Breast feeding and resilience against psychosocial stress

BACKGROUND: Some early life exposures may result in a well controlled stress response, which can reduce stress related anxiety. Breast feeding may be a marker of some relevant exposures. AIMS: To assess whether breast feeding is associated with modification of the relation between parental divorce and anxiety. METHODS: Observational study using longitudinal birth cohort data. Linear regression was used to assess whether breast feeding modifies the association of parental divorce/separation with anxiety using stratification and interaction testing. Data were obtained from the 1970 British Cohort Study, which is following the lives of those born in one week in 1970 and living in Great Britain. This study uses information collected at birth and at ages 5 and 10 years for 8958 subjects. Class teachers answered a question on anxiety among 10 year olds using an analogue scale (range 0–50) that was log transformed to minimise skewness. RESULTS: Among 5672 non‐breast fed subjects, parental divorce/separation was associated with a statistically significantly raised risk of anxiety, with a regression coefficient (95% CI) of 9.4 (6.1 to 12.8). Among the breast fed group this association was much lower: 2.2 (−2.6 to 7.0). Interaction testing confirmed statistically significant effect modification by breast feeding, independent of simultaneous adjustment for multiple potential confounding factors, producing an interaction coefficient of −7.0 (−12.8 to −1.2), indicating a 7% reduction in anxiety after adjustment. CONCLUSIONS: Breast feeding is associated with resilience against the psychosocial stress linked with parental divorce/separation. This could be because breast feeding is a marker of exposures related to maternal characteristics and parent–child interaction

Maternal smoking during pregnancy and appetite control in offspring

Aims: Intrauterine exposure to tobacco smoke products has been associated with long-term neurobehavioral effects. Modified appetite control might explain the recently observed association between maternal smoking during pregnancy and obesity in offspring. Methods: Some 10,557 British adults aged 42 years born between 3-9 March 1958 were followed up in a birth cohort study (NCDS). The main outcome measure was self-reported poor appetite at age 42 years and main exposure was maternal smoking during pregnancy. Results: The proportion of offspring with poor appetite increased with maternal smoking during pregnancy: nonsmoking 4.5%; (4.0% - 5.0%), medium smoking 5.6%; (4.5 % - 6.8 %), variable smoking 6.8 %; (4.9 % - 9.1 %) and heavy smoking 7.7 %; (6.3 % - 9.4 %). The unadjusted odds ratios for maternal smoking during pregnancy (ever/never) and poor appetite is 1.49 (1.25 - 1.77) and after adjustment for BMI at 42 years and other potential confounding factors it is 1.22 (1.07 - 1.48). Conclusions: Offspring of mothers who smoked during pregnancy were more likely to report a poor appetite independent of a number of potential confounding factors. Although not in the expected direction, the results suggest maternal smoking during pregnancy may influence appetite perception through a developmental influence or through confounding by social factors

Childhood indicators of susceptibility to subsequent cervical cancer

Common warts could indicate cervical cancer susceptibility, as both are caused by human papillomavirus (HPV). Eczema was also investigated, as atopic eczema has been negatively associated with warts, but non-atopic eczema may be associated with compromised host defences, as observed in patients with HIV, suggesting increased susceptibility to HPV infection and cervical cancer. ‘Cervical cancer’ was self-reported during an interview by 87 of 7594 women members of two longitudinal British birth cohorts. The accuracy of the diagnoses is limited by lack of confirmation using medical records. Odds ratios are adjusted for common warts and eczema in childhood; and cigarette smoking, number of cohabiting partners and social class in early adult life. The odds ratios of warts and eczema with cervical cancer are 2.50 (95% confidence interval 1.14–5.47) and 3.27 (1.95–5.49), respectively. The association of eczema with cervical cancer is independent of hay fever as a marker of atopy, suggesting the importance of non-atopic eczema. Both heavier smoking compared with non-smoking and four or more cohabiting partners compared with one/none have odds ratios for cervical cancer of 8.26 (4.25–15.10) and 4.89 (1.39–17.18), respectively. Common warts in childhood may indicate cervical cancer susceptibility; this and the relationship with eczema deserves investigation

A protocol for a trial of homeopathic treatment for irritable bowel syndrome

Background Irritable bowel syndrome is a chronic condition with no known cure. Many sufferers seek complementary and alternative medicine including homeopathic treatment. However there is much controversy as to the effectiveness of homeopathic treatment. This three-armed study seeks to explore the effectiveness of individualised homeopathic treatment plus usual care compared to both an attention control plus usual care and usual care alone, for patients with irritable bowel syndrome. Methods/design This is a three-armed pragmatic randomised controlled trial using the cohort multiple randomised trial methodology. Patients are recruited to an irritable bowel syndrome cohort from primary and secondary care using GP databases and consultants lists respectively. From this cohort patients are randomly selected to be offered, 5 sessions of homeopathic treatment plus usual care, 5 sessions of supportive listening plus usual care or usual care alone. The primary clinical outcome is the Irritable Bowel Syndrome Symptom Severity at 26 weeks. From a power calculation, it is estimated that 33 people will be needed for the homeopathic treatment arm and 132 for the usual care arm, to detect a minimal clinical difference at 80 percent power and 5 percent significance allowing for loss to follow up. An unequal group size has been used for reasons of cost. Analysis will be by intention to treat and will compare homeopathic treatment with usual care at 26 weeks as the primary analysis, and homeopathic treatment with supportive listening as an additional analysis. Discussion This trial has received NHS approval and results are expected in 2013. Trial registration Current Controlled Trials ISRCTN9065114

C-Terminal Region of EBNA-2 Determines the Superior Transforming Ability of Type 1 Epstein-Barr Virus by Enhanced Gene Regulation of LMP-1 and CXCR7

Type 1 Epstein-Barr virus (EBV) strains immortalize B lymphocytes in vitro much more efficiently than type 2 EBV, a difference previously mapped to the EBNA-2 locus. Here we demonstrate that the greater transforming activity of type 1 EBV correlates with a stronger and more rapid induction of the viral oncogene LMP-1 and the cell gene CXCR7 (which are both required for proliferation of EBV-LCLs) during infection of primary B cells with recombinant viruses. Surprisingly, although the major sequence differences between type 1 and type 2 EBNA-2 lie in N-terminal parts of the protein, the superior ability of type 1 EBNA-2 to induce proliferation of EBV-infected lymphoblasts is mostly determined by the C-terminus of EBNA-2. Substitution of the C-terminus of type 1 EBNA-2 into the type 2 protein is sufficient to confer a type 1 growth phenotype and type 1 expression levels of LMP-1 and CXCR7 in an EREB2.5 cell growth assay. Within this region, the RG, CR7 and TAD domains are the minimum type 1 sequences required. Sequencing the C-terminus of EBNA-2 from additional EBV isolates showed high sequence identity within type 1 isolates or within type 2 isolates, indicating that the functional differences mapped are typical of EBV type sequences. The results indicate that the C-terminus of EBNA-2 accounts for the greater ability of type 1 EBV to promote B cell proliferation, through mechanisms that include higher induction of genes (LMP-1 and CXCR7) required for proliferation and survival of EBV-LCLs

Pre‐pubertal growth and cognitive function

British longitudinal data were used to investigate the association of heights at 22 months and 5 years with a digit recall test at age 10 years. Greater height, particularly at 5 years, was associated with higher scores, suggesting that some exposures influence both growth and capability for cognitive function