Prediction models for the development of COPD: A systematic review

Early identification of people at risk of developing COPD is crucial for implementing preventive strategies. We aimed to systematically review and assess the performance of all published models that predicted development of COPD. A search was conducted to identify studies that developed a prediction model for COPD development. The Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies was followed when extracting data and appraising the selected studies. Of the 4,481 records identified, 30 articles were selected for full-text review, and only four of these were eligible to be included in the review. The only consistent predictor across all four models was a measure of smoking. Sex and age were used in most models; however, other factors varied widely. Two of the models had good ability to discriminate between people who were correctly or incorrectly classified as at risk of developing COPD. Overall none of the models were particularly useful in accurately predicting future risk of COPD, nor were they good at ruling out future risk of COPD. Further studies are needed to develop new prediction models and robustly validate them in external cohorts

Impact of uncomplicated traumatic dental injuries on the quality of life of children and adolescents: a systematic review and meta-analysis

BACKGROUND: Traumatic dental injuries (TDIs) are highly prevalent during childhood and adolescence and have a significant effect on their oral health related quality of life (OHRQoL). Uncomplicated TDIs, dental trauma involving enamel, enamel and dentin and tooth discolorations, account for approximately two-thirds of all diagnosed TDIs in children and adolescents. Hence, it may be important to understand the impact of uncomplicated TDIs on OHRQoL, by synthesizing the available literature. METHODS: Medline, Embase, Web of Science and Scopus databases were systematically searched from January 1966 to April 2018. Studies that evaluated the effect of TDIs on the OHRQoL of children and adolescents using validated methods were selected for analysis. A narrative synthesis and a meta-analysis were performed. The studies were pooled according to age groups and OHRQoL questionnaire used. A random-effect model was applied to calculate the pooled odds ratios (OR) and their respective 95% confidence intervals. RESULTS: There were 712 identified studies. Of these, 26 articles were selected for the review and included in the narrative synthesis, 20 of these articles concluded that uncomplicated TDIs were not associated with a negative impact in OHRQoL. Seventeen were included in the meta-analysis. The estimates were pooled by age groups: children (OR: 1.01; 95%CI; 0.85-1.19; I2 = 51.9%) and adolescents (OR: 1.07; 95%CI; 0.91, 1.26; I2 = 50.2%).When pooling all estimates the OR was 0.96 (95% CI: 0.85-1.10; I2 = 61.4%). CONCLUSIONS: Uncomplicated TDIs do not have a negative impact on the OHRQoL of children and adolescents. Further prospective studies are needed to confirm the results of this review. The majority of the studies included were of cross-sectional design, which may have limited the ability to reach conclusions on the nature of this association. The PROSPERO systematic review registry is CRD42018110471

Age at introduction to complementary solid food and food allergy and sensitization: a systematic review and meta-analysis

BACKGROUND AND OBJECTIVE: An infant's age at introduction of complementary solids may contribute to food allergy. We aimed to synthesize the literature on the association between age at introduction of complementary solids, excluding milk products, and food allergy and sensitization. DESIGN: We searched the electronic databases PubMed and EMBASE (January 1946-February 2017) using solid food, allergy and sensitization terms. METHODS: Two authors selected papers according to inclusion criteria, identifying 16 cohort studies, 1 case-control study and 8 randomized controlled trials (RCTs). Pooled effects across studies were estimated using random-effects meta-analysis. RESULTS: Cohort studies - Introducing complementary solids at age ≥4 months versus <4 months was not associated with food allergy (OR 1.22; 95%CI, 0.76-1.96) but was associated with food sensitization (OR 1.93; 95%CI 1.57-2.38). First exposure from age 4-6 months versus <4 months was not associated with food allergy (OR 1.01; 95%CI, 0.64-1.60) but was associated with food sensitization (OR 2.46; 95%CI 1.55-3.86). RCTs - Egg exposure from age 4 months was associated with reduced egg allergy (OR 0.63, 95%CI, 0.44-0.90) and sensitization (OR 0.76, 95%CI, 0.51-0.95). Peanut exposure from age 4 months compared to delayed exposure was associated with reduced peanut allergy (OR 0.28, 95%CI 0.14-0.57). CONCLUSIONS: We found no evidence from observational studies that introducing solids before 4 months protected against food allergy, but there was evidence for protection against food sensitization. From RCTs, introducing egg from 4-6 months and peanut from 4-11 months, reduced the risk of egg allergy, peanut allergy and egg sensitization. This article is protected by copyright. All rights reserved

Air Pollution and Otitis Media in Children: A Systematic Review of Literature

Young children are particularly vulnerable to otitis media (OM) which globally affects over 80% of children below the age of 3 years. Although there is convincing evidence for an association between environmental tobacco smoke exposure and OM in children, the relationship with ambient air pollution is not clear. We aimed to systematically review the literature on the relationship between ambient air pollution exposure and OM in children. A systematic search was performed in PubMed and EMBASE databases. Of 934 references identified, 24 articles were included. There is an increasing body of evidence supporting an association between higher ambient air pollution exposure and a higher risk of OM in children. While NO₂ showed the most consistent association with OM, other specific pollutants showed inconsistent associations. Studies were mainly conducted in high/middle income countries with limited evidence from low-income countries. Although there was a general consensus that higher air pollution exposure is associated with a greater prevalence of OM, the evidence for associations with specific pollutants is inconsistent. More well-designed studies on associations between specific air pollutants as risk factors for OM are warranted, especially in low income countries with high air pollution levels

Prediction models for the development of COPD: a systematic review

Melanie C Matheson,1,2,* Gayan Bowatte,1,3,* Jennifer L Perret,1,4 Adrian J Lowe,1,2 Chamara V Senaratna,1,5 Graham L Hall,6&ndash;8 Nick de Klerk,6,8 Louise A Keogh,9 Christine F McDonald,4 Nilakshi T Waidyatillake,1 Peter D Sly,10 Deborah Jarvis,11,12 Michael J Abramson,13 Caroline J Lodge,1,2,* Shyamali C Dharmage1,2,* 1Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; 2Murdoch Children&rsquo;s Research Institute, Melbourne, VIC, Australia; 3National Institute of Fundamental Studies, Kandy, Sri Lanka; 4Department of Respiratory and Sleep Medicine, Institute for Breathing and Sleep, Austin Health, University of Melbourne, Melbourne, VIC, Australia; 5Department of Community Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka; 6Telethon Kids Institute, Perth, WA, Australia; 7School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia; 8Centre of Child Health Research, University of Western Australia, Perth, WA, Australia; 9Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia; 10Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia; 11MRC-PHE Centre for Environment and Health, Imperial College London, London, UK; 12Population Health and Occupational Diseases, National Heart and Lung Institute, Imperial College London, London, UK; 13School of Public Health &amp; Preventive Medicine, Monash University, Melbourne, VIC, Australia *These authors contributed equally to this work Abstract: Early identification of people at risk of developing COPD is crucial for implementing preventive strategies. We aimed to systematically review and assess the performance of all published models that predicted development of COPD. A search was conducted to identify studies that developed a prediction model for COPD development. The Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies was followed when extracting data and appraising the selected studies. Of the 4,481 records identified, 30 articles were selected for full-text review, and only four of these were eligible to be included in the review. The only consistent predictor across all four models was a measure of smoking. Sex and age were used in most models; however, other factors varied widely. Two of the models had good ability to discriminate between people who were correctly or incorrectly classified as at risk of developing COPD. Overall none of the models were particularly useful in accurately predicting future risk of COPD, nor were they good at ruling out future risk of COPD. Further studies are needed to develop new prediction models and robustly validate them in external cohorts. Keywords: COPD, early detection, predictors and risk prediction model

Distinctive lung function trajectories from age 10 to 26 years in men and women and associated early life risk factors - a birth cohort study

Pre-bronchodilator lung function including forced vital capacity (FVC), forced expiratory flow in 1 second (FEV1), their ratio (FEV1/FVC), and forced expiratory flow 25-75% (FEF25-75) measured at age 10, 18, and 26 years in the Isle of Wight birth cohort was analyzed for developmental patterns (trajectories). Early life risk factors before the age of 10 years were assessed for the trajectories.METHOD: Members of the birth cohort (1989/90) were followed at age 1, 2, 4, 10, 18, and 26 years. Allergic sensitization and questionnaire data were collected. Spirometry tests were performed and evaluated according to the American Thoracic Society (ATS) criteria at 10, 18, and 26 years. To identify developmental trajectories for FVC, FEV1, FEV1/FVC, and FEF25-75 from 10 to 26 years, a finite mixture model was applied to the longitudinal lung function data, separately for males and females. Associations of early life factors with the respective lung function trajectories were assessed using log-linear and logistic regression analyses.RESULTS: Both high and low lung function trajectories were observed in men and women. FVC continued to grow beyond 18 years in men and women, whereas FEV1 peaked at age 18 years in female trajectories and in one male trajectory. For the FEV1/FVC ratios and FEF25-75 most trajectories appeared highest at age 18 and declined thereafter. However, the low FEV1/FVC trajectory in both sexes showed an early decline at 10 years. Lower birth weight was linked with lower lung function trajectories in males and females. Eczema in the first year of life was a risk factor for later lung function deficits in females, whereas the occurrence of asthma at 4 years of age was a risk factor for later lung function deficits in males. A positive skin prick test at age four was a risk for the low FEV1 trajectory in females and for the low FEV1/FVC trajectory in males.CONCLUSION: Men and women showed distinctive lung function trajectories and associated risk factors. Lower lung function trajectories can be explained by not achieving maximally attainable function at age 18 years and by a function decline from 18 to 26 years.</p