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Paciência I, Moreira A, Cavaleiro Rufo J, Santos AC, Barros H, Ribeiro AI. Association between Land Use Mix and Respiratory Symptoms and Asthma in Children from the Generation XXI Birth Cohort. J Urban Health 2022; 99:218-230. [PMID: 35066785 PMCID: PMC9033904 DOI: 10.1007/s11524-021-00604-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 10/19/2022]
Abstract
Land use mix (LUM) in the neighbourhoods has been associated with healthier lifestyles. However, less is known about the association between LUM and health outcomes, namely during childhood. The objective of this study was to evaluate the association between different LUM indexes for Porto Metropolitan Area and asthma and respiratory symptoms in children. A cross-sectional analysis was performed involving 6260 children enrolled in Generation XXI. Land use around the child's residence was assessed with the Portuguese official map of land cover using a GIS. Generalized linear mixed-effects models were fitted to estimate the association between LUM and respiratory symptoms and asthma at 7 years of age. Adjusted associations were quantified using odds ratio (OR) and 95% confidence interval (95% CI). After adjustment, LUM was associated with a lower odds of wheezing in the last 12 months [OR (95% CI) = 0.37 (0.15; 0.93) using Shannon's Evenness Index within 500 m; and OR = 0.93 (0.89; 0.98) using the number of different land use types within 250 m]. Living in neighbourhoods with high LUM has a protective effect on current wheezing symptoms. Our results highlight the association between LUM and respiratory symptoms among children, suggesting that public health considerations should be incorporated in land use decision-making.
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Affiliation(s)
- Inês Paciência
- EPIUnit, Instituto de Saúde Pública da Universidade do Porto, Rua das Taipas 135, 4050-600, Porto, Portugal. .,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Rua das Taipas 135, 4050-600, Porto, Portugal.
| | - André Moreira
- EPIUnit, Instituto de Saúde Pública da Universidade do Porto, Rua das Taipas 135, 4050-600, Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Rua das Taipas 135, 4050-600, Porto, Portugal.,Faculdade de Medicina da Universidade do Porto, Al. Prof. Hernâni Monteiro, 4200- 319, Porto, Portugal.,Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina da Universidade do Porto, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Serviço de Imunoalergologia, Centro Hospitalar Universitário de São João, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - João Cavaleiro Rufo
- EPIUnit, Instituto de Saúde Pública da Universidade do Porto, Rua das Taipas 135, 4050-600, Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Rua das Taipas 135, 4050-600, Porto, Portugal
| | - Ana Cristina Santos
- EPIUnit, Instituto de Saúde Pública da Universidade do Porto, Rua das Taipas 135, 4050-600, Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Rua das Taipas 135, 4050-600, Porto, Portugal.,Faculdade de Medicina da Universidade do Porto, Al. Prof. Hernâni Monteiro, 4200- 319, Porto, Portugal
| | - Henrique Barros
- EPIUnit, Instituto de Saúde Pública da Universidade do Porto, Rua das Taipas 135, 4050-600, Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Rua das Taipas 135, 4050-600, Porto, Portugal.,Faculdade de Medicina da Universidade do Porto, Al. Prof. Hernâni Monteiro, 4200- 319, Porto, Portugal
| | - Ana Isabel Ribeiro
- EPIUnit, Instituto de Saúde Pública da Universidade do Porto, Rua das Taipas 135, 4050-600, Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Rua das Taipas 135, 4050-600, Porto, Portugal.,Faculdade de Medicina da Universidade do Porto, Al. Prof. Hernâni Monteiro, 4200- 319, Porto, Portugal
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Beggs S, Mortyn E, Cunliffe T, Walters JAE. Systemic steroids versus placebo for acute wheeze in preschool aged children. Hippokratia 2013. [DOI: 10.1002/14651858.cd010865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Sean Beggs
- Royal Hobart Hospital; Department of Paediatrics; 48 Liverpool Street Hobart Tasmania Australia 7000
- University of Tasmania; School of Medicine; Hobart Tasmania Australia
| | - Emma Mortyn
- University of Tasmania; School of Medicine; Hobart Tasmania Australia
| | - Tessa Cunliffe
- University of Tasmania; School of Medicine; Hobart Tasmania Australia
| | - Julia AE Walters
- University of Tasmania; School of Medicine; Hobart Tasmania Australia
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Persistence of asthma medication use in preschool children. Respir Med 2008; 102:1446-51. [PMID: 18590955 DOI: 10.1016/j.rmed.2008.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2008] [Revised: 04/12/2008] [Accepted: 04/15/2008] [Indexed: 01/12/2023]
Abstract
OBJECTIVE In young children with asthmatic symptoms diagnostic difficulties lead to use of trials of asthma medication as a diagnostic tool. Our aim is to quantify the persistent use of asthma medication, initiated in the first year of life and identify determinants of this persistent use. PATIENTS AND METHODS We identified 165 children within the PIAMA (Prevention and Incidence of Asthma and Mite Allergy) birth cohort who used asthma medication before the age of one. Persistent use was investigated during three years after the first prescription. A Cox regression analysis was performed to identify factors associated with persistent use. RESULTS A total of 58.8% of children continued using asthma medication after the first prescription and 10.3% continued during three years. Children with doctor-diagnosed asthma (Hazard ratio of discontinuation (HR)=0.64, 95% CI: 0.45-0.91) or prescribed inhaled corticosteroids in the first year of life (HR of discontinuation=0.59, 95% CI: 0.40-0.86) were 1.6-1.7 times more likely to continue using asthma medication. CONCLUSIONS Persistence of asthma medication, prescribed in the first year of life is very low and is positively associated with doctor-diagnosed asthma and use of inhaled corticosteroids. Characterizing persistent users of asthma medication is important to understand prescribing of asthma medication in this age group.
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Zuidgeest MGP, van Dijk L, Smit HA, van der Wouden JC, Brunekreef B, Leufkens HGM, Bracke M. Prescription of respiratory medication without an asthma diagnosis in children: a population based study. BMC Health Serv Res 2008; 8:16. [PMID: 18211673 PMCID: PMC2245932 DOI: 10.1186/1472-6963-8-16] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2007] [Accepted: 01/22/2008] [Indexed: 11/30/2022] Open
Abstract
Background In pre-school children a diagnosis of asthma is not easily made and only a minority of wheezing children will develop persistent atopic asthma. According to the general consensus a diagnosis of asthma becomes more certain with increasing age. Therefore the congruence between asthma medication use and doctor-diagnosed asthma is expected to increase with age. The aim of this study is to evaluate the relationship between prescribing of asthma medication and doctor-diagnosed asthma in children age 0–17. Methods We studied all 74,580 children below 18 years of age, belonging to 95 GP practices within the second Dutch national survey of general practice (DNSGP-2), in which GPs registered all physician-patient contacts during the year 2001. Status on prescribing of asthma medication (at least one prescription for beta2-agonists, inhaled corticosteroids, cromones or montelukast) and doctor-diagnosed asthma (coded according to the International Classification of Primary Care) was determined. Results In total 7.5% of children received asthma medication and 4.1% had a diagnosis of asthma. Only 49% of all children receiving asthma medication was diagnosed as an asthmatic. Subgroup analyses on age, gender and therapy groups showed that the Positive Predictive Value (PPV) differs significantly between therapy groups only. The likelihood of having doctor-diagnosed asthma increased when a child received combination therapy of short acting beta2-agonists and inhaled corticosteroids (PPV = 0.64) and with the number of prescriptions (3 prescriptions or more, PPV = 0.66). Both prescribing of asthma medication and doctor-diagnosed asthma declined with age but the congruence between the two measures did not increase with age. Conclusion In this study, less than half of all children receiving asthma medication had a registered diagnosis of asthma. Detailed subgroup analyses show that a diagnosis of asthma was present in at most 66%, even in groups of children treated intensively with asthma medication. Although age strongly influences the chance of being treated, remarkably, the congruence between prescribing of asthma medication and doctor-diagnosed asthma does not increase with age.
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Affiliation(s)
- Mira G P Zuidgeest
- Department of Pharmacoepidemiology & Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, The Netherlands.
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Chuchalin AG, Tsoi AN, Richter K, Krug N, Dahl R, Luursema PB, Cameron R, Bao W, Higgins M, Woessner R, van As A. Safety and tolerability of indacaterol in asthma: a randomized, placebo-controlled 28-day study. Respir Med 2007; 101:2065-75. [PMID: 17643277 DOI: 10.1016/j.rmed.2007.06.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2007] [Revised: 05/31/2007] [Accepted: 06/01/2007] [Indexed: 11/20/2022]
Abstract
The safety and tolerability of indacaterol, a novel once-daily beta(2)-agonist bronchodilator with a fast onset of action, were assessed in 156 asthma patients in a multicentre, randomized, double-blind, placebo-controlled study. Patients received indacaterol 200, 400 or 600 microg or placebo once daily for 28 days. Adverse events (AEs), laboratory assessments, vital signs, electrocardiograms, spirometry and physical examinations were monitored. Indacaterol pharmacokinetics were assessed. There was no evidence of dose-related increases in AE incidence or clinically significant hypokalaemia or hyperglycaemia in indacaterol-treated patients. Mean pulse rate changes were minor in any group, with maximum 1-h post-dose changes from baseline of -3.7, -3.3 and -2.2 bpm for indacaterol 200, 400 and 600 microg, respectively, and -2.9 bpm for placebo. Mean QTc interval was similar between groups; change from baseline >60 ms occurred in only two patients. Mean FEV(1) increased after the first indacaterol dose; baseline-adjusted pre-dose (trough) values remained >or=166 mL higher than placebo at all subsequent visits, supporting a 24-h bronchodilator effect. Pre-dose (but not post-dose) serum indacaterol concentrations indicated a slight trend for accumulation. Once-daily indacaterol 200-600 microg has a favourable therapeutic index. It is well tolerated, and is not associated with any adverse cardiac or metabolic effects, while providing effective 24-h bronchodilation.
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Affiliation(s)
- Alexander G Chuchalin
- Pulmonology Research Institute, Parkovaya Street, 32/61, 105077 Moscow, Russian Federation.
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