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Nyenhuis SM, Dixon AE, Wood L, Lv N, Wittels NE, Ronneberg CR, Xiao L, Dosala S, Marroquin A, Barve A, Harmon W, Poynter ME, Parikh A, Camargo CA, Appel LJ, Ma J. Erratum to "The effects of the DASH dietary pattern on clinical outcomes and quality of life in adults with uncontrolled asthma: Design and methods of the ALOHA Trial" [Contemporary Clinical Trials 131 (2023) 107274]. Contemp Clin Trials 2024; 138:107373. [PMID: 38310039 PMCID: PMC10921235 DOI: 10.1016/j.cct.2023.107373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2024]
Affiliation(s)
- S M Nyenhuis
- Section of Allergy and Immunology, University of Chicago, Chicago, IL, USA
| | - A E Dixon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Vermont, Burlington, VT, USA
| | - L Wood
- University of Newcastle, Newcastle, Australia
| | - N Lv
- Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - N E Wittels
- Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - C R Ronneberg
- Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - L Xiao
- Department of Epidemiology and Population Health, Stanford University, Palo Alto, CA, USA
| | - S Dosala
- Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - A Marroquin
- Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - A Barve
- Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - W Harmon
- Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - M E Poynter
- Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - A Parikh
- Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - C A Camargo
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - L J Appel
- Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University, Baltimore, MD, USA
| | - J Ma
- Department of Medicine, University of Illinois Chicago, Chicago, IL, USA.
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Nyenhuis SM, Dixon A, Wood L, Lv N, Wittels N, Ronneberg CR, Xiao L, Dosala S, Marroquin A, Barve A, Harmon W, Poynter M, Parikh A, Camargo CA, Appel L, Ma J. The effects of the DASH dietary pattern on clinical outcomes and quality of life in adults with uncontrolled asthma: Design and methods of the ALOHA Trial. Contemp Clin Trials 2023; 131:107274. [PMID: 37380019 PMCID: PMC10629484 DOI: 10.1016/j.cct.2023.107274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 05/31/2023] [Accepted: 06/25/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Poor diet quality is an important risk factor for increased asthma prevalence and poor asthma control. To address the question of whether adults with asthma can benefit from following a healthy diet, this trial will test the efficacy and mechanisms of action of a behavioral intervention promoting the Dietary Approaches to Stop Hypertension (DASH) dietary pattern with sodium reduction among patients with uncontrolled asthma. METHODS In this 2-arm randomized clinical trial, 320 racially/ethnically and socioeconomically diverse adults with uncontrolled asthma on standard controller therapy will be randomized to either a control or an intervention group and assessed at baseline, 3, 6 and 12 months. Control and intervention participants will receive education on lung health, asthma, and other general health topics; additionally, the intervention group will receive DASH behavioral counseling over 12 months. The primary hypothesis is that the DASH behavioral intervention, compared with the education-only control, will lead to significantly more participants with minimum clinically important improvement (responders) in asthma-specific quality of life at 12 months. Secondary hypotheses will test the intervention effects on other asthma (e.g., asthma control, lung function) and non-asthma outcomes (e.g., quality of life). Additionally, therapeutic (e.g., short chain fatty acids, cytokines) and nutritional biomarkers (e.g., dietary inflammatory index, carotenoids) will be assessed to understand the mechanisms of the intervention effect. CONCLUSION This trial can substantially advance asthma care by providing rigorous evidence on the benefits of a behavioral dietary intervention and mechanistic insights into the role of diet quality in asthma. CLINICALTRIALS gov #: NCT05251402.
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Affiliation(s)
- S M Nyenhuis
- Section of Allergy and Immunology, University of Chicago, Chicago, IL, USA
| | - A Dixon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Vermont, Burlington, VT, USA
| | - L Wood
- University of Newcastle, Newcastle, Australia
| | - N Lv
- Division of Academic Internal Medicine, Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - N Wittels
- Division of Academic Internal Medicine, Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - C R Ronneberg
- Division of Academic Internal Medicine, Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - L Xiao
- Department of Epidemiology and Population Health, Stanford University, Palo Alto, CA, United States of America
| | - S Dosala
- Division of Academic Internal Medicine, Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - A Marroquin
- Division of Academic Internal Medicine, Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - A Barve
- Division of Academic Internal Medicine, Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - W Harmon
- Division of Academic Internal Medicine, Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - M Poynter
- Division of Academic Internal Medicine, Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - A Parikh
- Division of Academic Internal Medicine, Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - C A Camargo
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - L Appel
- Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University, Baltimore, MD, USA
| | - J Ma
- Division of Academic Internal Medicine, Department of Medicine, University of Illinois Chicago, Chicago, IL, USA.
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Malihi Z, Wu Z, Lawes C, Sluyter J, Waayer D, Toop L, Khaw KT, Camargo CA, Scragg R. Risk factors for reporting adverse events and for study withdrawal in a population-based trial of vitamin D supplementation. J Steroid Biochem Mol Biol 2020; 197:105546. [PMID: 31751782 DOI: 10.1016/j.jsbmb.2019.105546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 10/28/2019] [Accepted: 11/17/2019] [Indexed: 02/06/2023]
Abstract
With increasing numbers of randomized controlled trials (RCTs) investigating potential health events of vitamin D supplementation, a better understanding is required of the risk factors for adverse events and for study withdrawals. This analysis aimed to identify baseline risk factors of reporting an adverse event in a multi-year randomized double-blinded placebo-controlled trial of vitamin D supplementation. The secondary aim was to investigate if adverse events were associated with study withdrawals. We analyzed data from the Vitamin D Assessment (ViDA) study: 5110 adults, aged 50-84 years, living in Auckland, New Zealand. Monthly doses of 100,000 IU vitamin D3 or placebo were mailed to participants homes, with a questionnaire to collect data on adverse events and adherence to the study capsule (initially monthly, then 4-monthly). Median follow-up was 3.3 years. Data were analysed using multivariable log-binomial regression and Cox-regression. During the follow-up period, 818 people reported adverse events and 412 withdrew or stopped returning questionnaires. Vitamin D was not associated with reporting of adverse events. Of sociodemographic factors, ethnicity was associated with reporting adverse events: compared to European participants, Maori and Pacific Islander people were more likely to report an adverse event. Non-smokers were more likely to report an adverse event, compared to smokers (adjusted hazard ratio (HR) = 1.80; 95%CI = 1.24, 2.62); as were those who had reported a history of depression (adjusted HR = 1.27; 95%CI = 1.01, 1.60) or a recent cough or cold (adjusted HR = 1.22; 95%CI = 1.03, 1.44) at baseline. Reporting of adverse events was not associated with withdrawals (adjusted HR = 1.12; 95%CI = 0.86, 1.46). These data did not identify any clear pattern in the factors associated with self-reported adverse events, which themselves did not increase risk of withdrawals.
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Affiliation(s)
- Z Malihi
- School of Population Health, University of Auckland, New Zealand
| | - Z Wu
- School of Population Health, University of Auckland, New Zealand
| | - Cmm Lawes
- School of Population Health, University of Auckland, New Zealand
| | - J Sluyter
- School of Population Health, University of Auckland, New Zealand
| | - D Waayer
- School of Population Health, University of Auckland, New Zealand
| | - L Toop
- Department of Public Health & General Practice, The University of Otago, New Zealand
| | - K-T Khaw
- Department of Public Health, University of Cambridge, England, United Kingdom
| | - C A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, USA
| | - R Scragg
- School of Population Health, University of Auckland, New Zealand.
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Drucker AM, Cho E, Li WQ, Camargo CA, Li T, Qureshi AA. Diagnosis validation and clinical characterization of atopic dermatitis in Nurses' Health Study 2. J Eur Acad Dermatol Venereol 2019; 33:588-594. [PMID: 30468531 DOI: 10.1111/jdv.15360] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 10/17/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Epidemiologic studies of atopic dermatitis (AD) are often limited by case definitions that have not been validated. OBJECTIVE In this study, we assessed the accuracy of self-report of AD in a large cohort of US female nurses, the Nurses' Health Study 2 (NHS2). We also provide clinical characteristics of AD in the cohort. METHODS We sent an electronic questionnaire to NHS2 participants who previously reported ever having a diagnosis of AD. This questionnaire was designed to confirm cases of AD using previously validated algorithms with >85% specificity. We assessed the association of AD with asthma, comparing the results when different definitions of AD were applied. We also inquired about various aspects of participants' AD. RESULTS Responses were received from 2509 of 5126 (49%) nurses who were sent the questionnaire, with an average age of 62. Most participants (1996/2509, 80%) reiterated their previously reported clinician diagnosis of AD. Application of the two diagnostic algorithms yielded confirmation of 1538 and 1293 prevalent cases, respectively. The association of AD with asthma was stronger when more stringent AD case definitions were applied. Participants generally reported mild disease (92% with ≤10% maximal body surface area involved) and a high proportion (57%) reported adult-onset disease. CONCLUSIONS Self-report of AD diagnosis has good reliability, and future analyses will be strengthened by our ability to conduct sensitivity analyses with refined confirmed AD subgroups.
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Affiliation(s)
- A M Drucker
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute and Department of Medicine, Women's College Hospital, Toronto, ON, Canada.,Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - E Cho
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, RI, USA.,Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - W-Q Li
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, RI, USA.,Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - C A Camargo
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - T Li
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, RI, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - A A Qureshi
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, RI, USA.,Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Department of Dermatology, Rhode Island Hospital, Providence, RI, USA
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5
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Blumenthal KG, Li Y, Acker WW, Chang Y, Banerji A, Ghaznavi S, Camargo CA, Zhou L. Multiple drug intolerance syndrome and multiple drug allergy syndrome: Epidemiology and associations with anxiety and depression. Allergy 2018; 73:2012-2023. [PMID: 29574787 DOI: 10.1111/all.13440] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND The epidemiology of multiple drug intolerance syndrome (MDIS) and multiple drug allergy syndrome (MDAS) is poorly characterized. We used electronic health record (EHR) data to describe prevalences of MDIS and MDAS and to examine associations with anxiety and depression. METHODS Patients with ≥3 outpatient encounters at Partners HealthCare System from 2008 to 2015 were included. Patients with MDIS had intolerances to ≥3 drug classes, and patients with MDAS had hypersensitivities to ≥2 drug classes. Psychiatric conditions and comorbidities were defined from the EHR and used in multivariable logistic regression models to assess the relation between anxiety/depression and MDIS/MDAS. RESULTS Of 746 888 patients, 47 634 (6.4%) had MDIS and 8615 (1.2%) had MDAS; 3171 (0.4%) had both. Anxiety (adjusted odds ratio [aOR] 1.72 [1.65, 1.80]), depression (aOR 1.46 [1.41, 1.52]), and both anxiety and depression (aOR 1.97 [1.86, 2.08]) were associated with increased odds of MDIS. Depression was associated with increased odds of MDAS (aOR 1.41 [1.28, 1.56]), but there were no clear associations with anxiety (aOR 1.13 [0.99, 1.30]) nor both depression and anxiety (aOR 1.13 [0.92, 1.38]). CONCLUSION While 6% of patients had MDIS, only 1% had MDAS. MDIS was associated with both anxiety and depression; patients with both anxiety and depression had an almost twofold increased odds of MDIS. MDAS was associated with a 40% increased odds of depression, but there was no significant association with anxiety. Psychological assessments may be useful in the evaluation and treatment of patients with MDIS and MDAS; physiologic causes for MDAS warrant further investigation.
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Affiliation(s)
- K. G. Blumenthal
- Division of Rheumatology, Allergy, and Immunology Department of Medicine Massachusetts General Hospital Boston MA USA
- Medical Practice Evaluation Center Department of Medicine Massachusetts General Hospital Boston MA USA
- Harvard Medical School Boston MA USA
- Edward P. Lawrence Center for Quality and Safety Massachusetts General Hospital Boston MA USA
| | - Y. Li
- Division of Rheumatology, Allergy, and Immunology Department of Medicine Massachusetts General Hospital Boston MA USA
- Medical Practice Evaluation Center Department of Medicine Massachusetts General Hospital Boston MA USA
| | - W. W. Acker
- Division of General Internal Medicine Department of Medicine Brigham and Women's Hospital Boston MA USA
- Geisinger Commonwealth School of Medicine Scranton PA USA
| | - Y. Chang
- Harvard Medical School Boston MA USA
- Division of General Internal Medicine Department of Medicine Massachusetts General Hospital Boston MA USA
| | - A. Banerji
- Division of Rheumatology, Allergy, and Immunology Department of Medicine Massachusetts General Hospital Boston MA USA
- Harvard Medical School Boston MA USA
| | - S. Ghaznavi
- Harvard Medical School Boston MA USA
- Department of Psychiatry Massachusetts General Hospital Boston MA USA
| | - C. A. Camargo
- Division of Rheumatology, Allergy, and Immunology Department of Medicine Massachusetts General Hospital Boston MA USA
- Harvard Medical School Boston MA USA
- Department of Emergency Medicine Massachusetts General Hospital Boston MA USA
| | - L. Zhou
- Harvard Medical School Boston MA USA
- Division of General Internal Medicine Department of Medicine Brigham and Women's Hospital Boston MA USA
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Muraro A, Fernandez-Rivas M, Beyer K, Cardona V, Clark A, Eller E, Hourihane JO, Jutel M, Sheikh A, Agache I, Allen KJ, Angier E, Ballmer-Weber B, Bilò MB, Bindslev-Jensen C, Camargo CA, Cianferoni A, DunnGalvin A, Eigenmann PA, Halken S, Hoffmann-Sommergruber K, Lau S, Nilsson C, Poulsen LK, Rueff F, Spergel J, Sturm G, Timmermans F, Torres MJ, Turner P, van Ree R, Wickman M, Worm M, Mills ENC, Roberts G. The urgent need for a harmonized severity scoring system for acute allergic reactions. Allergy 2018; 73:1792-1800. [PMID: 29331045 DOI: 10.1111/all.13408] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2017] [Indexed: 11/29/2022]
Abstract
The accurate assessment and communication of the severity of acute allergic reactions are important to patients, clinicians, researchers, the food industry, and public health and regulatory authorities. Severity has different meanings to different stakeholders with patients and clinicians rating the significance of particular symptoms very differently. Many severity scoring systems have been generated, most focusing on the severity of reactions following exposure to a limited group of allergens. They are heterogeneous in format, none has used an accepted developmental approach, and none has been validated. Their wide range of outcome formats has led to difficulties with interpretation and application. Therefore, there is a persisting need for an appropriately developed and validated severity scoring system for allergic reactions that work across the range of allergenic triggers and address the needs of different stakeholder groups. We propose a novel approach to develop and then validate a harmonized scoring system for acute allergic reactions, based on a data-driven method that is informed by clinical and patient experience and other stakeholders' perspectives. We envisage two formats: (i) a numerical score giving a continuum from mild to severe reactions that are clinically meaningful and are useful for allergy healthcare professionals and researchers, and (ii) a three-grade-based ordinal format that is simple enough to be used and understood by other professionals and patients. Testing of reliability and validity of the new approach in a range of settings and populations will allow eventual implementation of a standardized scoring system in clinical studies and routine practice.
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Hasegawa K, Stewart CJ, Celedón JC, Mansbach JM, Tierney C, Camargo CA. Circulating 25-hydroxyvitamin D, nasopharyngeal airway metabolome, and bronchiolitis severity. Allergy 2018; 73:1135-1140. [PMID: 29315663 DOI: 10.1111/all.13379] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2017] [Indexed: 12/25/2022]
Abstract
Low circulating 25-hydroxyvitamin D (25OHD) levels are a risk factor for acute respiratory infection (eg, bronchiolitis) in children. However, little is known about the relation of circulating 25OHD with the many downstream functional molecules in target organs-such as the airway-and with clinical outcomes. In this prospective multicenter study of infants (age <1 year) hospitalized with bronchiolitis, we measured serum 25OHD levels and profiled the metabolome of 144 nasopharyngeal airway samples. Among 254 metabolites identified, we defined a set of 20 metabolites that are related to lower serum 25OHD and higher vitamin D-binding protein levels. Of these metabolites, 9 metabolites were associated with a significantly higher risk of positive pressure ventilation use. These metabolites were glycerophosphocholines esterified with proinflammatory fatty acids (palmitate, arachidonate, linoleate, and stearate), sphingomyelins, alpha-hydroxyisovalerate, 2-hydroxybutyrate, and 3-(4-hydroxyphenyl)lactate (all FDR<0.05). Based on the multicenter data, vitamin D-related airway metabolites were associated with risks of bronchiolitis severity.
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Affiliation(s)
- K. Hasegawa
- Department of Emergency Medicine; Massachusetts General Hospital; Harvard Medical School; Boston MA USA
| | - C. J. Stewart
- Alkek Center for Metagenomics and Microbiome Research; Department of Molecular Virology and Microbiology; Baylor College of Medicine; Houston TX USA
| | - J. C. Celedón
- Division of Pulmonary Medicine, Allergy, and Immunology; Department of Pediatrics; Children's Hospital of Pittsburgh; University of Pittsburgh; Pittsburgh PA USA
| | - J. M. Mansbach
- Department of Medicine; Boston Children's Hospital; Boston MA USA
| | - C. Tierney
- Department of Emergency Medicine; Massachusetts General Hospital; Harvard Medical School; Boston MA USA
| | - C. A. Camargo
- Department of Emergency Medicine; Massachusetts General Hospital; Harvard Medical School; Boston MA USA
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Del Puerto C, Navarrete-Dechent C, Molgó M, Camargo CA, Borzutzky A, González S. Immunohistochemical expression of vitamin D receptor in melanocytic naevi and cutaneous melanoma: a case-control study. Br J Dermatol 2018; 179:95-100. [PMID: 29106699 DOI: 10.1111/bjd.16103] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Vitamin D deficiency is associated with higher risk of cancer, possibly due to its antiproliferative, antiangiogenic, proapoptotic, cell-differentiating and anti-invasive effects. The anticarcinogenic role of vitamin D in melanoma is still a matter of debate. Loss of nuclear and cytoplasmic vitamin D receptor (VDR) expression in melanoma cells has been reported. OBJECTIVES To analyse VDR immunohistochemical expression in benign dermal naevi (DN) and malignant melanoma (MM). METHODS A case-control study evaluated nuclear and cytoplasmic VDR immunohistochemical staining in 54 DN and 55 MM tissue samples. RESULTS There was significantly higher cytoplasmic VDR positivity in DN compared with MM (59% vs. 16%, P < 0·001). The mean VDR cytoplasmic expression was also higher in DN vs. MM (P < 0·001). No differences in nuclear VDR positivity were observed between groups, but mean nuclear VDR expression was significantly lower in DN vs. MM (P = 0·02). The loss of cytoplasmic VDR in MM was associated with Clark level, tumour staging and American Joint Committee on Cancer pTNM staging (P=0·004, 0·009 and 0·02, respectively). CONCLUSIONS Alterations in VDR expression and localization are found in MM compared with DN. Loss of cytoplasmic VDR was associated with melanoma tumour size, suggesting that loss of cytoplasmic VDR may be a prognostic factor.
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Affiliation(s)
- C Del Puerto
- Department of Dermatology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - C Navarrete-Dechent
- Department of Dermatology, Pontificia Universidad Católica de Chile, Santiago, Chile.,Melanoma and Skin Cancer Unit, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - M Molgó
- Department of Dermatology, Pontificia Universidad Católica de Chile, Santiago, Chile.,Melanoma and Skin Cancer Unit, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - C A Camargo
- Department of Emergency Medicine and Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, U.S.A
| | - A Borzutzky
- Department of Pediatric Infectious Diseases and Immunology, Pontificia Universidad Católica de Chile, Santiago, Chile.,Millennium Institute on Immunology and Immunotherapy, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - S González
- Melanoma and Skin Cancer Unit, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.,Department of Pathology, Pontificia Universidad Católica de Chile, Santiago, Chile
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9
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Jensen ME, Murphy VE, Gibson PG, Mattes J, Camargo CA. Vitamin D status in pregnant women with asthma and its association with adverse respiratory outcomes during infancy. J Matern Fetal Neonatal Med 2018; 32:1820-1825. [PMID: 29303025 DOI: 10.1080/14767058.2017.1419176] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Vitamin D may influence pregnancy and infant outcomes, especially infant respiratory health. This study aimed to examine vitamin D status in pregnant women with asthma, and whether higher vitamin D levels are associated with fewer adverse respiratory outcomes in their infants. METHODS Pregnant women with asthma, recruited from John Hunter Hospital Newcastle Australia (latitude 33°S), had serum total 25-hydroxyvitamin-D (25(OH)D) measured at 16 and 35 weeks gestation. Infant respiratory outcomes were collected at 12 months by parent-report questionnaire. Mother-infant dyads were grouped by serum 25(OH)D during pregnancy: 25(OH)D < 75 nmol/L (at both time-points) versus 25(OH)D ≥ 75 nmol/L (at one or both time-points). RESULTS In 52 pregnant women with asthma, mean serum 25(OH)D levels were 61 (range 26-110) nmol/L at 16 weeks, and 65 (range 32-116) nmol/L at 35 weeks, gestation. Thirty-one (60%) women had 25(OH)D < 75 nmol/L at both time-points; 21 (40%) had 25(OH)D ≥ 75 nmol/L at one or both time-points. Maternal 25(OH)D < 75 nmol/L during pregnancy was associated with a higher proportion of infants with "wheeze ever" at 12 months, compared with 25(OH)D ≥ 75 nmol/L (71 versus 43%, p = .04). Infant acute-care presentations (45 versus 13%, p = .02) and oral corticosteroid use (26 versus 4%, p = .03) due to "asthma/wheezing" were higher in the maternal group with 25(OH)D < 75 nmol/L, versus ≥75 nmol/L. CONCLUSIONS Most pregnant women with asthma had low vitamin D status, which persisted across gestation. Low maternal vitamin D status was associated with greater risk of adverse respiratory outcomes in their infants, a group at high risk of developing childhood asthma.
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Affiliation(s)
- Megan E Jensen
- a Priority Research Centre Grow Up Well, University of Newcastle and Hunter Medical Research Institute , Newcastle , Australia
| | - V E Murphy
- a Priority Research Centre Grow Up Well, University of Newcastle and Hunter Medical Research Institute , Newcastle , Australia
| | - P G Gibson
- b Department of Respiratory and Sleep Medicine , John Hunter Hospital , Newcastle , Australia.,c Priority Research Centre for Healthy Lungs, University of Newcastle and Hunter Medical Research Institute , Newcastle , Australia
| | - J Mattes
- a Priority Research Centre Grow Up Well, University of Newcastle and Hunter Medical Research Institute , Newcastle , Australia.,d Respiratory Department , John Hunter Children's Hospital , Newcastle , Australia
| | - C A Camargo
- e Department of Emergency Medicine , Massachusetts General Hospital, Harvard Medical School , Boston , MA , USA
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10
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Reid IR, Horne AM, Mihov B, Gamble GD, Al-Abuwsi F, Singh M, Taylor L, Fenwick S, Camargo CA, Stewart AW, Scragg R. Effect of monthly high-dose vitamin D on bone density in community-dwelling older adults substudy of a randomized controlled trial. J Intern Med 2017; 282:452-460. [PMID: 28692172 DOI: 10.1111/joim.12651] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Severe vitamin D deficiency causes osteomalacia, yet trials of vitamin D supplementation in the community have not on average demonstrated benefit to bone mineral density (BMD) or fracture risk in adults. OBJECTIVE To determine whether monthly high-dose vitamin D supplementation influences BMD in the general population and in those with low 25-hydroxyvitamin D levels. METHODS Two-year substudy of a trial in older community-resident adults. A total of 452 participants were randomized to receive monthly doses of vitamin D3 100 000 IU, or placebo. The primary end-point was change in lumbar spine BMD. Exploratory analyses to identify thresholds of baseline 25-hydroxyvitamin D for vitamin D effects on BMD were prespecified. RESULTS Intention-to-treat analyses showed no significant treatment effect in the lumbar spine (between-groups difference 0.0071 g cm-2 , 95%CI: -0.0012, 0.0154) or total body but BMD loss at both hip sites was significantly attenuated by ~1/2% over 2 years. There was a significant interaction between baseline 25-hydroxyvitamin D and treatment effect (P = 0.04). With baseline 25-hydroxyvitamin D ≤ 30 nmol L-1 (n = 46), there were between-groups BMD changes at the spine and femoral sites of ~2%, significant in the spine and femoral neck, but there was no effect on total body BMD. When baseline 25-hydroxyvitamin D was >30 nmol L-1 , differences were ~1/2% and significant only at the total hip. CONCLUSIONS This substudy finds no clinically important benefit to BMD from untargeted vitamin D supplementation of older, community-dwelling adults. Exploratory analyses suggest meaningful benefit in those with baseline 25-hydroxyvitamin D ≤ 30 nmol L-1 . This represents a significant step towards a trial-based definition of vitamin D deficiency for bone health in older adults.
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Affiliation(s)
- I R Reid
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Endocrinology, Auckland District Health Board, Auckland, New Zealand
| | - A M Horne
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - B Mihov
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - G D Gamble
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - F Al-Abuwsi
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - M Singh
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - L Taylor
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - S Fenwick
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - C A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - A W Stewart
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - R Scragg
- School of Population Health, University of Auckland, Auckland, New Zealand
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11
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Sluyter JD, Hughes AD, Thom SAM, Lowe A, Camargo CA, Hametner B, Wassertheurer S, Parker KH, Scragg RKR. Arterial waveform parameters in a large, population-based sample of adults: relationships with ethnicity and lifestyle factors. J Hum Hypertens 2017; 31:760. [PMID: 28974780 PMCID: PMC5628395 DOI: 10.1038/jhh.2017.60] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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12
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Kamycheva E, Goto T, Camargo CA. Celiac disease is associated with reduced bone mineral density and increased FRAX scores in the US National Health and Nutrition Examination Survey. Osteoporos Int 2017; 28:781-790. [PMID: 27714440 DOI: 10.1007/s00198-016-3791-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 09/25/2016] [Indexed: 12/17/2022]
Abstract
UNLABELLED We investigated the association between celiac disease (CD) and bone mass density (BMD) and risk of osteoporotic fractures in the general US population. In children and men ≥18 years, CD was associated with reduced BMD, and in men ≥40 years, CD was associated with increased risk of osteoporotic fractures. INTRODUCTION Celiac disease (CD) is an autoimmune condition, characterized by inflammation of the small intestine. CD has an increasing prevalence, and if unrecognized or untreated, CD can lead to complications from malabsorption and micronutrient deficiencies. We aimed to study whether CD is an independent predictor of reduced bone mineral density (BMD) and FRAX scores in the general US population. METHODS We used data from the National Health and Nutrition Examination Survey, 2009-2010 and 2013-2014. CD was defined by positive tissue transglutaminase IgA antibody test. Multivariable models of BMD and FRAX scores were adjusted for BMI, serum 25-hydroxyvitamin D, vitamin D and calcium supplements, milk intake, serum calcium, and smoking status, when available. RESULTS In children, aged 8-17 years, CD was associated with decreased Z-scores, by 0.85 for hip and 0.46 for spine (both P < 0.001). In men aged ≥ 18 years, CD was associated with 0.06 g/cm2 decrease in BMD in hip and with 0.11 g/cm2 decrease in BMD in spine (P = 0.08 and P < 0.001, respectively). In women, there were no statistically significant differences in the multiple-adjusted model. In men aged ≥ 40 years, CD predicted FRAX scores, resulting in increased scores by 2.25 % (P = 0.006) for hip fracture and by 2.43 % (P = 0.05) for major osteoporotic fracture. CD did not predict FRAX scores in women aged ≥40 years. CONCLUSION CD is independently associated with reduced BMD in children and adults aged ≥18 years and is an independent risk factor of osteoporotic fractures in men aged ≥40 years.
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Affiliation(s)
- E Kamycheva
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, 125 Nashua St, Suite 920, Boston, MA, 02114, USA.
- Medical Clinic, University Hospital of North Norway, Sykehusveien 38, 9038, Tromsoe, Norway.
- Endocrine Research Group, Faculty of Health Sciences, Department of Clinical Medicine, UiT The Arctic University of Norway, Hansine Hansens veg 18, 9017, Tromsoe, Norway.
| | - T Goto
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, 125 Nashua St, Suite 920, Boston, MA, 02114, USA
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - C A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, 125 Nashua St, Suite 920, Boston, MA, 02114, USA
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
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13
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Otero TMN, Monlezun DJ, Christopher KB, Camargo CA, Quraishi SA. Vitamin D Status and Elevated Red Cell Distribution Width in Community-Dwelling Adults: Results from the National Health and Nutrition Examination Survey 2001-2006. J Nutr Health Aging 2017; 21:1176-1182. [PMID: 29188877 DOI: 10.1007/s12603-017-0980-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Elevated red cell distribution width (RDW) is associated with morbidity and mortality in community-dwelling individuals. Although RDW is traditionally used to diagnose anemia, it may also be a marker of systemic inflammation. Since vitamin D is a potent modulator of inflammatory cytokines our goal was to investigate whether 25-hydroxyvitamin D levels (25OHD) are associated with RDW in non-hospitalized adults. DESIGN To investigate this association, we conducted a cross-sectional study. Stepwise multivariable linear and logistic regression models were used to assess the independent association of 25OHD with RDW. Elevated RDW was defined as >14.5%. SETTING Nationwide sample of non-hospitalized adults within the United States. PARTICIPANTS Individuals from the National Health and Nutrition Examination Survey from 2001-2006. RESULTS 15,162 individuals comprised the analytic cohort. Mean 25OHD was 24.9 ng/mL (SE 0.4) and the prevalence of elevated RDW was 6.3%. Linear regression analysis, controlling for age, sex, race, mean corpuscular volume, albumin, and neutropenia, demonstrated that 25OHD was inversely associated with RDW (β=-0.01; 95%CI -0.01 to -0.01). Logistic regression analysis, controlling for the same covariates, also demonstrated an inverse association of 25OHD with elevated RDW (OR 0.96; 95%CI 0.94-0.99). Individuals with 25OHD <30 ng/mL were more likely to have elevated RDW (OR 1.65; 95%CI 1.13-2.40) compared to those individuals with levels ≥30ng/mL. CONCLUSIONS In a nationwide sample of non-hospitalized adults within the United States, low 25OHD was associated with increased likelihood of elevated RDW. Further studies are needed to determine whether optimizing vitamin D status can reduce the prevalence of elevated RDW, and thereby reduce morbidity and mortality in the general population.
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Affiliation(s)
- T M N Otero
- Sadeq A. Quraishi, MD, MHA, MMSc, Assistant Professor of Anaesthesia, Harvard Medical School, Staff Anesthetist and Intensivist, Massachusetts General Hospital, Department of Anesthesia, Critical Care, and Pain Medicine, 55 Fruit Street, GRJ 402, Boston, MA 02114, Tel: 617-643-5430, Fax: 617-724-6981,
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Martineau AR, Jolliffe DA, Hooper RL, Greenberg L, Aloia JF, Bergman P, Dubnov-Raz G, Esposito S, Ganmaa D, Goodall EC, Grant C, Janssens W, Laaksi I, Manaseki-Holland S, Murdoch D, Neale RE, Rees JR, Simpson S, Stelmach I, Kumar GT, Urashima M, Camargo CA. S102 Vitamin d supplementation to prevent acute respiratory infections: systematic review and meta-analysis of individual participant data. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.108] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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15
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Drucker AM, Li WQ, Cho E, Li T, Sun Q, Camargo CA, Qureshi AA. Atopic dermatitis is not independently associated with nonfatal myocardial infarction or stroke among US women. Allergy 2016; 71:1496-500. [PMID: 27291834 DOI: 10.1111/all.12957] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2016] [Indexed: 11/30/2022]
Abstract
We aimed to determine the association between atopic dermatitis (AD) and cardiovascular events in the Nurses' Health Study 2, a cohort of US women. We used logistic regression models to calculate age- and multivariate-adjusted odds ratios (OR) and 95% confidence intervals (CI) for the associations between history of AD and nonfatal MI and nonfatal stroke. Of the 78 702 participants in our analysis, 7916 (10%) had a history of AD. There were 392 and 391 cases of nonfatal MI and stroke, respectively. AD was not associated with MI in age- or multivariate-adjusted analyses. AD was significantly associated with stroke in the age-adjusted analysis (OR 1.38, 95% CI 1.03-1.85). This was no longer significant in multivariate models that adjusted for hypertension, hypercholesterolemia and diabetes (OR 1.31, 95% CI 0.98-1.76) and atopic comorbidities (OR 1.17, 95% CI 0.86-1.58). AD was not independently associated with nonfatal MI or stroke in this study.
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Affiliation(s)
- A. M. Drucker
- Department of Dermatology; Warren Alpert Medical School; Providence RI USA
- Department of Dermatology; Rhode Island Hospital; Providence RI USA
- School of Public Health; Brown University; Providence RI USA
| | - W.-Q. Li
- Department of Dermatology; Warren Alpert Medical School; Providence RI USA
- Department of Epidemiology; School of Public Health; Brown University; Providence RI USA
| | - E. Cho
- Department of Dermatology; Warren Alpert Medical School; Providence RI USA
- Department of Epidemiology; School of Public Health; Brown University; Providence RI USA
- Channing Division of Network Medicine; Department of Medicine; Brigham and Women's Hospital and Harvard Medical School; Boston MA USA
| | - T. Li
- Channing Division of Network Medicine; Department of Medicine; Brigham and Women's Hospital and Harvard Medical School; Boston MA USA
| | - Q. Sun
- Channing Division of Network Medicine; Department of Medicine; Brigham and Women's Hospital and Harvard Medical School; Boston MA USA
- Department of Nutrition; Harvard T.H. Chan School of Public Health; Boston MA USA
| | - C. A. Camargo
- Channing Division of Network Medicine; Department of Medicine; Brigham and Women's Hospital and Harvard Medical School; Boston MA USA
- Department of Emergency Medicine; Massachusetts General Hospital and Harvard Medical School; Boston MA USA
- Department of Epidemiology; Harvard T.H. Chan School of Public Health; Boston MA USA
| | - A. A. Qureshi
- Department of Dermatology; Warren Alpert Medical School; Providence RI USA
- Department of Dermatology; Rhode Island Hospital; Providence RI USA
- Department of Epidemiology; School of Public Health; Brown University; Providence RI USA
- Channing Division of Network Medicine; Department of Medicine; Brigham and Women's Hospital and Harvard Medical School; Boston MA USA
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16
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Grant CC, Crane J, Mitchell EA, Sinclair J, Stewart A, Milne T, Knight J, Gilchrist C, Camargo CA. Vitamin D supplementation during pregnancy and infancy reduces aeroallergen sensitization: a randomized controlled trial. Allergy 2016; 71:1325-34. [PMID: 27060679 DOI: 10.1111/all.12909] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Vitamin D has immune-modulating effects. We determined whether vitamin D supplementation during pregnancy and infancy prevents aeroallergen sensitization and primary care respiratory illness presentations. METHODS A randomized, double-blind, placebo-controlled parallel-group trial. We assigned pregnant women, from 27-week gestation to birth, and then their infants, from birth to 6 months, to placebo or one of two dosages of daily oral vitamin D. Woman/infant pairs were randomized to: placebo/placebo, 1000 IU/400 IU or 2000 IU/800 IU. When the children were 18 months old, we measured serum-specific IgE antibodies and identified acute primary care visits described by the doctor to be due to a cold, otitis media, an upper respiratory infection, croup, asthma, bronchitis, bronchiolitis, a wheezy lower respiratory infection or fever and cough. RESULTS Specific IgE was measured on 185 of 260 (71%) enrolled children. The proportion of children sensitized differed by study group for four mite antigens: Dermatophagoides farinae (Der-f1, Der-f2) and Dermatophagoides pteronyssinus (Der-p1, Der-p2). With results presented for placebo, lower dose, and higher dose vitamin D, respectively (all P < 0.05): Der-f1 (18%, 10%, 2%), Der-f2 (14%, 3%, 2%), Der-p1 (19%, 14%, 3%) and Der-p2 (12%, 2%, 3%). There were study group differences in the proportion of children with primary care visits described by the doctor as being for asthma (11%, 0%, 4%, P = 0.002), but not for the other respiratory diagnoses. CONCLUSIONS Vitamin D supplementation during pregnancy and infancy reduces the proportion of children sensitized to mites at age 18 months. Preliminary data indicate a possible effect on primary care visits where asthma is diagnosed.
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Affiliation(s)
- C. C. Grant
- Department of Paediatrics: Child & Youth Health; University of Auckland; Auckland New Zealand
- Starship Children's Hospital; Auckland New Zealand
| | - J. Crane
- Medicine; University of Otago; Wellington New Zealand
| | - E. A. Mitchell
- Department of Paediatrics: Child & Youth Health; University of Auckland; Auckland New Zealand
| | - J. Sinclair
- Starship Children's Hospital; Auckland New Zealand
| | - A. Stewart
- Epidemiology & Biostatistics; University of Auckland; Auckland New Zealand
| | - T. Milne
- Department of Paediatrics: Child & Youth Health; University of Auckland; Auckland New Zealand
| | - J. Knight
- Epidemiology & Biostatistics; University of Auckland; Auckland New Zealand
| | - C. Gilchrist
- Department of Paediatrics: Child & Youth Health; University of Auckland; Auckland New Zealand
| | - C. A. Camargo
- Emergency Medicine; Massachusetts General Hospital; Harvard Medical School; Boston Massachusetts USA
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17
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Dumas O, Varraso R, Gillman MW, Field AE, Camargo CA. Longitudinal study of maternal body mass index, gestational weight gain, and offspring asthma. Allergy 2016; 71:1295-304. [PMID: 26969855 DOI: 10.1111/all.12876] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Sparse data are available on the relationship between prenatal exposures and asthma during later childhood. In a longitudinal study of adolescents and their mothers, we examined the association of (i) maternal prepregnancy body mass index (BMI) and (ii) gestational weight gain (GWG), with incidence of allergic and nonallergic asthma in offspring. METHODS Analyses were conducted using data from 12 963 children aged 9-14 years at enrolment in the Growing Up Today Study, and their mothers, who are participants in the Nurses' Health Study II. Physician-diagnosed asthma and allergies were assessed by questionnaires sent regularly to participants and their mothers. Logistic regression was used to evaluate associations of maternal BMI and GWG with offspring asthma, overall and by subtype. RESULTS Physician-diagnosed asthma during childhood or adolescence was reported by 2694 children (21%). Maternal prepregnancy overweight (OR: 1.19, 95% CI: 1.03-1.38) and obesity (1.34, 1.08-1.68) were associated with offspring asthma. In asthma subtype analyses, the association was seen only for asthma onset before age 12 years. Moreover, the association of maternal obesity with nonallergic asthma was observed in boys (2.39, 1.40-4.09) and not in girls (0.96, 0.50-1.85; Pinteraction = 0.03); the opposite pattern was suggested for allergic asthma. With regard to GWG, an association was suggested between gains of <15 lb and higher risk of offspring asthma (1.28, 0.98-1.66), without clear allergy- or sex-related patterns. CONCLUSION The relation of several prenatal factors to risk of childhood asthma supports the early origins hypothesis for asthma. The observed allergy- and sex-specific patterns suggest multiple etiologic pathways.
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Affiliation(s)
- O. Dumas
- Channing Division of Network Medicine; Department of Medicine; Brigham & Women's Hospital and Harvard Medical School; Boston MA USA
- Department of Emergency Medicine; Massachusetts General Hospital and Harvard Medical School; Boston MA USA
- Inserm, VIMA: Aging and Chronic Diseases; Epidemiological and Public Health Approaches; Villejuif France
- UVSQ; UMR-S 1168; Université Versailles St-Quentin-en-Yvelines; Montigny le Bretonneux France
| | - R. Varraso
- Inserm, VIMA: Aging and Chronic Diseases; Epidemiological and Public Health Approaches; Villejuif France
- UVSQ; UMR-S 1168; Université Versailles St-Quentin-en-Yvelines; Montigny le Bretonneux France
| | - M. W. Gillman
- Department of Population Medicine; Harvard Medical School and Harvard Pilgrim Health Care Institute; Boston MA USA
| | - A. E. Field
- Channing Division of Network Medicine; Department of Medicine; Brigham & Women's Hospital and Harvard Medical School; Boston MA USA
- Division of Adolescent Medicine; Boston Children's Hospital and Harvard Medical School; Boston MA USA
- Department of Epidemiology; Harvard T.H. Chan School of Public Health; Boston MA USA
| | - C. A. Camargo
- Channing Division of Network Medicine; Department of Medicine; Brigham & Women's Hospital and Harvard Medical School; Boston MA USA
- Department of Emergency Medicine; Massachusetts General Hospital and Harvard Medical School; Boston MA USA
- Department of Epidemiology; Harvard T.H. Chan School of Public Health; Boston MA USA
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18
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Quinot C, Dumas O, Henneberger PK, Varraso R, Wiley AS, Speizer FE, Goldberg M, Zock JP, Camargo CA, Le Moual N. Development of a job-task-exposure matrix to assess occupational exposure to disinfectants among US nurses. Occup Environ Med 2016; 74:130-137. [PMID: 27566782 DOI: 10.1136/oemed-2016-103606] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 06/29/2016] [Accepted: 08/02/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Occupational exposure to disinfectants is associated with work-related asthma, especially in healthcare workers. However, little is known about the specific products involved. To evaluate disinfectant exposures, we designed job-exposure (JEM) and job-task-exposure (JTEM) matrices, which are thought to be less prone to differential misclassification bias than self-reported exposure. We then compared the three assessment methods: self-reported exposure, JEM and JTEM. METHODS Disinfectant use was assessed by an occupational questionnaire in 9073 US female registered nurses without asthma, aged 49-68 years, drawn from the Nurses' Health Study II. A JEM was created based on self-reported frequency of use (1-3, 4-7 days/week) of 7 disinfectants and sprays in 8 nursing jobs. We then created a JTEM combining jobs and disinfection tasks to further reduce misclassification. Exposure was evaluated in 3 classes (low, medium, high) using product-specific cut-offs (eg, <30%, 30-49.9%, ≥50%, respectively, for alcohol); the cut-offs were defined from the distribution of self-reported exposure per job/task. RESULTS The most frequently reported disinfectants were alcohol (weekly use: 39%), bleach (22%) and sprays (20%). More nurses were classified as highly exposed by JTEM (alcohol 41%, sprays 41%, bleach 34%) than by JEM (21%, 30%, 26%, respectively). Agreement between JEM and JTEM was fair-to-moderate (κ 0.3-0.5) for most disinfectants. JEM and JTEM exposure estimates were heterogeneous in most nursing jobs, except in emergency room and education/administration. CONCLUSIONS The JTEM may provide more accurate estimates than the JEM, especially for nursing jobs with heterogeneous tasks. Use of the JTEM is likely to reduce exposure misclassification.
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Affiliation(s)
- C Quinot
- INSERM, U1168, VIMA: Aging and Chronic Diseases. Epidemiological and Public Health Approaches, F-94807, Villejuif, France.,Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France
| | - O Dumas
- INSERM, U1168, VIMA: Aging and Chronic Diseases. Epidemiological and Public Health Approaches, F-94807, Villejuif, France.,Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France.,Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - P K Henneberger
- Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - R Varraso
- INSERM, U1168, VIMA: Aging and Chronic Diseases. Epidemiological and Public Health Approaches, F-94807, Villejuif, France.,Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France
| | - A S Wiley
- Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - F E Speizer
- Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - M Goldberg
- INSERM, U1168, VIMA: Aging and Chronic Diseases. Epidemiological and Public Health Approaches, F-94807, Villejuif, France.,Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France.,INSERM-UVSQ, UMS 011, Villejuif, France
| | - J P Zock
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.,ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - C A Camargo
- Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - N Le Moual
- INSERM, U1168, VIMA: Aging and Chronic Diseases. Epidemiological and Public Health Approaches, F-94807, Villejuif, France.,Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France
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Cairncross CT, Stonehouse W, Conlon CA, Grant CC, McDonald B, Houghton LA, Eyles D, Camargo CA, Coad J, von Hurst PR. Predictors of vitamin D status in New Zealand preschool children. Matern Child Nutr 2016; 13. [PMID: 27460693 DOI: 10.1111/mcn.12340] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 04/26/2016] [Accepted: 04/28/2016] [Indexed: 12/14/2022]
Abstract
Vitamin D deficiency has adverse health effects in young children. Our aims were to determine predictors of vitamin D status and then to use these factors to develop a practical tool to predict low 25(OH)D concentrations in preschool New Zealand children. A cross-sectional sample of 1329 children aged 2 to <5 years were enrolled from throughout New Zealand in late-winter to spring 2012. 25-Hydroxyvitamin D (25(OH)D) was measured on dried blood spot (DBS) samples collected using finger-prick sampling. Caregivers completed a questionnaire. Mean (SD) DBS 25(OH)D concentration was 52(19)nmol/L. 25(OH)D < 25 nmol/L was present in 86(7%), 25(OH)D < 50 nmol/L in 642(48%), 25(OH)D 50- < 75 nmol/L in 541(41%) and 25(OH)D > 75 nmol/L in 146(11%) of children. Factors independently associated with the risk of 25(OH)D < 25 nmol/L were female gender (OR 1.92,95%CI 1.17-3.14), other non-European ethnicities (not including Māori or Pacific) (3.51,1.89-6.50), had olive-dark skin colour (4.52,2.22-9.16), did not take vitamin D supplements (2.56,1.06-6.18), had mothers with less than secondary-school qualifications (5.00,2.44-10.21) and lived in more deprived households (1.27,1.06-1.53). Children who drank toddler milk (vitamin D fortified cow's milk formula marketed to young children) had a zero risk of 25(OH)D < 25 nmol/L. The predictive tool identified children at risk of 25(OH)D < 25 nmol/L with sensitivity 42%, specificity 97% and ROC area-under-curve 0.76(95%CI 0.67-0.86, p < 0.001). Predictors of low vitamin D status were consistent with those identified in previous studies of New Zealand children. The tool had insufficient predictive ability for use in clinical situations, and suggests a need to promote safe, inexpensive testing to determine vitamin D status in preschool children.
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Affiliation(s)
- C T Cairncross
- School of Food and Nutrition, Massey University, Auckland, New Zealand
| | | | - C A Conlon
- School of Food and Nutrition, Massey University, Auckland, New Zealand
| | - C C Grant
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand.,General Paediatrics, Starship Children's Hospital, Auckland, New Zealand
| | - B McDonald
- Institute of Natural and Mathematical Sciences, Massey University, Auckland, New Zealand
| | - L A Houghton
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - D Eyles
- Queensland Brain Institute, University of Queensland, Brisbane, Australia.,Queensland Centre for Mental Health Research, Brisbane, Australia
| | - C A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - J Coad
- School of Food and Nutrition, Massey University, Auckland, New Zealand
| | - P R von Hurst
- School of Food and Nutrition, Massey University, Auckland, New Zealand
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Drucker AM, Li WQ, Lin L, Cho E, Li T, Camargo CA, Qureshi AA. Atopic dermatitis (eczema) in US female nurses: lifestyle risk factors and atopic comorbidities. Br J Dermatol 2016; 174:1395-7. [PMID: 26707970 DOI: 10.1111/bjd.14373] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A M Drucker
- Division of Dermatology, University Health Network, Toronto, ON, Canada.,Department of Dermatology, Warren Alpert Medical School, Providence, RI, U.S.A
| | - W-Q Li
- Department of Dermatology, Warren Alpert Medical School, Providence, RI, U.S.A.,Department of Epidemiology, School of Public Health, Brown University, Providence, RI, U.S.A
| | - L Lin
- Department of Dermatology, Warren Alpert Medical School, Providence, RI, U.S.A
| | - E Cho
- Department of Dermatology, Warren Alpert Medical School, Providence, RI, U.S.A.,Department of Epidemiology, School of Public Health, Brown University, Providence, RI, U.S.A.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, U.S.A
| | - T Li
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, U.S.A
| | - C A Camargo
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, U.S.A.,Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, U.S.A.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, U.S.A
| | - A A Qureshi
- Department of Dermatology, Warren Alpert Medical School, Providence, RI, U.S.A.,Department of Epidemiology, School of Public Health, Brown University, Providence, RI, U.S.A.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, U.S.A.,Department of Dermatology, Rhode Island Hospital, Providence, RI, U.S.A
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Camargo CA. Gestational weight gain and offspring asthma: a novel opportunity for primary prevention research. Clin Exp Allergy 2015; 45:544-6. [PMID: 25711133 DOI: 10.1111/cea.12436] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- C A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Nambudiri VE, Dwyer RC, Camargo CA, Kupper TS, Pallin DJ. Outcome assessment in cellulitis clinical trials: is telephone follow up sufficient? Clin Microbiol Infect 2015; 21:676.e5-7. [PMID: 25882364 DOI: 10.1016/j.cmi.2015.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Revised: 03/04/2015] [Accepted: 03/20/2015] [Indexed: 11/30/2022]
Abstract
The US Food and Drug Administration has scrutinized clinical trial methodology in cellulitis, partly because the definition and timing of cure are debatable. We analysed the validity of telephone self-report as a proxy for in-person follow up in a cellulitis treatment trial comparing cephalexin alone with cephalexin-plus-trimethoprim/sulfamethoxazole. Our results demonstrate poor agreement between these two methods of outcome determination and have implications for future cellulitis clinical trial design and clinical management.
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Affiliation(s)
- V E Nambudiri
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA.
| | - R C Dwyer
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - C A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - T S Kupper
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
| | - D J Pallin
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Mai XM, Chen Y, Camargo CA, Langhammer A. Serum 25-hydroxyvitamin D levels and self-reported allergic rhinitis in Norwegian adults - The HUNT Study. Allergy 2014; 69:488-93. [PMID: 24467227 DOI: 10.1111/all.12365] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND The role of low vitamin D status in the development of allergic rhinitis is unclear. We aimed to investigate the relationship between serum 25-hydroxyvitamin D [25(OH)D] and incidence of allergic rhinitis in adults. METHODS The study included a random sample from an adult population who participated in the second and third surveys of the Nord-Trøndelag Health Study (HUNT) in Norway (HUNT2, 1995-1997 and HUNT3, 2006-2008). Serum 25(OH)D levels were measured in blood samples collected at baseline. Among 1351 adults who did not report allergic rhinitis at baseline, incident allergic rhinitis was identified by participant report of having or having had allergic rhinitis or hay fever at follow-up. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were calculated after adjustment for age, smoking, physical activity, socioeconomic status, family history of allergy, body mass index, and season. The analyses were stratified by sex due to its significant interaction with 25(OH)D levels (P < 0.02). RESULTS Over an average of 11 years, 9% of men and 15% of women developed allergic rhinitis. Among men, serum 25(OH)D level <50 nM was associated with an increased risk of incident allergic rhinitis (AOR 2.55; 95% CI 1.01-6.49); each 25 nM reduction in 25(OH)D level was associated with an AOR of 1.84 (95% CI 1.18-2.87). In women, however, the association was opposite, with AOR being 0.83 (95% CI 0.66-1.05) for each 25 nM reduction in serum 25(OH)D level. CONCLUSIONS Vitamin D appears to play different roles in the development of allergic rhinitis among men and women.
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Affiliation(s)
- X.-M. Mai
- Department of Public Health and General Practice; Faculty of Medicine; Norwegian University of Science and Technology; Trondheim Norway
| | - Y. Chen
- Department of Epidemiology and Community Medicine; Faculty of Medicine; University of Ottawa; Ottawa ON Canada
| | - C. A. Camargo
- Department of Emergency Medicine; Massachusetts General Hospital; Harvard Medical School; Boston MA USA
| | - A. Langhammer
- Department of Public Health and General Practice; Faculty of Medicine; Norwegian University of Science and Technology; Trondheim Norway
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Pallin DJ, Camargo CA. Reply to Chou et al. Clin Infect Dis 2013; 57:1217-8. [DOI: 10.1093/cid/cit450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Slow S, Priest PC, Chambers ST, Stewart AW, Jennings LC, Florkowski CM, Livesey JH, Camargo CA, Scragg R, Murdoch DR. Effect of vitamin D3 supplementation on Staphylococcus aureus nasal carriage: a randomized, double-blind, placebo-controlled trial in healthy adults. Clin Microbiol Infect 2013; 20:453-8. [PMID: 24004292 DOI: 10.1111/1469-0691.12350] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 07/23/2013] [Accepted: 07/25/2013] [Indexed: 11/28/2022]
Abstract
Observational studies have reported an inverse association between serum 25-hydroxyvitamin D (25OHD) concentrations and Staphylococcus aureus nasal carriage; however, clinical trials of vitamin D supplementation are lacking. To assess the effect of vitamin D3 supplementation on persistent S. aureus nasal carriage we conducted a randomized, double-blind, placebo-controlled trial among 322 healthy adults. Participants were given an oral dose of either 200 000 IU vitamin D3 for each of 2 months, followed by 100 000 IU monthly or placebo in an identical dosing regimen, for a total of 18 months. Nasal swabs for S. aureus culture and serum for 25OHD measurement were obtained at baseline, 6, 12 and 18 months of study. The mean baseline concentration of 25OHD was 72 nM (SD 22 nM). Vitamin D3 supplementation increased 25OHD levels which were maintained at >120 nM throughout the study. Nasal colonization by S. aureus was found in 31% of participants at baseline. Persistent carriage, defined as those that had positive S. aureus nasal cultures for all post-baseline swabs, occurred in 20% of the participants but vitamin D3 supplementation was not associated with a reduction in persistent carriage (OR = 1.39, 95% CI 0.63-3.06). Risk factor analysis showed that only gender was significantly associated with carriage, where women were less likely to be carriers than men (relative risk 0.83, 95% CI 0.54-0.99). Serum 25OHD concentrations were not associated with the risk of carriage. In conclusion, monthly administration of 100 000 IU of vitamin D3 did not reduce persistent S. aureus nasal carriage.
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Affiliation(s)
- S Slow
- Department of Pathology, University of Otago, Christchurch, New Zealand
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Pallin DJ, Binder WD, Allen MB, Lederman M, Parmar S, Filbin MR, Hooper DC, Camargo CA. Clinical Trial: Comparative Effectiveness of Cephalexin Plus Trimethoprim-Sulfamethoxazole Versus Cephalexin Alone for Treatment of Uncomplicated Cellulitis: A Randomized Controlled Trial. Clin Infect Dis 2013; 56:1754-62. [DOI: 10.1093/cid/cit122] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Thorp JM, Camargo CA, McGee PL, Harper M, Klebanoff MA, Sorokin Y, Varner MW, Wapner RJ, Caritis SN, Iams JD, Carpenter MW, Peaceman AM, Mercer BM, Sciscione A, Rouse DJ, Ramin SM, Anderson GB. Vitamin D status and recurrent preterm birth: a nested case-control study in high-risk women. BJOG 2012; 119:1617-23. [PMID: 23078336 PMCID: PMC3546544 DOI: 10.1111/j.1471-0528.2012.03495.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine whether vitamin D status is associated with recurrent preterm birth, and any interactions between vitamin D levels and fish consumption. DESIGN A nested case-control study, using data from a randomised trial of omega-3 fatty acid supplementation to prevent recurrent preterm birth. SETTING Fourteen academic health centres in the USA. POPULATION Women with prior spontaneous preterm birth. METHODS In 131 cases (preterm delivery at <35 weeks of gestation) and 134 term controls, we measured serum 25-hydroxyvitamin D [25(OH)D] concentrations by liquid chromatography-tandem mass spectrometry (LC-MS) from samples collected at baseline (16-22 weeks of gestation). Logistic regression models controlled for study centre, maternal age, race/ethnicity, number of prior preterm deliveries, smoking status, body mass index, and treatment. MAIN OUTCOME MEASURES Recurrent preterm birth at <37 and <32 weeks of gestation. RESULTS The median mid-gestation serum 25(OH)D concentration was 67 nmol/l, and 27% had concentrations of <50 nmol/l. Serum 25(OH)D concentration was not significantly associated with preterm birth (OR 1.33; 95% CI 0.48-3.70 for lowest versus highest quartiles). Likewise, comparing women with 25(OH)D concentrations of 50 nmol/l, or higher, with those with <50 nmol/l generated an odds ratio of 0.80 (95% CI 0.38-1.69). Contrary to our expectation, a negative correlation was observed between fish consumption and serum 25(OH)D concentration (-0.18, P < 0.01). CONCLUSIONS In a cohort of women with a prior preterm birth, vitamin D status at mid-pregnancy was not associated with recurrent preterm birth.
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Affiliation(s)
- J M Thorp
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7570, USA.
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Abstract
BACKGROUND Vitamin D is associated with a variety of health outcomes, but the exact definition of vitamin D sufficiency remains controversial. AIM We sought to define skeletal-related vitamin D sufficiency by estimating maximum PTH suppression in the U.S. population. METHODS We performed a cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES), 2003-2006. We examined the association between serum 25-hydroxyvitamin D (25OHD) level and serum PTH level in 14,681 participants aged ≥6 yr. We also evaluated the 25OHD-PTH association using 2 thresholds of hyperparathyroidism: PTH≥45 pg/ml and ≥75 pg/ml. RESULTS The mean 25OHD level was 24 ng/ml and mean PTH was 42 pg/ml. PTH≥45 pg/ml was present in 35% of the population, while PTH≥75 pg/ml was present in 7%. The prevalence of 25OHD levels <40 ng/ml and <30 ng/ml was 95% and 77%, respectively. In both unadjusted and adjusted models, there was a strong inverse relationship between 25OHD and PTH. Compared to 25OHD≥40 ng/ml, the 25OHD-PTH association was 2.36 [95% confidence interval (CI), 2.08-2.67] times greater for 25OHD<5 ng/ml and 1.12 (95%CI, 1.07-1.17) times greater for 25OHD 30-39.9 ng/ml. Compared to 25OHD≥40 ng/ml, 25OHD levels of 20- 29.9 ng/ml [odds ratio (OR) 2.0 (95%CI, 1.4-2.8)] but not 30- 39.9 ng/ml [OR 1.1 (95%CI, 0.8-1.6)] were independently associated with PTH≥45 pg/ml. CONCLUSIONS Optimal vitamin D status, defined by estimated maximum PTH suppression, does not occur until at least 25OHD levels ≥40 ng/ml. Using these thresholds, most of the U.S. population needs more vitamin D. Large, prospective studies are needed to determine optimal vitamin D supplementation.
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Affiliation(s)
- A A Ginde
- Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, CO 80045, USA.
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Abstract
BACKGROUND Low body mass index (BMI) is a strong prognostic marker in stable chronic obstructive pulmonary disease (COPD); however, little is known about its role in acute exacerbations of COPD. OBJECTIVES To determine the prevalence and determinants of low BMI in emergency department (ED) patients with acute exacerbations of COPD, and to examine whether low BMI was associated with more severe acute exacerbations, more intensive ED treatments and worse post-ED outcomes. METHODS A secondary analysis was performed using data from a prospective multicentre cohort study involving 29 ED in the USA and Canada. Using a standard protocol, ED patients with acute exacerbations of COPD were interviewed and their charts reviewed. BMI was calculated using self-reported weight and height. Main outcome measures included hospital admission, post-ED relapse and ongoing exacerbation. RESULTS 395 patients were enrolled. Their median age was 69 years (interquartile range 62-76); 52% were women. Thirteen per cent (95% CI 10% to 16%) were underweight, 37% normal weight, 27% overweight and 23% were obese. Current smoking was independently associated with underweight (OR 5.4, 95% CI 1.1 to 25.2). In the propensity-matched cohort, there were no significant differences in severity of exacerbation, treatments received in the ED, or short-term clinical outcomes, according to BMI. CONCLUSIONS Low BMI is not uncommon in patients with acute exacerbations of COPD, and current smoking is associated with low BMI in these patients. Unlike its role in stable COPD, BMI appears to have little impact on exacerbation severity, treatments received in the ED, and short-term clinical outcomes in acute exacerbations of COPD.
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Affiliation(s)
- C-L Tsai
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.
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Affiliation(s)
- M F Vassallo
- Massachusetts General Hospital, 326 Cambridge Street, Suite 410, Boston, MA 02114, USA
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Mullins RJ, Clark S, Camargo CA. Socio-economic status, geographic remoteness and childhood food allergy and anaphylaxis in Australia. Clin Exp Allergy 2010; 40:1523-32. [DOI: 10.1111/j.1365-2222.2010.03573.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Long AA, Camargo CA. Current practice of venom immunotherapy in the UK. Clin Exp Allergy 2008; 38:1576-8. [DOI: 10.1111/j.1365-2222.2008.03077.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Rowe BH, Cydulka RK, Tsai CL, Clark S, Sinclair D, Camargo CA. Comparison of Canadian versus United States emergency department visits for chronic obstructive pulmonary disease exacerbation. Can Respir J 2008; 15:295-301. [PMID: 18818783 PMCID: PMC2679560 DOI: 10.1155/2008/696482] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Despite the frequency of emergency department (ED) visits for chronic obstructive pulmonary disease (COPD) exacerbation, little is known about practice variation in EDs. OBJECTIVES To examine the differences between Canadian and United States (US) COPD patients, and the ED management they receive. METHODS A prospective multicentre cohort study was conducted involving 29 EDs in the US and Canada. Using a standard protocol, consecutive ED patients with COPD exacerbations were interviewed, their charts reviewed and a two-week telephone follow-up completed. Comparisons between Canadian and US patients, as well as their treatment and outcomes, were made. Predictors of antibiotic use were determined by multivariate logistic regression. RESULTS Of 584 patients who had physician-diagnosed COPD, 397 (68%) were enrolled. Of these, 63 patients (16%) were from Canada. Canadians were older (73 years versus 69 years; P=0.002), more often white (97% versus 65%; P<0.001), less educated (P=0.003) and more commonly insured (P<0.001) than the US patients. US patients more commonly used the ED for their usual COPD medications (17% versus 3%; P=0.005). Although Canadian patients had fewer pack-years of smoking (45 pack-years versus 53 pack-years; P=0.001), current COPD medications and comorbidities were similar. At ED presentation, Canadian patients were more often hypoxic and symptomatic. ED treatment with inhaled beta-agonists (approximately 90%) and systemic corticosteroids (approximately 65%) were similar; Canadians received more antibiotics (46% versus 25%; P<0.001) and other treatments (29% versus 11%; P=0.002). Admission rates were similar in both countries (approximately 65%), although Canadian patients remained in the ED longer than the US patients (10 h versus 5 h, respectively; P<0.001). CONCLUSIONS Overall, patients with acute COPD in Canada and the US appear to have similar history, ED treatment and outcomes; however, Canadian patients are older and receive more aggressive treatment in the ED. In both countries, the prolonged length of stay and high admission rate contribute to the ED overcrowding crisis facing EDs.
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Affiliation(s)
- B H Rowe
- Dept of Emergency Medicine, University of Alberta, Edmonton, Canada.
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Abstract
Epidemiological studies first demonstrated the association between obesity and asthma and they have begun to provide additional evidence to support causality: a dose-effect relationship, consistency across studies (especially among women) and the correct temporal order (ie, obesity before asthma). To date, relatively few studies have addressed reversibility, an important but less frequently demonstrated epidemiological criterion of causality. Reversibility suggests that if excessive weight is a risk factor for asthma, then reducing body weight should decrease the prevalence of asthma, or at least decrease asthma related symptoms or health care utilisation. We performed a systematic review on weight loss and asthma, based on searches between January 1966 and January 2007 of both PubMed and the Cochrane Clinical Trial Database. Of the 15 relevant studies, asthma was the primary outcome in only five. Only one study was conducted in children. Regardless of the type of intervention (surgical vs medical), all 15 studies noted an improvement in at least one asthma outcome after weight loss. The improvement was noted across studies that differed in sample age, gender or country of origin. The heterogeneity of the interventions and outcomes precluded quantitative synthesis. We briefly review the role of specific factors (eg, gastro-oesophageal reflux) in the weight loss-asthma association, and potential directions for future research.
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Affiliation(s)
- I U Eneli
- Department of Pediatrics, Ohio State University, Center for Healthy Weight and Nutrition, Columbus Children's Hospital, Columbus, Ohio 43205, USA.
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Sidbury R, Sullivan AF, Thadhani RI, Camargo CA. Randomized controlled trial of vitamin D supplementation for winter-related atopic dermatitis in Boston: a pilot study. Br J Dermatol 2008; 159:245-7. [PMID: 18489598 DOI: 10.1111/j.1365-2133.2008.08601.x] [Citation(s) in RCA: 162] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wolf M, Shah A, Gutierrez O, Ankers E, Monroy M, Tamez H, Steele D, Chang Y, Camargo CA, Tonelli M, Thadhani R. Vitamin D levels and early mortality among incident hemodialysis patients. Kidney Int 2007; 72:1004-13. [PMID: 17687259 DOI: 10.1038/sj.ki.5002451] [Citation(s) in RCA: 627] [Impact Index Per Article: 36.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Vitamin D deficiency is associated with cardiovascular disease, the most common cause of mortality in hemodialysis patients. To investigate the relation between blood levels of 25-hydroxyvitamin D (25D) and 1,25-dihydroxyvitamin D (1,25D) with hemodialysis outcomes, we measured baseline vitamin D levels in a cross-sectional analysis of 825 consecutive patients from within a prospective cohort of incident US hemodialysis patients. Of these patients, 78% were considered vitamin D deficient with 18% considered severely deficient. Calcium, phosphorus, and parathyroid hormone levels correlated poorly with 25D and 1,25D concentrations. To test the association between baseline vitamin D levels and 90-day mortality, we selected the next 175 consecutive participants who died within 90 days and compared them to the 750 patients who survived in a nested case-control analysis. While low vitamin D levels were associated with increased mortality, significant interaction was noted between vitamin D levels, subsequent active vitamin D therapy, and survival. Compared to patients with the highest 25D or 1,25D levels who received therapy, untreated deficient patients were at significantly increased risk for early mortality. Our study shows that among incident hemodialysis patients, vitamin D deficiency is common, correlates poorly with other components of mineral metabolism and is associated with increased early mortality.
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Affiliation(s)
- M Wolf
- Renal Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Goldstein JN, Camargo CA, Pelletier AJ, Edlow JA. Headache in United States emergency departments: demographics, work-up and frequency of pathological diagnoses. Cephalalgia 2006; 26:684-90. [PMID: 16686907 DOI: 10.1111/j.1468-2982.2006.01093.x] [Citation(s) in RCA: 172] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Headache is a common complaint in the emergency department (ED). In order to examine headache work-ups and diagnoses across the USA, we queried a representative sample of adult ED visits (the National Hospital Ambulatory Medical Care Survey) for the years 1992-2001. Headache accounted for 2.1 million ED visits per year (2.2% of visits). Of the 14% of patients who underwent neuroimaging, 5.5% received a pathological diagnosis. Of the 2% of patients who underwent lumbar puncture, 11% received a pathological diagnosis. On multivariable analysis, a decreased rate of imaging was noted for patients without private insurance [odds ratio (OR) 0.61, confidence interval (CI) 0.44, 0.86] and for those presenting off-hours (OR 0.55, CI 0.39, 0.77). Patients over 50 were more likely to receive a pathological diagnosis (OR 3.3, CI 1.2, 9.3). In conclusion, clinicians should ensure that appropriate work-ups are performed regardless of presentation time or insurance status, and be vigilant in the evaluation of older patients.
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Affiliation(s)
- J N Goldstein
- Department of Emergency Medicine, Brigham & Women's Hospital, Boston, MA, USA
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Mannino DM, Mott J, Ferdinands JM, Camargo CA, Friedman M, Greves HM, Redd SC. Boys with high body masses have an increased risk of developing asthma: findings from the National Longitudinal Survey of Youth (NLSY). Int J Obes (Lond) 2006; 30:6-13. [PMID: 16344843 DOI: 10.1038/sj.ijo.0803145] [Citation(s) in RCA: 142] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the relation between body mass index and the development of asthma in children. DESIGN Prospective study of 4393 asthma-free children followed for up to 14 years. SETTING Children of participants in the National Longitudinal Survey of Youth. METHODS Analysis was limited to children who were followed from birth and were asthma-free during the first 24 months of life. The outcome was the development of asthma during follow-up (incident asthma). Body mass index (BMI) was our main predictor of interest. Survival analyses, using time to development of asthma as the main endpoint, were stratified by sex and controlled for race/ethnicity, poverty status, and prenatal maternal smoking. RESULTS Asthma developed in 218 (5.0 %) children during the follow-up period. The relation between BMI and incident asthma varied by sex. A BMI > or =85th percentile at age 2-3 years was a risk factor for subsequent asthma development in boys (hazard ratio (HR) 1.6 95% confidence interval (CI) 1.1, 2.4) but not girls (HR 0.8, 95% CI 0.5, 1.4). Similarly, boys with BMIs always > or =85th percentile were at increased risk for subsequent asthma development (HR 2.4, 95% CI 1.4, 4.4) but not girls (HR 1.5, 95% CI 0.7, 2.9). CONCLUSION Boys with high body masses may be at an increased risk for developing asthma.
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Affiliation(s)
- D M Mannino
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky Medical Center, Lexington, 40536, USA.
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Abstract
BACKGROUND A systematic review was undertaken to evaluate the efficacy of tiotropium, a long acting anticholinergic drug, on clinical events, symptom scales, pulmonary function, and adverse events in stable chronic obstructive pulmonary disease (COPD). METHODS A systematic search was made of the Cochrane trials database, MEDLINE, EMBASE, CINAHL, and a hand search of 20 respiratory journals. Missing data were obtained from authors and the manufacturer. Randomised controlled trials of > or =12 weeks' duration comparing tiotropium with placebo, ipratropium bromide, or long acting beta2 agonists (LABA) were reviewed. Studies were pooled to yield odds ratios (OR) or weighted mean differences with 95% confidence intervals (CI). RESULTS Nine trials (8002 patients) met the inclusion criteria. Tiotropium reduced the odds of a COPD exacerbation (OR 0.73; 95% CI 0.66 to 0.81) and related hospitalisation (OR 0.68; 95% CI 0.54 to 0.84) but not pulmonary (OR 0.50; 95% CI 0.19 to 1.29) or all-cause (OR 0.96; 95% CI 0.63 to 1.47) mortality compared with placebo and ipratropium. Reductions in exacerbations and hospitalisations compared with LABA were not statistically significant. Similar patterns were evident for quality of life and symptom scales. Tiotropium yielded greater increases in forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) from baseline to 6-12 months than did placebo, ipratropium, and LABA. Decline in FEV1 over 1 year was 30 ml (95% CI 7 to 53) slower with tiotropium than with placebo and ipratropium (data were not available for LABA). Reports of dry mouth and urinary tract infections were increased with tiotropium. CONCLUSIONS Tiotropium reduced COPD exacerbations and related hospitalisations, improved quality of life and symptoms, and may have slowed the decline in FEV1. Long term trials are warranted to evaluate the effects of tiotropium on decline in FEV1 and to clarify its role compared with LABA.
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Affiliation(s)
- R G Barr
- Division of General Medicine, PH-9 East Room 105, Columbia University Medical Centre, 630 West 168th Street, New York, NY 10032, USA.
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Abstract
BACKGROUND Leptin, a pro-inflammatory cytokine produced by adipose tissue, has previously been shown to be associated with asthma in children. We hypothesised that high serum leptin concentrations would also be associated with asthma in adults. METHODS The Third National Health and Nutrition Examination Survey is a cross sectional study that included fasting serum leptin concentrations and self-report of doctor diagnosed asthma. Data were analysed using multivariable logistic regression analysis. RESULTS Of 5876 participants, those with current asthma had a higher mean unadjusted leptin concentration than those who had never had asthma (geometric mean (SE) 9.2 (0.6) microg/l v 7.6 (0.2) microg/l; p = 0.02). After adjustment for triceps skinfold thickness and other covariates, the association between leptin and asthma appeared stronger in women than in men, and in premenopausal women than in postmenopausal women. Body mass index (BMI) was also associated with current asthma in women, but this association was not significantly affected by adjustment for leptin concentrations. CONCLUSIONS The results of this large population based study support the hypothesis that leptin is associated with asthma in women. In addition, while BMI also is related to asthma in women, this study does not support the suggestion that leptin contributes significantly to this association.
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Affiliation(s)
- A Sood
- Division of Pulmonary and Critical Care Medicine, Southern Illinois University School of Medicine, 701 North First Street, Room D434, P O Box 19636, Springfield, IL 62794-9636, USA.
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Abstract
BACKGROUND The phase of the menstrual cycle is thought to influence the course of asthma in women. One recent study reported a large increase in exacerbations during the perimenstrual phase, while another found a preovulatory increase. A study was undertaken to determine the relation between phase of the menstrual cycle and acute asthma in patients presenting to the emergency department (ED). METHODS All women aged 18-54 years presenting with a diagnosis of acute asthma exacerbation were considered for enrollment in the study. Women who were pregnant, postmenopausal, following hysterectomy, with a >28 day menstrual cycle or incomplete reproductive history were excluded. The 792 eligible women were classified by menstrual phase based on both date of symptom onset and date of ED visit. RESULTS When classified by date of symptom onset, 28% were preovulatory (days 5 to 11), 25% were periovulatory (days 12 to 18), 21% were postovulatory (days 19 to 25), and 27% were perimenstrual (days 26 to 4; p = 0.03). When classified by date of ED visit, 28% were preovulatory, 22% were periovulatory, 22% were postovulatory, and 27% were perimenstrual (p = 0.004). Using either approach, there were no significant differences in demographic factors or in asthma severity of women in the various menstrual phase groups. CONCLUSION Acute asthma exacerbations do not markedly increase during the perimenstrual phase. The results support the suggestion that both preovulatory and perimenstrual phases are actual triggers of asthma exacerbation in some women, or that these two phases serve as "co-factors" that worsen other recognised triggers of acute asthma.
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Affiliation(s)
- B E Brenner
- Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
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Wiederkehr JC, Pereira JC, Ekermann M, Porto F, Kondo W, Nagima I, Amaral W, Camargo CA, Moreira M. Results of 132 hepatectomies for living donor liver transplantation: report of one death. Transplant Proc 2005; 37:1079-80. [PMID: 15848628 DOI: 10.1016/j.transproceed.2004.12.221] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AIMS Liver transplant is the primary therapy for patients with end-stage liver disease. Its high success rates have lead to a broadening of the indications for liver transplantation, resulting in an increasing shortage of donors. Living donor liver transplantation has become an option to overcome waiting list mortality. We describe our experience with hepatectomy for living donor liver transplantation and report a case of death. METHODS Patients (n = 132) underwent hepatectomy for living donor liver transplantation from June 2000 through June 2004. A 4-phase preoperative evaluation was performed on all patients, whose ages ranged from 13 to 54 years (mean = 29.7 +/- 8.1 years). Of the 132 patients, 76 patients (57.5%) underwent left lateral segmentectomy, 33 patients (25%) underwent left lobectomy, and 23 patients (16%) underwent right hepatectomy. In 2 other patients (1.5%), a monosegment (segment II) was obtained after left lateral segmentectomy. RESULTS Twenty patients (15%) experienced a complication, the most common being incisional hernia, pneumonia, and biliary fistulae. On the seventh postoperative day, 1 patient developed a fatal cerebral hemorrhage while recovering from mild liver dysfunction. CONCLUSIONS Although living donor liver transplantation is generally safe, serious and fatal complications may occur.
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Affiliation(s)
- J C Wiederkehr
- Santa Casa de Curitiba and Hospital Pequeno Principe, Catholic University of Parana PUCPR, Parana, Brazil.
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Abstract
Interleukin17F (IL17F) is a regulatory cytokine for T-cell-mediated immune responses. The gene coding for IL17F (IL17F) is located on chromosome 6p, a genomic region linked to asthma and asthma-related phenotypes in multiple genome scans. IL17F is expressed in lung tissue, in bronchoalveolar lavage fluid from asthmatic subjects, and in activated CD4+ cells. We were thus interested in testing for association between single-nucleotide polymorphisms (SNPs) and haplotypes in IL17F and asthma. To characterize polymorphisms in IL17F, we sequenced this gene in a group of African Americans and a group of European Americans. A total of 50 SNPs (30 not previously reported in a public database (dbSNP build 118)) and two insertions/deletions were detected in IL17F; five of these polymorphisms were genotyped in participants of the Nurses' Health Study. We then tested for association between SNPs and haplotypes in IL17F and physician-diagnosed asthma in subjects with (cases) and without (control subjects) physician-diagnosed asthma. None of the SNPs or haplotypes tested in IL17F were associated with asthma. The polymorphisms identified in this study may be used in future studies of association between IL17F and phenotypes related to immune responses.
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Affiliation(s)
- C D Ramsey
- Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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Camargo CA. Salmeterol Use and Risk of Admission among Emergency Department Patients with Acute Asthma. Acad Emerg Med 2005. [DOI: 10.1197/j.aem.2005.03.403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Camargo CA. Utility of NT-proBNP for the Diagnosis of Congestive Heart Failure in Patients with Pulmonary Disease. Acad Emerg Med 2005. [DOI: 10.1197/j.aem.2005.03.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Abstract
BACKGROUND Tiotropium is a new anticholinergic therapy for chronic obstructive pulmonary disease (COPD) that differs from ipratropium by its functional relative selectivity for muscarinic receptor subtypes and which allows once-per-day dosing. OBJECTIVES To determine the efficacy of tiotropium on clinical endpoints such exacerbations and hospitalisations, symptom scales and pulmonary function compared to placebo and other bronchodilators used for stable COPD. SEARCH STRATEGY Randomised controlled trials (RCTs) were identified from the Cochrane Airways Review Group Specialised Register, a compilation of systematic searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and CINAHL, and hand searching of 20 respiratory journals. Bibliographies from included studies and reviews were searched. The date of the last search was October 2004. SELECTION CRITERIA Randomised clinical trials comparing tiotropium with placebo, ipratropium bromide, or long-acting ss2-agonists for greater than, or equal to, one month's duration. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted data. Missing data were obtained from authors or the manufacturer of tiotropium. The data were analysed using the Cochrane Review Manager RevMan 4.2. Studies were pooled to yield weighted mean differences (WMD) or odds ratios (OR) and reported using 95% confidence intervals (CI). MAIN RESULTS From 69 identified references, nine RCTs (6,584 patients) met inclusion criteria. Tiotropium reduced the odds of a COPD exacerbation (OR 0.74; 95% CI 0.66 to 0.83) and related hospitalisations (OR 0.64; 95% CI 0.51 to 0.82) compared to placebo or ipratropium. When applied to an annual baseline risk of 45% for exacerbations and 10% for hospitalisation, the number of patients needed to treat with tiotropium for one year were 14 (95% CI 11 to 22) to prevent one exacerbation and 30 (95% CI 22 to 61) to prevent one hospitalisation compared to placebo and ipratropium. Reductions in these endpoints compared to long-acting ss2-agonists were not statistically significant. Similar patterns were evident for quality-of-life and symptom scales. Increases in FEV1 and FVC from baseline were significantly larger with tiotropium than with placebo, ipratropium and long-acting ss2-agonists over 6 to 12 months. The decline in trough FEV1 from steady state was 30 ml (95% CI 7 to 53 ml) less with tiotropium than with placebo or ipratropium over one year; no data on decline in FEV1 from steady state were available for long-acting ss2-agonists. Dry mouth was increased by tiotropium. AUTHORS' CONCLUSIONS Tiotropium reduced COPD exacerbations and related hospitalisations compared to placebo and ipratropium. It also improved health-related quality-of-life and symptom scores among patients with moderate and severe disease, and may have slowed decline in FEV1. Additional long-term studies are required to evaluate its effect on mortality and change in FEV1 to clarify its role in comparison to, or in combination with, long-acting ss2-agonists and to assess its effectiveness in mild and very severe COPD.
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Affiliation(s)
- R G Barr
- Division of General Medicine, PH-9 East Room 105, Columbia-Presbyterian Medical Center, 622 West 168th Street, New York, NY 10032, USA.
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Affiliation(s)
- C A Camargo
- Stanford University Medical Center, California 94305-5103, USA
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50
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Abstract
Asthma is a chronic inflammatory disease, which is characterised by reversible airflow obstruction in response to a variety of stimuli. Exacerbations in response to airway irritants are part of the natural history of asthma, but often they also represent a failure in chronic treatment. Presentations to emergency departments and other acute care settings are common and frequently lead to hospitalisation and other complications. After treatment, however, most patients are discharged to the care of their primary care physician for further management. This review highlights the role of systemic and inhaled corticosteroids as mainstays of treatment in the acute and sub-acute phase of an exacerbation. These agents form the basis of most current clinical practice guidelines, yet their use is not universal. We will review the evidence for the use of these agents that arises from the Cochrane Collaboration of Systematic Reviews contained in the Cochrane Library.
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Affiliation(s)
- B H Rowe
- Division Emergency Medicine, University of Alberta, 1G1.43 Walter Mackenzie Centre, 8440-112 Street, Edmonton, Alberta, Canada T6G 287.
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