Antibiotic overuse and allergy-related diseases: an epidemiological cross-sectional study in the grasslands of Northern China

Interpretable machine learning for allergic rhinitis prediction among preschool children in Urumqi, China

This study aimed to investigate the advantages and applications of machine learning models in predicting the risk of allergic rhinitis (AR) in children aged 2-8, compared to traditional logistic regression. The study analyzed questionnaire data from 7131 children aged 2-8, which was randomly divided into training, validation, and testing sets in a ratio of 55:15:30, repeated 100 times. Predictor variables included parental allergy, medical history during the child's first year (cfy), and early life environmental factors. The time of first onset of AR was restricted to after the age of 1 year to establish a clear temporal relationship between the predictor variables and the outcome. Feature engineering utilized the chi-square test and the Boruta algorithm, refining the dataset for analysis. The construction utilized Logistic Regression (LR), Support Vector Machine (SVM), Random Forest (RF), and Extreme Gradient Boosting Tree (XGBoost) as the models. Model performance was evaluated using the area under the receiver operating characteristic curve (AUROC), and the optimal decision threshold was determined by weighing multiple metrics on the validation sets and reporting results on the testing set. Additionally, the strengths and limitations of the different models were comprehensively analyzed by stratifying gender, mode of birth, and age subgroups, as well as by varying the number of predictor variables. Furthermore, methods such as Shapley additive explanations (SHAP) and purity of node partition in Random Forest were employed to assess feature importance, along with exploring model stability through alterations in the number of features. In this study, 7131 children aged 2-8 were analyzed, with 524 (7.35%) diagnosed with AR, with an onset age ranging from 2 to 8 years. Optimal parameters were refined using the validation set, and a rigorous process of 100 random divisions and repeated training ensured robust evaluation of the models on the testing set. The model construction involved incorporating fourteen variables, including the history of allergy-related diseases during the child's first year, familial genetic factors, and early-life indoor environmental factors. The performance of LR, SVM, RF, and XGBoost on the unstratified data test set was 0.715 (standard deviation = 0.023), 0.723 (0.022), 0.747 (0.015), and 0.733 (0.019), respectively; the performance of each model was stable on the stratified data, and the RF performance was significantly better than that of LR (paired samples t-test: p < 0.001). Different techniques for evaluating the importance of features showed that the top5 variables were father or mother with AR, having older siblings, history of food allergy and father's educational level. Utilizing strategies like stratification and adjusting the number of features, this study constructed a random forest model that outperforms traditional logistic regression. Specifically designed to detect the occurrence of allergic rhinitis (AR) in children aged 2-8, the model incorporates parental allergic history and early life environmental factors. The selection of the optimal cut-off value was determined through a comprehensive evaluation strategy. Additionally, we identified the top 5 crucial features that greatly influence the model's performance. This study serves as a valuable reference for implementing machine learning-based AR prediction in pediatric populations.

The mycobiome in atopic diseases: Inducers and triggers

Atopic diseases are characterized by type 2 inflammation, with high levels of allergen-specific TH2 cell immune responses and elevated production of IgE. These common disorders have increased in incidence around the world, which is partly explained by detrimental disturbances to the early-life intestinal microbiome. Although most studies have focused exclusively on bacterial members of the microbiome, intestinal fungi have started to be recognized for their impact on host immune development and atopy pathogenesis. From this perspective, we review recent findings demonstrating the strong interactions between members of the mycobiome and the host immune system early in life, leading to immune tolerance during eubiosis or inducing sensitization and overt TH2 cell responses during dysbiosis. Current evidence places intestinal fungi as central players in the development of allergic diseases and potential targets for atopy prevention and treatments.

A systematic review on antibiotics misuse in livestock and aquaculture and regulation implications in China

China is one of the largest producers and consumers of antibiotics, and China is a larger producer of livestock farming and aquaculture in the world. The livestock farming and aquaculture industry is a major area of antibiotic misuse, which has caused serious antibiotic residues and environment pollution. The antibiotic residues exceeding the standard may lead to antibiotic resistances in animals or human bodies, which poses a threat to human health. In this context, this study tries to systematically review the current situation of antibiotic misuse in livestock and aquaculture in China, and put forward corresponding regulatiory measures for the central government. Based on the status quo of livestock farming and aquaculture in China, this study reviewed antibiotic misuse in livestock farming and aquaculture and antibiotic resistance in China, introduced China's current policies on antibiotic regulation and the gap between China and developed countries, and analyzed the implications of current regulatory policies on animal health and productivity. At last, we put forward suggestions for the future antibiotic regulation, including strictly implementing the relevant laws and regulations, formulating specific supporting measures, encouraging the research and development of antibiotic substitutes, introducing advanced technologies for supervision and regulation, strengthening the publicity of science popularization and enhancing the public's awareness of the rational use of antibiotics. If these policy recommendations can be implemented, they will significantly promote the regulation of antibiotic abuse.

Assessment of the Knowledge and Approach of General Dentists Who Treat Children and Pediatric Dentists Regarding the Proper Use of Antibiotics for Children

Background: Antibiotics are widely used in dentistry. Dentists often provide antibiotics unnecessarily. Excessive use can induce resistant bacterial strains. There are certain indications for the proper use of antibiotics for pediatric dentistry according to the European and American Pediatric Dentistry (EAPD and AAPD). Very often dentists do not follow these guidelines. Objectives: This study aims to examine the level of knowledge among general dentists (who also treat children) and pediatric dentists on proper use of antibiotics. In addition, we examined whether there is unjustified use of antibiotics, if dentists are aware of the new and conservative approach of administering antibiotics to patients, and whether there is a relationship between years of professional seniority and dentist's knowledge level of proper use of antibiotics. Methods: One hundred general dentists (GD) who treat children in addition to 100 pediatric dentists (PD) completed the study questionnaires which measured knowledge, practice and attitudes regrading using antibiotics during dental treatment among children. Results: The general average of level of knowledge on proper use of antibiotics among general dentists was relatively low for both GD (60.7%) and PDs (65%). PDs demonstrated a relatively greater knowledge of correct use of antibiotics, especially in cases of endodontics and trauma. PDs also showed higher awareness to latest guidelines for the admission of "prophylactic antibiotics" according to the American Association (AAPD) and/or the European Union (EAPD) compared with GDs (86.2% vs. 66.3%). Conclusion: The level of knowledge of both general dentists and pediatric dentists is poor, with a large percentage of dentists from both groups not knowing whether antibiotics are needed in a specific dental case or not. Compliance with the EAPD/AAPD guidelines is also low and inadequate. The method of prescribing antibiotics given by dentists can be improved by increasing awareness, educational initiatives, and postgraduate courses among dentists regarding the recommended indications.

Risk factors for allergic diseases: a cross-sectional survey of 9,501 Chinese preschool-aged children

BACKGROUND

Childhood allergic diseases are increasing worldwide with unprecedented complexity and severity, and they cause a major burden on health and healthcare costs. We aimed to identify potential factors, both in isolation and in combination, associated with allergic diseases among preschool-aged children, and to construct a nomogram prediction model based on significant factors.

METHODS

We cross-sectionally recruited 9,501 preschool-aged children from 30 kindergartens in Beijing and Tangshan. Allergic diseases were ascertained according to the "International Study of Asthma and Allergies in Childhood" questionnaire. Risk for allergic diseases is quantified by odds ratio (OR) with 95% confidence interval (CI).

RESULTS

Four factors were identified to be independently, consistently, and significantly associated with the risk for allergic diseases overall and by four clinical manifestations separately, including bedtime (per 1 hour late) (taking asthma/wheezing as an example, OR, 95% CI, P: 1.21, 1.08 to 1.35, 0.001), outdoor activities ≤1.5 h per day (1.45, 1.26 to 1.68, 3.77E-07), family history of allergic diseases (2.23, 1.92 to 2.60, 0.00E+00), and antibiotic use during childhood (3.64, 2.44 to 5.42, 1.66E-10). Further analyses revealed that family history of allergic diseases acted with antibiotic use during childhood in an additive manner. For practical reasons, risk prediction nomogram models were constructed for allergic diseases respectively in Beijing and Tangshan based on significant and conventional factors, and the prediction accuracy was good, with the C-index 69% in Tangshan and 68% in Beijing (both P=0.00E+00).

CONCLUSIONS

Our findings identified four factors in significant association with the risk for allergic diseases, and in particular family history of allergic diseases and antibiotic use during childhood acted additively.

Prevalence of adult eczema, hay fever, and asthma, and associated risk factors: a population-based study in the northern Grassland of China

Background

There has been research about the prevalence and risk factors of eczema, hay fever, and asthma in children, but little is known about these conditions in adults in China.

Objectives

To explore the prevalence of adult eczema/atopic dermatitis (AD) and its risk factors in northern China.

Methods

A cluster sampling randomized population-based survey was conducted using a face-to-face questionnaire combined with skin prick tests of ten common aeroallergens including nine pollen allergens and Dermatophagoides pteronyssinu (Dp) allergen. The questionnaire was designed by specialists and included questions on the prevalence of eczema, hay fever, and asthma, socioeconomic risk factors, family history of atopy and environmental exposures. The prevalence of eczema with asthma and/or hay fever (EAH) was applied as a proxy of AD in this study.

Results

Overall, 2096 subjects were enrolled and completed the study. The prevalence of eczema was 15.7% (95% CI 14.3–17.4), while the prevalence of hay fever and asthma were 20.6% (95% CI 18.9–22.4) and 6.5% (95% CI 5.5–7.6), respectively. In particular, the prevalence of EAH was 5.1% (95% CI 4.4–7.0). The prevalence of eczema and EAH was significantly associated with younger age, atopy family history, high education level, urbanization, and antibiotic overuse (P < 0.05, logistic regression). The sensitization rate was higher in EAH compared with eczema (48.2% vs 41.0%, P = 0.018), with weed pollen sensitization being the most common. Subjects with two or more concomitant allergic diseases had increased risk of eczema and EAH (P < 0.001). Allergen sensitization increased the risk of eczema and EAH (P < 0.001, both).

Conclusions

Adult eczema and EAH are prevalent in northern China under high pollen exposure. Socioeconomic and environmental factors affected the prevalence of adult AD in China. Dp had a particular impact on the prevalence of eczema/AD in the grassland region.

Identifying unknown antibiotics with persistent and bioaccumulative properties and ecological risk in river water in Beijing, China

The goal of this study was to identify antibiotics with potential risk in river water of the megacity Beijing, China. This was accomplished by using a tiered approach that combined hazard (phase I) and monitoring-based risk (phase II) assessment. Ninety-five candidate antibiotics were screened and 31 was identified as hazardous during phase I assessment. Of these hazardous antibiotics, 29 were identified as persistent and 7 were identified as bioaccumulative antibiotics. Fluoroquinolones, macrolides, sulfonamides, and aminoglycosides account for over 80% of these hazardous antibiotics. During phase II, four antibiotics (erythromycylamine, cefotaxime, ampicillin, and fusidic acid) that were not previously reported were detected in the surface water sampled from four major rivers in Beijing, with concentrations ranging from not detected to approximately 300 ng/L. The ecological risk assessment showed that erythromycylamine, cefotaxime, and ampicillin posed low to high levels of risk to the aquatic organisms. To summarize, erythromycylamine, cefotaxime, and ampicillin were identified as priority antibiotics in rivers in Beijing, China. Our results demonstrated the necessity of conducting monitoring-based verification process in identification of priority antibiotics in a specific region.

Antibiotic exposure in hospitalized pediatric patients in the United States: prevalence and length of stay

BACKGROUND

Hospital antibiotic use is rising. We aimed to evaluate the antibiotic-use prevalence and length of stay.

METHODS

We conducted a single-center retrospective study of patients < 18-years-old admitted to general pediatric services who received ≥ 1 antibiotic over six months. Demographics, culture results and antibiotic details were collected. The primary outcome was to identify the total number and classes of antibiotics prescribed during the admission. Secondary outcomes included length of stay (LOS), culture results, and the most commonly used antibiotics.

RESULTS

Forty-eight percent of patients received monotherapy (single class antibiotic). Cephalosporins (55%), vancomycin (35%), and clindamycin (22%) were prescribed more commonly than other antibiotic classes. Children were exposed up to 4 classes of antibiotics (range 1-4). A moderate correlation existed between the length of stay and the number of antibiotic classes used (R² = 0.38). Two or more classes of antibiotic use prolonged the length of stay. Cephalosporin use was associated with 35% reduced LOS (95 CI, 21%-57%), and penicillin use correlated with 38% more prolonged LOS (95 CI, 22%-66%).

CONCLUSIONS

Antibiotic use in pediatric hospitals was high, and children received multiple classes of antibiotics. Inappropriate antibiotic use and culture results may have an untoward effect on hospital length of stay.

First-Year Antibiotics Exposure in Relation to Childhood Asthma, Allergies, and Airway Illnesses

Background: Associations of early antibiotics exposures with childhood asthma, allergies, and airway illnesses are debated. Objectives: We aimed to investigate associations of first-year antibiotics exposure with childhood asthma, allergies, and airway illnesses. Methods: A cross-sectional study was conducted among preschoolers in Shanghai, China during 2011–2012. A questionnaire regarding household environment and lifestyles and childhood health outcomes was reported by the child’s parents. Results: In total, 13,335 questionnaires (response rate: 85.3%) were analyzed and 3049 (24.1%) children had first-year antibiotics exposure. In the multivariate logistic regression analyses, first-year antibiotics exposure had significant associations with the higher odds of lifetime-ever pneumonia (adjusted OR, 95% CI: 2.15, 1.95–2.37), croup (1.46, 1.24–1.73), wheeze (1.44, 1.30–1.60), asthma (1.38, 1.19–1.61), food allergy (1.29, 1.13–1.46), and allergic rhinitis (1.23, 1.07–1.41), and as well as current (one year before the survey) common cold (≥3 times) (1.38, 1.25–1.52), dry cough (1.27, 1.13–1.42), atopic dermatitis (1.25, 1.09–1.43), wheeze (1.23, 1.10–1.38), and rhinitis symptoms (1.15, 1.04–1.26). These associations were different in children with different individual characteristics (age, sex, family history of atopy, and district) and other early exposures (breastfeeding, home decoration, pet-keeping, and environmental tobacco smoke). Conclusions: Our results indicate that first-year antibiotics exposure could be a strong risk factor for childhood pneumonia, asthma, allergies, and their related symptoms. The individual characteristics and other early exposures may modify effects of early antibiotic exposure on childhood allergies and airway illnesses.