Investigating International Time Trends in the Incidence and Prevalence of Atopic Eczema 1990-2010: A Systematic Review of Epidemiological Studies

The prevalence of atopic eczema has been found to have increased greatly in some parts of the world. Building on a systematic review of global disease trends in asthma, our objective was to study trends in incidence and prevalence of atopic eczema. Disease trends are important for health service planning and for generating hypotheses regarding the aetiology of chronic disorders. We conducted a systematic search for high quality reports of cohort, repeated cross-sectional and routine healthcare database-based studies in seven electronic databases. Studies were required to report on at least two measures of the incidence and/or prevalence of atopic eczema between 1990 and 2010 and needed to use comparable methods at all assessment points. We retrieved 2,464 citations, from which we included 69 reports. Assessing global trends was complicated by the use of a range of outcome measures across studies and possible changes in diagnostic criteria over time. Notwithstanding these difficulties, there was evidence suggesting that the prevalence of atopic eczema was increasing in Africa, eastern Asia, western Europe and parts of northern Europe (i.e. the UK). No clear trends were identified in other regions. There was inadequate study coverage worldwide, particularly for repeated measures of atopic eczema incidence. Further epidemiological work is needed to investigate trends in what is now one of the most common long-term disorders globally. A range of relevant measures of incidence and prevalence, careful use of definitions and description of diagnostic criteria, improved study design, more comprehensive reporting and appropriate interpretation of these data are all essential to ensure that this important field of epidemiological enquiry progresses in a scientifically robust manner

Sex differences in cardiovascular complications and mortality in hospital patients with covid-19: registry based observational study

Objective To assess whether the risk of cardiovascular complications of covid-19 differ between the sexes and to determine whether any sex differences in risk are reduced in individuals with pre-existing cardiovascular disease. Design Registry based observational study. Setting 74 hospitals across 13 countries (eight European) participating in CAPACITY-COVID (Cardiac complicAtions in Patients With SARS Corona vIrus 2 regisTrY), from March 2020 to May 2021 Participants All adults (aged ≥18 years), predominantly European, admitted to hospital with highly suspected covid-19 disease or covid-19 disease confirmed by positive laboratory test results (n=11 167 patients). Main outcome measures Any cardiovascular complication during admission to hospital. Secondary outcomes were in-hospital mortality and individual cardiovascular complications with ≥20 events for each sex. Logistic regression was used to examine sex differences in the risk of cardiovascular outcomes, overall and grouped by pre-existing cardiovascular disease. Results Of 11 167 adults (median age 68 years, 40% female participants) included, 3423 (36% of whom were female participants) had pre-existing cardiovascular disease. In both sexes, the most common cardiovascular complications were supraventricular tachycardias (4% of female participants, 6% of male participants), pulmonary embolism (3% and 5%), and heart failure (decompensated or de novo) (2% in both sexes). After adjusting for age, ethnic group, pre-existing cardiovascular disease, and risk factors for cardiovascular disease, female individuals were less likely than male individuals to have a cardiovascular complication (odds ratio 0.72, 95% confidence interval 0.64 to 0.80) or die (0.65, 0.59 to 0.72). Differences between the sexes were not modified by pre-existing cardiovascular disease; for the primary outcome, the female-to-male ratio of the odds ratio in those without, compared with those with, pre-existing cardiovascular disease was 0.84 (0.67 to 1.07). Conclusions In patients admitted to hospital for covid-19, female participants were less likely than male participants to have a cardiovascular complication. The differences between the sexes could not be attributed to the lower prevalence of pre-existing cardiovascular disease in female individuals. The reasons for this advantage in female individuals requires further research

The CHAMP-study: the CHemopreventive effect of lithium in familial AdenoMatous Polyposis; study protocol of a phase II trial

Background: Familial adenomatous polyposis (FAP) is a rare autosomal dominant disease characterized by germline mutations in the Adenomatous Polyposis Coli (APC) gene, resulting in the development of numerous colorectal adenomas. As these patients have a high risk of developing colorectal cancer (CRC), guidelines suggest prophylactic colectomy during early adulthood, however, adenoma development is still observed in the remaining intestinal tract. Therefore, FAP patients would benefit from chemoprevention strategies reducing the development of adenomas. Recent work in mice reveals a chemopreventive effect of lithium on the development of adenomas by inhibiting the expansion of Apc mutated intestinal stem cells (ISCs) within the crypts of normal intestinal mucosa. Here, we aim to investigate the effect of lithium on the spread of APC mutant cells within the human intestinal epithelium. Methods: This prospective phase II single arm trial has a duration of 18 months. FAP patients (18–35 years) with a genetically confirmed APC mutation who did not undergo colectomy will be treated with lithium carbonate orally achieving a serum level of 0.2–0.4 mmol/l between month 6 and 12. Colonoscopy with biopsies of normal intestinal mucosa will be performed at baseline and every six months. The primary endpoint is the effect of lithium on the spread of APC mutant cells within intestinal crypts over time by using APC specific marker NOTUM in situ hybridization. Secondary endpoints include change in adenoma burden, patient reported side effects and safety-outcomes. Total sample size is 12 patients and recruitment will take place in the Amsterdam UMC, location AMC in the Netherlands. Discussion: The outcome of this study will function as a proof-of-concept for the development of novel chemoprevention approaches that interfere with the competition between normal and mutant ISCs. Trial registration: ClinicalTrials.gov (https://clinicaltrials.gov/): NCT05402891 (June 1, 2022) and the EU Clinical Trials Register: EuraCT 2022-000240-30 (January 1, 2022)

Primary and secondary outcomes measures.

<p>Primary and secondary outcomes measures.</p

Good and moderate quality studies reporting the incidence and prevalence of parental- or self-report of atopic eczema between 1990 and 2010 in Europe.

<p>Abbreviations – CI: confidence intervals, SE: standard error, POR: prevalence odds ratio, OR: odds ratio.</p>*<p>Based on UN classification <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0039803#pone.0039803-United1" target="_blank">[16]</a>.</p>**<p>95% CI and SE are only reported if included in original report.</p>#<p>Point estimate extracted from graph or chart.</p

Good and moderate quality studies reporting the prevalence of parental- or self-report of atopic eczema between 1990 and 2010 in Asia.

<p>Abbreviations – CI: confidence intervals, SE: standard error, OR: odds ratio, POR: prevalence odds ratio, PR: prevalence ratio.</p>*<p>Based on UN classification <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0039803#pone.0039803-United1" target="_blank">[16]</a>.</p>**<p>95% CI or SE are only reported if included in original report.</p>#<p>Point estimate extracted from graph or chart.</p

Good and moderate quality studies reporting the prevalence of parental- or self-report of atopic eczema between 1990 and 2010 in Oceania.

<p>Abbreviations – CI: confidence intervals, SE: standard error, OR: odds ratio.</p>*<p>Based on UN classification <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0039803#pone.0039803-United1" target="_blank">[16]</a>.</p>**<p>95% CI and SE are only reported if included in original report.</p>#<p>Point estimate extracted from graph or chart.</p

PRISMA flow diagram.

<p>PRISMA flow diagram.</p

Good and moderate quality studies reporting the prevalence of parental- or self-report of atopic eczema between 1990 and 2010 in the Americas.

<p>Abbreviations – CI: confidence intervals, SE: standard error, OR: odds ratio.</p>*<p>Based on UN classification <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0039803#pone.0039803-United1" target="_blank">[16]</a>.</p>**<p>95% CI and SE are only reported if included in original report.</p