0.4–1.0), or strong beer (OR 0.6, 95% CI 0.4–1.0); there was a clear linear trend of decreasing risk with increasing consumption of these beverages (P-values for trends <0.05).

Immediate maternal thermal response to skin-to-skin care of newborn

AIM

To elucidate the immediate maternal thermal skin response when placing the neonate on the mothers' chest, skin-to-skin (STS).

METHODS

Ugandan mothers with non-asphyxiated newborns after vaginal delivery (n = 39) were studied. Maternal skin and axillary temperatures were measured immediately before STS contact, then every 2 min for 20 min and finally 10 min after removing the neonate. Neonatal axillary/forehead temperatures were measured immediately before STS contact, and twice after initiating STS, followed by a measurement 10 min after the newborn had been removed.

RESULTS

A rapid thermal response was demonstrated in maternal breast skin immediately after STS contact. It rose by 0.5 degrees C (p < 0.0001) on average the first 2 min after STS contact and fell by 0.5 degrees C 10 min after we had removed the neonate (p < 0.0001). Maternal axillary temperature also rose 2 min after initiation of STS (p < 0.0001) but stayed constant 10 min after removal of the newborn from the STS position.

CONCLUSION

The findings indicate that there is a rapid maternal, thermal response to the positioning of the newborn STS. The tactile contact may elicit a maternal adaptation enhancing the warming of the newborn. Possible mechanisms include maternal autonomic nerve-mediated skin vasodilatation.