The risk of school-age asthma after the first severe rhinovirus-induced wheezing

Background: The rhinovirus etiology of wheezing is an important risk factor for developing recurrent wheezing and asthma, especially in children with atopic predisposition. However, rhinovirus infection has not yet been included in the risk assessment of different asthma phenotypes at school-age. Aims: To study 1) the impact of known risk factors and rhinovirus etiology of the first severe virus-induced wheezing episode for developing persistent asthma; 2) risk factors for developing atopic and non-atopic asthma at school-age; and 3) whether prednisolone treatment of the first wheezing episode may prevent development of asthma symptoms. Methods: Risk factors for asthma symptoms were studied in a 7-year follow-up of Vinku study (n=111, median age 12 months at the first wheezing). Risk factors for atopic and non-atopic school-age asthma were studied in steroid-naive children jointly in Vinku and Vinku2 studies (n=127; 11 months, respectively). The preventive effect of prednisolone was assessed in two randomized trials; post hoc in Vinku study and prospectively in Vinku2 study. Results: Early-onset food sensitization and rhinovirus etiology of the first wheezing episode predicted persistent asthma symptoms, and development of atopic asthma at school-age. Parental smoking and age <12 months predicted non-atopic asthma at school-age. The children with rhinovirus-induced first wheezing in the Vinku study, and those with high rhinoviral load in the Vinku2 study benefitted from prednisolone in terms of less persistent asthma symptoms. Conclusions: Virus etiology and atopic status are worth assessing in wheezing children to recognize those with increased asthma risk. The separate risk factors of asthma phenotypes suggest different mechanisms underlying atopic and non-atopic asthma in children. This knowledge could provide a mean to identify children who would benefit from early anti-inflammatory treatment to prevent asthma.Kouluiän astmariski ensimmäisen rinoviruksen aiheuttaman uloshengitysvaikeuskohtauksen jälkeen Tausta: Varhaisen uloshengitysvaikeuden rinovirusetiologia on toistuvien uloshengitysvaikeuskohtausten ja astman kehittymisen tärkeä riskitekijä etenkin varhain herkistyneillä lapsilla. Tietoa uloshengitysvaikeuden rinovirusetiologiasta ei ole vielä kuitenkaan hyödynnetty kouluiän astman eri fenotyyppien riskiarvioinnissa. Tavoite: Tutkia, 1) tunnettujen riskitekijöiden ja ensimmäisen uloshengitysvaikeuskohtauksen rinovirusetiologian merkitystä pysyvien astmaoireiden kehittymisessä; 2) kouluiän allergisen ja ei-allergisen astman riskitekijöitä; sekä 3) vähentääkö ensimmäisen uloshengitysvaikeuskohtaukseen hoidoksi annettu prednisoloni astmaoireita. Menetelmät: Astman riskitekijöitä tutkittiin Vinku-tutkimuksen seitsemän vuoden seurannassa (n=111, mediaani-ikä 12 kk tutkimuksen alussa). Kouluiän allergisen ja ei-allergisen astman riskitekijöitä tutkittiin steroidia saamattomilla lapsilla yhdistetysti Vinku- ja Vinku2-tutkimuksissa (n=127, mediaani-ikä 11 kk). Prednisolonin suojaavaa vaikutusta arvioitiin kahdessa randomoidussa tutkimuksessa; Vinku-tutkimuksessa post hoc ja Vinku2-tutkimuksessa prospektiivisesti. Tulokset: Varhainen ruoka-aineherkistyminen ja ensimmäisen ulos-hengitysvaikeuden rinovirusetiologia ennustivat pysyviä astmaoireita ja kouluiän allergisen astman kehittymistä. Vanhempien tupakointi ja alkuvaiheessa <12 kuukauden ikä ennustivat kouluiän ei-allergista astmaa. Prednisoloni vähensi astmaoireita niillä lapsilla, joilla oli ensimmäisen uloshengitysvaikeuden yhteydessä rinovirus Vinku-tutkimuksessa ja korkea rinovirusmäärä Vinku2-tutkimuksessa. Päätelmät: Herkistymisen ja virusetiologian tutkiminen on kannattavaa uloshengitysvaikeuskohtauksen yhteydessä, jotta tunnistetaan astmariskilapset. Lapsuusiän astmafenotyypeillä on todennäköisesti eri mekanismit, koska niillä on eri riskitekijät. Tämä tieto voisi edesauttaa myös niiden lasten tunnistamista, jotka hyötyisivät astman ehkäisystä varhaisella anti-inflammatorisella lääkkeellä.Siirretty Doriast

Maternal prenatal psychological distress associates with offspring early-life wheezing - FinnBrain Birth Cohort

Background: Exposure to prenatal maternal psychological distress may contribute to the development of childhood atopic disorders. Little is known about the importance of distress severity and its duration for the risk. Our aim was to investigate how chronic maternal depressive and anxiety symptoms across gestation influence the risk of wheezing and eczema at child age 24 months.Methods: The study population was drawn from the FinnBrain Birth Cohort Study, including 1305 mother-infant dyads followed across gestation until the child age of 24 months when the outcomes were mother-reported wheezing ever and doctor-diagnosed eczema. To investigate the risk of wheezing phenotypes, wheezing with and without eczema was separated. Maternal distress was assessed with the Edinburgh Postnatal Depression Scale for depressive and the Symptom Checklist-90 for anxiety symptoms three times during pregnancy, and the chronicity was demonstrated using symptom trajectories composed by latent growth mixture modeling.Results: Of the children, 219/1305 (17%) had wheezing ever and 285/1276 (22%) had eczema. Risk of wheezing ever was elevated with maternal consistently high depressive symptoms (adjusted odds ratio 2.74; 95% confidence interval 1.37-5.50) or moderate and increasing anxiety symptoms (1.94; 1.06-3.54, respectively). Similarly, wheezing without eczema was associated with consistently high depressive (3.60; 1.63-7.94, respectively) and moderate and increasing anxiety symptoms (2.43; 1.21-4.91, respectively).Conclusions: Maternal chronic psychological distress across gestation was associated with toddler wheezing and especially wheezing without other atopic features (eczema). This finding supports the theory of intrauterine programming effect by maternal psychological distress on offspring immune system and respiratory morbidity.</p

Interactions of genetic variants and prenatal stress in relation to the risk for recurrent respiratory infections in children

Genetic variants may predispose children to recurrent respiratory infections (RRIs) but studies on genotype-environment interaction are rare. We hypothesized that the risk for RRIs is elevated in children with innate immune gene variants, and that prenatal exposure to maternal psychological distress further increases the risk. In a birth cohort, children with RRIs (n=96) were identified by the age of 24 months and compared with the remaining cohort children (n=894). The risk for RRIs in children with preselected genetic variants and the interaction between maternal distress during pregnancy and child genotype were assessed with logistic regression. The IL6 minor allele G was associated with elevated risk for RRIs (OR 1.55; 95% CI 1.14-2.12). Overall, there was no interaction between maternal psychological distress and child genotype. Exploratory analyses showed that, the association between the variant type of IL6 and the risk for RRIs was dependent on prenatal exposure to maternal psychological distress in males (OR 1.96; 95% CI 1.04-3.67). Our study didn't find genotype-environment interaction between prenatal maternal distress and child genotype. Exploratory analyses suggest sex differences in gene-environment interaction related to susceptibility to RRIs.Peer reviewe

Reflexive use of methods: a framework for navigating different types of knowledge and power in transformative research

In transformative sustainability science, reflexivity is considered critical for ethically sound and socially relevant research. In practice, many transdisciplinary knowledge co-production processes have faced problems in mitigating power hierarchies among the participating actors and the different types of knowledge. In this paper, we develop and test a reflexive framework that enables transdisciplinary researchers to convey more explicitly how their methodological choices play a role in im/balancing power relations in knowledge co-production. The reflexive framework allows researchers to distinguish the different types of knowledge co-produced by the methods, as well as tracking the movements between them. We utilize the framework to reflect upon the methodological choices made through the application of three different transformative methods, namely the Transition Arena, Theory of Change, and Participatory Food Sustainability Assessment and Transformation Framework in different contexts. The results illuminate how the agility between the knowledge types is critical for navigating tensions in power imbalances, as well as producing transformative knowledge. Moreover, the results call further attention to the co-production of critical knowledge in sustainability science

Prevalence and evolution of snoring and the associated factors in two-year-old children

Objectives: To evaluate the prevalence and persistence of snoring during the first two years of life in two Finnish birth cohorts and to assess the associated factors. Study design: The study population comprised 947 children from the CHILD-SLEEP (CS) and 1393 children from the FinnBrain (FB) birth cohorts. Questionnaires were provided to both parents when the child was 24 months of age. The questionnaire consisted of parts concerning the child's sleep and environmental factors. Results: The combined prevalence of habitual snoring in the two birth cohorts at the age of 24 months was 2.3% (95% CI 1.5-3.1), which is markedly lower than reported previously. Children suffering from recurrent infections (CS odds ratio (OR) 3.9, 95% CI 1.2-12.5) or asthma (FB OR 4.3, 1.4-13.5) snored habitually more often. Both the mother's (CS OR 3.2, 1.2-9.0) and father's (CS OR 3.4, 1.4-8.0) snoring every night added to the risk of the child snoring. In the multivariate models, parental snoring (CS adjusted odds ratio (ORa) 2.8, 1.1-6.8), the mother's lower level of education (CS ORa 2.9, 1.2-7.5, FB ORa 2.1, 1.0-4.5), and the mother's lower monthly income (FB ORa 2.9, 1.3-6.3) associated with the child's habitual snoring. Conclusions: The prevalence of habitual snoring in two Finnish birth cohorts is lower than reported previously. The independent risk factors for habitual snoring at the age of two years were the parents' snoring and the mother's low income and low education.Objectives: To evaluate the prevalence and persistence of snoring during the first two years of life in two Finnish birth cohorts and to assess the associated factors. Study design: The study population comprised 947 children from the CHILD-SLEEP (CS) and 1393 children from the FinnBrain (FB) birth cohorts. Questionnaires were provided to both parents when the child was 24 months of age. The questionnaire consisted of parts concerning the child's sleep and environmental factors. Results: The combined prevalence of habitual snoring in the two birth cohorts at the age of 24 months was 2.3% (95% CI 1.5-3.1), which is markedly lower than reported previously. Children suffering from recurrent infections (CS odds ratio (OR) 3.9, 95% CI 1.2-12.5) or asthma (FB OR 4.3, 1.4-13.5) snored habitually more often. Both the mother's (CS OR 3.2, 1.2-9.0) and father's (CS OR 3.4, 1.4-8.0) snoring every night added to the risk of the child snoring. In the multivariate models, parental snoring (CS adjusted odds ratio (ORa) 2.8, 1.1-6.8), the mother's lower level of education (CS ORa 2.9, 1.2-7.5, FB ORa 2.1, 1.0-4.5), and the mother's lower monthly income (FB ORa 2.9, 1.3-6.3) associated with the child's habitual snoring. Conclusions: The prevalence of habitual snoring in two Finnish birth cohorts is lower than reported previously. The independent risk factors for habitual snoring at the age of two years were the parents' snoring and the mother's low income and low education. (C) 2021 The Authors. Published by Elsevier B.V.Peer reviewe

Interactions of genetic variants and prenatal stress in relation to the risk for recurrent respiratory infections in children

Genetic variants may predispose children to recurrent respiratory infections (RRIs) but studies on genotype-environment interaction are rare. We hypothesized that the risk for RRIs is elevated in children with innate immune gene variants, and that prenatal exposure to maternal psychological distress further increases the risk. In a birth cohort, children with RRIs (n = 96) were identified by the age of 24 months and compared with the remaining cohort children (n = 894). The risk for RRIs in children with preselected genetic variants and the interaction between maternal distress during pregnancy and child genotype were assessed with logistic regression. The IL6 minor allele G was associated with elevated risk for RRIs (OR 1.55; 95% CI 1.14–2.12). Overall, there was no interaction between maternal psychological distress and child genotype. Exploratory analyses showed that, the association between the variant type of IL6 and the risk for RRIs was dependent on prenatal exposure to maternal psychological distress in males (OR 1.96; 95% CI 1.04–3.67). Our study didn’t find genotype-environment interaction between prenatal maternal distress and child genotype. Exploratory analyses suggest sex differences in gene-environment interaction related to susceptibility to RRIs. © 2021, The Author(s).</p

Prevalence and evolution of snoring and the associated factors in two-year-old children

AbstractObjectivesTo evaluate the prevalence and persistence of snoring during the first two years of life in two Finnish birth cohorts and to assess the associated factors.Study designThe study population comprised 947 children from the CHILD-SLEEP (CS) and 1393 children from the FinnBrain (FB) birth cohorts. Questionnaires were provided to both parents when the child was 24 months of age. The questionnaire consisted of parts concerning the child's sleep and environmental factors.ResultsThe combined prevalence of habitual snoring in the two birth cohorts at the age of 24 months was 2.3% (95% CI 1.5–3.1), which is markedly lower than reported previously.Children suffering from recurrent infections (CS odds ratio (OR) 3.9, 95% CI 1.2–12.5) or asthma (FB OR 4.3, 1.4–13.5) snored habitually more often. Both the mother's (CS OR 3.2, 1.2–9.0) and father's (CS OR 3.4, 1.4–8.0) snoring every night added to the risk of the child snoring. In the multivariate models, parental snoring (CS adjusted odds ratio (ORa) 2.8, 1.1–6.8), the mother's lower level of education (CS ORa 2.9, 1.2–7.5, FB ORa 2.1, 1.0–4.5), and the mother's lower monthly income (FB ORa 2.9, 1.3–6.3) associated with the child's habitual snoring.ConclusionsThe prevalence of habitual snoring in two Finnish birth cohorts is lower than reported previously. The independent risk factors for habitual snoring at the age of two years were the parents' snoring and the mother's low income and low education.</p

Test-retest reliability of diffusion tensor imaging scalars in 5-year-olds

Diffusion tensor imaging (DTI) has provided great insights into the microstructural features of the developing brain. However, DTI images are prone to several artifacts and the reliability of DTI scalars is of paramount importance for interpreting and generalizing the findings of DTI studies, especially in the younger population. In this study, we investigated the intrascan test-retest repeatability of four DTI scalars: fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) in 5-year-old children (N = 67) with two different data preprocessing approaches: a volume censoring pipeline and an outlier replacement pipeline. We applied a region of interest (ROI) and a voxelwise analysis after careful quality control, tensor fitting and tract-based spatial statistics. The data had three subsets and each subset included 31, 32, or 33 directions thus a total of 96 unique uniformly distributed diffusion encoding directions per subject. The repeatability of DTI scalars was evaluated with intraclass correlation coefficient (ICC(3,1)) and the variability between test and retest subsets. The results of both pipelines yielded good to excellent (ICC(3,1) > 0.75) reliability for most of the ROIs and an overall low variability (<10%). In the voxelwise analysis, FA and RD had higher ICC(3,1) values compared to AD and MD and the variability remained low (<12%) across all scalars. Our results suggest high intrascan repeatability in pediatric DTI and lend confidence to the use of the data in future cross-sectional and longitudinal studies