Severe asthma and asthma control in schoolchildren

Background: Asthma is a major health problem in children and most troublesome during severe or persistent symptoms. Children with problematic severe asthma have a disproportionate consumption of health care, despite high-dose treatment with inhaled corticosteroids (ICS). Little is known about children with impaired asthma control or problematic severe asthma in regards to prevalence in a normal population, characterisation and classification, and health effects measured as health-related quality of life (HR-QoL). Aim: The overall aim of this doctoral thesis was to evaluate the burden of symptoms and factors associated with impaired asthma control in schoolchildren. Materials and Methods: The study population consisted of 3 015 children up to 12 years of age from the prospective birth cohort BAMSE, and children from the Severe asthma study with problematic severe asthma (n = 56) and, for comparison, controlled asthma (n = 39). Parental questionnaires collected data on environmental exposures, asthma symptoms and treatments. In the BAMSE study, asthma control was classified based on parental reports and according to a modified GINA classification. The prevalence of severe asthma with dispensed high-dose ICS was estimated through the Swedish drug register. Evaluations with component-resolved allergy diagnostics, exhaled nitric oxide (FeNO), bronchial hyperresponsiveness to methacholine (BHR), blood count of eosinophils and HR-QoL were applied in the Severe asthma study. Results: In the BAMSE cohort, a high proportion of children with asthma were classified as impaired in their asthma control (partly or uncontrolled) at 8 years, 84% of 323, and at 12 years, 53% of 329, (p 4 times in last year (52% vs. 38%, p = 0.002) at 12 years compared with at 8 years, but fewer with nocturnal symptoms (36% vs. 82%, p < 0.001) and less acute healthcare utilization (15% vs. 34%, p < 0.001) at 12 years. Severe asthma was prevalent in 0.4% of children in a normal urban population at age 12, or 4% among children with asthma. Children with impaired asthma control at both 8 and 12 years in the BAMSE cohort (n = 91) and children with problematic severe asthma had more often a family history of allergic disease and comorbidity of rhinitis than children with controlled asthma. Multi-sensitization to animal-derived components was more pronounced in problematic severe asthma than in controlled asthma, 25% vs. 8% (p = 0.03), and was associated with increased eosinophil inflammation as compared with children sensitized to fewer animal-derived components, FeNO 38 ppb vs. 25 ppb (p = 0.002), blood eosinophils 0.65 vs. 0.39 (p = 0.021), and BHR 112 vs. 28 (p = 0.002). Children with problematic severe asthma were more impaired in HR-QoL than children with controlled asthma 5.4 vs. 6.7 (p < 0.001). Conclusion: A high proportion of schoolchildren reported impaired asthma control. Children with problematic severe asthma have impaired HR-QoL, with effects of limitations in daily activities and reduced emotional well-being. Common factors associated with children having impaired asthma control at both 8 and 12 years and problematic severe asthma were family history of allergic disease and comorbidity of rhinitis

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

Eczema distribution in girls and boys during infancy: A cohort study on atopic dermatitis

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Fecal Microbiota Nutrient Utilization Potential Suggests Mucins as Drivers for Initial Gut Colonization of Mother-Child-Shared Bacteria

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Gut bacteria at 6 months of age are associated with immune cell status in 1-year-old children

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Fetal thoracic circumference and lung volume and their rlation to fetal size and pulmonary artery blood flow

Objective: Research on early origins of lung disease suggests the need for studying the relationships of thoracic and lung size with fetal size and pulmonary circulation. The primary aim of this study is therefore to explore the associations between fetal thoracic circumference, lung volume, and fetal size. We also aim to assess if lung volume and thoracic circumference are associated with fetal pulmonary artery blood flow velocity measures. Methods: Cross-sectional assessment of singleton pregnancies from the general population (n = 447) at 30 gestational weeks (GW) was performed using ultrasound measurement of fetal thoracic circumference, lung volume, head and abdominal circumference, and femur length. We obtained Doppler blood flow velocity measures from the proximal branches of the fetal pulmonary artery. Associations between variables were studied using Pearson's correlation and multiple linear regression analyses. Results: Both thoracic circumference and lung volume correlated with fetal size measures, ranging from r = 0.64 between thoracic circumference and abdominal circumference, to r = 0.28 between lung volume and femur length. Adjustment for gestational age, maternal nicotine use, pre-pregnancy body mass index, and fetal sex marginally influenced the associations with abdominal circumference. The correlations of thoracic circumference and lung volume with pulmonary artery blood flow velocity measures were weak (r ≤ 0.17). Conclusion: We found moderate to low correlation between thoracic circumference, lung volume, and fetal size at 30 GW. The closest relationship was with the abdominal circumference. We found low correlations of thoracic circumference and lung volume with pulmonary artery blood flow velocity measures.publishedVersio

Maternal human papillomavirus infections at mid-pregnancy and delivery in a Scandinavian mother–child cohort study

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ARIA digital anamorphosis: Digital transformation of health and care in airway diseases from research to practice

Digital anamorphosis is used to define a distorted image of health and care that may be viewed correctly using digital tools and strategies. MASK digital anamorphosis represents the process used by MASK to develop the digital transformation of health and care in rhinitis. It strengthens the ARIA change management strategy in the prevention and management of airway disease. The MASK strategy is based on validated digital tools. Using the MASK digital tool and the CARAT online enhanced clinical framework, solutions for practical steps of digital enhancement of care are proposed

Lärarkårens Nationalism : En studie av nationalismen i Svensk Läraretidning 1882-1914

Denna uppsats behandlar lärarkårens nationalismunder perioden 1882-1914. Dess syfte är att undersöka hur lärarkåren underdenna period ansåg att man bäst förmedlade nationell fostran och vad dennafostran borde innebära. Med hjälp av den tidigare forskningen på området somofta behandlar skolans roll och funktion inom nationalistisk fostran så har jagtagit mig an att undersöka hur lärarkåren själva uttryckt denna sin roll ochuppgift genom sitt dåtida fackorgan SvenskLäraretidning. De teorier som jag stöder mig på har framföralltpresenterats av författarna Eric Hobsbawm och Herbert Tingsten. Den förre harbeskrivit ingående hur nationalism, patriotism och fosterlandskärlek bildas ochvad de stöder sig på, den senare har mer ingående beskrivit processen i Sverigeoch i förhållande till skolväsendet. Med hjälp av dessa har jag sedanformulerat två idealtyper av nationalism med vars hjälp jag sedan genomfört minundersökning. Dessa två idealtyper är den statsnationella modellen och denetnisk-lingvistiska. Den första baserar nationalism utefter en gemenskap byggdpå institutioner såsom författning, lagar och statsledning medan den senarebaserar nationalism på gemensamt språk och kulturella traditioner. Det resultatjag kommit fram till är att lärarkåren till viss del baserade sin undervisningpå den statsnationella modellen men i större utsträckning på den etnisk-lingvistiska. De skolämnen som kom att dominera debatten kringfosterländsk fostran var historie- och språkämnena. Avslutningsvis kan sägasatt den nationalism som förspråkades centrerades kring det gemensammakulturella arvet och förmedlandet av dygder

Conceptual design and solution evaluation of a cooling and fuelling auxiliary unit for Wärtsilä 31DF

Auxiliary systems for marine vessel applications are often delivered and used as individual and separate components. The purpose of this thesis was to initiate development of a modular auxiliary unit, whose main functionality was to feed and regulate cooling water and fuel oil for Wärtsilä 31DF engines. The goal was to design a 3D-model concept of the auxiliary unit regarding requirements and functionalities from the Offshore market segment. The thesis presents different types of functional schemes, auxiliary system components and technical specifications, and theory about product development and marine market segments. The theory chapter supports development of the conceptual design. Different functional solutions were presented during the design phase, and system components were selected based on the determined functionalities. Siemens NX was used to design different 3D-models and the auxiliary unit assembly, based on the selected system components. The thesis resulted in a modular cooling and fuelling unit variant for Wärtsilä 31DF, which covered the 12V, 14V and 16V cylinder configurations. The modular thinking and functional maps were key solutions to develop a flexible auxiliary unit that could be offered to the broad market. The work enables further development and evaluation of different layout solutions, to determine a final solution used for detail design.Hjälpsystem för marina fartygsapplikationer levereras och används ofta som enskilda och separata komponenter. Syftet med detta examensarbete var att initiera utveckling av en moduluppbyggd hjälpenhet, vars huvudsakliga funktionalitet var att mata och reglera kylvatten och dieselbränsle för Wärtsilä 31DF-motorer. Målet var att utforma ett 3D-modellkoncept av hjälpenheten med avseende på krav och funktionaliteter från Offshore-marknadssegmentet. I arbetet presenteras olika typer av funktionsdiagram, systemkomponenter och tekniska specifikationer samt teori om produktutveckling och marinmarknadssegment. Teoridelen fungerar som beslutsgrund för konceptlösningen. Under designfasen presenterades olika funktionslösningar. Utgående från de bestämda funktionslösningarna valdes specifika systemkomponenter. Siemens NX användes för att designa 3D-modeller, utgående från de valda systemkomponenterna. Arbetet resulterade i en 3D-modell för en moduluppbyggd kylnings- och bränslehjälpenhet för Wärtsilä 31DF, som täckte de olika cylinderkonfigurationerna 12V, 14V och 16V. Modultänkandet och funktionsdiagrammen var viktiga lösningar för att förstärka utvecklingen av en flexibel hjälpenhet som kunde erbjudas till en bred andel av den marina marknaden. Arbetet möjliggör vidareutveckling och utvärdering av olika layoutlösningar, för att bestämma en slutlig lösning för detaljdesign.Merialusten sovellukset kuten tukijärjestelmät toimitetaan ja käytetään usein erillisinä osina. Tämän opinnäytetyön tarkoitus oli alkaa kehittää modulaarista avustusyksikköä, jonka päätoiminto on jäähdytysveden ja dieselpolttoaineen syöttäminen ja säätäminen Wärtsilä 31DF -moottoreille. Tavoitteena oli suunnitella 3D-konseptimalli avustusyksiköstä Offshore-markkinasegmentin vaatimusten ja toimintojen perusteella. Työssä esitellään erilaisia toimintakaavioita, järjestelmäkomponentteja ja teknisiä eritelmiä, sekä tuotekehityksen ja merimarkkinasegmenttien teoriaa. Teoreettinen osa toimii konseptiratkaisun päätöksenteon perustana. Suunnitteluvaiheen aikana esitettiin erilaisia toiminnallisia ratkaisuja. Määritettyjen toiminnallisten ratkaisujen perusteella valittiin tiettyjä järjestelmäkomponentteja. Siemens NX-ohjelmistoa käytettiin 3D-mallien suunnitteluun, valittujen järjestelmäkomponenttien perusteella. Lopputulos on 3D-konseptimalli modulaariselle jäähdytys- ja polttoaineavustusyksikölle Wärtsilä 31DF-moottoreille, joka kattaa sylinterikokoonpanot 12V, 14V ja 16V. Modulaarinen ajattelutapa ja toimintakaaviot ovat tärkeitä ratkaisuja joustavan avustusyksikön kehittämisessä. Avustusyksikköä voidaan tarjota laajalle osalle merimarkkinoita. Työn avulla voidaan edelleen kehittää ja arvioida eri ratkaisuja, jotta voidaan määrittää lopullinen ratkaisu yksityiskohtaiseen suunnitteluun