Prevalence of food allergy in Icelandic infants during first year of life

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)Objective: This study is a part of EuroPrevall, an EU-funded European food allergy project. The aim was to evaluate the prevalence of food allergy in Icelandic infants during their first year of life. Material and methods: Infants (n=1,341) were followed prospectively from birth to 12 months of age. Questionnaires were obtained at birth and 12 months. Children with symptoms of possible food allergy were assessed with a skin-prick test (SPT) and specific IgE. Food allergy was confirmed with a double-blind placebo-controlled food challenge (DBPCFC). Results: Out of 170 symptomatic children 44 infants (3.27%) had either positive SPT (n=21; 1.57%) or specific IgE (n=40; 2.98%). Food allergy was confirmed in 25 (1.86%); egg allergy 1.42%, milk 0.52%, fish 0.22%, wheat 0.15%, peanuts 0.15%, and soy 0.07%. Atopic dermatitis was diagnosed in 7.90% (n=106) and according to questionnaires 8.80% had asthma (n=118). Positive family history was the strongest risk factor for asthma (OR=2.12; p<0.001) and atopic dermatitis (OR=1.90; p=0.004). Family history influenced the relationship between predisposing factors and allergy symptoms. Conclusion: Our results show lower prevalence of food allergy than previously reported in a study of Icelandic children at two years of age. The prevalence was also lower than reported in some other European countries and could be explained by different genetic and environmental factors.Key words: exem, infants, food allergy, prevalence, asthma, atopic dermatitis.Inngangur: Rannsóknin er hluti af alþjóðlegri fæðuofnæmisrannsókn, EuroPrevall. Markmiðið var að rannsaka algengi fæðuofnæmis hjá íslenskum börnum á fyrsta ári. Efniviður og aðferðir: Börnum (n=1341) var fylgt eftir frá fæðingu til eins árs aldurs. Spurningalistar voru lagðir fyrir við fæðingu og 12 mánaða aldur. Barn með einkenni fæðuofnæmis var skoðað af rannsóknarlækni, ofnæmishúðpróf gerð og sértækt IgE mælt. Fæðuofnæmi var staðfest eða afsannað með tvíblindu þolprófi. Niðurstöður: Alls kom 231 barn í læknisheimsókn. Fjörutíu og fjögur börn (3,27%) voru með jákvæð ofnæmispróf, þar af 21 (1,57%) með jákvætt húðpróf og 40 (2,98%) með sértækt IgE í sermi. Fæðuofnæmi var staðfest hjá 25 börnum (1,86%). Algengi ofnæmis fyrir eggjum var 1,42%; mjólk 0,52%; fiski 0,22%; hveiti 0,15%; jarðhnetum 0,15% og soja 0,07%. Exem var greint hjá 7,90% (n=106) og samkvæmt spurningalista voru 8,80% með astma (n=118). Jákvæð fjölskyldusaga var sterkasti áhættuþátturinn fyrir astma (OR=2,12; p<0,001) og exemi (OR=1,90; p=0,004). Fylgni var á milli áhættuþátta og ofnæmissjúkdóma innan fjölskyldna. Ályktun: Niðurstöðurnar sýna heldur lægri tíðni en fyrri rannsókn á fæðuofnæmi hjá íslenskum börnum á öðru ári. Þær sýna einnig lægri tíðni fæðuofnæmis en í sumum öðrum Evrópulöndum sem hugsanlega má rekja til erfða og umhverfisþátta

Taking into account sensory knowledge: the case of geo-techologies for children with visual impairments

This paper argues for designing geo-technologies supporting non-visual sensory knowledge. Sensory knowledge refers to the implicit and explicit knowledge guiding our uses of our senses to understand the world. To support our argument, we build on an 18 months field-study on geography classes for primary school children with visual impairments. Our findings show (1) a paradox in the use of non-visual sensory knowledge: described as fundamental to the geography curriculum, it is mostly kept out of school; (2) that accessible geo-technologies in the literature mainly focus on substituting vision with another modality, rather than enabling teachers to build on children's experiences; (3) the importance of the hearing sense in learning about space. We then introduce a probe, a wrist-worn device enabling children to record audio cues during field-trips. By giving importance to children's hearing skills, it modified existing practices and actors' opinions on non-visual sensory knowledge. We conclude by reflecting on design implications, and the role of technologies in valuing diverse ways of understanding the world

Pilot implementation project for reduction of coronary restenosis in usual medical practice

GesamtdissertationDas Modellprojekt zur Vermeidung von Koronar-Restenosen untersucht die Folgeereignisse und gesundheitsökonomische Implikationen nach Implantation von Sirolimus-eluting Stents (SES) im Vergleich zu Bare-Metal Stents (BMS) bei der Behandlung von koronarer Herzerkrankung (CAD) in der deutschen Routineversorgung. Im Rahmen einer prospektiven, multizentrischen, kontrollierten Studie wurden CAD Patienten in 35 Kliniken in Deutschland mit Koronarstenosen und elektiver PCI Indikation mit SES oder konventionelle BMS behandelt (sequentielles Kontrolldesign mit Fall : Kontroll Ratio von 2 : 1). Das Follow-Up umfasste standardisierte Erhebungen beim Patienten und dem weiterbehandelnden Arzt zu Studienbeginn, nach 3, 6, 12 und 18 Monaten mit Dokumentation von kardial und ökonomisch relevanten Ereignissen (MACE: Re-PCI im behandelten Gefäß, Myokardinfarkt, Bypass und Tod), krankheitsbezogenen Kosten sowie Patientenlebensqualität. Von April 2003 bis Juni 2005 wurden 658 Patienten mit SES (87% männlich, 63±9 Jahre) und 294 Patienten mit BMS (79% männlich, 64±10 Jahre) behandelt. Baseline Unterschiede der beiden Patientengruppen zeigten sich bei Alter, Geschlecht, Haushaltsstatus, 3-Gefäßerkrankung und Anzahl der implantierten Stents. In den ersten 18 Monaten traten bei SES 12% und bei BMS 21% MACE auf (p adjustiert=0,003). Die SES-Patienten verursachten im Vergleich zu BMS über 18 Monate im Mittel höhere Gesamtkosten (SES EUR 13.950±468 versus BMS EUR 12.273±525, p adjustiert=0,003), vor allem wegen der inkrementellen Mehrkosten der SES. Die Ergebnisse der allgemeinen gesundheitsbezogenen (SF-36) und MacNew Lebensqualität zeigten nach Implantation eines SES verglichen mit BMS eine höhere Lebensqualität. Patienten mit SES haben im Vergleich zu BMS nach 18 Monaten deutlich weniger klinisch relevante Ereignisse. Die sektorübergreifende Kostenbetrachtung von SES versus BMS ergab insgesamt eine Überlegenheit zum Vorteil der BMS.The study Reduction of Coronary Restenosis evaluated the clinical outcomes and economic implications of drug-eluting sirolimus stents (SES) vs. bare- metal stents (BMS) in the treatment of coronary artery disease (CAD) in usual care in Germany. In this prospective intervention study in 35 hospitals, CAD patients undergoing elective percutaneous coronary intervention (PCI) were treated with BMS or SES (sequential control design with a case:control ratio of 2:1). Standardized questionnaires were completed by patients and their physicians at 3, 6, 12 and 18 months following PCI to document major adverse cardiac events (MACE) including death, myocardial infarction, coronary bypass surgery and intervention for restenosis, disease-related direct and indirect costs, as well as health-related and disease-specific quality of life. From April 2003 until June 2005, 658 patients were treated with SES (mean age 63±9, 87% male) and 294 patients with BMS (mean age 64±10, 79% male). Baseline differences included age, gender, household status, 3-vessel disease and number of implanted stents. After 18 months, 12% of the SES vs. 21% of the BMS group had suffered MACE (p adjusted=0.003). Overall, disease-related costs over 18 months were higher in the SES compared to BMS group: 13,950±468 vs. 12,273±562, p adjusted=0.003, primarily due to the higher cost of the SES. The increase in health-related (SF-36) and disease-specific (MacNew) quality of life was higher in SES compared to BMS patients. In comparison to patients with BMS, patients with implantation of SES experienced significantly fewer MACE during the 18-month follow-up. The evaluation of total associated costs demonstrated a cost advantage of BMS

Assessing changes in chronic spontaneous/idiopathic urticaria: comparisons of patient-reported outcomes using latent growth modeling

Introduction Assessing the consequences of chronic spontaneous/idiopathic urticaria (CSU) requires the evaluation of health-related quality of life (HRQoL) associated with the severity of CSU signs and symptoms. It is important to understand how signs, symptoms, and HRQoL change over time in CSU. Evidence is lacking on how closely changes in signs and symptoms of CSU are related to changes in HRQoL. The objective of this study was to assess the correlation between changes in patient-reported outcome measures (PROMs) of signs and symptoms, dermatologic quality of life (QoL), and urticaria-specific QoL. Methods Latent growth models (LGMs) were applied to longitudinal data from three randomized, Phase 3 clinical trials investigating the efficacy and safety of omalizumab in CSU. Results A near-perfect association between changes in signs and symptoms and changes in dermatologic and urticaria-specific QoLs was identified in each clinical trial when using LGMs (correlation coefficient range 0.88–0.92). Conclusion Evidence showed that changes in signs and symptoms are closely related to changes in HRQoL. However, analyses were performed on clinical trial results of an extremely effective treatment; a less effective treatment with much smaller changes over time may not show such close correlations. Results suggest that any of these PROMs may be used to understand changes in CSU

Prevalence of food allergy in Icelandic infants during first year of life

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)Objective: This study is a part of EuroPrevall, an EU-funded European food allergy project. The aim was to evaluate the prevalence of food allergy in Icelandic infants during their first year of life. Material and methods: Infants (n=1,341) were followed prospectively from birth to 12 months of age. Questionnaires were obtained at birth and 12 months. Children with symptoms of possible food allergy were assessed with a skin-prick test (SPT) and specific IgE. Food allergy was confirmed with a double-blind placebo-controlled food challenge (DBPCFC). Results: Out of 170 symptomatic children 44 infants (3.27%) had either positive SPT (n=21; 1.57%) or specific IgE (n=40; 2.98%). Food allergy was confirmed in 25 (1.86%); egg allergy 1.42%, milk 0.52%, fish 0.22%, wheat 0.15%, peanuts 0.15%, and soy 0.07%. Atopic dermatitis was diagnosed in 7.90% (n=106) and according to questionnaires 8.80% had asthma (n=118). Positive family history was the strongest risk factor for asthma (OR=2.12; p<0.001) and atopic dermatitis (OR=1.90; p=0.004). Family history influenced the relationship between predisposing factors and allergy symptoms. Conclusion: Our results show lower prevalence of food allergy than previously reported in a study of Icelandic children at two years of age. The prevalence was also lower than reported in some other European countries and could be explained by different genetic and environmental factors.Key words: exem, infants, food allergy, prevalence, asthma, atopic dermatitis.Inngangur: Rannsóknin er hluti af alþjóðlegri fæðuofnæmisrannsókn, EuroPrevall. Markmiðið var að rannsaka algengi fæðuofnæmis hjá íslenskum börnum á fyrsta ári. Efniviður og aðferðir: Börnum (n=1341) var fylgt eftir frá fæðingu til eins árs aldurs. Spurningalistar voru lagðir fyrir við fæðingu og 12 mánaða aldur. Barn með einkenni fæðuofnæmis var skoðað af rannsóknarlækni, ofnæmishúðpróf gerð og sértækt IgE mælt. Fæðuofnæmi var staðfest eða afsannað með tvíblindu þolprófi. Niðurstöður: Alls kom 231 barn í læknisheimsókn. Fjörutíu og fjögur börn (3,27%) voru með jákvæð ofnæmispróf, þar af 21 (1,57%) með jákvætt húðpróf og 40 (2,98%) með sértækt IgE í sermi. Fæðuofnæmi var staðfest hjá 25 börnum (1,86%). Algengi ofnæmis fyrir eggjum var 1,42%; mjólk 0,52%; fiski 0,22%; hveiti 0,15%; jarðhnetum 0,15% og soja 0,07%. Exem var greint hjá 7,90% (n=106) og samkvæmt spurningalista voru 8,80% með astma (n=118). Jákvæð fjölskyldusaga var sterkasti áhættuþátturinn fyrir astma (OR=2,12; p<0,001) og exemi (OR=1,90; p=0,004). Fylgni var á milli áhættuþátta og ofnæmissjúkdóma innan fjölskyldna. Ályktun: Niðurstöðurnar sýna heldur lægri tíðni en fyrri rannsókn á fæðuofnæmi hjá íslenskum börnum á öðru ári. Þær sýna einnig lægri tíðni fæðuofnæmis en í sumum öðrum Evrópulöndum sem hugsanlega má rekja til erfða og umhverfisþátta

The burden of chronic spontaneous urticaria: unsatisfactory treatment and healthcare resource utilization in France (the ASSURE-CSU study)

International audienceData on the clinical burden of chronic spontaneous urticaria (CSU) and economic consequences are lacking in France. To characterize the clinical and economic burden of CSU in symptomatic patients despite treatment by analysing data of French patients from the ASSURE-CSU study. ASSURE-CSU was an international observational study that included CSU patients with symptoms that lasted for 12 months or more despite treatment. Disease characteristics and healthcare resource use were obtained from medical records. Data on disease history, health-related quality of life (HR-QoL), and work productivity were collected from a patient survey. A total of 101 patients were analysed (76.2% female; mean age: 48.9 years) with moderate to severe disease (UAS7 score ≥16) in 43.4% and angioedema in 72.3%. The mean (S.D.) total scores of Chronic Urticaria Quality of Life (CU-QoL) and Dermatology Life Quality Index (DLQI) were 37.7 (22.3) and 9.7 (6.9), respectively, thus indicating a significant impact of the disease on HR-QoL. Mean absenteeism and presenteeism were 6.4% and 20.8%, respectively, with a mean loss of work productivity estimated at 20.7%. The mean (S.D.) total direct cost of CSU was €2,397 per patient per year and was mainly driven by therapies (€1,435) and inpatient costs (€859). The indirect costs for four weeks were mainly presenteeism (€421) and loss of work productivity (€420). CSU significantly impairs HR-QoL, which increases with the severity of the disease. The direct and indirect costs for the management of symptomatic CSU are an important economic burden.</p

Physician's appraisal vs documented signs and symptoms in the interpretation of food challenge tests:The EuroPrevall birth cohort

Background. Blinded food challenges are considered the current gold standard for the diagnosis of food allergies. We used data from a pan-European multicentre project to assess differences between study centres, aiming to identify the impact of subjective aspects for the interpretation of oral food challenges. Methods: Nine study centres of the EuroPrevall birth cohort study on food allergy recruited 12,049 newborns and followed them for up to 30 months in regular intervals. Intensive training was conducted and every centre visited to ensure similar handling of the protocols. Suspected food allergy was clinically evaluated by double-blind, placebocontrolled food challenges using a nine dose escalation protocol. The primary challenge outcomes based on physician’s appraisal were compared to documented signs and symptoms. Results: Of 839 challenges conducted, study centres confirmed food allergy in 15.6% to 53.6% of locally conducted challenges. Centres reported 0 to 16 positive placebo challenges. Worsening of eczema was the most common sign when challenged with placebo. Agreement between documented objective signs and the challenge outcome assigned by the physician was heterogeneous, with Cohen’s kappa spanning from 0.42 to 0.84. Conclusions: These differences suggest that the comparison of food challenge outcomes between centres is difficult despite common protocols and training. We recommend detailed symptom assessment and documentation as well as objective sign-based challenge outcome algorithms to assur

ASSURE-CSU : a real-world study of burden of disease in patients with symptomatic chronic spontaneous urticaria

Chronic spontaneous urticaria (CSU) formerly known as chronic idiopathic urticaria (CIU) is a severe and distressing skin condition that remains uncontrolled in approximately one half of patients, despite the use of licensed, recommended doses of modern, second-generation H-antihistamines. So far, the humanistic, societal and economic burden of CSU/CIU has not been well quantified. Therefore it is important to broaden our understanding of how CSU/CIU impacts patients, society, and healthcare systems, by determining the disease burden of CSU/CIU and the associated unmet need; as well as to further guide the use of new treatments in an efficient and cost-effective manner. ASSURE-CSU is an observational, multicenter study being conducted in the UK, Germany, Canada, France, Italy, Spain, and The Netherlands. The study comprises a retrospective medical chart review in conjunction with patient surveys (including validated tools for assessment of disease impact) and an 8-day patient diary. The primary objectives of the study are to describe patient demographics, medical history, treatments, and healthcare resource utilization based on medical-record data and to assess the impact of disease, healthcare resource utilization, work days missed, and productivity loss based on patient-reported data. Approximately 700 patients (aged ≥18 years) will be enrolled who have CSU/CIU despite currently receiving treatment, and have had persistent symptoms for at least 12 months. Data will be collected retrospectively for the 12 months (±1 month) prior to enrolment wherever possible, and prospectively for the week following enrolment. ASSURE-CSU will be the first study to examine the economic and humanistic burden of disease in patients diagnosed with CSU/CIU who are symptomatic despite treatment. By combining retrospective evaluation of medical records with prospective patient surveys and 8-day diaries, across seven different countries, the ASSURE-CSU study will contribute to a better understanding and acknowledgement of the burden of disease in patients with symptomatic chronic spontaneous urticaria