Diesel Exhaust Exposure, Wheezing and Sneezing

The rising incidence of allergic disorders in developed countries is unexplained. Exposure to traffic related air pollutants may be an important cause of wheezing and asthma in childhood. Experimental evidence from human studies suggests that diesel exhaust particles, constituents of fine particulate matter less than 2.5 microns (PM2.5), may act to enhance IgE mediated aeroallergen sensitization and Th2 directed cytokine responses. To date, epidemiologic investigations indicate that children living in close proximity to heavily travelled roads are more likely to be atopic and wheeze. The Cincinnati Childhood Allergy and Air Pollution Study (CCAAPS) birth cohort study was initiated to test the hypothesis that early high exposure to traffic related air pollutants is associated with early aeroallergen sensitization and allergic respiratory phenotypes. Using an exposure cohort design, more than 700 infants born to atopic parents were recruited at age 1 living either less than 400 meters (high traffic pollutant exposure) or greater than 1,500 meters (low exposure) from a major road. Children were medically evaluated and underwent skin prick testing with aeroallergen at screening, and re-evaluated sequentially at ages 1, 2, 3, 4, and 7. In this study, both proximity and land use regression (LUR) models of traffic air pollutant exposure have been assessed. Proximity to stop and go traffic with large concentrations of bus and truck traffic predicted persistent wheezing during infancy. The LUR model estimated elemental carbon attributable to traffic (ECAT) as a proxy for diesel exhaust particulate exposure. High ECAT was significantly associated with wheezing at age 1 as well as persistent wheezing at age 3. High mold exposure predicted a well defined asthma phenotype at age 7

Early exposure to secondhand tobacco smoke and the development of allergic diseases in 4 year old children in Malmö, Sweden

<p>Abstract</p> <p>Background</p> <p>Earlier studies have shown an association between secondhand tobacco smoke and allergy development in children. Furthermore, there is an increased risk of developing an allergy if the parents have an allergy. However, there are only few studies investigating the potential synergistic effect of secondhand tobacco smoke and allergic heredity on the development of an allergy.</p> <p>Methods</p> <p>The study was population-based cross-sectional with retrospective information on presence of secondhand tobacco smoke during early life. The study population consisted of children who visited the Child Health Care (CHC) centres in Malmö for their 4-year health checkup during 2006-2008 and whose parents answered a self-administered questionnaire (n = 4,278 children). The questionnaire was distributed to parents of children registered with the CHC and invited for the 4-year checkup during the study period.</p> <p>Results</p> <p>There was a two to four times increased odds of the child having an allergy or having sought medical care due to allergic symptoms if at least one parent had an allergy, while there were rather small increased odds related to presence of secondhand smoke during the child's first month in life or at the age of 8 months. However, children with heredity for allergies and with presence of secondhand tobacco smoke during their first year in life had highly increased odds of developing an allergy and having sought medical care due to allergic symptoms at 4 years of age. Thus, there was a synergistic effect enhancing the independent effects of heredity and exposure to secondhand tobacco smoke on allergy development.</p> <p>Conclusions</p> <p>Children with a family history of allergies and early exposure to secondhand tobacco smoke is a risk group that prevention and intervention should pay extra attention to. The tobacco smoke effect on children is an essential and urgent question considering it not being self chosen, possibly giving life lasting negative health effects and being possible to reduce.</p

The development of socio-economic health differences in childhood: results of the Dutch longitudinal PIAMA birth cohort

Background: People with higher socio-economic status (SES) are generally in better health. Less is known about when these socio-economic health differences set in during childhood and how they develop over time. The goal of this study was to prospectively study the development of socio-economic health differences in the Netherlands, and to investigate possible explanations for socio-economic variation in childhood health. Methods: Data from the Dutch Prevention and Incidence of Asthma and Mite Allergy (PIAMA) birth cohort study were used for the analyses. The PIAMA study followed 3,963 Dutch children during their first eight years of life. Common childhood health problems (i.e. eczema, asthma symptoms, general health, frequent respiratory infections, overweight, and obesity) were assessed annually using questionnaires. Maternal educational level was used to indicate SES. Possible explanatory lifestyle determinants (breastfeeding, smoking during pregnancy, smoking during the first three months, and day-care centre attendance) and biological determinants (maternal age at birth, birthweight, and older siblings) were analysed using generalized estimating equations. Results: This study shows that socio-economic differences in a broad range of health problems are already present early in life, and persist during childhood. Children from families with low socio-economic backgrounds experience more asthma symptoms (odds ratio (OR) 1.27; 95% Confidence Interval (CI) 1.08-1.49), poorer general health (OR 1.36; 95% CI 1.16-1.60), more frequent respiratory infections (OR 1.57; 95% CI 1.35-1.83), more overweight (OR 1.42; 95% CI 1.16-1.73), and more obesity (OR 2.82; 95% CI 1.80-4.41). The most important contributors to the observed childhood socio-economic health disparities are socio-economic differences in maternal age at birth, breastfeeding, and day-care centre attendance. Conclusions: Socio-economic health disparities already occur very early in life. Socio-economic disadvantage takes its toll on child health before birth, and continues to do so during childhood. Therefore, action to reduce health disparities needs to start very early in life, and should also address socio-economic differences in maternal age at birth, breastfeeding habits, and day-care centre attendance

Prevalence and early-life risk factors of school-age allergic multimorbidity: The EuroPrevall-iFAAM birth cohort.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadBackground: Coexistence of childhood asthma, eczema and allergic rhinitis is higher than can be expected by chance, suggesting a common mechanism. Data on allergic multimorbidity from a pan-European, population-based birth cohort study have been lacking. This study compares the prevalence and early-life risk factors of these diseases in European primary school children. Methods: In the prospective multicentre observational EuroPrevall-iFAAM birth cohort study, we used standardized questionnaires on sociodemographics, medical history, parental allergies and lifestyle, and environmental exposures at birth, 12 and 24 months. At primary school age, parents answered ISAAC-based questions on current asthma, rhinitis and eczema. Allergic multimorbidity was defined as the coexistence of at least two of these. Results: From 10,563 children recruited at birth in 8 study centres, we included data from 5,572 children (mean age 8.2 years; 51.8% boys). Prevalence estimates were as follows: asthma, 8.1%; allergic rhinitis, 13.3%; and eczema, 12.0%. Allergic multimorbidity was seen in 7.0% of the whole cohort, ranging from 1.2% (Athens, Greece) to 10.9% (Madrid, Spain). Risk factors for allergic multimorbidity, identified with AICc, included family-allergy-score, odds ratio (OR) 1.50 (95% CI 1.32-1.70) per standard deviation; early-life allergy symptoms, OR 2.72 (2.34-3.16) for each symptom; and caesarean birth, OR 1.35 (1.04-1.76). Female gender, OR 0.72 (0.58-0.90); older siblings, OR 0.79 (0.63-0.99); and day care, OR 0.81 (0.63-1.06) were protective factors. Conclusion: Allergic multimorbidity should be regarded as an important chronic childhood disease in Europe. Some of the associated early-life factors are modifiable and may be considered for prevention strategies. Keywords: allergic multimorbidity; allergic rhinitis; asthma; children; eczema.European Commission under the 6th Framework Programme within the collaborative research initiative 'EuroPrevall' European Commission under 7th Framework Programme (FP7-KBBE-2012-6) within the collaborative project 'iFAAM' Icelandic birth cohort centre from Landspitali University Hospital Iceland Science Fund GlaxoSmithKline UK birth cohort centre from the UK Food Standards Agenc

Parental smoking, wheezing and sensitisation in early childhood

The aim of this thesis is to explore the possible effects of exposure to cigarette smoking during foetal and early postnatal life on lower respiratory disease and sensitisation in children up to four years of age. A prospective birth cohort of 4,089 newborn infants (BAMSE) was followed during four years using parental questionnaires. When the infant was two months old the parents completed a questionnaire on various lifestyle factors, including maternal smoking during pregnancy and parental smoking after birth. At one, two and four years of age information was obtained by questionnaire on symptoms of allergic and respiratory diseases as well as on environmental exposures, particularly exposure to environmental tobacco smoke (ETS). At four years of age the response rate was 91% (3,619 children) and among these 73% participated in a clinical investigation including peak flow measurements and blood sampling for analyses of IgE antibodies to common inhalant and food allergens. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using logistic regression with adjustments for confounders. Maternal smoking during pregnancy, parental smoking after the baby was born and keeping of cat or dog were all associated with short education. The risk of respiratory illness in children increased with exposure to parental cigarette smoking. When the mother had smoked during pregnancy but not after that, there was an increased risk of recurrent wheezing up to two years´ age, ORadj=2.2 (95% CI 1.3 3.6). The corresponding OR was 1.6 (95% CI 1.2 2.3) for reported exposure to ETS with or without maternal smoking during pregnancy. Follow up at four years´ age showed that exposure in utero to maternal smoking was associated with an increased risk of transient (OR=1.8, 95% CI 1.2 2.5), persistent (OR=2.1, 1.5 2.8) and late-onset wheezing (OR=1.5, 1.0 2.2). There was no strong association between exposure to parental smoking and any kind of wheezing. Neither prenatal nor postnatal exposure to tobacco smoking was associated with impairment of lung function (peak expiratory flow). An increased risk with ETS was found for sensitisation to inhalant and/or food allergens, ORadj=1.3, (95% CI 1.0 1.6). Among single allergens the effect of ETS on sensitisation to cat was particularly strong, ORadj=2.00 (95% CI 1.3 3.0). A doseresponse effect was found for exposure to ETS from parental smoking during the first few months of life and IgE-sensitisation. In conclusion, our data indicate that exposure to maternal cigarette smoking in utero is a risk factor for wheezing up to four years of age and exposure of infants to ETS increases the risk of IgE-sensitisation to indoor inhalant and food allergens

Musikalisk dialog – dialogisk instrumentalundervisning : En undersökning av kommunikation i instrumentalundervisning på musik- och kulturskolan

Syftet med denna uppsats är att undersöka hur kommunikation i instrumentalundervisning kan förstås i förhållande till teorier om dialog och dialogisk undervisning. Med avstamp i den ryske litteraturteoretikern Michail Bachtins dialogbegrepp och med tankar och forskning om dialogisk undervisning som referenspunkter undersöks det i denna uppsats hur kommunikation i individuell instrumentalundervisning respektive ensembleundervisning kan se ut och förstås. En instrumentallärare som arbetar på en kommunal kulturskola har observerats när denne undervisar elever individuellt samt i ensemble. Observationerna har strukturerats och analyserats med hjälp av begrepp och idéer om dialogisk undervisning i klassrumssituation. Under observations- och analysprocessen har begreppen omarbetats för att kunna belysa det specifika i den instrumentalpedagogiska situationen i allmänhet och den individuella undervisningsformen i synnerhet. Några dialogiska huvudteman har visat sig förekomma i den observerade lärarens undervisning och dessa har kopplats samman med de redan befintliga begreppen om dialogisk undervisning för att på så vis söka förståelse i hur kommunikationen i de observerade undervisningssituationerna kan förstås i förhållande till tidigare forskning. Den musikaliska kommunikationen var det som tydligast skiljde resultatet av undersökningen från den tidigare forskning om dialogisk undervisning som presenterats, och just denna typ av kommunikation visade sig också skilja sig i hur den användes i individuell undervisning respektive ensemble. Det finns i allmänhet grundläggande skillnader i hur kommunikation i grupp och kommunikation mellan enbart två individer fungerar och detta var också något som resultatet av undersökningen underströk. Kommunikationen i de individuella lektionerna kännetecknas av en tät ord- eller yttrandeväxling mellan lärare och elev. Generellt sett kan sägas att huvuddelen av den kommunikation som förekommer i ensembleundervisning också förekommer i individuell undervisning, men i mer koncentrerad form i den senare undervisningsformen

"Two o'clock in the morning, that's when you should do everything, because then it's at its lowest" : – a qualitative study on challenges and opportunities regarding conscious use of electricity supported by digital technology in a family context

Denna studie undersöker utmaningar kring medveten elanvändning i familjehushåll. Tidigare forskning har uppmärksammat att människor ofta har bristande kunskap inom energiområdet, inklusive den egna elanvändningen i hemmet. Dessutom bidrar den aktuella geo-politiska situationen (med sanktioner och spänningar mellan Ryssland och Västvärlden) till att elanvändning- och förbrukning har uppdagats som ett aktuellt fenomen. Genom metoder baserade i designforskning, så kallat kulturellt utforskande (vår översättning av eng. cultural probes) och uppföljande intervjuer, undersöker denna uppsats hur familjer förstår sitt eget hushålls elförbrukning och föreslår designförslag för tekniska tjänster med syfte att stötta familjer till en mer medveten elanvändning hemma. Användning av återkoppling, bättre anpassning utifrån barns behov samt invävning av designlösningar i hemmet är aspekter som i studien identifierats som relevanta att ta i beaktande i förhållande till framtida designlösningar på området.This study examines challenges regarding conscious electricity use in family households. Previous research has drawn attention to the fact that people often lack knowledge in the field of energy, including their own use of electricity at home. In addition, the current geo-political situation (with sanctions and tensions between Russia and the West) contributes to electricity use being identified as a present phenomenon. Through methods based in design research, so-called cultural probes and follow-up interviews, this study examines how families understand their own household's electricity consumption and proposes design solutions for technical services with the aim of supporting families to a more conscious use of electricity at home. The use of feedback, better adaptation based on children's needs as well as integrating design solutions in the home are aspects identified in the study to consider in relation to future design solutions in the area