Preschool asthma : infant lung function, inflammation and skin barrier function in early life

Background: Asthma is among the most common obstructive respiratory disorders in children, characterized by airway inflammation with features such as wheeze, cough and shortness of breath. Though the etiology behind the disease partly remains unknown, the roots likely origin from early life. Lower lung function, skin barrier impairment, as well as eosinophil inflammation are factors related to asthma development, but are largely unexplored in early life. The overall aim of this doctoral thesis was to explore early risk factors for the development of preschool asthma, related to infant lung function, eosinophil inflammation and skin barrier function in early life. Methods: All four sub studies (I-IV) were based on data prospectively collected from children actively participating in the Preventing Atopic Dermatitis and ALLergies in children (PreventADALL) mother-child cohort (n=2394) recruited from the general population in Sweden and Norway. First, with infant lung function measured in both the awake and sleeping state at three months, we aimed to determine whether lung function by tidal flow-volume (TFV) loops differed according to arousal state (sub study I). Thereafter, we investigated the potential association between infant lung function while awake and preschool asthma at three years (sub study IV). Second, we aimed to explore if infant skin barrier function by transepidermal water loss (TEWL), eczema at three months and mutations in the skin barrier filaggrin (FLG) gene were associated with infant lung function at three months (sub study II) and/or preschool asthma at three years (sub study IV). Third, we aimed to identify if higher levels of inflammation by serum eosinophil-derived neurotoxin (EDN) at one and three years were associated with preschool asthma at three years (sub study III). Lastly, we aimed to assess if the potential associations between infant lung- and skin barrier function as well as early-life eosinophil inflammation and preschool asthma differed by sex (sub study III-IV). Results: Among 91 infants with paired lung function measurements, TFV loop parameters overall differed, with a higher ratio of time to peak tidal expiratory flow to expiratory time, tPTEF/tE, shorter tE but similar tPTEF while awake compared to the sleeping state. Studying 563 children with information on infant lung function while awake and preschool asthma, a fiverespectively three-fold higher odds ratio (OR) of asthma was observed among infants with lower tPTEF/tE (<0.25) and shorter tPTEF (<0.17 s). While the presence of eczema or FLG mutations were not associated with a shorter tPTEF in 899 infants, a high TEWL was. Similarly, a two-fold higher OR of preschool asthma was observed in infants with high TEWL, but not eczema or FLG mutations among 1337 children. Among 1233 children with available serum eosinophil-derived neurotoxin (EDN) levels, EDN levels >26.7 μg/L in late infancy and >20.5 μg/L at preschool age were associated with preschool asthma, increasing the OR by two- and almost five-fold at respective age. Overall, boys had higher rates of preschool asthma compared to girls; >15% versus <9%. Similarly, infant lung function was lower in boys compared to girls; 0.38 versus 0.40 for tPTEF/tE and 0.20 versus 0.21 s for tPTEF, whereas TEWL, eczema and FLG mutations were distributed equally across the sexes. Boys had higher EDN levels in late infancy and at preschool age (32.0 and 20.9 μg/L) compared to girls (24.5 and 19.0 μg/L). The associations to preschool asthma differed by sex, with an eight- and three-fold higher OR in boys with a lower tPTEF/tE respectively shorter tPTEF, and a four-fold higher OR observed in girls with FLG mutations, only, whereas neither eczema nor high TEWL remained significant risk factors. Higher EDN levels in late infancy increased the OR of preschool asthma by four-fold in boys only, whereas at preschool age, higher levels increased the OR in both sexes. Conclusion: Based on our findings, we conclude that lower lung function in the awake state, skin barrier impairment as well as eosinophil inflammation in early life overall may be linked to preschool asthma. However, as the associations to preschool asthma differed by sex, with a higher OR observed in boys with lower lung function, while FLG gene mutations increased the OR in girls, and in late infancy, higher EDN levels remained a significant risk factor in boys, only, our observations point to the importance of potential sex differences

Infant tidal flow–volume parameters and arousal state

This version is distributed under the terms of the Creative Commons Attribution NonCommercial Licence 4.0. For commercial reproduction rights and permissions contact: [email protected]: Infant lung function can be assessed with tidal flow–volume (TFV) loops. While TFV loops can be measured in both awake and sleeping infants, the influence of arousal state in early infancy is not established. The aim of the present study was to determine whether TFV loop parameters in healthy infants differed while awake compared to the sleeping state at 3 months of age. Methods: From the population-based Scandinavian Preventing Atopic Dermatitis and ALLergies in children (PreventADALL) birth cohort, 91 infants had reproducible TFV loops measured with Exhalyzer® D in both the awake and sleeping state at 3 months of age. The TFV loops were manually selected according to a standardised procedure. The ratio of time to peak tidal expiratory flow (tPTEF) to expiratory time (tE) and the corresponding volume ratio (VPTEF/VE), as well as tidal volume (VT) and respiratory rate were compared using nonparametric tests. Results: The mean (95% CI) tPTEF/tE was significantly higher while awake compared to the sleeping state: 0.39 (0.37–0.41) versus 0.28 (0.27–0.29); with the corresponding VPTEF/VE of 0.38 (0.36–0.40) versus 0.29 (0.28–0.30). The VT was similar, while the respiratory rate was higher while awake compared to the sleeping state: 53 (51–56) breaths·min−1 versus 38 (36–40) breaths·min−1 . Conclusion: Higher tPTEF/tE, VPTEF/VE and respiratory rate, but similar VT while awake compared to the sleeping state suggests that separate normative TFV loop values according to arousal state may be required in early infancy.publishedVersio

Eosinophil-derived neurotoxin levels in early childhood and association with preschool asthma – A prospective observational study

publishedVersio

Fetal thoracic circumference in mid-pregnancy and infant lung function

This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.Background and Aim: Impaired lung function in early infancy is associated with later wheeze and asthma, while fetal thoracic circumference (TC) predicts severity of neonatal lung hypoplasia. Exploring fetal origins of lung function in infancy, we aimed to determine if fetal TC in mid‐pregnancy was associated with infant lung function. Methods: From the prospective Scandinavian general population‐based PreventADALL mother–child birth cohort, all 851 3‐month‐old infants with tidal flow‐volume measurements in the awake state and ultrasound fetal size measures at 18 (min–max 16–22) weeks gestational age were included. Associations between fetal TC and time to peak tidal expiratory flow to expiratory time (tPTEF/tE) were analyzed in linear regression models. To account for gestational age variation, we adjusted TC for simultaneously measured general fetal size, by head circumference (TC/HC), abdominal circumference (TC/AC), and femur length (TC/FL). Multivariable models were adjusted for maternal age, maternal asthma, pre‐pregnancy body mass index, parity, nicotine exposure in utero, and infant sex. Results: The infants (47.8% girls) were born at mean (SD) gestational age of 40.2 (1.30) weeks. The mean (SD) tPTEF/tE was 0.39 (0.08). The mean (SD) TC/HC was 0.75 (0.04), TC/AC 0.87 (0.04), and TC/FL 4.17 (0.26), respectively. Neither TC/HC nor TC/AC were associated with infant tPTEF/tE while a week inverse association was observed between TC/FL and tPTEF/tE (β ^ = −0.03, 95% confidence interval [−0.05, −0.007], p = 0.01). Conclusion: Mid‐pregnancy fetal TC adjusted for fetal head or abdominal size was not associated with tPTEF/tE in healthy, awake 3‐month‐old infants, while a weak association was observed adjusting for fetal femur length.publishedVersio

Studenters kunskap om fruktsamhet och deras önskan om barnafödande. : en väntrumsundersökning

Aim: The purpose of this study was to describe, analyze and compare university students’ desire to have children, when they wanted to have their first and last child and their knowledge about fecundity in relation to the background factors: age, gender and educational level. This study will also investigate differences regarding university students’ desire to have children along with when they wanted to have their first and last child and their knowledge of declining fecundity at increasing age. Method: A descriptive, comparative, cross-sectional study with quantitative method was used in the study. Five hundred university students visiting a Student Health Centre (SHC) in a Swedish town, Uppsala, participated in the study. All visitors at the SHC were asked to participate in the study. The participants answered 52 questions, of which 10 questions were selected for this study. Results: The majority of the participating students (128 men and 324 women) wanted to have children. Despite this fact they lacked knowledge about the age at which fecundity declines. Men in general had poorer knowledge of fecundity than women, and young students had poorer knowledge than older students. The study showed that women wanted children earlier than men and younger students earlier than older students. There was no difference found in educational level and knowledge in fecundity or desire to have children. The level of knowledge students had about declining fecundity at increasing age did not affect their desire to have children, or when they wanted their first and last child. Conclusion: The study confirms previous research on knowledge about fecundity and the desire to have children among students. Once again evidence is presented that women have greater knowledge than men, that young people lack adequate knowledge about fecundity, and that the majority of students want to have children. Evident is that there is a need for further education and to create better conditions for childbearing, with purpose to facilitate a secure family planning for students

Studenters kunskap om fruktsamhet och deras önskan om barnafödande. : en väntrumsundersökning

Aim: The purpose of this study was to describe, analyze and compare university students’ desire to have children, when they wanted to have their first and last child and their knowledge about fecundity in relation to the background factors: age, gender and educational level. This study will also investigate differences regarding university students’ desire to have children along with when they wanted to have their first and last child and their knowledge of declining fecundity at increasing age. Method: A descriptive, comparative, cross-sectional study with quantitative method was used in the study. Five hundred university students visiting a Student Health Centre (SHC) in a Swedish town, Uppsala, participated in the study. All visitors at the SHC were asked to participate in the study. The participants answered 52 questions, of which 10 questions were selected for this study. Results: The majority of the participating students (128 men and 324 women) wanted to have children. Despite this fact they lacked knowledge about the age at which fecundity declines. Men in general had poorer knowledge of fecundity than women, and young students had poorer knowledge than older students. The study showed that women wanted children earlier than men and younger students earlier than older students. There was no difference found in educational level and knowledge in fecundity or desire to have children. The level of knowledge students had about declining fecundity at increasing age did not affect their desire to have children, or when they wanted their first and last child. Conclusion: The study confirms previous research on knowledge about fecundity and the desire to have children among students. Once again evidence is presented that women have greater knowledge than men, that young people lack adequate knowledge about fecundity, and that the majority of students want to have children. Evident is that there is a need for further education and to create better conditions for childbearing, with purpose to facilitate a secure family planning for students

Gymnasieelevers kunskap om och inställning till HPV och HPV-vaccin

Bakgrund: Humant papillomvirus (HPV) är ett sexuellt överförbart vårtvirus, som kan orsaka cellförändringar och livmoderhalscancer. Tidigare forskning har visat att kunskap om HPV och HPV-vaccin generellt är låg och att vaccinationstäckningen bland unga kvinnor i många länder varit suboptimal. Syfte: Syftet med föreliggande studie var att kartlägga gymnasieelevers kunskap om och inställning till HPV och HPV-vaccin, samt undersöka om det föreligger skillnader mellan elever på praktiska och teoretiska gymnasieprogram. Metod: Studien var en deskriptiv komparativ tvärsnittsstudie med kvantitativ ansats. Orems egenvårdsteori användes som teoretisk referensram. De 230 deltagarna från fyra gymnasieskolor i Uppsala besvarade ett enkätformulär. Resultat: Majoriteten av eleverna hade generellt låg kunskap om HPV och HPV-vaccinet, hade låg tilltro till vaccinet och var osäkra på huruvida de i framtiden ville vaccineras, dock hade elever på teoretiska program bättre kunskap och mer positiv inställning än elever på praktiska program. Flickor hade bättre kunskap och om HPV och HPV-vaccin än pojkar. De flesta hade inte hört talas om vaccin mot HPV, men de allra flesta hade kännedom om vaccin mot livmoderhalscancer. Slutsats: Den låga kunskapen om HPV och HPV-vaccin kan påverka elevernas inställning samt deras intentioner att i framtiden vaccineras. Resultatet indikerar på ett behov av mer information om HPV och HPV-vaccin. Skolsköterskans hälsosamtal med gymnasieelever bör inkludera information och diskussion om HPV och HPV-vaccin anpassad för ungdomar, för att ge dem möjlighet att förstå sambandet mellan kondylom, HPV och livmoderhalscancer, och därmed lättare kunna ta ställning till vaccination

Gymnasieelevers kunskap om och inställning till HPV och HPV-vaccin

Bakgrund: Humant papillomvirus (HPV) är ett sexuellt överförbart vårtvirus, som kan orsaka cellförändringar och livmoderhalscancer. Tidigare forskning har visat att kunskap om HPV och HPV-vaccin generellt är låg och att vaccinationstäckningen bland unga kvinnor i många länder varit suboptimal. Syfte: Syftet med föreliggande studie var att kartlägga gymnasieelevers kunskap om och inställning till HPV och HPV-vaccin, samt undersöka om det föreligger skillnader mellan elever på praktiska och teoretiska gymnasieprogram. Metod: Studien var en deskriptiv komparativ tvärsnittsstudie med kvantitativ ansats. Orems egenvårdsteori användes som teoretisk referensram. De 230 deltagarna från fyra gymnasieskolor i Uppsala besvarade ett enkätformulär. Resultat: Majoriteten av eleverna hade generellt låg kunskap om HPV och HPV-vaccinet, hade låg tilltro till vaccinet och var osäkra på huruvida de i framtiden ville vaccineras, dock hade elever på teoretiska program bättre kunskap och mer positiv inställning än elever på praktiska program. Flickor hade bättre kunskap och om HPV och HPV-vaccin än pojkar. De flesta hade inte hört talas om vaccin mot HPV, men de allra flesta hade kännedom om vaccin mot livmoderhalscancer. Slutsats: Den låga kunskapen om HPV och HPV-vaccin kan påverka elevernas inställning samt deras intentioner att i framtiden vaccineras. Resultatet indikerar på ett behov av mer information om HPV och HPV-vaccin. Skolsköterskans hälsosamtal med gymnasieelever bör inkludera information och diskussion om HPV och HPV-vaccin anpassad för ungdomar, för att ge dem möjlighet att förstå sambandet mellan kondylom, HPV och livmoderhalscancer, och därmed lättare kunna ta ställning till vaccination

Gymnasieelevers kunskap om och inställning till HPV och HPV-vaccin

Bakgrund: Humant papillomvirus (HPV) är ett sexuellt överförbart vårtvirus, som kan orsaka cellförändringar och livmoderhalscancer. Tidigare forskning har visat att kunskap om HPV och HPV-vaccin generellt är låg och att vaccinationstäckningen bland unga kvinnor i många länder varit suboptimal. Syfte: Syftet med föreliggande studie var att kartlägga gymnasieelevers kunskap om och inställning till HPV och HPV-vaccin, samt undersöka om det föreligger skillnader mellan elever på praktiska och teoretiska gymnasieprogram. Metod: Studien var en deskriptiv komparativ tvärsnittsstudie med kvantitativ ansats. Orems egenvårdsteori användes som teoretisk referensram. De 230 deltagarna från fyra gymnasieskolor i Uppsala besvarade ett enkätformulär. Resultat: Majoriteten av eleverna hade generellt låg kunskap om HPV och HPV-vaccinet, hade låg tilltro till vaccinet och var osäkra på huruvida de i framtiden ville vaccineras, dock hade elever på teoretiska program bättre kunskap och mer positiv inställning än elever på praktiska program. Flickor hade bättre kunskap och om HPV och HPV-vaccin än pojkar. De flesta hade inte hört talas om vaccin mot HPV, men de allra flesta hade kännedom om vaccin mot livmoderhalscancer. Slutsats: Den låga kunskapen om HPV och HPV-vaccin kan påverka elevernas inställning samt deras intentioner att i framtiden vaccineras. Resultatet indikerar på ett behov av mer information om HPV och HPV-vaccin. Skolsköterskans hälsosamtal med gymnasieelever bör inkludera information och diskussion om HPV och HPV-vaccin anpassad för ungdomar, för att ge dem möjlighet att förstå sambandet mellan kondylom, HPV och livmoderhalscancer, och därmed lättare kunna ta ställning till vaccination

Studenters kunskap om fruktsamhet och deras önskan om barnafödande. : en väntrumsundersökning

Aim: The purpose of this study was to describe, analyze and compare university students’ desire to have children, when they wanted to have their first and last child and their knowledge about fecundity in relation to the background factors: age, gender and educational level. This study will also investigate differences regarding university students’ desire to have children along with when they wanted to have their first and last child and their knowledge of declining fecundity at increasing age. Method: A descriptive, comparative, cross-sectional study with quantitative method was used in the study. Five hundred university students visiting a Student Health Centre (SHC) in a Swedish town, Uppsala, participated in the study. All visitors at the SHC were asked to participate in the study. The participants answered 52 questions, of which 10 questions were selected for this study. Results: The majority of the participating students (128 men and 324 women) wanted to have children. Despite this fact they lacked knowledge about the age at which fecundity declines. Men in general had poorer knowledge of fecundity than women, and young students had poorer knowledge than older students. The study showed that women wanted children earlier than men and younger students earlier than older students. There was no difference found in educational level and knowledge in fecundity or desire to have children. The level of knowledge students had about declining fecundity at increasing age did not affect their desire to have children, or when they wanted their first and last child. Conclusion: The study confirms previous research on knowledge about fecundity and the desire to have children among students. Once again evidence is presented that women have greater knowledge than men, that young people lack adequate knowledge about fecundity, and that the majority of students want to have children. Evident is that there is a need for further education and to create better conditions for childbearing, with purpose to facilitate a secure family planning for students