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Reyna ME, Dai R, Tran MM, Breton V, Medeleanu M, Lou WYW, Foong RE, Emmerson M, Dharma C, Miliku K, Lefebvre DL, Simons E, Azad MB, Chan-Yeung M, Becker AB, Mandhane PJ, Turvey SE, Hall GL, Moraes TJ, Sears MR, Subbarao P. Development of a Symptom-Based Tool for Screening of Children at High Risk of Preschool Asthma. JAMA Netw Open 2022; 5:e2234714. [PMID: 36201211 PMCID: PMC9539714 DOI: 10.1001/jamanetworkopen.2022.34714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Despite advances in asthma therapeutics, the burden remains highest in preschool children; therefore, it is critical to identify primary care tools that distinguish preschool children at high risk for burdensome disease for further evaluation. Current asthma prediction tools, such as the modified Asthma Predictive Index (mAPI), require invasive tests, limiting their applicability in primary care and low-resource settings. OBJECTIVE To develop and evaluate the use of a symptom-based screening tool to detect children at high risk of asthma, persistent wheeze symptoms, and health care burden. DESIGN, SETTING, AND PARTICIPANTS The cohort for this diagnostic study included participants from the CHILD Study (n = 2511) from January 1, 2008, to December 31, 2012, the Raine Study from January 1, 1989, to December 31, 2012 (n = 2185), and the Canadian Asthma Primary Prevention Study (CAPPS) from January 1, 1989, to December 31, 1995 (n = 349), with active follow-up to date. Data analysis was performed from November 1, 2019, to May 31, 2022. EXPOSURES The CHILDhood Asthma Risk Tool (CHART) identified factors associated with asthma in patients at 3 years of age (timing and number of wheeze or cough episodes, use of asthma medications, and emergency department visits or hospitalizations for asthma or wheeze) to identify children with asthma or persistent symptoms at 5 years of age. MAIN OUTCOMES AND MEASURES Within the CHILD Study cohort, CHART was evaluated against specialist clinician diagnosis and the mAPI. External validation was performed in both a general population cohort (Raine Study [Australia]) and a high-risk cohort (CAPPS [Canada]). Predictive accuracy was measured by sensitivity, specificity, area under the receiver operating characteristic curve (AUROC), and positive and negative predicted values. RESULTS Among 2511 children (mean [SD] age at 3-year clinic visit, 3.08 [0.17] years; 1324 [52.7%] male; 1608 of 2476 [64.9%] White) with sufficient questionnaire data to apply CHART at 3 years of age, 2354 (93.7%) had available outcome data at 5 years of age. CHART applied in the CHILD Study at 3 years of age outperformed physician assessments and the mAPI in predicting persistent wheeze (AUROC, 0.94; 95% CI, 0.90-0.97), asthma diagnosis (AUROC, 0.73; 95% CI, 0.69-0.77), and health care use (emergency department visits or hospitalization for wheeze or asthma) (AUROC, 0.70; 95% CI, 0.61-0.78). CHART had a similar predictive performance for persistent wheeze in the Raine Study (N = 2185) in children at 5 years of age (AUROC, 0.82; 95% CI, 0.79-0.86) and CAPPS (N = 349) at 7 years of age (AUROC, 0.87; 95% CI, 0.80-0.94). CONCLUSIONS AND RELEVANCE In this diagnostic study, CHART was able to identify children at high risk of asthma at as early as 3 years of age. CHART could be easily incorporated as a routine screening tool in primary care to identify children who need monitoring, timely symptom control, and introduction of preventive therapies.
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Affiliation(s)
- Myrtha E. Reyna
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ruixue Dai
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Maxwell M. Tran
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Vanessa Breton
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Maria Medeleanu
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Wendy Y. W. Lou
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Rachel E. Foong
- Wal-yan Respiratory Centre, Children's Lung Health, Telethon Kids Institute, Perth, Western Australia, Australia
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Melanie Emmerson
- Department of Precision Genomics, Intermountain Healthcare, Salt Lake City, Utah
| | - Christoffer Dharma
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Kozeta Miliku
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Diana L. Lefebvre
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Elinor Simons
- Department of Pediatrics and Child Health, University of Manitoba, Manitoba, Winnipeg, Canada
| | - Meghan B. Azad
- Department of Pediatrics and Child Health, University of Manitoba, Manitoba, Winnipeg, Canada
| | - Moira Chan-Yeung
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Allan B. Becker
- Department of Pediatrics and Child Health, University of Manitoba, Manitoba, Winnipeg, Canada
| | - Piush J. Mandhane
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Stuart E. Turvey
- Department of Pediatrics, BC Children’s Hospital, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Graham L. Hall
- Wal-yan Respiratory Centre, Children's Lung Health, Telethon Kids Institute, Perth, Western Australia, Australia
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Theo J. Moraes
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Malcolm R. Sears
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Padmaja Subbarao
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Kang LJ, Vu KN, Koleva PT, Field CJ, Chow A, Azad MB, Becker AB, Mandhane PJ, Moraes TJ, Sears MR, Lefebvre DL, Turvey SE, Subbarao P, Lou WYW, Scott JA, Kozyrskyj AL. Cover Image. Clin Exp Allergy 2020. [DOI: 10.1111/cea.13574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kang LJ, Vu KN, Koleva PT, Field CJ, Chow A, Azad MB, Becker AB, Mandhane PJ, Moraes TJ, Sears MR, Lefebvre DL, Turvey SE, Subbarao P, Lou WYW, Scott JA, Kozyrskyj AL. Maternal psychological distress before birth influences gut immunity in mid-infancy. Clin Exp Allergy 2020; 50:178-188. [PMID: 31845414 DOI: 10.1111/cea.13551] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 12/03/2019] [Accepted: 12/12/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Maternal pre-postnatal psychosocial distress increases the risk for childhood allergic disease. This may occur through a host immunity pathway that involves intestinal secretory immunoglobulin A (sIgA). Experimental animal models show changes in the gut microbiome and immunity of offspring when exposed to direct or prenatal maternal stress, but little is known in humans. OBJECTIVE We determined the association between maternal depression and stress symptom trajectories and infant fecal sIgA concentrations. METHODS 1043 term infants from the Canadian Healthy Infant Longitudinal Development (CHILD) birth cohort were studied. Trajectories of maternal perceived stress and depression were based on scored scales administered in pregnancy and postpartum. sIgA was quantified in infant stool (mean age 3.7 months) with Immundiagnostik ELISA. Linear regression and logistic regression were employed to test associations. RESULTS Very low fecal sIgA concentrations were more common in infants of mothers in the antepartum and persistent depression trajectories (6% and 2% of women, respectively). Independent of breastfeeding status at fecal sampling, infant antibiotic exposure or other covariates, the antepartum depressive symptom trajectory was associated with reduced mean infant sIgA concentrations (β=-0.07, P < .01) and a two fold risk for lowest quartile concentrations (OR, 1.86; 95% CI: 1.02, 3.40). This lowering of sIgA yielded a large effect size in older infants (4-8 months)-breastfed and not. No associations were seen with postpartum depressive symptoms (7% of women) or with any of the perceived stress trajectories. CONCLUSION AND CLINICAL RELEVANCE Despite improved mood postpartum and independent of breastfeeding status, mothers experiencing antepartum depressive symptoms delivered offspring who exhibited lower fecal sIgA concentrations especially in later infancy. The implications of lowered sIgA concentrations in infant stool are altered microbe-sIgA interactions, greater risk for C difficile colonization and atopic disease in later years.
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Affiliation(s)
- Liane J Kang
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Khanh N Vu
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Petya T Koleva
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Catherine J Field
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Angela Chow
- Department of Applied Health Science, Indiana University, Bloomington, IN, USA
| | - Meghan B Azad
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Allan B Becker
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | | | - Theo J Moraes
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Malcolm R Sears
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Diana L Lefebvre
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Stuart E Turvey
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Padmaja Subbarao
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Wendy Y W Lou
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - James A Scott
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, 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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Dharma C, Lefebvre DL, Lu Z, Lou WYW, Becker AB, Mandhane PJ, Turvey SE, Moraes TJ, Azad MB, Chen E, Elliott SJ, Kozyrskyj AL, Sears MR, Subbarao P. Risk for Maternal Depressive Symptoms and Perceived Stress by Ethnicities in Canada: From Pregnancy Through the Preschool Years. Can J Psychiatry 2019; 64:190-198. [PMID: 30068224 PMCID: PMC6405811 DOI: 10.1177/0706743718792190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Past cross-sectional studies have reported that mothers from ethnic minorities experience higher levels of prenatal and post-partum psychosocial distress compared with mothers from ethnic majorities. However, no studies have examined how the pattern varies longitudinally in a Canadian population of heterogeneous ethnicity. METHODS We analyzed data from 3,138 mothers participating in the Canadian Healthy Infant Longitudinal Development (CHILD) Study, a longitudinal multi-center study incorporating 10 distinct waves of psychosocial data collection from pregnancy until the index child was aged 5 y. Maternal self-identified ethnicity was grouped as White Caucasian, First Nations, Black, Southeast Asian, East Asian, South Asian, Middle Eastern, Hispanic and mixed ethnicity. We performed a multi-level regression to determine whether mothers of specific minority ethnicities were more likely to experience higher levels of distress (i.e. depressive symptoms and perceived stress) compared to white Caucasian mothers. RESULTS Mothers self-identifying as Black or First Nations had consistently higher distress scores than mothers from other ethnicities across all data collection times. After adjusting for relevant variables (history of depression, education, household income, marital status, and social support), First Nations mothers had a 20% increase in the mean scores of depressive symptoms compared to White Caucasian Mothers. CONCLUSIONS Increased levels of perinatal and post-partum distress were seen in only some ethnic minority groups. Studies should avoid collapsing all categories into ethnic minority or majority and may need to consider how ethnicity interacts with other sociodemographic factors such as poverty.
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Affiliation(s)
| | | | - Zihang Lu
- Dalla Lana School of Public Health, University of Toronto, Toronto,
Canada
- Department of Pediatrics, University of Toronto & Hospital for Sick
Children, Toronto, Canada
| | - Wendy Y. W. Lou
- Dalla Lana School of Public Health, University of Toronto, Toronto,
Canada
| | - Allan B. Becker
- Department of Pediatrics & Child Health, University of Manitoba,
Winnipeg, Canada
| | | | - Stuart E. Turvey
- Department of Pediatrics, University of British Columbia, Vancouver,
Canada
| | - Theo J. Moraes
- Department of Pediatrics, University of Toronto & Hospital for Sick
Children, Toronto, Canada
| | - Meghan B. Azad
- Department of Pediatrics & Child Health, University of Manitoba,
Winnipeg, Canada
| | - Edith Chen
- Department of Psychology, Northwestern University, IL, USA
- Institute for Policy Research, Northwestern University, IL, USA
| | - Susan J. Elliott
- Department of Geography and Environmental Management, University of
Waterloo, Ontario, Canada
| | | | | | - Padmaja Subbarao
- Department of Pediatrics, University of Toronto & Hospital for Sick
Children, Toronto, Canada
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5
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Dharma C, Lefebvre DL, Tran MM, Lu Z, Lou WYW, Subbarao P, Becker AB, Mandhane PJ, Turvey SE, Moraes TJ, Azad MB, Sears MR. Diagnosing atopic dermatitis in infancy: Questionnaire reports vs criteria-based assessment. Paediatr Perinat Epidemiol 2018; 32:556-567. [PMID: 30461044 DOI: 10.1111/ppe.12525] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 09/27/2018] [Accepted: 10/11/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Persisting atopic dermatitis (AD) is known to be associated with more serious allergic diseases at later ages; however, making an accurate diagnosis during infancy is challenging. We assessed the diagnostic performance of questionnaire-based AD measures with criteria-based in-person clinical assessments at age 1 year and evaluated the ability of these diagnostic methods to predict asthma, allergic rhinitis and food allergies at age 5 years. METHODS Data relate to 3014 children participating in the Canadian Healthy Infant Longitudinal Development (CHILD) Study who were directly observed in a clinical assessment by an experienced healthcare professional using the UK Working Party criteria. The majority (2221; 73.7%) of these children also provided multiple other methods of AD ascertainment: a parent reporting a characteristic rash on a questionnaire, a parent reporting the diagnosis provided by an external physician and a combination of these two reports. RESULTS Relative to the direct clinical assessment, the area under the Receiver Operating Characteristic curve for a parental report of a characteristic rash, reported physician diagnosis and a combination of both were, respectively, 0.60, 0.69 and 0.70. The strongest predictor of asthma at 5 years was AD determined by criteria-based in-person clinical assessment followed by the combination of parental and physician report. CONCLUSIONS These findings suggest that questionnaire data cannot accurately substitute for assessment by experienced healthcare professionals using validated criteria for diagnosis of atopic dermatitis. Combining the parental report with diagnosis by a family physician might sometimes be appropriate (eg to avoid costs of a clinical assessment).
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Affiliation(s)
| | | | - Maxwell M Tran
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Zihang Lu
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Department of Pediatrics, University of Toronto & Hospital for Sick Children, Toronto, Canada
| | - Wendy Y W Lou
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Padmaja Subbarao
- Department of Pediatrics, University of Toronto & Hospital for Sick Children, Toronto, Canada
| | - Allan B Becker
- Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, Canada
| | - Piush J Mandhane
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Stuart E Turvey
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Theo J Moraes
- Department of Pediatrics, University of Toronto & Hospital for Sick Children, Toronto, Canada
| | - Meghan B Azad
- Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, Canada
| | - Malcolm R Sears
- Department of Medicine, McMaster University, Hamilton, Canada
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Miliku K, Robertson B, Sharma AK, Subbarao P, Becker AB, Mandhane PJ, Turvey SE, Lefebvre DL, Sears MR, Bode L, Azad MB, Anand SS, Azad M, Becker AB, Befus AD, Brauer M, Brook JR, Chen E, Cyr M, Daley D, Dell SD, Denburg JA, Duan Q, Eiwegger T, Grasemann H, HayGlass K, Hegele RG, Holness DL, Hystad P, Kobor M, Kollman TR, Kozyrskyj AL, Laprise C, Lou WYW, Macri J, Miller G, Moraes TJ, Ramsey C, Ratjen F, Sandford A, Scott JA, Scott J, Silverman F, Simons E, Takaro T, Tebbutt S, To T. Human milk oligosaccharide profiles and food sensitization among infants in the CHILD Study. Allergy 2018; 73:2070-2073. [PMID: 29775217 DOI: 10.1111/all.13476] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- K. Miliku
- Manitoba Developmental Origins of Chronic Diseases in Children Network (DEVOTION) Children's Hospital Research Institute of Manitoba Winnipeg MB Canada
- Department of Pediatrics and Child Health University of Manitoba Winnipeg MB Canada
- The Generation R Study Group Departments of Pediatrics and Epidemiology Erasmus University Medical Center Rotterdam Rotterdam The Netherlands
| | - B. Robertson
- Department of Pediatrics and Larsson‐Rosenquist Foundation Mother‐Milk‐Infant Center of Research Excellence University of California San Diego La Jolla CA USA
| | - A. K. Sharma
- George & Fay Yee Centre for Healthcare Innovation University of Manitoba Winnipeg MB Canada
| | - P. Subbarao
- Departments of Pediatrics & Physiology University of Toronto Toronto ON Canada
| | - A. B. Becker
- Manitoba Developmental Origins of Chronic Diseases in Children Network (DEVOTION) Children's Hospital Research Institute of Manitoba Winnipeg MB Canada
- Department of Pediatrics and Child Health University of Manitoba Winnipeg MB Canada
| | - P. J. Mandhane
- Department of Pediatrics University of Alberta Edmonton AB Canada
| | - S. E. Turvey
- Department of Pediatrics University of British Columbia Vancouver BC Canada
| | - D. L. Lefebvre
- Department of Medicine McMaster University Hamilton ON Canada
| | - M. R. Sears
- Department of Medicine McMaster University Hamilton ON Canada
| | - L. Bode
- Department of Pediatrics and Larsson‐Rosenquist Foundation Mother‐Milk‐Infant Center of Research Excellence University of California San Diego La Jolla CA USA
| | - M. B. Azad
- Manitoba Developmental Origins of Chronic Diseases in Children Network (DEVOTION) Children's Hospital Research Institute of Manitoba Winnipeg MB Canada
- Department of Pediatrics and Child Health University of Manitoba Winnipeg MB Canada
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7
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Tran MM, Lefebvre DL, Dharma C, Dai D, Lou WYW, Subbarao P, Becker AB, Mandhane PJ, Turvey SE, Sears MR. Predicting the atopic march: Results from the Canadian Healthy Infant Longitudinal Development Study. J Allergy Clin Immunol 2017; 141:601-607.e8. [PMID: 29153857 DOI: 10.1016/j.jaci.2017.08.024] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/10/2017] [Accepted: 08/23/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND The atopic march describes the progression from atopic dermatitis during infancy to asthma and allergic rhinitis in later childhood. In a Canadian birth cohort we investigated whether concomitant allergic sensitization enhances subsequent development of these allergic diseases at age 3 years. METHODS Children completed skin prick testing at age 1 year. Children were considered sensitized if they produced a wheal 2 mm or larger than that elicited by the negative control to any of 10 inhalant or food allergens. Children were also assessed for atopic dermatitis by using the diagnostic criteria of the UK Working Party. At age 3 years, children were assessed for asthma, allergic rhinitis, food allergy, and atopic dermatitis. Data from 2311 children were available. RESULTS Atopic dermatitis without allergic sensitization was not associated with an increased risk of asthma at age 3 years after adjusting for common confounders (relative risk [RR], 0.46; 95% CI, 0.11-1.93). Conversely, atopic dermatitis with allergic sensitization increased the risk of asthma more than 7-fold (RR, 7.04; 95% CI, 4.13-11.99). Atopic dermatitis and allergic sensitization had significant interactions on both the additive (relative excess risk due to interaction, 5.06; 95% CI, 1.33-11.04) and multiplicative (ratio of RRs, 5.80; 95% CI, 1.20-27.83) scales in association with asthma risk. There was also a positive additive interaction between atopic dermatitis and allergic sensitization in their effects on food allergy risk (relative excess risk due to interaction, 15.11; 95% CI, 4.19-35.36). CONCLUSIONS Atopic dermatitis without concomitant allergic sensitization was not associated with an increased risk of asthma. In combination, atopic dermatitis and allergic sensitization had strong interactive effects on both asthma and food allergy risk at age 3 years.
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Affiliation(s)
- Maxwell M Tran
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Diana L Lefebvre
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - David Dai
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Wendy Y W Lou
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Padmaja Subbarao
- Department of Pediatrics, University of Toronto and Hospital for Sick Children, Toronto, Ontario, Canada
| | - Allan B Becker
- Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Piush J Mandhane
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Stuart E Turvey
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Malcolm R Sears
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
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Landsman V, Lou WYW, Graubard BI. Estimating survival probabilities by exposure levels: utilizing vital statistics and complex survey data with mortality follow-up. Stat Med 2015; 34:1864-75. [PMID: 25656596 DOI: 10.1002/sim.6455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 10/26/2014] [Accepted: 01/22/2015] [Indexed: 11/08/2022]
Abstract
We present a two-step approach for estimating hazard rates and, consequently, survival probabilities, by levels of general categorical exposure. The resulting estimator utilizes three sources of data: vital statistics data and census data are used at the first step to estimate the overall hazard rate for a given combination of gender and age group, and cohort data constructed from a nationally representative complex survey with linked mortality records, are used at the second step to divide the overall hazard rate by exposure levels. We present an explicit expression for the resulting estimator and consider two methods for variance estimation that account for complex multistage sample design: (1) the leaving-one-out jackknife method, and (2) the Taylor linearization method, which provides an analytic formula for the variance estimator. The methods are illustrated with smoking and all-cause mortality data from the US National Health Interview Survey Linked Mortality Files, and the proposed estimator is compared with a previously studied crude hazard rate estimator that uses survey data only. The advantages of a two-step approach and possible extensions of the proposed estimator are discussed.
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Affiliation(s)
- V Landsman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, M5T 3M7, Canada
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Abstract
Asthma and obesity are both chronic conditions and their prevalences have risen in affluent societies. A positive association between asthma and being overweight or obese has been reported in children and women, but associations in men are less clearly described. The objective of this study was to explore the association between body mass index (BMI) and asthma in men and women of diverse ethnic and socioeconomic background living in New York State, USA. In this study, we analyzed cross-sectional data on 5524 subjects aged 18 years and older who were interviewed by telephone in the 1996 and 1997 New York State Behavioral Risk Factor Surveillance System. Asthma (doctor-diagnosed), and weight and height were self-reported. BMI (kg/m2) was used as a measure of adiposity. Weighted logistic regression analysis, with stratification by gender and age, was used to examine the relationship between asthma prevalence and BMI, adjusting for race/ethnicity, education, health insurance, time since last physical examination, physical activity and smoking status. The results showed that the prevalence of asthma was 4.6% (CI: 3.6-5.5%) among men and 8.1% (CI: 7.1-9.1%) among women. In women, the prevalence of asthma was significantly increased in those with a BMI 25 kg/m2 or higher (BMI 25-27.5: OR = 1.76, 95% CI: 1.06-2.94; BMI 27.5-29.9: OR = 2.45, 95% CI: 1.41-4.25; BMI > or = 30: OR = 2.67, 95% CI: 1.66-4.29) when compared to the reference category (BMI: 22-24.9 kg/m2). In men, the prevalence of asthma was increased in the lowest weight category, BMI < 22 kg/m2 (OR = 3.05, 95% CI: 1.37-6.78) and in the highest category, BMI > or = 30 kg/m2 (OR = 2.92, 95% CI: 1.39-6.14). This U-shaped association persisted when restricting the analysis to men who had never smoked and was more pronounced for those between 18 and 49 years of age. In conclusion, this cross-sectional study showed that men and women differ significantly in the association between BMI and asthma prevalence only with respect to the lowest weight category. While women had a monotonic association, men showed a U-shaped relationship, indicating that both extremes of weight are associated with a higher prevalence of asthma.
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Affiliation(s)
- E Luder
- Department of Pediatrics, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1202B, New York, NY 10029, USA.
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Abstract
AIM This is a retrospective study of percutaneous transluminal balloon angioplasty (PTA) efficacy for treatment of surgical vein mobilization site ("swing point") stenoses in hemodialysis arteriovenous fistulae (AVF) that fail to mature or are poorly functioning. METHOD Between February 1, 1999, and February 28, 2001, 65 non-maturing or poorly functioning AVF were studied in 63 consecutive hemodialysis patients (30 male, 33 female, aged 26-92 years). All AVF underwent contrast angiography to study the inflow artery, AVF, outflow and central veins. PTA of stenotic sites was performed to initiate or restore AVF function. RESULTS Seventy-eight venous and 2 arterial stenoses were found and treated with PTA in the 65 AVF. All PTA were technically successful. A total of 55 stenoses were identified in the vein at the site of surgical mobilization ("swing point"). Additionally, 19 cephalic and 4 central venous stenoses were found. During the study, 13 AVF underwent repeat PTA at the "swing point". Of the 65 AVF treated, 50 were being successfully used as an access site, 4 AVF were lost during follow-up (34-688 days; mean: 258 days) and 8 patients died within the study period. The duration of functional patency of the treated AVF was 39-660 days (mean: 280 days). CONCLUSION Non-maturing or poorly functioning AVF frequently have stenoses in the outflow vein at the original site of surgical vein mobilization. These "swing point stenoses" are amenable to PTA, which is a safe and effective treatment for prolonging AVF patency and function.
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Affiliation(s)
- A Falk
- Department of Radiology, Mount Sinai-NYU Medical Center, New York, NY 10029, USA.
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