Rationale for a Swedish cohort consortium

We herein outline the rationale for a Swedish cohort consortium, aiming to facilitate greater use of Swedish cohorts for world-class research. Coordination of all Swedish prospective population-based cohorts in a common infrastructure would enable more precise research findings and facilitate research on rare exposures and outcomes, leading to better utilization of study participants' data, better return of funders' investments, and higher benefit to patients and populations. We motivate the proposed infrastructure partly by lessons learned from a pilot study encompassing data from 21 cohorts. We envisage a standing Swedish cohort consortium that would drive development of epidemiological research methods and strengthen the Swedish as well as international epidemiological competence, community, and competitiveness.Peer reviewe

Bronchial Responsiveness Is Related to Increased Exhaled NO (FENO) in Non-Smokers and Decreased FENO in Smokers

Rationale Both atopy and smoking are known to be associated with increased bronchial responsiveness. Fraction of nitric oxide (NO) in the exhaled air (FENO), a marker of airways inflammation, is decreased by smoking and increased by atopy. NO has also a physiological bronchodilating and bronchoprotective role. Objectives To investigate how the relation between FENO and bronchial responsiveness is modulated by atopy and smoking habits. Methods Exhaled NO measurements and methacholine challenge were performed in 468 subjects from the random sample of three European Community Respiratory Health Survey II centers: Turin (Italy), Gothenburg and Uppsala (both Sweden). Atopy status was defined by using specific IgE measurements while smoking status was questionnaire-assessed. Main Results Increased bronchial responsiveness was associated with increased FENO levels in non-smokers (p = 0.02) and decreased FENO levels in current smokers (p = 0.03). The negative association between bronchial responsiveness and FENO was seen only in the group smoking less <10 cigarettes/day (p = 0.008). Increased bronchial responsiveness was associated with increased FENO in atopic subjects (p = 0.04) while no significant association was found in non-atopic participants. The reported interaction between FENO and smoking and atopy, respectively were maintained after adjusting for possible confounders (p-values<0.05). Conclusions The present study highlights the interactions of the relationship between FENO and bronchial responsiveness with smoking and atopy, suggesting different mechanisms behind atopy- and smoking-related increases of bronchial responsiveness

Projekt X-69

Health assessments were performed on subjects living in a city area. In total was 24 179 invited and 18 543 responded. Of the responders were 5 885 later examined. The results of the ECG, X-ray and medical examinations created the X-69 database and its continuation, the X-71, when they were performed gathered knowledge of conditions associated with population health and morbidity in the short term. At the same time gave the two surveys opportunity to create a basis for so-called prospective, prospective, epidemiological studies. The population studied the development of illness and diseases are therefore in the years after the original the examinations at different times and with different orientations followed and related to the original measurement results. When the X-69 and X-71 was carried out it led to vast amounts of data and large computer technology was utilized which in turn required high and specific professional skills in the computer field. This was met through cooperation with Uppsala University computer centre, UDAC. In connection with a reorganization 1997 - 1998 some parts of the data to feed over CD-ROMs for continued storage at Gävleborg. In connection with the transfer was additionally linkage with the Swedish National Board of cancer and mortality registries. Purpose: Health examination X-69 was essentially a study of technical object and the purpose was to: • highlight the diagnostic enrichment effect of the use of the screening system, and especially of its blood chemical part, when it comes to identify people with deviations depending on the disease state and with current health care needs • examine the use of thermal imaging (thermography) at screening directed at female breast cancer • assessing the computational evaluation of the electrocardiogram for the detection of coronary and cardiac muscle, • examine the dip-slide technique for the detection of abnormal bacterial excretion in the urine in a unselected population • examine the practical value of the data machined questionnaire as a screening instrument.Hälsoundersökningar gjordes på en liten population i en stadsdel. Totalt inbjöds 24 179 personer och 18 543 svarade på inbjudan. Av de svarande så gick 5 885 vidare till undersökning. Genom resultaten från EKG, röntgen- och läkarundersökningar skapade X-69 och dess fortsättning, X-71, när de genomfördes, kunskaper om förhållanden som hänger samman med befolkningens hälsa och sjuklighet i ett kort perspektiv. Samtidigt gav de två undersökningarna möjlighet att skapa underlag för s.k. prospektiva, framåtsyftande, epidemiologiska studier. Den studerade populationens utveckling av ohälsa och sjukdom har därför under åren efter de ursprungliga undersökningarnas genomförande vid olika tillfällen och med olika inriktning följts och relateras till de ursprungliga mätresultaten. När X-69 och X-71 genomfördes medförde de stora datamängderna att stordatorteknik utnyttjades något som i sin tur krävde hög och specifik yrkeskunskap på dataområdet. Detta tillgodosågs genom samarbete med Uppsala Universitets datacentral, UDAC. I samband med en omorganisation 1997 - 1998 fördes vissa delar av datamaterialet över till CD-rom skivor. I samband med överföringen genomfördes dessutom samkörningar med Socialstyrelsens cancer- och dödsorsaksregister. Syfte: X-69 hade huvudsakligen en undersökningsteknisk målsättning och syftade till: • att belysa den diagnostiska anrikningseffekten av det använda screeningsystemet och särskilt av dess blodkemiska del, när det gäller att in¬dikera personer med avvikelser beroende på väsentliga sjukdomstill¬stånd och med aktuellt vårdbehov, • att pröva användandet av värmekamera (termografi) vid screening riktad mot kvinnlig bröstcancer, • att pröva datamaskinell utvärdering av elektrokardiogram för påvisande av kranskärls- och hjärtmuskelsjukdomar, • att pröva dip-slide teknik för påvisande av abnorm bakterieutsöndring i urinen på ett oselekterat klientel, • att pröva det praktiska värdet av datamaskinellt bearbetade frågeformulär såsom screeninginstrument

Reference equations for exhaled nitric oxide-what is needed?

Standardisation is the road to improvement! If we all measure exhaled nitric oxide (NO) the same way, we will be successful in having data to make reference questions. Many research groups have published their reference equation, but most differ considerably. About 25 years ago, using the flow of 50 ml s(-1) was recommended and not using a nose clip. When collecting data worldwide, we still see publications that do not indicate what flow was used and that nose clip was utilised. Three things are needed: the analysing method, a flow recording and a filled-in nitric oxide questionnaire. The analysing method is because the techniques have different sensitivity, response times and calibration. The flow of 50 ml s(-1) is on the steep part of the NO output curve; therefore, we need to record the flow to analyse repeated measurements or compare results. The NO questionnaire controls individual factors that may influence the NO measurements, i.e. food intake, smoking and upper airway infection. An important tool in following old and new disease treatments, at home or in health care, is exhaled biomarkers. If we follow the standardisation we have agreed upon, we will be able to have data to say what a high or a low exhaled NO value is

Innovative exhaled breath analysis with old breathing manoeuvres-is there a problem or an advantage?

As the field of exhaled breath research is expanding, the question that arises is can the old usual method of spirometry be used in all cases? The answer is yes for some analysation methods and definitely not for others: it all depends on the result you are looking for. Exhaled breath condensate collection can be accomplished with silent tidal breathing, but not in the analysation of the amount of exhaled particles, as they become very low during tidal breathing. There are gases that are exhalation flow dependent, e.g. nitric oxide, acetone and ethanol, that require a special breathing manoeuvre with flow control. Physiological changes of the lung, i.e. inhalation to total lung capacity or forced exhalation such as during spirometry, will affect the result of exhaled biomarkers. The standardisation of exhaled breath requires further development, and there are many aspects to consider