Diverging prevalences and different risk factors for childhood asthma and eczema: a cross-sectional study

This is the final version of the article. Available from BMJ Publishing Groupvia the DOI in this record.OBJECTIVE: To compare the prevalences of and risk factors for asthma, wheeze, hay fever and eczema in primary schoolchildren in Aberdeen in 2014. DESIGN: Cross-sectional survey. SETTING: Primary schools in Aberdeen, North-East Scotland. PARTICIPANTS: Children in Scottish school years primary 1-7 were handed a questionnaire by their class teacher to be completed by their parents and returned to the researchers by post or online. MAIN OUTCOME MEASURES: Lifetime history of asthma, eczema and hay fever, and recent history of wheeze. RESULTS: 41 schools agreed to participate (87%). 11,249 questionnaires were distributed and 3935 returned (35%). A parent-reported lifetime history of asthma, eczema and hay fever was present in 14%, 30% and 24% of children, respectively. The odds of lifetime asthma increased with age (OR 1.1 per year, 95% CI 1.1 to 1.2), male sex (OR 1.89, 95% CI 1.4 to 2.3), parental smoking (OR 1.7, 95% CI 1.2 to 2.3) and eczema (OR 6.6, 95% CI 5.2 to 8.4). Prevalence of recent wheeze was also reported to be 14% and was positively associated with male sex, parental smoking and eczema. In contrast, parental eczema was the only identified predictor of childhood eczema risk. CONCLUSIONS: The lifetime prevalence of asthma in primary schoolchildren was 14% in this survey, approximately half the prevalence of eczema. We report diverging prevalences in relation to previous studies in our locality, and different risk factors for asthma and eczema. These findings suggest that asthma and eczema are unlikely to have a common origin.This study was funded by Chest Heart and Stroke Scotland and a private donation from the family of Blanche Dawson, who conducted the initial 1964 Aberdeen Schools Asthma Survey

Duration of total and exclusive breastfeeding, timing of solid food introduction and risk of allergic diseases: a systematic review and meta-analysis [Abstract]

Background Allergic diseases are the leading causes of chronic illness in children and young adults in the UK. Aim To undertake a comprehensive review of the evidence on the effect of breastfeeding (BF) duration and timing of solid food introduction (SFI), on the risk of wheeze, atopic dermatitis, rhino-conjunctivitis, food allergy, allergic sensitisation and measures of lung function or bronchial hyper-responsiveness. Methods We carried out a systematic review following the PRISMA guidelines (International Prospective Register of Systematic Reviews [PROSPERO] CRD42013003802). We included intervention, cohort, case-control and cross-sectional studies. Following literature searches (July 2013), study eligibility, data extraction and risk of bias assessments were conducted independently by two investigators. Random effects meta-analyses were used to pool results. Five levels of comparison of total or exclusive BF duration were used to assess disease risk in children at age 0–4 yrs, 5–15 yrs or 15+yrs: ‘never vs ever’,’≥1–2 months vs. <1–2 months’, ‘≥3–4 months vs. <3–4 months’, ‘≥5–7 months vs. <5–7 months’, and ‘≥8–12 months vs. <8–12 months’. Exclusive BF (EBF; BF without formula or solid food supplementation) was categorised as ‘≥0–2 months vs. <0–2 months’, ‘≥3–4 months vs. <3–4 months’ and ‘≥5+ months vs. <5+ months’, and SFI as ‘≥3–4 months vs. <3–4 months’. Publication bias was assessed using Egger’s asymmetry test. Results Of 16,289 identified studies, 564 met the inclusion criteria and were eligible for analysis. We found reduced risk of wheezing in children aged 5–14 yrs with longer BF or EBF duration, which was dose-dependent, but there was evidence of publication bias (BF and odds of recurrent wheezing P = 0.007). Similar results were found for recurrent wheeze at age 5–14 yrs but not in other ages. Measures of lung function were also increased with increased BF or EBF duration. We found no evidence that BF duration influences other allergic outcomes, and no evidence that timing of SFI influences any of the outcomes assessed. Conclusion Longer breastfeeding duration may protect against wheezing later in childhood. Any effect is likely to be through effects on lung function rather than allergic sensitisati

Pulmonary epithelial barrier and immunological functions at birth and in early life - key determinants of the development of asthma? A description of the protocol for the Breathing Together study

Acknowledgements The authors are indebted to the participants and parents who have already been recruited. We also acknowledge the enthusiasm and endeavour of the research nurse team which includes: Stephen Main, Margaret Connon, Catherine Beveridge, Julie Baggott, Kay Riding, Ellie McCamie, Maria Larsson, Lynda Melvin, Mumtaz Idris, Tara Murray, Nicky Tongue, Nicolene Plaatjies, Sheila Mortimer, Sally Spedding, Susy Grevatt, Victoria Welch, Morag Zelisko, Jillian Doherty, Jane Martin, Emma Macleod and Cilla Snape. We are also delighted to be working alongside the following colleagues in laboratories: Marie Craigon, Marie McWilliam, Maria Zarconi, Judit Barabas, Lindsay Broadbent, Ceyda Oksel and Sheerien Manzoor. Grant information The study is supported by the Wellcome Trust [108818]; and the PHA HSC R&D Division, Northern Ireland.Peer reviewedPublisher PD

The Canadian Healthy Infant Longitudinal Development (CHILD) birth cohort study: Assessment of environmental exposures

The Canadian Healthy Infant Longitudinal Development birth cohort was designed to elucidate interactions between environment and genetics underlying development of asthma and allergy. Over 3600 pregnant mothers were recruited from the general population in four provinces with diverse environments. The child is followed to age 5 years, with prospective characterization of diverse exposures during this critical period. Key exposure domains include indoor and outdoor air pollutants, inhalation, ingestion and dermal uptake of chemicals, mold, dampness, biological allergens, pets and pests, housing structure, and living behavior, together with infections, nutrition, psychosocial environment, and medications. Assessments of early life exposures are focused on those linked to inflammatory responses driven by the acquired and innate immune systems. Mothers complete extensive environmental questionnaires including time-activity behavior at recruitment and when the child is 3, 6, 12, 24, 30, 36, 48, and 60 months old. House dust collected during a thorough home assessment at 3–4 months, and biological specimens obtained for multiple exposure-related measurements, are archived for analyses. Geo-locations of homes and daycares and land-use regression for estimating traffic-related air pollution complement time-activity-behavior data to provide comprehensive individual exposure profiles. Several analytical frameworks are proposed to address the many interacting exposure variables and potential issues of co-linearity in this complex data set

Фінансування і бюджетування охорони здоров'я: пріоритети регіональної політики у відповідь на COVID-19

This paper summarizes the arguments and counter-arguments in the scholarly debates on transformations in healthcare budgeting that should consider the differentiated regional vulnerability in responding to the pandemic. The primary purpose of the study is to identify priorities for local health development programs. The urgency of solving this problem is that the pandemic has revealed the unprecedented unpreparedness of the health care system to respond effectively to challenges; also, hidden problems accumulated during the last decades, which increase the emerging risks. The study is carried out in the following logical sequence: 1) collection, processing, and analysis of statistical data; 2) conducting a cluster analysis for group regions by vulnerability to different classes of diseases; 3) conducting correlation and regression analysis to compare the effects of the COVID-19 pandemic (cases and deaths) and the state of the region; 4) selection of the most significant features of the vulnerability of the region; 5) designing the matrix of the choice of priorities for financing targeted programs in the field of health care. Methodological tools of the study were methods of correlation and regression analysis, cluster analysis, testing for autocorrelation by Darbin — Watson method, sigma limited parameterization to identify the most significant coefficients. The method is tested for 25 regions of Ukraine (including Kyiv), as they can serve as pilots for other regions with similar demographic and economic characteristics. The article presents the results of an empirical analysis of the readiness of regions for critical conditions, such as COVID-19. Identifying such readiness and appropriate distribution of regions by disease classes allows to make decisions in financing and budgeting and improve the quality of health care.Узагальнено аргументи і контраргументи в межах наукової дискусії з питання зміни бюджетної оптимізації в галузі охорони здоров’я з урахуванням диференційованої регіональної вразливості від наслідків пандемії. Основною метою проведеного дослідження є визначення пріоритетних напрямів розвитку місцевих програм розвитку в галузі охорони здоров’я. Актуальність розв’язання наукової проблеми полягає в тому, що пандемія виявлила неготовність системи охорони здоров’я реагувати ефективно на виклики, окрім того, виявила приховані проблеми, закумульовані протягом останнього часу, яку підвищують ризики, що з’являться в майбутньому. Дослідження питання виявлення пріоритетних напрямів розвитку програм у галузі охорони здоров’я здійснено в такій логічній послідовності: 1) збір, обробка та аналіз масиву статистичних даних; 2) проведення кластерного аналізу для групування регіонів за вразливістю до різних класів хвороб; 3) проведення кореляційно-регреійного аналізу для зіставлення наслідків впливу пандемії COVID-19 і стану досліджуваної галузі в регіонах; 4) виділення найбільш впливових ознак на вразливість регіону; 5) запропонована матриця вибору пріоритетів фінансування цільових програм у сфері охорони здоров’я. Методичним інструментарієм проведеного дослідження стали методи кореляційно-регресійного аналізу, кластерного аналізу, перевірка на наявність автокореляції методом Дарбіна — Уотсона, проведена сигма обмежена параметризація для виявлення найбільш значущих коефіцієнтів. Об’єктом дослідження обрано 25 регіонів України (включно із м. Києвом), оскільки вони можуть служити пілотними для інших регіонів, схожих за демографічними та економічними характеристиками. Представлено результати емпіричного аналізу готовності регіонів до критичних станів, таких як COVID. Вииявлення такої готовності та відповідний розподіл регіонів за класами хвороб дозволить знайти оптимальний шлях для перерозподілу фінансових ресурсів і поліпшення якості надання медичної допомоги