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Bhat AA, Afzal M, Goyal A, Gupta G, Thapa R, Almalki WH, Kazmi I, Alzarea SI, Shahwan M, Paudel KR, Ali H, Sahu D, Prasher P, Singh SK, Dua K. The impact of formaldehyde exposure on lung inflammatory disorders: Insights into asthma, bronchitis, and pulmonary fibrosis. Chem Biol Interact 2024; 394:111002. [PMID: 38604395 DOI: 10.1016/j.cbi.2024.111002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/27/2024] [Accepted: 04/07/2024] [Indexed: 04/13/2024]
Abstract
Lung inflammatory disorders are a major global health burden, impacting millions of people and raising rates of morbidity and death across many demographic groups. An industrial chemical and common environmental contaminant, formaldehyde (FA) presents serious health concerns to the respiratory system, including the onset and aggravation of lung inflammatory disorders. Epidemiological studies have shown significant associations between FA exposure levels and the incidence and severity of several respiratory diseases. FA causes inflammation in the respiratory tract via immunological activation, oxidative stress, and airway remodelling, aggravating pre-existing pulmonary inflammation and compromising lung function. Additionally, FA functions as a respiratory sensitizer, causing allergic responses and hypersensitivity pneumonitis in sensitive people. Understanding the complicated processes behind formaldehyde-induced lung inflammation is critical for directing targeted strategies aimed at minimizing environmental exposures and alleviating the burden of formaldehyde-related lung illnesses on global respiratory health. This abstract explores the intricate relationship between FA exposure and lung inflammatory diseases, including asthma, bronchitis, allergic inflammation, lung injury and pulmonary fibrosis.
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Affiliation(s)
- Asif Ahmad Bhat
- School of Pharmacy, Suresh Gyan Vihar University, Jagatpura, 302017, Mahal Road, Jaipur, India
| | - Muhammad Afzal
- Department of Pharmaceutical Sciences, Pharmacy Program, Batterjee Medical College, P.O. Box 6231, Jeddah, 21442, Saudi Arabia
| | - Ahsas Goyal
- Institute of Pharmaceutical Research, GLA University, Mathura, U.P., India
| | - Gaurav Gupta
- School of Pharmacy, Graphic Era Hill University, Dehradun, 248007, India; Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates.
| | - Riya Thapa
- School of Pharmacy, Suresh Gyan Vihar University, Jagatpura, 302017, Mahal Road, Jaipur, India
| | - Waleed Hassan Almalki
- Department of Pharmacology, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Imran Kazmi
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, 21589, Jeddah, Saudi Arabia
| | - Sami I Alzarea
- Department of Pharmacology, College of Pharmacy, Jouf University, 72341, Sakaka, Aljouf, Saudi Arabia
| | - Moyad Shahwan
- Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates; Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman, 346, United Arab Emirates
| | - Keshav Raj Paudel
- Centre for Inflammation, Centenary Institute and University of Technology Sydney, Faculty of Science, School of Life Sciences, Sydney, NSW, 2050, Australia
| | - Haider Ali
- Centre for Global Health Research, Saveetha Medical College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, India; Department of Pharmacology, Kyrgyz State Medical College, Bishkek, Kyrgyzstan
| | - Dipak Sahu
- Department of Pharmacology, Amity University, Raipur, Chhattisgarh, India
| | - Parteek Prasher
- Department of Chemistry, University of Petroleum & Energy Studies, Energy Acres, Dehradun, 248007, India
| | - Sachin Kumar Singh
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, 144411, India; Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, NSW, 2007, Australia; School of Medical and Life Sciences, Sunway University, 47500 Sunway City, Malaysia
| | - Kamal Dua
- Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, NSW, 2007, Australia; Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, NSW, 2007, Australia; Uttaranchal Institute of Pharmaceutical Sciences, Uttaranchal University, Dehradun, India.
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Gilgoff R, Mengelkoch S, Elbers J, Kotz K, Radin A, Pasumarthi I, Murthy R, Sindher S, Harris NB, Slavich GM. The Stress Phenotyping Framework: A multidisciplinary biobehavioral approach for assessing and therapeutically targeting maladaptive stress physiology. Stress 2024; 27:2327333. [PMID: 38711299 PMCID: PMC11219250 DOI: 10.1080/10253890.2024.2327333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/02/2024] [Indexed: 05/08/2024] Open
Abstract
Although dysregulated stress biology is becoming increasingly recognized as a key driver of lifelong disparities in chronic disease, we presently have no validated biomarkers of toxic stress physiology; no biological, behavioral, or cognitive treatments specifically focused on normalizing toxic stress processes; and no agreed-upon guidelines for treating stress in the clinic or evaluating the efficacy of interventions that seek to reduce toxic stress and improve human functioning. We address these critical issues by (a) systematically describing key systems and mechanisms that are dysregulated by stress; (b) summarizing indicators, biomarkers, and instruments for assessing stress response systems; and (c) highlighting therapeutic approaches that can be used to normalize stress-related biopsychosocial functioning. We also present a novel multidisciplinary Stress Phenotyping Framework that can bring stress researchers and clinicians one step closer to realizing the goal of using precision medicine-based approaches to prevent and treat stress-associated health problems.
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Affiliation(s)
- Rachel Gilgoff
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, CA, USA
| | - Summer Mengelkoch
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Jorina Elbers
- Trauma recovery Program, HeartMath Institute, Boulder Creek, CA, USA
| | | | | | - Isha Pasumarthi
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, CA, USA
| | - Reanna Murthy
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, CA, USA
| | - Sayantani Sindher
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, CA, USA
| | | | - George M. Slavich
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
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Freeman RE, Qi YS, Geller RJ, Cohen AR, Iyer SS, Waynik IY, Sullivan AF, Camargo CA. Parental Mental Health and Childhood Respiratory Outcomes in a Severe Bronchiolitis Cohort. Clin Pediatr (Phila) 2023; 62:1067-1079. [PMID: 36715245 DOI: 10.1177/00099228221150608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Parental mental health conditions appear to contribute to the development of childhood respiratory illness. We investigated the relationship between parental mental health and childhood respiratory illness using data from a 17-center prospective cohort study of infants hospitalized with bronchiolitis between 2011 and 2014 (n = 921). Among 779 (84.6%) participants with self-reported parental mental health history data, 184 (23.6%) had parental history of depression and 155 (19.9%) had anxiety. Multivariable analyses found that both parental history of depression (hazard ratio [HR] 1.41, 95% confidence interval [CI] 1.01-1.99) and anxiety (HR 1.28, 95% CI 1.08-1.52) were associated with an increased risk of recurrent wheezing by age 3 years. However, only parental history of anxiety was associated with asthma by age 5 years (odds ratio 1.79, 95% CI 1.25-2.55). Further research on exposure severity, other early life stressors, and effective methods of parental psychosocial support is needed to develop targeted risk factor prevention strategies to reduce the burden of childhood respiratory illness.
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Affiliation(s)
- Rain E Freeman
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Center for Population Health Research, School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA
| | - Ying Shelly Qi
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ruth J Geller
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ari R Cohen
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sujit S Iyer
- Department of Pediatric Emergency Medicine, Dell Children's Medical Center of Central Texas, Austin, TX, USA
| | - Ilana Y Waynik
- Connecticut Children's Medical Center, Hartford, CT, USA
| | - Ashley F Sullivan
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Rodriguez-Martinez CE, Sossa-Briceño MP. Disparities in prevalence and outcomes of respiratory disease in low- and middle-income countries. Pediatr Pulmonol 2023. [PMID: 37378459 DOI: 10.1002/ppul.26573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/18/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023]
Abstract
OBJECTIVES To provide a comprehensive overview of disparities in prevalence and outcomes of respiratory diseases and notable challenges for providing optimal treatment to pediatric patients with respiratory diseases living in low- and middle-income countries (LMICs), as an input to help better understand the roots of respiratory health disparities. METHODS We conducted a narrative review of relevant literature published in electronic databases from inception to February 2023 that present data on disparities in prevalence and outcomes of respiratory disease in LMICs. Additionally, we included studies that describe and discuss challenges for providing optimal treatment to pediatric patients with respiratory diseases living in LMICs. RESULTS A number of early life exposures have been associated with adverse respiratory outcomes in later life. Several studies have shown marked geographical variations in the prevalence and burden of pediatric asthma, with consistently lower prevalence rates but significantly higher burdens and worse outcomes in LMICs. There is a wide range of challenges that adversely affect the efficient care of children with respiratory diseases that can be classified into three categories: patient-related factors, social/environmental factors, and factors related to healthcare providers or the healthcare system. CONCLUSIONS Respiratory health disparities in children living in LMICs represent a global public health issue mainly explained by an unequal distribution of preventable and modifiable risk factors for respiratory diseases across different demographic groups.
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Affiliation(s)
- Carlos E Rodriguez-Martinez
- Department of Pediatrics, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia
- Department of Pediatric Pulmonology, School of Medicine, Universidad El Bosque, Bogota, Colombia
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Drouin O, Perez T, Barnett TA, Ducharme FM, Fleegler E, Garg A, Lavoie K, Li P, Métras MÉ, Sultan S, Tse SM, Zhao J. Impact of Unmet Social Needs, Scarcity, and Future Discounting on Adherence to Treatment in Children With Asthma: Protocol for a Prospective Cohort Study. JMIR Res Protoc 2023; 12:e37318. [PMID: 36881458 PMCID: PMC10131837 DOI: 10.2196/37318] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/08/2022] [Accepted: 11/18/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Asthma is one of the most prevalent chronic diseases of childhood and disproportionately affects children with lower socioeconomic status. Controller medications such as inhaled corticosteroids significantly reduce asthma exacerbations and improve symptoms. However, a large proportion of children still have poor asthma control, in part owing to suboptimal adherence. Financial barriers contribute to hindering adherence, as do behavioral factors related to low income. For example, unmet social needs for food, lodging, and childcare may create stress and worry in parents, negatively influencing medication adherence. These needs are also cognitively taxing and force families to focus on immediate needs, leading to scarcity and heightening future discounting; thus, there is the tendency to attribute greater value to the present than to the future in making decisions. OBJECTIVE In this project, we will investigate the relationship between unmet social needs, scarcity, and future discounting as well as their predictive power over time on medication adherence in children with asthma. METHODS This 12-month prospective observational cohort study will recruit 200 families of children aged 2 to 17 years at the Asthma Clinic of the Centre Hospitalier Universitaire Sainte-Justine, a tertiary care pediatric hospital in Montreal, Canada. The primary outcome will be adherence to controller medication, measured using the proportion of prescribed days covered during follow-up. Exploratory outcomes will include health care use. The main independent variables will be unmet social needs, scarcity, and future discounting, measured using validated instruments. These variables will be measured at recruitment as well as at 6- and 12-month follow-ups. Covariates will include sociodemographics, disease and treatment characteristics, and parental stress. Primary analysis will compare adherence to controller medication, measured using the proportion of prescribed days covered, between families with versus those without unmet social needs during the study period using multivariate linear regression. RESULTS The research activities of this study began in December 2021. Participant enrollment and data collection began in August 2022 and are expected to continue until September 2024. CONCLUSIONS This project will allow the documentation of the impact of unmet social needs, scarcity, and future discounting on adherence in children with asthma using robust metrics of adherence and validated measures of scarcity and future discounting. If the relationship between unmet social needs, behavioral factors, and adherence is supported by our findings, this will suggest the potential for novel targets for integrated social care interventions to improve adherence to controller medication and reduce risk across the life course for vulnerable children with asthma. TRIAL REGISTRATION ClinicalTrials.gov NCT05278000; https://clinicaltrials.gov/ct2/show/NCT05278000. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/37318.
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Affiliation(s)
- Olivier Drouin
- CHU Sainte-Justine Research Centre, Montreal, QC, Canada
- Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine, Montréal, QC, Canada
- Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, QC, Canada
| | - Tamara Perez
- CHU Sainte-Justine Research Centre, Montreal, QC, Canada
| | - Tracie A Barnett
- CHU Sainte-Justine Research Centre, Montreal, QC, Canada
- Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Francine M Ducharme
- Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Clinical Research and Knowledge Transfer Research Centre, Department of Pediatrics, CHU Sainte-Justine, Montreal, QC, Canada
| | - Eric Fleegler
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Arvin Garg
- Department of Pediatrics, University of Massachusetts Medical School, Boston, MA, United States
- Division of General Academic Pediatrics, Department of Pediatrics, Boston Medical Center and School of Medicine, Boston University, Boston, MA, United States
| | - Kim Lavoie
- Montreal Behavioural Medicine Centre, CIUSSS du Nord-de-l'Ile-de-Montreal, Montreal, QC, Canada
- Department of Psychology, Université de Quebec à Montreal, Montreal, QC, Canada
| | - Patricia Li
- Centre for Outcomes Research and Evaluation, McGill University Health Centre Research Institute, Montreal, QC, Canada
- Department of Pediatrics, McGill University, Montreal, QC, Canada
- Division of General Pediatrics, Montreal Children's Hospital, Montreal, QC, Canada
| | - Marie-Élaine Métras
- Pharmacy Department and Pharmacy Practice Research Unit, CHU Sainte-Justine, Montreal, QC, Canada
| | - Serge Sultan
- Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Department of Psychology, Faculty of Arts and Sciences, Université de Montréal, Montreal, QC, Canada
| | - Sze Man Tse
- Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine, Montréal, QC, Canada
- Division of Respiratory Medicine, Department of Pediatrics, Sainte-Justine University Hospital Center, University of Montreal, Montreal, QC, Canada
| | - Jiaying Zhao
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
- Institute for Resources, Environment and Sustainability, University of British Columbia, Vancouver, BC, Canada
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Margolis RHF, Shelef DQ, Gordish-Dressman H, Masur JE, Teach SJ. Stressful life events, caregiver depressive symptoms, and child asthma symptom-free days: a longitudinal analysis. J Asthma 2023; 60:508-515. [PMID: 35383524 DOI: 10.1080/02770903.2022.2062674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To examine relationships among stressful life events (SLE), caregiver depression, and asthma symptom free days (SFDs) in publicly insured Black children aged 4-12 years with persistent asthma. METHODS Secondary analysis of longitudinal data from a clinical trial assessing the efficacy of a six-month parental stress management intervention. Using repeated measures Poisson regression, we constructed four models of SLE (Rochester Youth Development Stressful Life Events scale-Parent Items), caregiver depression (Center for Epidemiologic Studies Depression scale ≥ 11), and child asthma symptom-free days (SFDs) in the prior 14 days. RESULTS There was no association between SLE and child SFDs, but there was for caregiver depression (Incidence Rate Ratio [IRR]: 0.904; 95% CI 0.86-0.95). The interaction between SLE and caregiver depression was not significant. A specific SLE (recent serious family accident or illness) predicted fewer child SFDs (IRR: 0.91, 95% CI: 0.85-0.98). In the interaction model between caregiver depression and recent accident/illness, caregiver depression was associated with fewer child SFDs (IRR: 0.95, 95% CI: 0.91-0.99) as was the interaction between caregiver depression and recent accident/illness (IRR: 0.77, 95% CI 0.66-0.91); but the relationship between recent accident/illness and child SFDs was not (IRR: 1.00, 95% CI, 0.92-1.09), meaning accident/illness was only associated with fewer child SFDs among depressed caregivers. CONCLUSIONS In a sample of publicly insured Black children with persistent asthma, caregiver depression was negatively associated with child SFDs while overall SLE were not. A recent family accident or illness was negatively associated with child SFDs only when the caregiver was depressed.
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Affiliation(s)
- Rachel H F Margolis
- Center for Translational Research, Children's National Research Institute, Washington, DC, USA
| | - Deborah Q Shelef
- Center for Translational Research, Children's National Research Institute, Washington, DC, USA.,School of Public Health, University of Maryland, College Park, MD, USA
| | | | - Julia E Masur
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Stephen J Teach
- Center for Translational Research, Children's National Research Institute, Washington, DC, USA
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Robles TF, Bai S, Meng YY. Ozone Pollution, Perceived Support at Home, and Asthma Symptom Severity in the Adolescent Sample of the California Health Interview Survey. Int J Behav Med 2022; 30:398-408. [PMID: 35655059 PMCID: PMC10167194 DOI: 10.1007/s12529-022-10103-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Outdoor air pollution, including ozone (O3) pollution, and childhood family environments may interact and impact asthma exacerbations in children. Previous epidemiology studies have primarily focused on stress in the home, rather than support, and whether psychosocial factors modify the association between pollution and health outcomes, rather than whether pollution exposure modifies associations between psychosocial factors and health outcomes. METHODS Data from the cross-sectional 2003 representative, population-based California Health Interview Survey were linked with air quality monitoring data on O3 pollution from the California Air Resources Board. Adolescents (N = 209) ages 12-17 who reported an asthma diagnosis and lived within 5 mi of the nearest air monitoring station had linked O3 data for a 12-month period preceding the survey interview date. Adolescents reported perceived available support from an adult at home and frequency of asthma symptoms. RESULTS In unadjusted models, for adolescents living in high O3 pollution regions, greater perceived support was related to lower asthma symptom frequency. Follow-up analyses suggested that the most plausible interpretation of the interaction was that O3 exposure modified the association between perceived support and symptom frequency. O3 × perceived support interactions were not statistically significant after adjusting for covariates. CONCLUSIONS These data provide preliminary evidence that the association between the lack of support in the home environment and worse asthma symptoms may be stronger in areas with higher O3 exposure. Future work may benefit from incorporating personal pollution exposure assessments, comprehensive family environment assessments, and longitudinal follow-up of asthma exacerbations over time.
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Affiliation(s)
- Theodore F Robles
- Department of Psychology, University of California, 1285 Psychology Building, Box 951563, Los Angeles, CA, 90095-1563, USA.
| | - Sunhye Bai
- Department of Human Development and Family Studies, The Pennsylvania State University, 216 Health and Human Development Building, University Park, PA, 16802, USA
| | - Ying-Ying Meng
- Center for Health Policy Research, UCLA Fielding School of Public Health, 10960 Wilshire Blvd, Suite 1550, Box 957143, Los Angeles, CA, 90095-7143, USA
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Gois-Santos VTD, Santos VS, Tavares CSS, Araújo BCL, Ribeiro KMN, Simões SDM, Martins Filho PR. Association between deleterious oral habits and asthma in children: a systematic review and meta-analysis. Braz Oral Res 2022; 36:e039. [PMID: 35293504 DOI: 10.1590/1807-3107bor-2022.vol36.0039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 10/28/2021] [Indexed: 11/21/2022] Open
Abstract
Deleterious oral habits (DOH) have been described as a common finding in pediatric series. Studies have investigated their association with local and systemic health problems. In this study, the association between DOH and asthma was investigated. PubMed, Scopus, Lilacs, Web of Science, Google Scholar, and OpenThesis were accessed to identify observational studies that evaluated the association between DOH (thumb sucking, pacifier use, onychophagia or nail biting, bottle feeding) and asthma in children aged 2-17 years. Information on DOH was obtained from the verbal report of the children's parents. Asthma diagnosis was performed by a physician or using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. We used a random-effects model to pool the results. The odds ratio (OR) was used as measure of association between DOH and asthma. The National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess risk of bias. The GRADE approach was used to assess the quality of evidence. Five studies were included and data from 18,733 children aged 2 to 13 years were analyzed. We found an association between bottle feeding and asthma (OR = 1.25; 95%CI 1.13-1.38; p < 0.001) with moderate level of certainty. Despite the association between pacifier use and asthma (OR = 1.11; 95%CI 1.00-1.24; p = 0.05), the quality of evidence was low. Only one study provided data on nail biting and thumb-sucking, and the individual results showed no association between these habits and asthma. This meta-analysis found an association between bottle feeding, pacifier use, and asthma in children.
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Affiliation(s)
| | - Victor Santana Santos
- Universidade Federal de Alagoas - UFAL, Centre for Epidemiology and Public Health, Arapiraca, AL, Brazil
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Finegood ED, Miller GE. Childhood Violence Exposure, Inflammation, and Cardiometabolic Health. Curr Top Behav Neurosci 2022; 54:439-459. [PMID: 34935115 DOI: 10.1007/7854_2021_283] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Exposure to interpersonal violence during childhood, a severe and often traumatic form of social stress, is an enduring problem that an emerging body of work suggests may be relevant to cardiometabolic health and the progression of cardiovascular disease (CVD) across the life course. Less is known about this association causally, and consequently, the biological mechanisms that may confer risk for, and resilience to, poor health outcomes in the aftermath of violence are not well understood. Drawing on recent theoretical insights and empirical research in both humans and non-human animal models, the current paper articulates a hypothesis for one way that childhood violence could get "under the skin" to influence CVD. Based on this emerging literature, one plausible way that childhood violence exposure could increase susceptibility to CVD in later life is by sensitizing stress-response neurobiology and immune processes that regulate and promote inflammation, which is a key pathogenic mechanism in CVD. This is inherently a developmental process that begins in early life and that unfolds across the life course, although less is known about the specific mechanisms through which this occurs. The goal of this paper is to articulate some of these plausible mechanisms and to suggest areas for future research that aims to reduce the burden of disease among individuals who are exposed to violence.
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Affiliation(s)
- Eric D Finegood
- Department of Psychology, Institute for Policy Research, Northwestern University, Evanston, IL, USA.
| | - Gregory E Miller
- Department of Psychology, Institute for Policy Research, Northwestern University, Evanston, IL, USA
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Resting-State Functional Connectivity of the Central Executive Network Moderates the Relationship Between Neighborhood Violence and Proinflammatory Phenotype in Children. Biol Psychiatry 2021; 90:165-172. [PMID: 33962781 PMCID: PMC8286315 DOI: 10.1016/j.biopsych.2021.03.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/27/2021] [Accepted: 03/04/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Neighborhood violence increases children's risk for a variety of health problems. Yet, little is known about biological pathways involved or neural mechanisms that might render children more or less vulnerable. Here, we address these questions by considering whether neighborhood violence is associated with the expression of a proinflammatory phenotype and whether this relationship is moderated by resting-state functional connectivity (rsFC) of the central executive network (CEN). METHODS The study involved 217 children (13.9 years old; 66.4% female; 36.9% Black; 30.9% Latinx), enrolled in eighth grade and reassessed 2 years later. At time 1, geocoding was used to estimate murder frequency in children's neighborhoods, and functional magnetic resonance imaging was used to characterize CEN rsFC. At both visits, children gave antecubital blood for ex vivo studies, where leukocytes were incubated with stimulators and inhibitors of inflammation, and cytokine production was measured. RESULTS Consistent with our hypotheses, the relationship between neighborhood murder and inflammatory activity was moderated by CEN rsFC. Among children with lower rsFC, neighborhood violence covaried with a proinflammatory phenotype, reflected in larger cytokine responses to triggering stimuli and lower sensitivity to inhibitory agents. These associations were generally not apparent for children with higher rsFC, although occasionally they ran in the opposite direction. The same patterns were apparent 2 years later. CONCLUSIONS These results advance the understanding of neighborhood violence and its relationship with processes involved in the initiation and resolution of inflammation. They also deepen understanding of variability in children's immunologic responses to stress and suggest that the CEN may be a neurobiological contributor to resilience.
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Chen S, Chen S. Are prenatal anxiety or depression symptoms associated with asthma or atopic diseases throughout the offspring's childhood? An updated systematic review and meta-analysis. BMC Pregnancy Childbirth 2021; 21:435. [PMID: 34158009 PMCID: PMC8218439 DOI: 10.1186/s12884-021-03909-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 05/28/2021] [Indexed: 12/04/2022] Open
Abstract
Background Asthma is the most common respiratory disease among children, while atopic diseases such as atopic dermatitis affect about 20% of infants under 2 years of age. Studies suggested that these conditions might be related to prenatal depression or anxiety. This study aimed to explore the association between prenatal mental disorders and childhood asthma or atopic disease in a systematic review and meta-analysis. Methods PubMed, Embase, and the Cochrane Library were searched up to May 2020. The primary outcome was childhood asthma and childhood atopic dermatitis. Random-effects models were used because of high heterogeneity indicated by I2 > 50% and Q-test P < 0.10. Results A total of 598 studies were initially identified, but nine studies met the inclusion criteria. Prenatal mental disorder was associated with childhood asthma (n = 6 studies; ES = 1.146, 95%CI: 1.054–1.245, P = 0.001; I2 = 93.5%, Pheterogeneity < 0.001) whereas no significant association was found for childhood atopic dermatitis (n = 4 studies; ES = 1.211, 95%CI: 0.982–1.494, P = 0.073; I2 = 78.5%, Pheterogeneity < 0.001). Childhood asthma seems to be related more to depression (n = 1 study; ES = 1.170, 95%CI: 1.061–1.291, P = 0.002) and anxiety/depression (n = 4 studies; ES = 1.157, 95%CI: 1.050–1.275, P = 0.073; I2 = 95.3%, Pheterogeneity < 0.001). Conclusion This meta-analysis demonstrated that prenatal mental disorders increase the risk of childhood asthma. We limited the included samples to pregnant women to investigate the association between prenatal psychological factors and offspring’s physical health. Future studies should include large high-quality cohort studies to investigate the behavioral, environmental, and genetic causes for this association. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03909-z.
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Affiliation(s)
- Shuguang Chen
- Department of Dermatology, Southwest Hospital, Third Military M, edical University, Chongqing, China
| | - Sheng Chen
- Department of Pediatrics, Southwest Hospital, Third Military Medical University, Chongqing, 400030, China.
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12
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Lietzén R, Suominen S, Sillanmäki L, Virtanen P, Virtanen M, Vahtera J. Multiple adverse childhood experiences and asthma onset in adulthood: Role of adulthood risk factors as mediators. J Psychosom Res 2021; 143:110388. [PMID: 33639528 DOI: 10.1016/j.jpsychores.2021.110388] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 01/21/2021] [Accepted: 02/01/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE This population-based study of 21,902 Finnish adults examined whether adulthood risk factors for asthma mediate the association between the exposure to multiple adverse childhood experiences (ACEs) assessed retrospectively and the risk of new-onset asthma in adulthood. METHODS Baseline characteristics, occurrence of ACEs, and risk factors of asthma in adulthood were collected with a postal survey at baseline in 1998. The participants were linked to records on incident asthma from national health registers from 1999 to 2012. Counterfactual mediation analysis was used to examine the effects of multiple ACEs (≥2) on asthma through adulthood risk factors of asthma (mediators). RESULTS Of the 21,902 participants without asthma at baseline, 7552 (34%) were exposed to multiple ACEs during childhood. During the follow-up period, 2046 participants were diagnosed with incident asthma. Exposure to multiple ACEs increased the risk of asthma onset by 31% compared with ≤1 ACE. The association between ACEs and asthma onset was partly mediated by the following adulthood risk factors: severe life events (29%), smoking (15%), allergic rhinitis (8%), low education level (6%), and obesity (3%). Specific stressful life events mediating the ACE-asthma association were 'severe financial difficulties' (24%), 'emotional, physical or sexual violence' (15%), 'major increase in marital problems' (8%), 'severe conflicts with supervisor' (7%), and 'divorce or separation' (5%). CONCLUSIONS Exposure to multiple ACEs increased the risk of asthma in adulthood. Adulthood risk factors of asthma mediated a significant proportion of the effect of ACEs on the risk of asthma onset.
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Affiliation(s)
- Raija Lietzén
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland.
| | - Sakari Suominen
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland; University of Skövde, School of Health Sciences, Department of Public Health, Sweden.
| | - Lauri Sillanmäki
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland; Department of Public Health, University of Helsinki, Finland.
| | - Pekka Virtanen
- Faculty of Social Sciences, Tampere University, Tampere, Finland.
| | - Marianna Virtanen
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland.
| | - Jussi Vahtera
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland; Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland.
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13
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Compounding Effects of Social Vulnerability and Recurring Natural Disasters on Mental and Physical Health. Disaster Med Public Health Prep 2021; 16:1013-1021. [PMID: 33757617 DOI: 10.1017/dmp.2020.476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study evaluated the relationships between the occurrence of recent and recurring natural disasters on the incidence of acute and chronic health outcomes at the census tract level in 500 cities across the United States between 2001 and 2015. METHODS Using the Centers for Disease Control and Prevention (CDC) 500 cities data set, the CDC Social Vulnerability Index, and the US Small Business Administration (SBA) Disaster Loan Database, we modeled the incidence of self-reported, poor mental and physical health, or a clinical diagnosis of high blood pressure or asthma in census tracts (N = 27 204 tracts in 500 cities) that had experienced recent or recurring natural disasters while controlling for social and environmental risk factors. RESULTS Communities that experienced a natural disaster in the previous 5 years compared to those that had not had a higher incidence of poor mental health (RR: 1.02, 95% CI: 1.01-1.02), poor physical health (RR: 1.03, 95% CI: 1.02-1.04), high blood pressure (RR: 1.04, 95% CI: 1.02-1.05), and asthma (RR: 1.01, 95% CI: 1.01-1.02). The incidence of these poor health outcomes increased 1-2% with each additional year that a community experienced a disaster. CONCLUSIONS Prevention and preparedness plans that work to build resilience in communities before disasters should focus on closing the gap in environmental and social determinants that have been linked with disproportionate health burdens and slow recovery post-disaster.
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14
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Rabito FA, Werthmann D, He H, Madkour AS, Arroyave WD, Sever ML, LaVeist TA. Cockroach exposure and perceived stress interact to predict clinical outcomes in childhood asthma. BMC Pulm Med 2021; 21:83. [PMID: 33706736 PMCID: PMC7953637 DOI: 10.1186/s12890-021-01447-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 02/23/2021] [Indexed: 11/17/2022] Open
Abstract
Background Nonpharmacologic interventions for asthma management rely on identification and mitigation of important asthma triggers. Cockroach exposure is strongly associated with asthma morbidity. It is also associated with stress, another risk factor for asthma. Despite high prevalence of both in vulnerable populations, the impact of joint exposure has not been examined. Methods Participants included 173 children with asthma in New Orleans, Louisiana. Cockroach exposure was based on visual inspection using standard protocols. Caregiver stress was measured using Cohen’s 4-item Perceived Stress Scale. Outcomes included unscheduled clinic or emergency department (ED) visits, hospitalization, and pulmonary function. Multivariable logistic regression was performed to assess independent effects of the exposure on the outcome and effect modification was examined in stratified analysis based on stress. Path analysis to explore the mediation effect by stress was performed using a probit link with parameters based on Bayes’ method with non-informative priors. Results Adjusting for stress and other covariates, cockroach exposure was associated with unscheduled clinic/ED visits (aOR = 6.2; 95% CI 1.8, 21.7). Positive associations were also found for hospitalization and FEV1 < 80%. High stress modified the relationship with unscheduled clinic/ED visits (high aOR = 7.7 95% CI 1.0, 60.2, versus normal aOR = 4.1 95% CI 0.8, 21.9). Path models identified direct and indirect effects (p = 0.05) indicating that a majority of the total effect on unscheduled clinic/ED visits is attributed directly to cockroach exposure. Conclusion The strong association between cockroach exposure and asthma morbidity is not due to uncontrolled confounding by stress. The combination of cockroach exposure and high stress, common in urban homes, are modifiable factors associated with poor asthma outcomes.
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Affiliation(s)
- Felicia A Rabito
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2016, New Orleans, LA, 70112, USA.
| | - Derek Werthmann
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2016, New Orleans, LA, 70112, USA
| | - Hua He
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2016, New Orleans, LA, 70112, USA
| | - Aubrey S Madkour
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2016, New Orleans, LA, 70112, USA
| | - Whitney D Arroyave
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2016, New Orleans, LA, 70112, USA
| | - Michelle L Sever
- PPD Government and Public Health Services , 3900 Paramount Parkway, Morrisville, NC, 27560, USA
| | - Thomas A LaVeist
- Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2016, New Orleans, LA, 70112, USA
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15
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Amutah C, Greenidge K, Mante A, Munyikwa M, Surya SL, Higginbotham E, Jones DS, Lavizzo-Mourey R, Roberts D, Tsai J, Aysola J. Misrepresenting Race - The Role of Medical Schools in Propagating Physician Bias. N Engl J Med 2021; 384:872-878. [PMID: 33406326 DOI: 10.1056/nejmms2025768] [Citation(s) in RCA: 159] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Christina Amutah
- From the Perelman School of Medicine (C.A., A.M., M.M., S.L.S., E.H., R.L.-M., J.A.), School of Arts and Sciences (K.G., D.R.), the Penn Medicine Center for Health Equity Advancement (K.G., J.A.), the Leonard Davis Institute of Health Economics (E.H., R.L.-M., J.A.), Carey Law School (D.R.), and the Penn Program on Race, Science, and Society (D.R.), University of Pennsylvania, Philadelphia; Harvard Medical School, Boston (D.S.J.); the Department of Emergency Medicine, Yale School of Medicine, New Haven, CT (J.T.); and the Warren Alpert Medical School of Brown University, Providence, RI (J.T.)
| | - Kaliya Greenidge
- From the Perelman School of Medicine (C.A., A.M., M.M., S.L.S., E.H., R.L.-M., J.A.), School of Arts and Sciences (K.G., D.R.), the Penn Medicine Center for Health Equity Advancement (K.G., J.A.), the Leonard Davis Institute of Health Economics (E.H., R.L.-M., J.A.), Carey Law School (D.R.), and the Penn Program on Race, Science, and Society (D.R.), University of Pennsylvania, Philadelphia; Harvard Medical School, Boston (D.S.J.); the Department of Emergency Medicine, Yale School of Medicine, New Haven, CT (J.T.); and the Warren Alpert Medical School of Brown University, Providence, RI (J.T.)
| | - Adjoa Mante
- From the Perelman School of Medicine (C.A., A.M., M.M., S.L.S., E.H., R.L.-M., J.A.), School of Arts and Sciences (K.G., D.R.), the Penn Medicine Center for Health Equity Advancement (K.G., J.A.), the Leonard Davis Institute of Health Economics (E.H., R.L.-M., J.A.), Carey Law School (D.R.), and the Penn Program on Race, Science, and Society (D.R.), University of Pennsylvania, Philadelphia; Harvard Medical School, Boston (D.S.J.); the Department of Emergency Medicine, Yale School of Medicine, New Haven, CT (J.T.); and the Warren Alpert Medical School of Brown University, Providence, RI (J.T.)
| | - Michelle Munyikwa
- From the Perelman School of Medicine (C.A., A.M., M.M., S.L.S., E.H., R.L.-M., J.A.), School of Arts and Sciences (K.G., D.R.), the Penn Medicine Center for Health Equity Advancement (K.G., J.A.), the Leonard Davis Institute of Health Economics (E.H., R.L.-M., J.A.), Carey Law School (D.R.), and the Penn Program on Race, Science, and Society (D.R.), University of Pennsylvania, Philadelphia; Harvard Medical School, Boston (D.S.J.); the Department of Emergency Medicine, Yale School of Medicine, New Haven, CT (J.T.); and the Warren Alpert Medical School of Brown University, Providence, RI (J.T.)
| | - Sanjna L Surya
- From the Perelman School of Medicine (C.A., A.M., M.M., S.L.S., E.H., R.L.-M., J.A.), School of Arts and Sciences (K.G., D.R.), the Penn Medicine Center for Health Equity Advancement (K.G., J.A.), the Leonard Davis Institute of Health Economics (E.H., R.L.-M., J.A.), Carey Law School (D.R.), and the Penn Program on Race, Science, and Society (D.R.), University of Pennsylvania, Philadelphia; Harvard Medical School, Boston (D.S.J.); the Department of Emergency Medicine, Yale School of Medicine, New Haven, CT (J.T.); and the Warren Alpert Medical School of Brown University, Providence, RI (J.T.)
| | - Eve Higginbotham
- From the Perelman School of Medicine (C.A., A.M., M.M., S.L.S., E.H., R.L.-M., J.A.), School of Arts and Sciences (K.G., D.R.), the Penn Medicine Center for Health Equity Advancement (K.G., J.A.), the Leonard Davis Institute of Health Economics (E.H., R.L.-M., J.A.), Carey Law School (D.R.), and the Penn Program on Race, Science, and Society (D.R.), University of Pennsylvania, Philadelphia; Harvard Medical School, Boston (D.S.J.); the Department of Emergency Medicine, Yale School of Medicine, New Haven, CT (J.T.); and the Warren Alpert Medical School of Brown University, Providence, RI (J.T.)
| | - David S Jones
- From the Perelman School of Medicine (C.A., A.M., M.M., S.L.S., E.H., R.L.-M., J.A.), School of Arts and Sciences (K.G., D.R.), the Penn Medicine Center for Health Equity Advancement (K.G., J.A.), the Leonard Davis Institute of Health Economics (E.H., R.L.-M., J.A.), Carey Law School (D.R.), and the Penn Program on Race, Science, and Society (D.R.), University of Pennsylvania, Philadelphia; Harvard Medical School, Boston (D.S.J.); the Department of Emergency Medicine, Yale School of Medicine, New Haven, CT (J.T.); and the Warren Alpert Medical School of Brown University, Providence, RI (J.T.)
| | - Risa Lavizzo-Mourey
- From the Perelman School of Medicine (C.A., A.M., M.M., S.L.S., E.H., R.L.-M., J.A.), School of Arts and Sciences (K.G., D.R.), the Penn Medicine Center for Health Equity Advancement (K.G., J.A.), the Leonard Davis Institute of Health Economics (E.H., R.L.-M., J.A.), Carey Law School (D.R.), and the Penn Program on Race, Science, and Society (D.R.), University of Pennsylvania, Philadelphia; Harvard Medical School, Boston (D.S.J.); the Department of Emergency Medicine, Yale School of Medicine, New Haven, CT (J.T.); and the Warren Alpert Medical School of Brown University, Providence, RI (J.T.)
| | - Dorothy Roberts
- From the Perelman School of Medicine (C.A., A.M., M.M., S.L.S., E.H., R.L.-M., J.A.), School of Arts and Sciences (K.G., D.R.), the Penn Medicine Center for Health Equity Advancement (K.G., J.A.), the Leonard Davis Institute of Health Economics (E.H., R.L.-M., J.A.), Carey Law School (D.R.), and the Penn Program on Race, Science, and Society (D.R.), University of Pennsylvania, Philadelphia; Harvard Medical School, Boston (D.S.J.); the Department of Emergency Medicine, Yale School of Medicine, New Haven, CT (J.T.); and the Warren Alpert Medical School of Brown University, Providence, RI (J.T.)
| | - Jennifer Tsai
- From the Perelman School of Medicine (C.A., A.M., M.M., S.L.S., E.H., R.L.-M., J.A.), School of Arts and Sciences (K.G., D.R.), the Penn Medicine Center for Health Equity Advancement (K.G., J.A.), the Leonard Davis Institute of Health Economics (E.H., R.L.-M., J.A.), Carey Law School (D.R.), and the Penn Program on Race, Science, and Society (D.R.), University of Pennsylvania, Philadelphia; Harvard Medical School, Boston (D.S.J.); the Department of Emergency Medicine, Yale School of Medicine, New Haven, CT (J.T.); and the Warren Alpert Medical School of Brown University, Providence, RI (J.T.)
| | - Jaya Aysola
- From the Perelman School of Medicine (C.A., A.M., M.M., S.L.S., E.H., R.L.-M., J.A.), School of Arts and Sciences (K.G., D.R.), the Penn Medicine Center for Health Equity Advancement (K.G., J.A.), the Leonard Davis Institute of Health Economics (E.H., R.L.-M., J.A.), Carey Law School (D.R.), and the Penn Program on Race, Science, and Society (D.R.), University of Pennsylvania, Philadelphia; Harvard Medical School, Boston (D.S.J.); the Department of Emergency Medicine, Yale School of Medicine, New Haven, CT (J.T.); and the Warren Alpert Medical School of Brown University, Providence, RI (J.T.)
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16
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Shonkoff JP, Boyce WT, Levitt P, Martinez FD, McEwen B. Leveraging the Biology of Adversity and Resilience to Transform Pediatric Practice. Pediatrics 2021; 147:peds.2019-3845. [PMID: 33495367 DOI: 10.1542/peds.2019-3845] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/28/2020] [Indexed: 11/24/2022] Open
Abstract
Advances in science are fundamentally changing the way we understand how inextricable interactions among genetic predispositions, physical and social environments, and developmental timing influence early childhood development and the foundations of health and how significant early adversity can lead to a lifetime of chronic health impairments. This article and companion article illustrate the extent to which differential outcomes are shaped by ongoing interactive adaptations to context that begin at or even before conception and continue throughout life, with increasing evidence pointing to the importance of the prenatal period and early infancy for the developing brain, the immune system, and metabolic regulation. Although new discoveries in the basic sciences are transforming tertiary medical care and producing breakthrough outcomes in treating disease, this knowledge is not being leveraged effectively to inform new approaches to promoting whole-child development and preventing illness. The opportunity for pediatrics to serve as the leading edge of science-based innovation across the early childhood ecosystem has never been more compelling. In this article, we present a framework for leveraging the frontiers of scientific discovery to inform new strategies in pediatric practice and advocacy to protect all developing biological systems from the disruptive effects of excessive early adversity beyond providing information on child development for parents and enriched learning experiences for young children.
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Affiliation(s)
- Jack P Shonkoff
- Center on the Developing Child and .,Harvard Graduate School of Education, Harvard University, Cambridge, Massachusetts.,Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts.,Department of Social & Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts.,Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - W Thomas Boyce
- Departments of Pediatrics and Psychiatry, University of California, San Francisco, San Francisco, California
| | - Pat Levitt
- The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, California.,Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Fernando D Martinez
- Asthma and Airway Disease Research Center, The University of Arizona, Tucson, Arizona; and
| | - Bruce McEwen
- The Rockefeller University, New York, New York.,Deceased
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17
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Barry LE, O'Neill C, Heaney LG. Association between asthma, corticosteroids and allostatic load biomarkers: a cross-sectional study. Thorax 2020; 75:835-841. [PMID: 32796118 DOI: 10.1136/thoraxjnl-2019-214139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 05/30/2020] [Accepted: 06/07/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Allostatic load, a measure of early ageing or 'wear and tear' from adapting to environmental challenges, has been suggested as a framework with which to understand the stress-related disruption of multiple biological systems which may be linked to asthma. Considering the socioeconomic context is also critical given asthma and allostatic overload are more common in lower socioeconomic groups. AIMS Estimate the relationship between allostatic load and its constituent biomarkers, asthma and corticosteroid prescribing while controlling for socioeconomic status. METHODS Data from Understanding Society (a nationally representative survey of UK community-dwelling adults) waves 1-3 (2009-2012) allowed the identification of a sex-specific risk profile across 12 biomarkers used to construct an Allostatic Load Index for a sample of 9816 adults. Regression analyses were used to examine the association of asthma status and corticosteroid prescriptions with allostatic load and its constituent biomarkers while controlling for socioeconomic status (n=9805). RESULTS Subjects with currently treated asthma and no corticosteroid prescription have an allostatic load 1.21 times higher than those without asthma (p<0.001). Asthmatic subjects in receipt of inhaled corticosteroids had an allostatic load, approximately 1.12 times higher than those without asthma (p<0.001). This association persisted in sensitivity analyses and appeared to be driven by an association with specific biomarkers (dehydroepiandrosterone-sulfate, waist-to-height ratio and C-reactive protein). CONCLUSION Early ageing, in the form of a higher allostatic load, was present even in the mildest asthma group not receiving inhaled corticosteroids. Allostatic load is helpful in understanding the increased all-cause mortality and multimorbidity observed in asthma.
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Affiliation(s)
- Luke Evan Barry
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Ciaran O'Neill
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Liam G Heaney
- Centre for Infection and Immunity, Queen's University Belfast, Belfast, UK
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18
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López-Lois B, González-Barcala FJ, Facal D. Application of mindfulness techniques in patients with asthma or COPD. J Asthma 2020; 58:1237-1246. [PMID: 32475186 DOI: 10.1080/02770903.2020.1776729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Mindfulness is the ability to pay attention to the present moment without judgment. Mindfulness interventions have proved to be effective in improving the management of psychological symptoms of chronic patients. The objective of this work is to update the evidence about the effects of mindfulness interventions on psychological symptoms in patients with asthma and chronic obstructive pulmonary disease (COPD). METHODOLOGY Data sources were PubMed and PsycInfo. From a first set of 109 articles, 12 about mindfulness-interventions in adult populations with asthma or COPD were finally included in the review. RESULTS Of the total of 12 studies included, 5 were qualitative and 6 quantitative (5 randomized controlled trials). One quantitative study reported long-term psychological effects in asthma patients, two studies reported short-term psychological effects in COPD patients. Relevant themes identified in qualitative studies included increased awareness, development of new relationships with dyspnea, including new cognitive strategies, and slowing down. CONCLUSIONS Mindfulness interventions could increase psychological resources in situations related to asthma and COPD symptoms. More randomized control trials are needed.
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Affiliation(s)
- Begoña López-Lois
- Departamento de Psicoloxía Evolutiva, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Francisco-Javier González-Barcala
- Department of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain.,Spanish Biomedical Research Networking Centre-CIBERES, Madrid, Spain.,Department of Respiratory Medicine, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain.,Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - David Facal
- Departamento de Psicoloxía Evolutiva, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
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19
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van der Leek AP, Bahreinian S, Chartier M, Dahl ME, Azad MB, Brownell MD, Kozyrskyj AL. Maternal Distress During Pregnancy and Recurrence in Early Childhood Predicts Atopic Dermatitis and Asthma in Childhood. Chest 2020; 158:57-67. [PMID: 32173490 DOI: 10.1016/j.chest.2020.01.052] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 01/20/2020] [Accepted: 01/23/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Early-life stress is becoming an important determinant of immune system programming. Maternal prenatal distress is found to be associated with atopic disease in offspring but the separate effects of postnatal distress are not well-studied. RESEARCH QUESTION Does the likelihood of asthma and atopic dermatitis in children increase when they are exposed to maternal distress pre- and postnatally in a sex-specific manner? STUDY DESIGN AND METHODS Using data from a provincial newborn screen and health-care database for 12,587 children born in 2004, maternal distress (depression or anxiety) was defined as prenatal, self-limiting, recurrent, or late-onset postpartum. Atopic dermatitis (AD) and asthma at ages 5 years and 7 years of age were diagnosed by using hospitalization, physician visit, or prescription records. Associations between maternal distress and childhood asthma and AD were determined by using multiple logistic regression. RESULTS After adjusting for risk factors, a significant association between maternal prenatal (OR, 1.27; 95% CI, 1.11-1.46), recurrent postpartum (OR, 1.28; 95% CI, 1.11-1.48), and late-onset postpartum (OR, 1.19, 95% CI, 1.06-1.34) distress was found with AD at age 5 years. Asthma at age 7 years was also associated with maternal prenatal distress (OR, 1.57; 95% CI, 1.29-1.91) and late-onset postnatal distress (OR, 1.22; 95% CI, 1.01-1.46). Self-limiting postnatal distress was not found to be a risk factor for either atopic condition. Associations with AD or asthma were of a similar magnitude in boys and girls; the exception was recurrent postnatal distress, which increased risk for asthma in boys only. INTERPRETATION This population-based study provides evidence for sex-specific associations between maternal prenatal and postnatal distress, as well as the development of AD and asthma. The findings support recommendations for greater psychosocial support of mothers during pregnancy and early childhood to prevent childhood atopic disease.
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Affiliation(s)
| | - Salma Bahreinian
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Mariette Chartier
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Matthew E Dahl
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Meghan B Azad
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Marni D Brownell
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Anita L Kozyrskyj
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada; School of Public Health, University of Alberta, Edmonton, AB, Canada.
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20
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MacGinty R, Lesosky M, Barnett W, Nduru PM, Vanker A, Stein DJ, Zar HJ. Maternal psychosocial risk factors and lower respiratory tract infection (LRTI) during infancy in a South African birth cohort. PLoS One 2019; 14:e0226144. [PMID: 31887159 PMCID: PMC6936815 DOI: 10.1371/journal.pone.0226144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 11/20/2019] [Indexed: 02/04/2023] Open
Abstract
Objective To investigate the association between maternal antenatal and/or postnatal psychosocial risk factors (including depression, psychological distress, alcohol abuse and intimate partner violence (IPV) and infant lower respiratory tract infection (LRTI) in a low- and middle-income-country (LMIC). Study design Pregnant women (n = 1137) enrolled in a South African birth cohort study, the Drakenstein Child Health Study (DCHS) were longitudinally assessed for psychosocial risk factors including depression, psychological distress, alcohol abuse and/or intimate partner violence (IPV). Infants were followed from birth until one year of age for the development of LRTI by active surveillance. Two outcomes were evaluated: any LRTI, and severe and/or hospitalised LRTI. Logistic regression was used to identify associations between individual maternal psychosocial risk factors and LRTI outcomes. Analyses stratified by age were also performed to determine which age groups related to infant LRTI were linked with maternal psychosocial risk factors. Results There were 606 LRTI episodes in 369 infants in the first year (crude incidence rate = 0.53 episodes per person-year, 95%CI: 0.50; 0.56); 31% (n = 186) of episodes were severe or hospitalised events. Maternal psychosocial risk factors were associated with LRTI and severe LRTI, particularly postnatal and long-term maternal psychological distress, antenatal maternal alcohol consumption, and postnatal maternal IPV. Age stratified analyses found that antenatal maternal alcohol consumption was associated with early infant LRTI, while antenatal maternal depression was linked with infant severe LRTI between 3 and 6 months of age, and postnatal maternal IPV was associated with early LRTI and severe forms of LRTI. Conclusion The associations between maternal psychosocial risk factors and infant LRTI highlight the potential value of screening for maternal psychosocial risk factors in clinical settings and developing targeted interventions. Such interventions may not only improve maternal well-being, but also help reduce the burden of infant LRTI in LMIC settings.
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Affiliation(s)
- Rae MacGinty
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and South African Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
- * E-mail:
| | - Maia Lesosky
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Whitney Barnett
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and South African Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Polite M. Nduru
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and South African Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Aneesa Vanker
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and South African Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Dan J. Stein
- Department of Psychiatry and Mental Health, South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa
| | - Heather J. Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and South African Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
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21
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Facal D, López-Lois B, Gonzalez-Barcala FJ. A Current Overview of the Psychological Aspects of Asthma in Adults. Arch Bronconeumol 2019; 56:475-476. [PMID: 31759845 DOI: 10.1016/j.arbres.2019.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 09/25/2019] [Accepted: 10/17/2019] [Indexed: 10/25/2022]
Affiliation(s)
- David Facal
- Departamento de Psicoloxía Evolutiva e da Educación, Universidade de Santiago de Compostela, Santiago de Compostela, La Coruña, España; Unidad Especializada en Asma Altamente Complejo, Hospital Clínico Universitario de Santiago, Santiago de Compostela, La Coruña, España; Fundación Instituto de Investigación Sanitaria (FIDIS), Santiago de Compostela, La Coruña, España.
| | - Begoña López-Lois
- Departamento de Psicoloxía Evolutiva e da Educación, Universidade de Santiago de Compostela, Santiago de Compostela, La Coruña, España; Unidad Especializada en Asma Altamente Complejo, Hospital Clínico Universitario de Santiago, Santiago de Compostela, La Coruña, España
| | - Francisco-Javier Gonzalez-Barcala
- Unidad Especializada en Asma Altamente Complejo, Hospital Clínico Universitario de Santiago, Santiago de Compostela, La Coruña, España; Fundación Instituto de Investigación Sanitaria (FIDIS), Santiago de Compostela, La Coruña, España; Servicio de Neumología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, La Coruña, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES)
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22
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Rusconi F, Gagliardi L, Gori E, Porta D, Popovic M, Asta F, Brescianini S, Richiardi L, Ronfani L, Stazi MA. Perinatal maternal mental health is associated with both infections and wheezing in early childhood. Pediatr Allergy Immunol 2019; 30:732-738. [PMID: 31251839 DOI: 10.1111/pai.13103] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 06/09/2019] [Accepted: 06/11/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Wheezing and infections are common during infancy, and the role of early-life exposures in their development is still under investigation. We examined associations between maternal mental health in pregnancy and after delivery and subsequent offspring wheezing and infections. METHODS We studied 2314 mother-child pairs recruited in the Piccolipiù birth cohort (Italy) from 2011 to 2015. Maternal mental health was assessed in pregnancy and 12 months after delivery via the General Health Questionnaire-12 (GHQ-12). GHQ-12 Likert scores were collapsed into low (below the upper tercile) and high (above). Risk ratios (RR) and 95% confidence intervals (CI) between each combination of scores-during pregnancy and 1 year after delivery-and outcomes were computed by log-binomial regression models. RESULTS High scores both in pregnancy and after delivery, compared with low scores in both periods, were associated with wheezing (RR: 1.35; 95% CI: 1.08, 1.69), recurrent (≥2 episodes) wheezing (1.35; 0.99, 1.83), any and recurrent (≥4 episodes) upper respiratory infections (1.20; 1.04, 1.41, and 1.45; 1.07, 1.97, respectively), lower respiratory infections (1.31; 1.08, 1.61), and diarrhea (1.49; 1.23, 1.80). High scores either during pregnancy or 1 year after delivery only were less consistently associated with outcomes. CONCLUSIONS Maternal mental health problems extending from pregnancy to the first year after delivery are associated with development of both wheezing and infections. As wheezing is mostly triggered by infections, increased infection susceptibility could represent a possible common biologic mechanism. This study confirms the importance of early-life exposures on childhood health.
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Affiliation(s)
- Franca Rusconi
- Unit of Epidemiology, Meyer Children's University Hospital, Florence, Italy
| | - Luigi Gagliardi
- Department of Pediatrics, Ospedale Versilia, Viareggio, Italy
| | - Elisa Gori
- Unit of Epidemiology, Meyer Children's University Hospital, Florence, Italy
| | - Daniela Porta
- Department of Epidemiology, Lazio Regional Health Service-ASL ROMA1, Rome, Italy
| | - Maja Popovic
- Department of Medical Sciences, CPO Piemonte, University of Turin, Turin, Italy
| | - Federica Asta
- Department of Epidemiology, Lazio Regional Health Service-ASL ROMA1, Rome, Italy
| | - Sonia Brescianini
- Center for Behavioural Sciences and Mental Health, Istituto Superiore di Sanità, Rome, Italy
| | - Lorenzo Richiardi
- Department of Medical Sciences, CPO Piemonte, University of Turin, Turin, Italy
| | - Luca Ronfani
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Italy
| | - Maria Antonietta Stazi
- Center for Behavioural Sciences and Mental Health, Istituto Superiore di Sanità, Rome, Italy
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Risk and protective factors for child development: An observational South African birth cohort. PLoS Med 2019; 16:e1002920. [PMID: 31560687 PMCID: PMC6764658 DOI: 10.1371/journal.pmed.1002920] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 08/23/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Approximately 250 million (43%) children under the age of 5 years in low- and middle-income countries (LMICs) are failing to meet their developmental potential. Risk factors are recognised to contribute to this loss of human potential. Expanding understanding of the risks that lead to poor outcomes and which protective factors contribute to resilience in children may be critical to improving disparities. METHODS AND FINDINGS The Drakenstein Child Health Study is a population-based birth cohort in the Western Cape, South Africa. Pregnant women were enrolled between 20 and 28 weeks' gestation from two community clinics from 2012 to 2015; sociodemographic and psychosocial data were collected antenatally. Mothers and children were followed through birth until 2 years of age. Developmental assessments were conducted by trained assessors blinded to background, using the Bayley-III Scales of Infant and Toddler Development (BSID-III), validated for use in South Africa, at 24 months of age. The study assessed all available children at 24 months; however, some children were not able to attend, because of loss to follow-up or unavailability of a caregiver or child at the correct age. Of 1,143 live births, 1,002 were in follow-up at 24 months, and a total of 734 children (73%) had developmental assessments, of which 354 (48.2%) were girls. This sample was characterised by low household employment (n = 183; 24.9%) and household income (n = 287; 39.1% earning <R1,000 per month), and high prevalence of maternal psychosocial risk factors including alcohol use in pregnancy (n = 95; 14.5%), smoking (n = 241; 34.7%), depression (n = 156; 23.7%), lifetime intimate partner violence (n = 310; 47.3%), and history of maternal childhood trauma (n = 228; 34.7%). A high proportion of children were categorised as delayed (defined by scoring < -1 standard deviation below the mean scaled score calculated using the BSID-III norms from a United States population) in different domains (369 [50.5%] cognition, 402 [55.6%] receptive language, 389 [55.4%] expressive language, 169 [23.2%] fine motor, and 267 [38.4%] gross motor). Four hundred five (55.3%) children had >1 domain affected, and 75 (10.2%) had delay in all domains. Bivariate and multivariable analyses revealed several factors that were associated with developmental outcomes. These included protective factors (maternal education, higher birth weight, and socioeconomic status) and risk factors (maternal anaemia in pregnancy, depression or lifetime intimate partner violence, and maternal HIV infection). Boys consistently performed worse than girls (in cognition [β = -0.74; 95% CI -1.46 to -0.03, p = 0.042], receptive language [β = -1.10; 95% CI -1.70 to -0.49, p < 0.001], expressive language [β = -1.65; 95% CI -2.46 to -0.84, p < 0.001], and fine motor [β = -0.70; 95% CI -1.20 to -0.20, p = 0.006] scales). There was evidence that child sex interacted with risk and protective factors including birth weight, maternal anaemia in pregnancy, and socioeconomic factors. Important limitations of the study include attrition of sample from birth to assessment age and missing data in some exposure areas from those assessed. CONCLUSIONS This study provides reliable developmental data from a sub-Saharan African setting in a well-characterised sample of mother-child dyads. Our findings highlight not only the important protective effects of maternal education, birth weight, and socioeconomic status for developmental outcomes but also sex differences in developmental outcomes and key risk and protective factors for each group.
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24
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Sease KK, Amati JB. "Housing First" for Optimal Child Health. Pediatrics 2019; 144:peds.2019-0500. [PMID: 31262777 DOI: 10.1542/peds.2019-0500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- Kerry K Sease
- Department of Pediatrics, School of Medicine Greenville, University of South Carolina, Greenville, South Carolina; and .,Prisma Health Children's Hospital-Midlands, Columbia, South Carolina
| | - J Blakely Amati
- Department of Pediatrics, School of Medicine Greenville, University of South Carolina, Greenville, South Carolina; and.,Prisma Health Children's Hospital-Midlands, Columbia, South Carolina
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25
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Rusconi F, Gagliardi L. Pregnancy Complications and Wheezing and Asthma in Childhood. Am J Respir Crit Care Med 2019; 197:580-588. [PMID: 29064265 DOI: 10.1164/rccm.201704-0744pp] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Franca Rusconi
- 1 Epidemiology Unit, Anna Meyer Children's University Hospital, Florence, Italy; and
| | - Luigi Gagliardi
- 2 Pediatrics and Neonatology Division, Versilia Hospital, Azienda Toscana Nord Ovest, Pisa, Italy
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26
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Arnetz BB, Arnetz J, Harkema JR, Morishita M, Slonager K, Sudan S, Jamil H. Neighborhood air pollution and household environmental health as it relates to respiratory health and healthcare utilization among elderly persons with asthma. J Asthma 2019; 57:28-39. [PMID: 30810414 DOI: 10.1080/02770903.2018.1545856] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objective: The study investigated the associations between fine particulate matter (PM2.5; <2.5 μm in diameter), indoor environment, pulmonary function, and healthcare utilization in a vulnerable group of elderly persons with asthma. We hypothesized that environmental conditions were associated with adverse pulmonary health outcomes. Methods: The study involved elderly (n = 76; mean age 64.6 years; 48 women) vulnerable persons in Detroit, Michigan, USA, with physician-diagnosed asthma. Exposure variables included measured outdoor PM2.5, self-rated outdoor and household environmental pollutants. Outcome variables were self-rated and measured pulmonary function, and asthma-related healthcare utilization. Results: Mean ambient PM2.5 concentrations during the study was 14.14 ± (S.D. 6.36) µg/m3 during the summer and 14.20 (6.33) during the winter (p = 0.95). In multiple regression analyses, adjusting for age and gender, mean 6-month concentration of PM2.5 was related to shortness of breath (SHOB; standardized β = 0.26, p = 0.02) and inversely with self-rated respiratory health (SRRH; β = 0.28, p = 0.02). However, PM2.5 did not predict lung function (FEV1% predicted and FEV1/FVC). However, PM2.5 was related to use of asthma controller drugs (β = 0.38, p = 0.001). Participants' air pollution ratings predicted total healthcare utilization (β = 0.33, p = 0.01). Conclusions: In elderly persons with asthma, living near heavy industry and busy highways, objective and perceived environmental pollution relate to participants' respiratory health and healthcare utilization. Importantly, air pollution might increase use of asthma controller drugs containing corticosteroids with implication for elderly persons' risk to develop osteoporosis and cardiovascular disease.
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Affiliation(s)
- Bengt B Arnetz
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA.,Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Judy Arnetz
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA.,Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Jack R Harkema
- Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Masako Morishita
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA
| | - Kathleen Slonager
- Asthma and Allergy Foundation of America, Michigan Chapter, Franklin, MI, USA
| | - Sukhesh Sudan
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA
| | - Hikmet Jamil
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA
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27
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Manczak EM, Dougherty B, Chen E. Parental Depressive Symptoms Potentiate the Effect of Youth Negative Mood Symptoms on Gene Expression in Children with Asthma. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2019; 47:99-108. [PMID: 29556870 PMCID: PMC6148436 DOI: 10.1007/s10802-018-0420-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Depressive symptoms in parents and in youths have been found to relate to disease comorbidity processes in children, including greater disease-related impairment and poorer clinical outcomes. The current study sought to assess whether coming from a family characterized by more depressive symptoms on average would potentiate the effects of changes in youths' own negative mood on the expression of two receptor genes relevant to asthma that are the primary targets of asthma medication, such that the combination of low child negative mood in the context of greater parental depressive symptoms would relate to the lowest levels of gene expression. One-hundred-twenty youths with diagnosed asthma and their parents participated every 6 months for 2 years. Parents reported on their depressive symptoms, children reported negative mood symptoms, and youths completed blood draws from which expression of Glucocorticoid Receptor (GR) and Beta2 Adrenergic Receptor (β2-AR) genes was extracted. Multilevel linear modeling revealed significant interactions between average levels of parental depressive symptoms and changes in youths' negative mood symptoms predicting gene expression, such that youths expressed significantly less GR and β2-AR during times when they experienced more negative mood symptoms, but this was only true if they came from families with higher levels of average parental depressive symptoms. The current study identifies novel and biologically-proximal molecular signaling patterns that connect depressive symptoms to pediatric asthma while also highlighting the important role of family environment for biological processes that may operate within depression comorbidity.
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Affiliation(s)
- Erika M Manczak
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA, 94305, USA.
| | - Bryn Dougherty
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Edith Chen
- Department of Psychology and the Institute for Policy Research, Northwestern University, Evanston, IL, USA
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28
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Associations of urban greenness with asthma and respiratory symptoms in Mexican American children. Ann Allergy Asthma Immunol 2018; 122:289-295. [PMID: 30557617 DOI: 10.1016/j.anai.2018.12.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 12/06/2018] [Accepted: 12/10/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Evidence on the association between residential surrounding greenness (RSG) in urban areas with asthma and asthma symptoms is inconsistent. OBJECTIVE To examine the association of RSG with respiratory outcomes in a sample of Mexican American children living in inner-city Chicago, Illinois. METHODS This study is based on parent-reported data on 1915 Mexican American children. We calculated RSG using the normalized difference vegetation index based on satellite imagery within buffers of 100, 250, and 500 m of each child's residence. Multivariable multilevel mixed-effect logistic regression was used to estimate adjusted odds ratios (aORs) for the effect of a 1-interquartile range increase in greenness. RESULTS In adjusted analyses, a protective effect of greenness within 100 m was observed for lifetime wheezing (aOR, 0.82; 95% CI, 0.69-0.96). Environmental tobacco smoke (ETS) exposure modified the association of RSG with lifetime asthma and current dry cough at night. For all buffer distances, increased greenness was associated with lower odds of lifetime asthma among children with current ETS exposure (100 m: aOR, 0.43; 95% CI, 0.22-0.87; 250 m: aOR, 0.39; 95% CI, 0.18-0.84; 500 m: aOR, 0.48; 95% CI, 0.26-0.90) and lower odds of current dry cough at night among children with perinatal ETS exposure (100 m: aOR, 0.53; 95% CI, 0.31-0.92; 250 m: aOR, 0.55; 95% CI, 0.31-0.98; 500 m: aOR, 0.55; 95% CI, 0.35-0.87). CONCLUSION Our results suggest inverse associations of urban greenness with respiratory outcomes, especially in children exposed to ETS. Further research is needed to examine the mechanisms through which RSG may be associated with the risk of asthma and contribute to health.
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Eze IC, Foraster M, Schaffner E, Vienneau D, Héritier H, Pieren R, Thiesse L, Rudzik F, Rothe T, Pons M, Bettschart R, Schindler C, Cajochen C, Wunderli JM, Brink M, Röösli M, Probst-Hensch N. Transportation noise exposure, noise annoyance and respiratory health in adults: A repeated-measures study. ENVIRONMENT INTERNATIONAL 2018; 121:741-750. [PMID: 30321849 DOI: 10.1016/j.envint.2018.10.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 09/19/2018] [Accepted: 10/02/2018] [Indexed: 05/17/2023]
Abstract
Transportation noise leads to sleep disturbance and to psychological and physiological sustained stress reactions, which could impact respiratory health. However, epidemiologic evidence on associations of objective transportation noise exposure and also perceived noise annoyance with respiratory morbidity is limited. We investigated independent associations of transportation noise exposure and noise annoyance with prevalent respiratory symptoms and incident asthma in adults. Using 17,138 observations (from 7049 participants) from three SAPALDIA (Swiss Cohort Study on Lung and Heart Diseases in Adults) surveys, we assessed associations of transportation noise exposure and noise annoyance with prevalent respiratory symptoms, and with incident asthma (in 10,657 nested observations from 6377 participants). Annual day-evening-night transportation noise comprising road, railway and aircraft Lden (Transportation Lden) was calculated for the most exposed façade of participants' residence using Swiss noise models. Transportation noise annoyance was assessed using an 11-point scale, and participants reported respiratory symptoms and doctor-diagnosed asthma at each survey. We estimated associations with transportation Lden (as well as source-specific Lden) and noise annoyance, independent of air pollution and other potential confounders, using mutually-adjusted mixed logistic and Poisson models and applying random intercepts at the level of the participants. Prevalent respiratory symptoms ranged from 5% (nocturnal dyspnoea) to 23% (regular cough/phlegm). Transportation noise annoyance, but not Lden, was independently associated with respiratory symptoms and current asthma in all participants, with odds ratios (OR) and 95% confidence intervals (CI) ranging between 1.03 (95%CI: 1.01, 1.06) and 1.07 (95% CI: 1.04, 1.11) per 1-point difference in noise annoyance. Both noise annoyance and Lden showed independent associations with asthma symptoms among asthmatics, especially in those reporting adult-onset asthma [ORLden: 1.90 (95% CI: 1.25, 2.89) per 10 dB; p-value of interaction (adult-onset vs. childhood-onset): 0.03; ORnoise annoyance: 1.06 (95%CI: 0.97, 1.16) per 1-point difference; p-value of interaction: 0.06]. No associations were found with incident asthma. Transportation noise level and annoyance contributed to symptom exacerbation in adult asthma. This suggests both psychological and physiological noise reactions on the respiratory system, and could be relevant for asthma care. More studies are needed to better understand the effects of objective and perceived noise in asthma aetiology and overall respiratory health.
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Affiliation(s)
- Ikenna C Eze
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
| | - Maria Foraster
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; ISGlobal, Barcelona Institute for Global Health, University Pompeu Fabra, Barcelona, Spain; CIBER Epidemiologia y Salud Publica, Madrid, Spain; Blanquerna School of Health Science, Universitat Ramon Llull, Barcelona, Spain
| | - Emmanuel Schaffner
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Danielle Vienneau
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Harris Héritier
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Reto Pieren
- Empa Laboratory for Acoustics/Noise Control, Swiss Federal Laboratories for Material Science and Technology, Dübendorf, Switzerland
| | - Laurie Thiesse
- Center for Chronobiology, Psychiatric Hospital of the University of Basel, Basel, Switzerland
| | - Franziska Rudzik
- Center for Chronobiology, Psychiatric Hospital of the University of Basel, Basel, Switzerland
| | - Thomas Rothe
- Abteilung Innere Medizin, Kantonsspital Graubunden, Chur, Switzerland
| | - Marco Pons
- Department of Internal Medicine, Regional Hospital of Lugano, Lugano, Switzerland
| | | | - Christian Schindler
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Christian Cajochen
- Center for Chronobiology, Psychiatric Hospital of the University of Basel, Basel, Switzerland
| | - Jean-Marc Wunderli
- Empa Laboratory for Acoustics/Noise Control, Swiss Federal Laboratories for Material Science and Technology, Dübendorf, Switzerland
| | - Mark Brink
- Federal Office for the Environment, Bern, Switzerland
| | - Martin Röösli
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
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Does the Stress of Laboratory Life and Experimentation on Animals Adversely Affect Research Data? A Critical Review. Altern Lab Anim 2018; 46:291-305. [DOI: 10.1177/026119291804600501] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Recurrent acute and/or chronic stress can affect all vertebrate species, and can have serious consequences. It is increasingly and widely appreciated that laboratory animals experience significant and repeated stress, which is unavoidable and is caused by many aspects of laboratory life, such as captivity, transport, noise, handling, restraint and other procedures, as well as the experimental procedures applied to them. Such stress is difficult to mitigate, and lack of significant desensitisation/habituation can result in considerable psychological and physiological welfare problems, which are mediated by the activation of various neuroendocrine networks that have numerous and pervasive effects. Psychological damage can be reflected in stereotypical behaviours, including repetitive pacing and circling, and even self-harm. Physical consequences include adverse effects on immune function, inflammatory responses, metabolism, and disease susceptibility and progression. Further, some of these effects are epigenetic, and are therefore potentially transgenerational: the biology of animals whose parents/grandparents were wild-caught and/or have experienced chronic stress in laboratories could be altered, as compared to free-living individuals. It is argued that these effects must have consequences for the reliability of experimental data and their extrapolation to humans, and this may not be recognised sufficiently among those who use animals in experiments.
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Wood BL, Brown ES, Lehman HK, Khan DA, Lee MJ, Miller BD. The effects of caregiver depression on childhood asthma: Pathways and mechanisms. Ann Allergy Asthma Immunol 2018; 121:421-427. [PMID: 29981440 DOI: 10.1016/j.anai.2018.06.031] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/14/2018] [Accepted: 06/28/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To review the literature regarding the effects of caregiver depression on childhood asthma and integrate the findings into a multilevel model of pathways by which these effects occur to further the understanding of the complex biopsychosocial nature of childhood asthma and the key role that is played by caregiver depression. DATA SOURCES PubMed was searched for articles published from 2007 to the present (10-year search), and Google Scholar was searched for articles published in 2017 and 2018 to identify the most recent publications. STUDY SELECTIONS Studies selected were recent, empirical, or meta-analytic, conducted in humans, and had specific relevance to one or more of the identified pathways. Articles published before 2007 were included if deemed essential because they addressed key pathways, for which there were no more recent articles. RESULTS Review of the literature substantiates that caregiver depression plays a key role in the socioeconomic, familial, psychological, and biological cascade of effects on childhood asthma. Childhood asthma outcomes are affected indirectly by socioeconomic status and family stress mediated by caregiver depression, which affects disease management, and/or stress and depression in the child, which, in turn, affect asthma through alterations in immune modulation and autonomic regulation. CONCLUSION Findings indicate that future research should concentrate on mediators and moderators to further clarify the complex interplay of these factors that affect childhood asthma. The findings also have substantial translational implications. Given that child stress and depression contribute to asthma disease activity and that treating caregiver depression improves child stress and depression, there is strong rationale for treating depressed caregivers of children with asthma as a component means of improving childhood asthma control.
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Affiliation(s)
- Beatrice L Wood
- Department of Psychiatry, Jacobs School of Medicine, University at Buffalo, Buffalo, New York; Department of Pediatrics, Jacobs School of Medicine, University at Buffalo, Buffalo, New York.
| | - E Sherwood Brown
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas
| | - Heather K Lehman
- Department of Pediatrics, Jacobs School of Medicine, University at Buffalo, Buffalo, New York
| | - David A Khan
- Department of Internal Medicine, Division of Allergy & Immunology, UT Southwestern Medical Center, Dallas, Texas
| | - Min Jung Lee
- Department of Internal Medicine, Division of Allergy & Immunology, UT Southwestern Medical Center, Dallas, Texas; Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas
| | - Bruce D Miller
- Department of Psychiatry, Jacobs School of Medicine, University at Buffalo, Buffalo, New York; Department of Pediatrics, Jacobs School of Medicine, University at Buffalo, Buffalo, New York
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Tafà M, Cerniglia L, Cimino S, Ballarotto G, Marzilli E, Tambelli R. Predictive Values of Early Parental Loss and Psychopathological Risk for Physical Problems in Early Adolescents. Front Psychol 2018; 9:922. [PMID: 29928249 PMCID: PMC5998644 DOI: 10.3389/fpsyg.2018.00922] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/18/2018] [Indexed: 12/15/2022] Open
Abstract
Background: Several studies have suggested that the early loss of parents is a potentially traumatic experience, exposing adolescents to a higher risk for the onset of psychopathological symptoms. Furthermore, research has shown an association between the loss of a parent in childhood and subsequent physical illnesses, but much less attention has been given to the predictive role of loss in the development of physical illness in adolescence. Methods: From a larger normative sample, we selected 418 early adolescents (and their surviving parents) each of whom had lost a parent in their first 3 years of life. We evaluate the offspring's and parents' psychopathological symptoms, dissociation, and physical problems over a 6-year period. Univariate and multivariate Cox proportional hazard regression analyses with time-dependent variables were used to examine the predictive values of the adolescents' and surviving parents' psychopathological symptoms, and youths' demographic characteristics (sex and age) for the occurrence of physical illness during a 6-year period of follow-up. Results: Independently of sex, the psychopathological risk of the surviving parents' and adolescents' affective problems and dissociation has been found to predict the occurrence of physical illnesses. Furthermore, dissociation was the most significant predictor of significant physical problems. Conclusion: These results may be relevant and an addition to the previous literature, opening up new possibilities for prevention and intervention that are oriented toward greater support for children who have experienced the loss of one parent and for surviving parents.
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Affiliation(s)
- Mimma Tafà
- Department of Dynamic and Clinical Psychology, Sapienza Università di Roma, Rome, Italy
| | - Luca Cerniglia
- Faculty of Psychology, Università Telematica Internazionale Uninettuno, Rome, Italy
| | - Silvia Cimino
- Department of Dynamic and Clinical Psychology, Sapienza Università di Roma, Rome, Italy
| | - Giulia Ballarotto
- Department of Dynamic and Clinical Psychology, Sapienza Università di Roma, Rome, Italy
| | - Eleonora Marzilli
- Department of Dynamic and Clinical Psychology, Sapienza Università di Roma, Rome, Italy
| | - Renata Tambelli
- Department of Dynamic and Clinical Psychology, Sapienza Università di Roma, Rome, Italy
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Miller GE, Chen E, Shalowitz MU, Story RE, Leigh AKK, Ham P, Arevalo JMG, Cole SW. Divergent transcriptional profiles in pediatric asthma patients of low and high socioeconomic status. Pediatr Pulmonol 2018. [PMID: 29528197 PMCID: PMC5992048 DOI: 10.1002/ppul.23983] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AIM There are marked socioeconomic disparities in pediatric asthma control, but the molecular origins of these disparities are not well understood. To fill this gap, we performed genome-wide expression profiling of monocytes and T-helper cells from pediatric asthma patients of lower and higher socioeconomic status (SES). METHOD Ninety-nine children with asthma participated in a cross-sectional assessment. Out of which 87% were atopic, and most had disease of mild (54%) or moderate (29%) severity. Children were from lower-SES (n = 49; household income <$50 000) or higher-SES (n = 50; household income >$140 000) families. Peripheral blood monocytes and T-helper cells were isolated for genome-wide expression profiling of mRNA. RESULTS Lower-SES children had worse asthma quality of life relative to higher-SES children, by both their own and their parents' reports. Although the groups had similar disease severity and potential confounds were controlled, their transcriptional profiles differed notably. The monocytes of lower-SES children showed transcriptional indications of up-regulated anti-microbial and pro-inflammatory activity. The T-helper cells of lower-SES children also had comparatively reduced expression of genes encoding γ-interferon and tumor necrosis factor-α, cytokines that orchestrate Type 1 responses. They also showed up-regulated activity of transcription factors that polarize cells towards Type 2 responses and promote Th17 cell maturation. CONCLUSION Collectively, these patterns implicate pro-inflammatory monocytes and Type 2 cytokine activity as mechanisms contributing to worse asthma control among lower-SES children.
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Affiliation(s)
- Gregory E Miller
- Department of Psychology and Institute for Policy Research, Northwestern University, Evanston, Illinois
| | - Edith Chen
- Department of Psychology and Institute for Policy Research, Northwestern University, Evanston, Illinois
| | - Madeleine U Shalowitz
- NorthShore University Health Systems, University of Chicago, Pritzker School of Medicine, Chicago, Illinois
| | - Rachel E Story
- NorthShore University Health Systems, University of Chicago, Pritzker School of Medicine, Chicago, Illinois
| | - Adam K K Leigh
- Department of Psychology and Institute for Policy Research, Northwestern University, Evanston, Illinois
| | - Paula Ham
- Department of Psychology and Institute for Policy Research, Northwestern University, Evanston, Illinois
| | - Jesusa M G Arevalo
- Division of Hematology-Oncology, UCLA AIDS Institute, Molecular Biology Institute, Jonsson Comprehensive Cancer Center, and Norman Cousins Center, UCLA School of Medicine, Los Angeles, California
| | - Steve W Cole
- Division of Hematology-Oncology, UCLA AIDS Institute, Molecular Biology Institute, Jonsson Comprehensive Cancer Center, and Norman Cousins Center, UCLA School of Medicine, Los Angeles, California
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Bandoli G, Ghosh JK, von Ehrenstein O, Ritz B. Psychosocial stressors and lung function in youth ages 10-17: an examination by stressor, age and gender. J Public Health (Oxf) 2018; 39:297-303. [PMID: 27160859 DOI: 10.1093/pubmed/fdw035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Research on the impact of psychosocial stressors on child and adolescent lung function is uncommon, and has primarily relied either on parents' own stress measures or parent-reported stressors the child experienced, which may be a poor proxy for perceived stress in older children and adolescents. Methods We performed multivariate linear regression of spirometry measures (FVC, FEV1 and FEF25-75) and psychosocial stressors in 584 adolescents in the Los Angeles Family and Neighborhood Survey. We examined family conflict, unsafe neighborhood or school, and the absence of a father in models stratified by gender, adjusting for PM2.5 and potential confounders. Results We observed reductions in lung function in males related to the absence of a father in the house (FEV1: -176.2 ml, 95% CI -322.7, -29.7) and family conflict (FEV1: -156.2 ml, 95% CI -327.8, 15.5); associations were stronger in older males ages 15-17 years for each stressor (P for interaction of age and sex was 0.009 and 0.06, respectively). Conclusions This research informs a very small literature on psychosocial stressors and lung function in adolescents. Our finding of differential vulnerability by age and gender warrants further exploration of adolescent psychosocial stressor response on lung function.
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Affiliation(s)
- G Bandoli
- Department of Pediatrics, University of California, 7910 Frost Street, Ste 370, San Diego, CA 92123, USA
| | - J K Ghosh
- Unaffiliated, Los Angeles, CA 91214, USA
| | - O von Ehrenstein
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, CA 90095, USA
| | - B Ritz
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA 90095, USA
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Diep J, Fagnano M, Tremblay P, Halterman JS. The relationship between caregivers' subjective social status and asthma symptoms and management for urban children. J Asthma 2018; 56:211-217. [PMID: 29494268 DOI: 10.1080/02770903.2018.1437176] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Subjective social status (SSS) is a person's perception of his/her social standing among others. We explored the relationship between caregivers' SSS and asthma symptoms, visits, and medication use among children with persistent asthma. METHODS We analyzed baseline data of children (3-10 years) from the SB-TEAM trial in Rochester, NY. Using a modified MacArthur Scale of SSS, caregivers rated themselves "a lot worse off" to "a lot better off" compared to 4 groups (e.g., neighbors). "Low SSS" was defined by a response of "a lot worse off" or "somewhat worse off" for any of the referent groups. Caregivers reported their child's asthma symptoms, healthcare visits for asthma, and medication use. Bivariate and multivariate statistics were used. RESULTS We found that, of the 230 children enrolled (participation rate:78%, 62% Black, 72% Medicaid), 29% of caregivers had low SSS. Caregivers with low SSS had more depressive symptoms (46% vs. 28%) and lower social support (69.1 vs. 77.7). In multivariable analyses, children of caregivers with low SSS had fewer symptom-free days/2 weeks (5.8 vs. 7.9, p = .01). While they were more likely to have a routine asthma visit in the past year (35% vs. 23%, adjusted p = .03), there was no difference in their use of preventive medication. CONCLUSIONS Many caregivers of children with persistent asthma report low SSS. While children of these caregivers had fewer symptom-free days, they were not more likely to use preventive medications. Efforts are needed to support these caregivers to ensure optimal preventive care and reduce morbidity.
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Affiliation(s)
- Judy Diep
- a University of Rochester School of Medicine and Dentistry , Rochester , NY , USA
| | - Maria Fagnano
- a University of Rochester School of Medicine and Dentistry , Rochester , NY , USA
| | - Paul Tremblay
- a University of Rochester School of Medicine and Dentistry , Rochester , NY , USA
| | - Jill S Halterman
- a University of Rochester School of Medicine and Dentistry , Rochester , NY , USA
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Bandoli G, von Ehrenstein O, Ghosh JKC, Flores MES, Dunkel Schetter C, Ritz B. Prenatal Maternal Stress and the Risk of Lifetime Wheeze in Young Offspring: An Examination by Stressor and Maternal Ethnicity. J Immigr Minor Health 2018; 18:987-995. [PMID: 26343048 DOI: 10.1007/s10903-015-0269-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Prenatal psychosocial stressors may increase the risk of wheeze in young offspring, yet little attention has been given to the effects that maternal ethnicity may have on this relationship. From a population-based cohort of 1193 children, we assessed the effect of maternal prenatal stressors on the risk of lifetime wheeze in young offspring. We further studied whether maternal Latina ethnicity modified these associations. The risk of wheeze in the offspring was increased from high levels of pregnancy anxiety (aRR 1.40, 95 % CI 1.07, 1.83), negative life events (aRR 1.36, 95 % CI 1.06, 1.75), or low paternal support (aRR 1.41, 95 % CI 1.02, 1.96). The risk of lifetime wheeze was stronger in the offspring of Latina mothers than of White mothers for these same stressors. Multiple maternal prenatal stressors are associated with increased risk of lifetime wheeze in young offspring, with slight effect modification by Latina ethnicity.
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Affiliation(s)
- Gretchen Bandoli
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Box 951772, Los Angeles, CA, 90095, USA.
| | - Ondine von Ehrenstein
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Marie E S Flores
- Department of Family and Social Medicine, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Beate Ritz
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Box 951772, Los Angeles, CA, 90095, USA
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The effects of early life adversity on the immune system. Psychoneuroendocrinology 2017; 82:140-154. [PMID: 28549270 DOI: 10.1016/j.psyneuen.2017.05.012] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 05/11/2017] [Accepted: 05/15/2017] [Indexed: 11/23/2022]
Abstract
Early life adversity (ELA) is associated with a higher risk for diseases in adulthood. Although the pathophysiological effects of ELA are varied, there may be a unifying role for the immune system in all of the long-term pathologies such as chronic inflammatory disorders (autoimmune diseases, allergy, and asthma). Recently, significant efforts have been made to elucidate the long-term effects ELA has on immune function, as well as the mechanisms underlying these immune changes. In this review, we focus on data from human studies investigating immune parameters in relation to post-natal adverse experiences. We describe the current understanding of the 'ELA immune phenotype', characterized by inflammation, impairment of the cellular immune system, and immunosenescence. However, at present, data addressing specific immune functions are limited and there is a need for high-quality, well powered, longitudinal studies to unravel cause from effect. Besides the immune system, also the stress system and health behaviors are altered in ELA. We discuss probable underlying mechanisms based on epigenetic programming that could explain the ELA immune phenotype and whether this is a direct effect of immune programming or an indirect consequence of changes in behavior or stress reactivity. Understanding the underlying mechanisms will help define effective strategies to prevent or counteract negative ELA-associated outcomes.
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Miller GE, Borders AE, Crockett AH, Ross KM, Qadir S, Keenan-Devlin L, Leigh AK, Ham P, Ma J, Arevalo JM, Ernst LM, Cole SW. Maternal socioeconomic disadvantage is associated with transcriptional indications of greater immune activation and slower tissue maturation in placental biopsies and newborn cord blood. Brain Behav Immun 2017; 64:276-284. [PMID: 28434870 PMCID: PMC5493326 DOI: 10.1016/j.bbi.2017.04.014] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 04/17/2017] [Accepted: 04/18/2017] [Indexed: 12/13/2022] Open
Abstract
Children from economically disadvantaged families experience worse cognitive, psychiatric, and medical outcomes compared to more affluent youth. Preclinical models suggest some of the adverse influence of disadvantage could be transmitted during gestation via maternal immune activation, but this hypothesis has not been tested in humans. It also remains unclear whether prenatal interventions can mitigate such effects. To fill these gaps, we conducted two studies. Study 1 characterized the socioeconomic conditions of 79 women during pregnancy. At delivery, placenta biopsies and umbilical blood were collected for transcriptional profiling. Maternal disadvantage was associated with a transcriptional profile indicative of higher immune activation and slower fetal maturation, particularly in pathways related to brain, heart, and immune development. Cord blood cells of disadvantaged newborns also showed indications of immaturity, as reflected in down-regulation of pathways that coordinate myeloid cell development. These associations were independent of fetal sex, and characteristics of mothers (age, race, adiposity, diabetes, pre-eclampsia) and babies (delivery method, gestational age). Study 2 performed the same transcriptional analyses in specimens from 20 women participating in CenteringPregnancy, a group-based psychosocial intervention, and 20 women in traditional prenatal care. In both placenta biopsies and cord blood, women in CenteringPregnancy showed up-regulation of transcripts found in Study 1 to be most down-regulated in conjunction with disadvantage. Collectively, these results suggest socioeconomic disparities in placental biology are evident at birth, and provide clues about the mechanistic origins of health disparities. They also suggest the possibility that psychosocial interventions could have mitigating influences.
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Affiliation(s)
- Gregory E. Miller
- Department of Psychology and Institute for Policy Research, Northwestern University, Evanston IL
| | - Ann E. Borders
- Department of Obstetrics & Gynecology, NorthShore University Health System, University of Chicago Pritzker School of Medicine, Evanston IL
| | - Amy H. Crockett
- Department of Obstetrics & Gynecology, Greenville Hospital System University Medical Center, Greenville SC
| | - Kharah M. Ross
- Department of Psychology and Institute for Policy Research, Northwestern University, Evanston IL
| | - Sameen Qadir
- Department of Obstetrics & Gynecology, NorthShore University Health System, University of Chicago Pritzker School of Medicine, Evanston IL
| | - Lauren Keenan-Devlin
- Department of Obstetrics & Gynecology, NorthShore University Health System, University of Chicago Pritzker School of Medicine, Evanston IL
| | - Adam K. Leigh
- Department of Psychology and Institute for Policy Research, Northwestern University, Evanston IL
| | - Paula Ham
- Department of Psychology and Institute for Policy Research, Northwestern University, Evanston IL
| | - Jeffrey Ma
- Division of Hematology-Oncology, UCLA AIDS Institute, Molecular Biology Institute, Jonsson Comprehensive Cancer Center, Norman Cousins Center, UCLA School of Medicine, Los Angeles CA
| | - Jesusa M.G. Arevalo
- Division of Hematology-Oncology, UCLA AIDS Institute, Molecular Biology Institute, Jonsson Comprehensive Cancer Center, Norman Cousins Center, UCLA School of Medicine, Los Angeles CA
| | - Linda M. Ernst
- Department of Pathology, NorthShore University Health System, University of Chicago Pritzker School of Medicine, Evanston IL
| | - Steve W. Cole
- Division of Hematology-Oncology, UCLA AIDS Institute, Molecular Biology Institute, Jonsson Comprehensive Cancer Center, Norman Cousins Center, UCLA School of Medicine, Los Angeles CA
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Verkleij M, Beelen A, van Ewijk BE, Geenen R. Multidisciplinary treatment in children with problematic severe asthma: A prospective evaluation. Pediatr Pulmonol 2017; 52:588-597. [PMID: 27736038 DOI: 10.1002/ppul.23623] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 09/16/2016] [Accepted: 09/27/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE For children with problematic severe asthma, achieving adequate control of asthma is difficult. The aim of this prospective observational study was to evaluate the effects of intensive multidisciplinary inpatient treatment on multiple outcome variables in children with problematic severe asthma. METHODS Participants were 89 children with problematic severe asthma (mean age 13.6 ± 2.5 years) treated in tertiary care clinics at high altitude (Switzerland) or sea level (Netherlands) and their parents (85 mothers, 55 fathers). The primary outcome variable was the Childhood Asthma Control Test (C-ACT). Other outcome variables were forced expiratory volume in 1 sec (FEV1 ), fractional concentration of exhaled nitric oxide (FeNO), quality of life [PAQLQ(S)], children's coping (UCL-A), parents' report of behavioral problems (CBCL), and parenting stress (PSI/NOSI). Evaluations were taken pre-treatment, post-treatment, and 3-6 months follow-up. Median [P25;P75] treatment duration 74 [56;80] days; Median follow-up interval 131 [103;177] days. RESULTS The percentages of children showing controlled asthma (C-ACT) were 18% (pre-treatment), 69% (post-treatment), and 44% (follow-up). The vast majority of the children (80%) showed an improvement on C-ACT with 4% showing a deterioration. On C-ACT, FeNO, quality of life, and behavioral problems, improvements at post-treatment were highly significant. Improvements generally remained at a functional level at follow-up. Children's coping and parenting stress in parents did not change. CONCLUSIONS The improvement in asthma control and other outcome variables suggests that multidisciplinary inpatient treatment is an effective approach for a heterogeneous group of children with asthma that remained uncontrolled in secondary care. Pediatr Pulmonol. 2017;52:588-597. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Marieke Verkleij
- Merem Netherlands Asthma Center, Davos, Switzerland.,Merem Asthma Center Heideheuvel, Hilversum, The Netherlands.,Department of Pediatric Psychology, VU University Medical Center, Amsterdam, The Netherlands
| | - Anita Beelen
- Merem Asthma Center Heideheuvel, Hilversum, The Netherlands.,Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Rinie Geenen
- Department of Psychology, Utrecht University, Utrecht, The Netherlands
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Ramratnam SK, Visness CM, Jaffee KF, Bloomberg GR, Kattan M, Sandel MT, Wood RA, Gern JE, Wright RJ. Relationships among Maternal Stress and Depression, Type 2 Responses, and Recurrent Wheezing at Age 3 Years in Low-Income Urban Families. Am J Respir Crit Care Med 2017; 195:674-681. [PMID: 27654103 PMCID: PMC5363974 DOI: 10.1164/rccm.201602-0272oc] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 09/21/2016] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Maternal depression and prenatal and early life stress may influence childhood wheezing illnesses, potentially through effects on immune development. OBJECTIVES To test the hypothesis that maternal stress and/or depression during pregnancy and early life are associated with recurrent wheezing and aeroallergen sensitivity and altered cytokine responses (enhanced type 2 or reduced virus-induced cytokine responses) from stimulated peripheral blood mononuclear cells at age 3 years. METHODS URECA (Urban Environment and Childhood Asthma) is a birth cohort at high risk for asthma (n = 560) in four inner cities. Maternal stress, depression, and childhood wheezing episodes were assessed by quarterly questionnaires beginning at birth. Logistic and linear regression techniques were used to examine the relation of maternal stress/depression to recurrent wheezing and peripheral blood mononuclear cell cytokine responses at age 3 years. MEASUREMENTS AND MAIN RESULTS Overall, 166 (36%) children had recurrent wheeze at age 3 years. Measures of maternal perceived stress at Years 2 and 3 were positively associated with recurrent wheeze (P < 0.05). Maternal depression (any year) was significantly associated with recurrent wheezing (P ≤ 0.01). These associations were also significant when considered in a longitudinal analysis of cumulative stress and depression (P ≤ 0.02). Neither stress nor depression was significantly related to aeroallergen sensitization or antiviral responses. Contrary to our original hypothesis, prenatal and Year 1 stress and depression had significant inverse associations with several type 2 cytokine responses. CONCLUSIONS In urban children at high risk for asthma, maternal perceived stress and depression were significantly associated with recurrent wheezing but not increased atopy or reduced antiviral responses.
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Affiliation(s)
- Sima K. Ramratnam
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | | | | | - Meyer Kattan
- Columbia University College of Physicians and Surgeons, New York, New York
| | | | - Robert A. Wood
- Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - James E. Gern
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Rosalind J. Wright
- Kravis Children’s Hospital and Mindich Child Health & Development Institute, Icahn School of Medicine at Mount Sinai, New York, New York
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Brewer M, Kimbro RT, Denney JT, Osiecki KM, Moffett B, Lopez K. Does neighborhood social and environmental context impact race/ethnic disparities in childhood asthma? Health Place 2017; 44:86-93. [PMID: 28219854 DOI: 10.1016/j.healthplace.2017.01.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 11/20/2016] [Accepted: 01/09/2017] [Indexed: 12/22/2022]
Abstract
Utilizing over 140,000 geocoded medical records for a diverse sample of children ages 2-12 living in Houston, Texas, we examine whether a comprehensive set of neighborhood social and environmental characteristics explain racial and ethnic disparities in childhood asthma. Adjusting for all individual risk factors, as well as neighborhood concentrated disadvantage, particulate matter, ozone concentration, and race/ethnic composition, reduced but did not fully attenuate the higher odds of asthma diagnosis among black (OR=2.59, 95% CI=2.39, 2.80), Hispanic (OR=1.22, 95% CI=1.14, 1.32) and Asian (OR=1.18, 95% CI=1.04, 1.33) children relative to whites.
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Affiliation(s)
| | | | | | - Kristin M Osiecki
- University of Illinois Springfield, One University Plaza, Springfield, IL 62703-5407, USA.
| | - Brady Moffett
- Baylor College of Medicine and Texas Children's Hospital, 6621 Fannin Street, Houston, TX 77030, USA.
| | - Keila Lopez
- Baylor College of Medicine and Texas Children's Hospital, 6621 Fannin Street, Houston, TX 77030, USA.
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Bush A, Bolton CE. Longer Term Sequelae of Prematurity: The Adolescent and Young Adult. RESPIRATORY OUTCOMES IN PRETERM INFANTS 2017. [DOI: 10.1007/978-3-319-48835-6_7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Thakur N, White MJ, Burchard EG. Race and Ethnicity. Respir Med 2017. [DOI: 10.1007/978-3-319-43447-6_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Asthma as a disruption in iron homeostasis. Biometals 2016; 29:751-79. [PMID: 27595579 DOI: 10.1007/s10534-016-9948-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 07/07/2016] [Indexed: 12/28/2022]
Abstract
Over several decades, asthma has evolved from being recognized as a single disease to include a diverse group of phenotypes with dissimilar natural histories, pathophysiologies, responses to treatment, and distinctive molecular pathways. With the application of Occam's razor to asthma, it is proposed that there is one cause underlying the numerous phenotypes of this disease and that the responsible molecular pathway is a deficiency of iron in the lung tissues. This deficiency can be either absolute (e.g. asthma in the neonate and during both pregnancy and menstruation) or functional (e.g. asthma associated with infections, smoking, and obesity). Comparable associations between asthma co-morbidity (e.g. eczema, urticaria, restless leg syndrome, and pulmonary hypertension) with iron deficiency support such a shared mechanistic pathway. Therapies directed at asthma demonstrate a capacity to impact iron homeostasis, further strengthening the relationship. Finally, pathophysiologic events producing asthma, including inflammation, increases in Th2 cells, and muscle contraction, can correlate with iron availability. Recognition of a potential association between asthma and an absolute and/or functional iron deficiency suggests specific therapeutic interventions including inhaled iron.
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Parenting Stress Related to Behavioral Problems and Disease Severity in Children with Problematic Severe Asthma. J Clin Psychol Med Settings 2016; 22:179-93. [PMID: 26054697 PMCID: PMC4575360 DOI: 10.1007/s10880-015-9423-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Our study examined parenting stress and its association with behavioral problems and disease severity in children with problematic severe asthma. Research participants were 93 children (mean age 13.4 ± 2.7 years) and their parents (86 mothers, 59 fathers). As compared to reference groups analyzed in previous research, scores on the Parenting Stress Index in mothers and fathers of the children with problematic severe asthma were low. Higher parenting stress was associated with higher levels of internalizing and externalizing behavioral problems in children (Child Behavior Checklist). Higher parenting stress in mothers was also associated with higher airway inflammation (FeNO). Thus, although parenting stress was suggested to be low in this group, higher parenting stress, especially in the mother, is associated with more airway inflammation and greater child behavioral problems. This indicates the importance of focusing care in this group on all possible sources of problems, i.e., disease exacerbations and behavioral problems in the child as well as parenting stress.
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Beck AF, Huang B, Ryan PH, Sandel MT, Chen C, Kahn RS. Areas with High Rates of Police-Reported Violent Crime Have Higher Rates of Childhood Asthma Morbidity. J Pediatr 2016; 173:175-182.e1. [PMID: 26960918 PMCID: PMC4884512 DOI: 10.1016/j.jpeds.2016.02.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 12/31/2015] [Accepted: 02/02/2016] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To assess whether population-level violent (and all) crime rates were associated with population-level child asthma utilization rates and predictive of patient-level risk of asthma reutilization after a hospitalization. STUDY DESIGN A retrospective cohort study of 4638 pediatric asthma-related emergency department visits and hospitalizations between 2011 and 2013 was completed. For population-level analyses, census tract asthma utilization rates were calculated by dividing the number of utilization events within a tract by the child population. For patient-level analyses, hospitalized patients (n = 981) were followed until time of first asthma-related reutilization. The primary predictor was the census tract rate of violent crime as recorded by the police; the all crime (violent plus nonviolent) rate was also assessed. RESULTS Census tract-level violent and all crime rates were significantly correlated with asthma utilization rates (both P < .0001). The violent crime rate explained 35% of the population-level asthma utilization variance and remained associated with increased utilization after adjustment for census tract poverty, unemployment, substandard housing, and traffic exposure (P = .002). The all crime rate explained 28% of the variance and was similarly associated with increased utilization after adjustment (P = .02). Hospitalized children trended toward being more likely to reutilize if they lived in higher violent (P = .1) and all crime areas (P = .01). After adjustment, neither relationship was significant. CONCLUSIONS Crime data could help facilitate early identification of potentially toxic stressors relevant to the control of asthma for populations and patients.
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Affiliation(s)
- Andrew F. Beck
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Bin Huang
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Patrick H. Ryan
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Megan T. Sandel
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts, U.S.A
| | - Chen Chen
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Robert S. Kahn
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
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Rosas-Salazar C, Han YY, Brehm JM, Forno E, Acosta-Pérez E, Cloutier MM, Alvarez M, Colón-Semidey A, Canino G, Celedón JC. Gun Violence, African Ancestry, and Asthma: A Case-Control Study in Puerto Rican Children. Chest 2016; 149:1436-44. [PMID: 26905363 PMCID: PMC4944789 DOI: 10.1016/j.chest.2016.02.639] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 12/23/2015] [Accepted: 02/02/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Exposure to gun violence and African ancestry have been separately associated with increased risk of asthma in Puerto Rican children. OBJECTIVE The objective of this study was to examine whether African ancestry and gun violence interact on asthma and total IgE in school-aged Puerto Rican children. METHODS This is a case-control study of 747 Puerto Rican children aged 9 to 14 years living in San Juan, Puerto Rico (n = 472), and Hartford, Connecticut (n = 275). Exposure to gun violence was defined as the child's report of hearing gunshots more than once, and the percentage of African ancestry was estimated using genome-wide genotypic data. Asthma was defined as parental report of physician-diagnosed asthma and wheeze in the previous year. Serum total IgE (IU/mL) was measured in study participants. Multivariate logistic and linear regressions were used for the analysis of asthma and total IgE, respectively. RESULTS In multivariate analyses, there was a significant interaction between exposure to gun violence and African ancestry on asthma (P = .001) and serum total IgE (P = .04). Among children exposed to gun violence, each quartile increase in the percentage of African ancestry was associated with approximately 45% higher odds of asthma (95% CI, 1.15-1.84; P = .002) and an approximately 19% increment in total IgE (95% , 0.60-40.65, P = .04). In contrast, there was no significant association between African ancestry and asthma or total IgE in children not exposed to gun violence. CONCLUSIONS Our results suggest that exposure to gun violence modifies the estimated effect of African ancestry on asthma and atopy in Puerto Rican children.
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Affiliation(s)
- Christian Rosas-Salazar
- Division of Pediatric Allergy, Immunology, and Pulmonary Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University, Nashville, TN
| | - Yueh-Ying Han
- Division of Pediatric Pulmonary Medicine, Allergy, and Immunology, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA
| | - John M Brehm
- Division of Pediatric Pulmonary Medicine, Allergy, and Immunology, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA
| | - Erick Forno
- Division of Pediatric Pulmonary Medicine, Allergy, and Immunology, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA
| | - Edna Acosta-Pérez
- Behavioral Sciences Research Institute and Department of Pediatrics, University of Puerto Rico, San Juan, PR
| | - Michelle M Cloutier
- Department of Pediatrics, University of Connecticut Health Center, Farmington, CT
| | - María Alvarez
- Behavioral Sciences Research Institute and Department of Pediatrics, University of Puerto Rico, San Juan, PR
| | - Angel Colón-Semidey
- Behavioral Sciences Research Institute and Department of Pediatrics, University of Puerto Rico, San Juan, PR
| | - Glorisa Canino
- Behavioral Sciences Research Institute and Department of Pediatrics, University of Puerto Rico, San Juan, PR
| | - Juan C Celedón
- Division of Pediatric Pulmonary Medicine, Allergy, and Immunology, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA.
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Cao-Lei L, Veru F, Elgbeili G, Szyf M, Laplante DP, King S. DNA methylation mediates the effect of exposure to prenatal maternal stress on cytokine production in children at age 13½ years: Project Ice Storm. Clin Epigenetics 2016; 8:54. [PMID: 27182285 PMCID: PMC4866030 DOI: 10.1186/s13148-016-0219-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 05/04/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Prenatal maternal stress (PNMS) is an important programming factor of postnatal immunity. We tested here the hypothesis that DNA methylation of genes in the NF-κB signaling pathway in T cells mediates the effect of objective PNMS on Th1 and Th2 cytokine production in blood from 13½ year olds who were exposed in utero to the 1998 Quebec ice storm. RESULTS Bootstrapping analyses were performed with 47 CpGs across a selection of 20 genes for Th1-type cytokines (IFN-γ and IL-2) and Th2-type cytokines (IL-4 and IL-13). Six CpGs in six different NF-κB signaling genes (PIK3CD, PIK3R2, NFKBIA, TRAF5, TNFRSF1B, and LTBR) remained as significant negative mediators of objective PNMS on IFN-γ secretion after correcting for multiple comparisons. However, no mediation effects on IL-2, IL-4 and IL-13 survived Bonferroni correction. CONCLUSIONS The present study provides preliminary evidence supporting the mediating role of DNA methylation in the association between objective aspects of PNMS and child immune states, favoring a Th2 shift.
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Affiliation(s)
- Lei Cao-Lei
- />Department of Psychiatry, McGill University and Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, Quebec H4H 1R3 Canada
| | - Franz Veru
- />Douglas Hospital Research Centre, Montreal, Quebec Canada
| | | | - Moshe Szyf
- />Department of Pharmacology and Therapeutics and Sackler Program for Epigenetics and Developmental Psychobiology, McGill University, Montreal, Quebec Canada
| | | | - Suzanne King
- />Department of Psychiatry, McGill University and Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, Quebec H4H 1R3 Canada
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Bandoli G, von Ehrenstein O, Ghosh JK, Ritz B. Synergistic effects of air pollution and psychosocial stressors on adolescent lung function. J Allergy Clin Immunol 2016; 138:918-920.e4. [PMID: 27262744 DOI: 10.1016/j.jaci.2016.04.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 03/30/2016] [Accepted: 04/13/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Gretchen Bandoli
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Calif.
| | - Ondine von Ehrenstein
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Calif
| | | | - Beate Ritz
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Calif
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Lee A, Mathilda Chiu YH, Rosa MJ, Jara C, Wright RO, Coull BA, Wright RJ. Prenatal and postnatal stress and asthma in children: Temporal- and sex-specific associations. J Allergy Clin Immunol 2016; 138:740-747.e3. [PMID: 26953156 DOI: 10.1016/j.jaci.2016.01.014] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 12/22/2015] [Accepted: 01/07/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Temporal- and sex-specific effects of perinatal stress have not been examined for childhood asthma. OBJECTIVES We examined associations between prenatal and/or postnatal stress and children's asthma (n = 765) and effect modification by sex in a prospective cohort study. METHODS Maternal negative life events were ascertained prenatally and postpartum. Negative life event scores were categorized as 0, 1 to 2, 3 to 4, or 5 or greater to assess exposure-response relationships. We examined effects of prenatal and postnatal stress on children's asthma by age 6 years, modeling each as independent predictors, mutually adjusting for prenatal and postnatal stress, and finally considering interactions between prenatal and postnatal stress. Effect modification by sex was examined in stratified analyses and by fitting interaction terms. RESULTS When considering stress in each period independently, among boys, a dose-response relationship was evident for each level increase on the ordinal scale prenatally (odds ratio [OR], 1.38; 95% CI, 1.06-1.79; P value for trend = .03) and postnatally (OR, 1.53; 95% CI, 1.16-2.01; P value for trend = .001); among girls, only the postnatal trend was significant (OR, 1.60; 95% CI, 1.14-2.22; P value for trend = .005). Higher stress in both the prenatal and postnatal periods was associated with increased odds of receiving a diagnosis of asthma in girls (OR, 1.37; 95% CI, 0.98-1.91; Pinteraction = .07) but not boys (OR, 1.08; 95% CI, 0.82-1.42; Pinteraction = .61). CONCLUSIONS Although boys were more vulnerable to stress during the prenatal period, girls were more affected by postnatal stress and cumulative stress across both periods in relation to asthma. Understanding sex and temporal differences in response to early-life stress might provide unique insight into the cause and natural history of asthma.
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Affiliation(s)
- Alison Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Yueh-Hsiu Mathilda Chiu
- Department of Pediatrics, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Maria José Rosa
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Calvin Jara
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Robert O Wright
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Mindich Child Health & Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Brent A Coull
- Department of Biostatistics, Harvard School of Public Health, Boston, Mass; Department of Environmental Health, Harvard School of Public Health, Boston, Mass
| | - Rosalind J Wright
- Department of Pediatrics, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, NY; Mindich Child Health & Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY.
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