Men who have sex with men: estimating the size of at-risk populations in London primary care trusts

The objective of this study was to estimate local at-risk populations of men who have sex with men (MSM) in London primary care trusts (PCTs) to inform the commissioning of targeted health interventions. Estimated population size and prevalence of diagnosed HIV in MSM in all of London were calculated using data from the British National Survey of Sexual Attitudes and Lifestyles (NATSAL), Greater London Authority population estimates and the annual survey of diagnosed MSM (Survey of Prevalent HIV Infections Diagnosed [SOPHID]). Estimated MSM population sizes at the PCT level were calculated using un-weighted and SOPHID-weighted methods and methods discussed. Four-fifths of MSM with diagnosed HIV infection in Greater London lived in inner London. Estimated population size of MSM 16-44 years in inner London was 66,000; estimated overall prevalence of diagnosed HIV infection among MSM was 9.5%. Our models show substantial variation at the PCT level between the two methods. Using the SOPHID-weighted method MSM account for up to 16% of the male population in some London PCTs, compared with as low as 3% in others. We provide a novel method of estimating at-risk MSM populations living in inner London PCTs indicating that proportions of MSM vary widely between PCTs. Significant proportions of MSM among the resident populations in several PCTs warrant inclusion of MSM health needs in core PCT prevention and service programming. In light of data source limitations further validation studies are needed.

Quality of life in patients with advanced gastroesophageal (GE) adenocarcinoma treated with modified docetaxel, cisplatin, and fluorouracil (mDCF)

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Background: Although DCF is a standard first line chemotherapy option for advanced GE adenocarcinoma, the regimen is associated with significant toxicity. Even so, time to detriment in quality of life (QoL) was significantly better with parent DCF than CF (Ajani, JCO 2007). Modified DCF (mDCF) has demonstrated less toxicity than parent DCF without compromising efficacy in two phase II studies (Shah, GI ASCO 2010; Kelsen, ASCO 2009). We report the quality of life (QoL) over time of patients receiving mDCF on these two clinical trials.

Methods: Patients (pts) treated on two protocols utilizing the mDCF regimen, either alone or in combination with bevacizumab, were administered standard EORTC QoL questionnaires (QLC –C30 version 3), at baseline, 6 weeks, 3, 6, 9 and 12 months (m). Chemotherapy and QoL assessment continued until disease progression. Mean score change from baseline was assessed using Wilcoxon test.

Results: 94 eligible pts have been enrolled on both studies; QoL questionnaires are available on 87 pts. 74% are male, median age 58 years (range 28-78), with baseline Karnofsky performance status of 80% (range 70-100). Patient compliance with QoL assessment was high at baseline but diminished with time; 89% of pts completed the questionnaire at baseline and 41% at 12m. There was no significant detriment in EORTC QOL scores (including global health, physical and social functioning and fatigue) during treatment with mDCF (Table).

Conclusions: In patients with advanced GE cancer, we observed no detriment in QoL scores in patients receiving mDCF therapy. Specifically, physical and social functioning, fatigue, appetite, and global heath QoL scores were maintained at baseline levels during the first 6 months of therapy, and appear to improve in patients who remained on protocol therapy during the next 6 months of treatment.

[Table: see text]

No significant financial relationships to disclose.

Smoking status and immunoglobulin E seropositivity to workplace allergens

BACKGROUND

Detection of serum-specific immunoglobulin E (IgE) can be helpful in the diagnosis of work-related allergic conditions. There have been conflicting reports regarding any association between smoking and specific IgE levels.

AIMS

To establish whether a relationship exists between smoking status and the outcome of specific IgE tests to workplace allergens.

METHODS

The Health and Safety Laboratory provides test services for workplace allergens and the request form used collects data on smoking status. Laboratory results of 695 subjects who had undergone specific IgE tests were examined by information on smoking.

RESULTS

Smokers were more likely than non-smokers to have positive specific IgE tests (P < 0.05). Smoking was the only independent predictor of a positive specific IgE test in logistic regression, with odds ratio of 2.39 (95% confidence interval 1.01-5.65, P < 0.05) for IgE seropositivity. Allergen subgroups also showed a positive association with smoking and in particular for high molecular weight allergens.

CONCLUSIONS

Being a current smoker is a risk factor for sensitization to workplace allergens especially for those of high molecular weight. Workplace well-being activities may make use of such information for smoking cessation programmes and emphasizing the importance of allergen exposure control. Collaboration between testing laboratories may provide useful datasets for further analysis.

How is the risk of undernutrition associated with cardiovascular disease among individuals of advanced age?

BACKGROUND

The oldest old (85+) are the fastest growing population segment in New Zealand. Cardiovascular disease (CVD) is the main cause of death and is associated with various risk factors including risk of undernutrition.

OBJECTIVES

To determine if there is an association between CVD and nutrition risk in advanced age.

SETTING

Three North Island locations (rural and urban areas) in New Zealand.

PARTICIPANTS

108 participants aged 85 years (75-79 for Maori).

MEASUREMENTS

Comprehensive health assessments were undertaken. Clinically manifest CVD was pre-defined and ascertained from interviews and hospitalisation records. Nutrition risk was assessed using a validated questionnaire-Seniors in the Community: Risk evaluation for eating and nutrition, Version II (SCREEN II).

RESULTS

72 participants (67%) had CVD (49% men); 52% of participants had a SCREEN II score < 50. Those with CVD had lower HDL level [median(IQR)] [1.4(0.7) vs. 1.6(0.6)] (p=0.041), and higher waist circumference [97.5(19.1) vs. 89.3(20.6)] (p=0.043) compared to those without CVD. Those with CVD were at no greater nutrition risk than those without CVD (SCREEN II score: [49(7) vs. 51(10)] (p=0.365). Using logistic regression controlling for confounders, SCREEN II scores trended towards an inverse association with CVD (p=0.10).

CONCLUSION

Two thirds of the study participants had CVD and half were at risk of undernutrition. Nutrition risk was mildly associated with CVD. This study provides further evidence that those in advanced age are at risk of undernutrition. Further research is needed to establish how the causes and consequences of CVD are related to nutrition risk.

Interaction between anandamide and sphingosine-1-phosphate in mediating vasorelaxation in rat coronary artery

BACKGROUND AND PURPOSE

Anandamide and sphingosine-1-phosphate (S1P) both regulate vascular tone in a variety of vessels. This study aimed to examine the mechanisms involved in the regulation of coronary vascular tone by anandamide and S1P, and to determine whether any functional interaction occurs between these receptor systems.

EXPERIMENTAL APPROACH

Mechanisms used by anandamide and S1P to regulate rat coronary artery (CA) reactivity were investigated using wire myography. Interactions between S1P and the cannabinoid (CB)(2) receptor were determined using human embryonic kidney 293 (HEK293) cells that stably over-express recombinant CB(2) receptor.

KEY RESULTS

Anandamide and S1P induced relaxation of the rat CA. CB(2) receptor antagonists attenuated anandamide-induced relaxation, while S1P-mediated relaxation was dependent on the vascular endothelium and S1P(3). Anandamide treatment resulted in an increase in the phosphorylation of sphingosine kinase-1 within the CA. Conversely, anandamide-mediated relaxation was attenuated by inhibition of sphingosine kinase. Moreover, S1P(3), specifically within the vascular endothelium, was required for anandamide-mediated vasorelaxation. In addition to this, S1P-mediated relaxation was also reduced by CB(2) receptor antagonists and sphingosine kinase inhibition. Further evidence that S1P functionally interacts with the CB(2) receptor was also observed in HEK293 cells over-expressing the CB(2) receptor.

CONCLUSIONS AND IMPLICATIONS

In the vascular endothelium of rat CA, anandamide induces relaxation via a mechanism requiring sphingosine kinase-1 and S1P/S1P(3). In addition, we report that S1P may exert some of its effects via a CB(2) receptor- and sphingosine kinase-dependent mechanism, where subsequently formed S1P may have privileged access to S1P(3) to induce vascular relaxation.

Falling asleep: the determinants of sleep latency

BACKGROUND

Difficulty falling asleep (prolonged sleep latency) is a frequently reported problem in school-aged children.

AIMS

This study aimed to describe the distribution of sleep latency and factors that influence its duration.

METHODS

871 children of European mothers were recruited at birth. 591 (67.9%) children took part in the follow-up at 7 years of age. Sleep and daytime activity were measured objectively by an actigraph worn for 24 h.

RESULTS

Complete sleep data were available for 519 children (87.8%) with a mean age of 7.3 years (SD 0.2). Median sleep latency was 26 minutes (interquartile range 13-42). Higher mean daytime activity counts were associated with a decrease in sleep latency (-1.2 minutes per 102 movement count per minute, p = 0.05). Time spent in sedentary activity was associated with an increase in sleep latency (3.1 minutes per hour of sedentary activity, p = 0.01).

CONCLUSIONS

These findings emphasise the importance of physical activity for children, not only for fitness, cardiovascular health and weight control, but also for promoting good sleep.

Analysis of survival with modified docetaxel, cisplatin, fluorouracil (mDCF), and bevacizumab (BEV) in patients with metastatic gastroesophageal (GE) adenocarcinoma: Results of a phase II clinical trial

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Background: Metastatic GE cancer is an aggressive disease with poor patient (pt) outcomes. Despite response rates of 30–60% to combination chemotherapy, response duration is usually 4–6 mo and 24-mo survival is 5–10%. The addition of BEV to chemotherapy has improved survival in several solid tumors, and has demonstrated encouraging activity in GE cancer (Shah et al, JCO 2006). We report mature tolerability and efficacy results of mDCF+BEV in GE cancer, with an emphasis on prolonged pt survival. Methods: Previously untreated metastatic GE pts with adequate end organ function received BEV 10mg/kg, Docetaxel 40mg/m2, FU 400mg/m2, Leucovorin 400mg/m2 on day 1, FU 1000 mg/m2/day x 2 days IVCI, and Cisplatin 40mg/m2 on day 3. Treatment is repeated every 14 days without prophylactic growth factor support. The primary objective is to improve 6-month progression free survival (PFS) from 43% (historical DCF control) to 63% with the addition of BEV. Target accrual is 44 evaluable pts, with 10% type I & II error. Secondary objectives include tolerability, response rates (RECIST), median PFS, 12-mo survival, and overall survival (OS). Results: Pt enrollment has completed: median age 57(range 29–74), median KPS 80% (70–100), M:F 32:12, gastric/GEJ/esophagus 22:17:5. In 39 patients with measurable disease we observed 26 confirmed partial responses (67%, 95% CI 50%- 81%), and 12 (31%) stable disease. Six-month PFS is 79% (95% CI 68%-93%), the median PFS is 12 mo (95% CI: 8.8–16). At median follow up of 12.3 mo, median OS is 16.2 mo (95%CI 11.4-infinitiy). 12- and 18-mo OS is 63% (95%CI 44–77%) and 46% (95%CI 27–63%), respectively. Minimal chemotherapy related grade 3–4 adverse events were observed: fatigue (20%), dehydration (13%), mucositis (9%), nausea/vomiting (7%), febrile neutropenia (4%). BEV related adverse event was perforation (n=1) and bleeding (n=1). 31% developed grade 3–4 venous thromboembolism, of which 93% were asymptomatic. No grade 3–4 hypertension, proteinuria or arterial thrombosis was observed. Conclusions: mDCF+BEV appears tolerable and has notable long term pt outcomes: 6-mo PFS is 79% (surpassing our efficacy endpoint), median OS 16.2 mo, and 18-mo OS 46%.

No significant financial relationships to disclose.

Critical success factors of a whole of business extension approach for increased capacity of beef producers and improved enterprise profit and sustainability

The ‘Research to Reality Project’ assisted beef producers in the Burdekin catchment of north Queensland to develop practical responses to a range of production and grazing land management challenges. The project involved three groups of beef producers encompassing 19 enterprises, 680 000 ha of land and the management of 162 000 cattle. The project was founded on a continuous improvement and innovation approach, and included an employed industry champion and multi-disciplinary project team who used a range of extension methods to identify, develop and implement on-property projects. Extension methods included one-on-one property planning activities, economic benchmarking, land condition assessments, on-property demonstrations, structured learning workshops and information products. The value of project evaluation to producers and the project staff is discussed. Further, the link between increased profitability and better land management was established for many producers. This learning is reflected in the uptake of recommended grazing practices and the decisions producer participants are now making about their grazing business.

An association between ethnicity and cardiovascular outcomes for people with Type 2 diabetes in New Zealand

AIMS

To investigate the association between ethnicity and risk of first cardiovascular (CV) event for people with Type 2 diabetes in New Zealand.

METHODS

A prospective cohort study using routinely collected data from a national primary health care diabetes annual review programme linked to national hospital admission and mortality data. Ethnicity was recorded as European, Maori, Pacific, Indo-Asian, East-Asian or Other. A Cox proportional hazards model was used to investigate factors associated with first CV event. Data was collected from 48,444 patients with Type 2 diabetes, with first data collected between 1 January 2000 and 20 December 2005, no previous cardiovascular event at entry and with complete measurements. Risk factors included ethnicity, gender, socio-economic status, body mass index, smoking, age at diagnosis, duration of diabetes, systolic blood pressure, serum lipids, glycated haemoglobin and urine albumin : creatinine ratio. The main outcome measures were time to first fatal or non-fatal CV event.

RESULTS

Median follow-up was 2.4 years. Using combined European and Other ethnicities as a reference, hazard ratios for first CV event were 1.30 for Maori (95% confidence interval 1.19-1.41), 1.04 for Pacific (0.95-1.13), 1.06 for Indo-Asian (0.91-1.24) and 0.73 for East-Asian (0.62-0.85) after controlling for all other risk factors.

CONCLUSIONS

Ethnicity was independently associated with time to first CV event in people with Type 2 diabetes. Maori were at 30% higher risk of first CV event and East-Asian 27% lower risk compared with European/Other, with no significant difference in risk for Pacific and Indo-Asian peoples.

Glycated haemoglobin and cardiovascular outcomes in people with Type 2 diabetes: a large prospective cohort study

AIMS

To investigate the association between long-term glycaemic control, measured by glycated haemoglobin (HbA(1c)), and time to first cardiovascular disease (CVD) event for people with Type 2 diabetes in New Zealand.

METHODS

A prospective cohort study including people with Type 2 diabetes but no previous CVD. The primary outcome measure was time to first recorded fatal or non-fatal CVD event (ischaemic heart disease, cerebrovascular accident, transient ischaemic attack or peripheral vascular disease) as identified from linked primary care, hospital and mortality records between January 2000 and December 2005. A Cox proportional hazards model was used to examine the association between HbA(1c) and time to CVD event, adjusting for age at diagnosis, duration of diabetes, gender, ethnicity, socio-economic status, smoking, blood pressure (BP), serum total cholesterol : high-density lipoprotein ratio, body mass index (BMI) and urine albumin : creatinine ratio.

RESULTS

Participants included 48 444 people with Type 2 diabetes. Fifty-one per cent (n = 24 721) were women, median age 60 years. Median duration of diabetes was 3 years, median BMI 31 kg/m(2), median HbA(1c) 7.1% and mean BP was 138/81 mmHg. During the study period (median follow-up 2.4 years), there were 5667 first CVD events (11.7% of cohort). Each 1% increase in HbA(1c) was associated with an increase in hazard ratio (HR) for CVD of 1.08 (95% confidence interval 1.06-1.10, P < 0.001), myocardial infarction [HR 1.08 (1.04, 1.11)] and stroke [HR 1.09 (1.04, 1.13)].

CONCLUSION

This study has confirmed in a large prospective cohort that increased HbA(1c) is an independent risk factor for cardiovascular disease after controlling for traditional risk factors.

Cellular characterisation of magnetic resonance imaging bone oedema in rheumatoid arthritis; implications for pathogenesis of erosive disease

Objectives:

Magnetic resonance imaging (MRI) bone oedema is an important predictor of bone erosion in rheumatoid arthritis (RA). This study aimed to determine the cellular components of MRI bone oedema, and clarify the relationship between bone erosion and MRI bone oedema.

Methods:

Twenty-eight bones from 11 patients with RA undergoing orthopaedic surgery were analysed by quantitative and semi-quantitative immunohistochemistry. Pre-operative contrast-enhanced MRI scans were analysed for bone oedema.

Results:

The density of osteoclasts was higher in those samples with MRI bone oedema than those without MRI bone oedema (p = 0.01). Other cells identified within bone marrow included macrophages and plasma cells, and these were more numerous in samples with MRI bone oedema (p = 0.02 and 0.05 respectively). B cells were present in lower numbers, but B cell aggregates were identified in some samples with MRI bone oedema. There was a trend to increased RANKL expression in samples with MRI bone oedema (p = 0.09). Expression of RANKL correlated with the number of osteoclasts (r = 0.592, p = 0.004).

Conclusions:

The increased number of osteoclasts and RANKL expression in samples with MRI bone oedema supports the hypothesis that bone erosion in RA occurs through activation of local bone resorption mechanisms within subchondral bone as well as through synovial invasion into bone.

Impaired stroke volume and aerobic capacity in female adolescents with type 1 and type 2 diabetes mellitus

AIM/HYPOTHESIS

This study was designed to determine whether type 2 diabetic adolescents have reduced aerobic capacity and to investigate the role of cardiac output and arteriovenous oxygen difference (a-vO(2)) in their exercise response.

METHODS

Female adolescents (age 12-18 years) with type 2 diabetes mellitus (n = 8) and type 1 diabetes mellitus (n = 12) and obese (n = 10) and non-obese (n = 10) non-diabetic controls were recruited for this study. Baseline data included maximal aerobic capacity (cycle ergometer) and body composition. Cardiac output and a-vO(2) were determined at rest and during submaximal exercise.

RESULTS

Diabetic groups had lower aerobic capacity than non-diabetic groups (p < 0.05). Adolescents with type 2 diabetes had lower aerobic capacity than the type 1 diabetic group. Maximal heart rate was lower in the type 2 diabetic group (p < 0.05). Exercise stroke volume was 30-40% lower at 100 and 120 beats per min in the diabetic than in the non-diabetic groups (p < 0.05). The a-vO(2) value was not different in any condition.

CONCLUSIONS AND INTERPRETATION

Type 2 diabetic adolescents have reduced aerobic capacity and reduced heart rate response to maximal exercise. Furthermore, type 2 and type 1 diabetic adolescent girls have a blunted exercise stroke volume response compared with non-diabetic controls. Central rather than peripheral mechanisms contribute to the reduced aerobic capacity in diabetic adolescents. Although of short duration, type 2 diabetes in adolescence is already affecting cardiovascular function in adolescents.

An angled insertion technique using 6-mm needles markedly reduces the risk of intramuscular injections in children and adolescents

AIMS

The aims of this study were (i) to establish which children with Type 1 diabetes are at risk of intramuscular or intradermal insulin injections and (ii) to determine a needle length and technique that reliably administers insulin into subcutaneous fat.

METHODS

Seventy-two healthy diabetic children (age 6.3-14.3 years, body mass index standard deviation score 1.0 +/- 1.4) were recruited for study 1 and 37 of this cohort participated in study 2. In study 1, 200 microl air was injected into the abdomen and anterior thigh by a pinched skin-fold technique using either a perpendicular insertion of NovoFine(R) 31G 6-mm or an angled insertion of NovoFine(R) 30G 8-mm needles. In study 2, subjects received injections into abdomen and anterior thigh via angled 6-mm needles with either an unpinched or pinched technique. The site of air injection was visualized by ultrasound scan and measurements taken of subcutaneous fat thickness.

RESULTS

In study 1, intramuscular injections were detected in 32% of subjects, and in a further 22% air was visualized at the muscle fascia. In study 2, intramuscular injections occurred in 3% of subjects and a further 11% had muscle fascia air detected. No intramuscular injections occurred in subjects injecting with a 6-mm needle and an angled pinched skin-fold technique. Pinching abdomen and thigh skin folds increased the subcutaneous fat thickness by 192 +/- 16% and 22 +/- 6%, respectively. In very lean subjects, pinching thighs actually reduced subcutaneous fat thickness.

CONCLUSIONS

While intramuscular injections were observed frequently using standard injection protocols, an angled 6-mm needle technique reliably injects into the subcutaneous fat.

High-grade MRI bone oedema is common within the surgical field in rheumatoid arthritis patients undergoing joint replacement and is associated with osteitis in subchondral bone

OBJECTIVES

MRI bone oedema has been observed in early and advanced RA and may represent a cellular infiltrate (osteitis) in subchondral bone. We studied MRI scans from RA patients undergoing surgery, seeking to identify regions of bone oedema and examine its histopathological equivalent in resected bone.

METHODS

Preoperative contrast-enhanced MRI scans were obtained in 11 RA patients scheduled for orthopaedic surgery to the hands/wrists or feet. In 9, MRI scans were scored by 2 readers for bone oedema (RAMRIS system). Its distribution with respect to surgical site was investigated. In 4 patients, 7 bone samples were examined for a cellular infiltrate, and this was compared with MRI bone oedema, scored for spatial extent and intensity.

RESULTS

Inter-reader intraclass correlation coefficients for bone oedema were 0.51 (all sites) and 0.98 (bone samples for histology). Bone oedema was observed at 60% of surgical sites vs 38% of non-surgical sites. High-grade bone oedema (score >/=50% maximum) was strongly associated with the surgical field (OR 9.3 (3.5 to 24.2), p<0.0001). Bone oedema scores correlated with pain (r = 0.67, p = 0.048) and CRP (r = 0.86, p = 0.01). In 4 of the 7 bone samples, there was concordance between bone oedema and subchondral osteitis. In 3, there was no MRI bone oedema, and osteitis was "slight".

CONCLUSION

High-grade MRI bone oedema was common within the field of intended surgery and associated with pain. There was concordance between the presence and severity of MRI bone oedema and osteitis on histology, with an MRI threshold effect due to differences in image resolution.

Functional MRI in NPSLE patients reveals increased parietal and frontal brain activation during a working memory task compared with controls

OBJECTIVES

Anatomical MRI brain scans may not reflect neurological dysfunction in patients with NPSLE. We used blood-oxygen-level-dependent functional MRI (BOLD-fMRI) to investigate working memory function in NPSLE patients.

METHODS

Twenty-seven females took part: nine NPSLE patients (mean age 40 yrs; SLEDAI 10.9); nine RA patients and nine healthy controls. Subjects were tested using the n-back paradigm for working memory, where patients indicate when a stimulus matches one presented n trials previously. Functional scans used 3 mm slices x 30, repetition time 2570 ms, echo time 50 ms. Echo planar images were superimposed onto T1w anatomical images (Siemens 1.5 T). Data analysis used Brain Voyager QX Version 1.7.

RESULTS

During the memory task, there was activation in areas serving working memory, executive function and attention in all groups. Nine regions of interest were selected for activation during working memory (N-back task vs fixation, P < or = 0.005). In six out of nine regions, there was greater activation in the NPSLE group. This reached significance in three regions: the posterior inferior parietal lobules of both hemispheres [Brodmann area (BA) 7] separately and combined (P = 0.014, 0.016 and 0.004, respectively), and the supplementary motor area (mid-line frontal lobe) (BA32/6; P = 0.032).

CONCLUSIONS

NPSLE patients showed greater frontoparietal activation than the other groups during the memory task, suggesting a greater need to recruit extra cortical pathways, possibly to supplement impaired function of standard pathways.

Risk factors for asthma at 3.5 and 7 years of age

BACKGROUND

It has been suggested that factors in early life including exposure to allergens and microbes may influence the development of asthma.

OBJECTIVE

To identify risk factors for asthma in early childhood. Methods Eight-hundred and seventy-one children of European mothers were enrolled at birth, of whom 385 (44.2%) were born small for gestational age (SGA) and 486 were appropriate for gestational age (AGA). Data were collected at birth, 12 months, 3.5 years of age (y) and 7 y. The outcome of interest (current wheeze) was defined as a positive response to the question: 'Has your child had wheezing or whistling in the chest in the last 12 months?'

RESULTS

Participation rate was 85.4% at 1 y, 63.1% at 3.5 y and 68.0% at 7 y. The prevalence of asthma was 23.8% at 3.5 y and 18.1% at 7 y. Antibiotic use in the first year of life and day care in the first year of life were associated with increased risk of wheeze at 7 y [odds ratio (OR)=4.3 95% confidence interval (CI) (1.8-10.1) and OR=2.8 95% CI (1.2-6.5), respectively], but not at 3.5 y. Exposure to dogs was a risk factor for asthma at both ages [OR=2.1 95% CI (1.1-3.8)] as was sleeping on a used cot mattress in the first year of life [OR=1.8 95% CI (1.0-3.2)].

CONCLUSIONS

There was a significant association between antibiotic use and day care in the first year of life and wheezing at 7 y but not at 3.5 y. This strengthens the argument that these factors increase the risk of asthma. We have also made the novel observation that sleeping on a used mattress in the first year of life is a risk factor for wheezing at 3.5 and 7 y. Capsule summary This prospective study of 871 children made the novel observation that sleeping on a used mattress in the first year of life was a risk factor for wheezing at 3.5 and 7 y.