[Seasonality in asthma: Impact and treatments]

Seasonal Variation and Severity of Acute Abdomen in Japan: A Nine-Year Retrospective Analysis

The seasonal incidence of acute abdomens, such as appendicitis, is reportedly more common in summer but is reported less frequently in Asia. Additionally, seasonal variations in the severity of acute abdomens have been evaluated insufficiently. This study evaluated the seasonal variations in the incidence and severity of acute abdomens in Japan. This retrospective observational study used a multicenter database containing data from 42 acute hospitals in Japan. We included all patients diagnosed with acute appendicitis, diverticulitis, cholecystitis, and cholangitis between January 2011 and December 2019. Baseline patient data included admission date, sequential organ failure assessment score, presence of sepsis, and disseminated intravascular coagulation. We enrolled 24,708 patients with acute abdomen. Seasonal admissions for all four acute abdominal diseases were the highest in summer [acute appendicitis, (OR = 1.35; 95% CI = 1.28-1.43); diverticulitis, (OR = 1.23; 95% CI = 1.16-1.31; cholecystitis (OR = 1.23; 95% CI = 1.11-1.36); and cholangitis (OR = 1.23; 95% CI = 1.12-1.36)]. The proportion of patients with sepsis and disseminated intravascular coagulation as well as the total SOFA score for each disease, did not differ significantly across seasons. Seasonal variations in disease severity were not observed.

Modelling the patient accrual with truncated Gaussian mixture distribution for the accurate estimation of sample size in survival trials

In survival trials with fixed trial length, the patient accrual rate has a significant impact on the sample size estimation or equivalently, on the power of trials. A larger sample size is required for the staggered patient entry. During enrollment, the patient accrual rate changes with the recruitment publicity effect, disease incidence and many other factors and fluctuations of the accrual rate occur frequently. However, the existing accrual models are either over-simplified for the constant rate assumption or complicated in calculation for the subdivision of the accrual period. A more flexible accrual model is required to represent the fluctuant patient accrual rate for accurate sample size estimation. In this paper, inspired by the flexibility of the Gaussian mixture distribution in approximating continuous densities, we propose the truncated Gaussian mixture distribution accrual model to represent different variations of accrual rate by different parameter configurations. The sample size calculation formula and the parameter setting of the proposed accrual model are discussed further.

Air pollutants and asthma patient visits: Indication of source influence

BACKGROUND

Sources of air pollutants are significant factors for adverse health effect. Few current studies explored the linking of sources influence and ambient pollutants to asthma patient visits in Shanghai, China.

OBJECTIVES

This study explored the associations between short-term exposures to ambient pollutants and asthma morbidity with terrestrial and marine source influence in Shanghai.

METHODS

Generalized additive model (GAM) was used to explore the association of daily patient visits and ambient pollutants. These analyses were calculated in R statistical software in mgcv package. PSCF modeling was used to locate potential source areas contributing to the concentrations of pollutants.

RESULTS

We found that per IQR of PM_2.5, PM₁₀, NO₂, SO₂, O₃ and CO in terrestrial source were associated with an increase of 6.63% (95% CI: -0.27% to 14%), 6.48% (95% CI: 0.06% to 13.3%), 1.68% (95% CI: -2.68% to 6.24%), 2.81% (95% CI: -1.42% to 7.22%), -0.60% (95% CI: -5.94% to 5.04%) and 16.6% (95% CI: 8.68% to 25.2%), respectively in asthma patient visits. Per IQR of PM_2.5, PM₁₀, NO₂, SO₂, O₃ and CO in marine source were associated with an increase of 5.34% (95% CI: 0.42% to 10.5%), 3.84% (95% CI: 0.08% to 7.74%), 3.21% (95% CI: -0.92% to 7.52%), 2.58% (95% CI: -1.02% to 6.30%), 1.42% (95% CI: -3.10% to 6.15%) and 8.81% (95% CI: 2.56% to 15.4%). The PSCF show all of the pollutants except O₃ mainly come from terrestrial during observation. We also found that all of the pollutants except NO₂ displayed the highest effect in the spring for relative risk of asthma morbidity.

CONCLUSIONS

Ambient air pollutants that cause an increase in asthma patient visits, such as PM_2.5, PM₁₀, NO₂, SO₂ and CO are mainly produced from terrestrial sources, while O₃ is primarily from marine sources. The association of ambient pollutants and asthma patient visits is closely related with seasons, especially with spring. PM_2.5 and CO are major air pollutants increasing the relative risk of asthma patient visits in Shanghai.

Effect of enterovirus infections on asthma in young children: A national cohort study

BACKGROUND

We conducted a cohort study to determine the relationship between enterovirus (EV) infection and asthma.

MATERIALS AND METHODS

From the National Health Insurance Research Database of Taiwan, we identified patients who received a new diagnosis of asthma and concurrent treatment between January 2000 and December 2011 (EV cohort: n = 208 213; non-EV cohort: n = 208 213). Cox proportional hazards regression analysis was performed to determine and compare the adjusted hazard ratios (aHRs) of asthma between these 2 cohorts. Kaplan-Meier analysis was conducted to assess the differences in the cumulative incidence curves of asthma between the 2 cohorts.

RESULTS

The overall aHR of asthma was 1.48-fold higher in the EV cohort than in the non-EV cohort (95% confidence interval = 1.45-1.50). The aHR of asthma was higher in the EV cohort than in the non-EV cohort, comprising children aged ≤5 years, regardless of sex, sociodemographic factors (urbanization level and parental occupation) or comorbidities. The risk of asthma was higher in 1-3, 4-6, 7-9 and 10-12 months (all P < .001), particularly in those with a higher frequency of admission (>5 per year).

CONCLUSION

The incidence of asthma was higher in the EV cohort than in the non-EV cohort, comprising children aged ≤5 years, regardless of sex, urbanization level, parental occupation or season. In particular, the risk of asthma was higher in children with a higher frequency of admission, even in the absence of atopy or other respiratory infections.