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Karyanti MR, Uiterwaal CSPM, Hadinegoro SR, Widyahening IS, Saldi SRF, Heesterbeek JAPH, Hoes AW, Bruijning-Verhagen P. The Value of Warning Signs From the WHO 2009 Dengue Classification in Detecting Severe Dengue in Children. Pediatr Infect Dis J 2024:00006454-990000000-00807. [PMID: 38652064 DOI: 10.1097/inf.0000000000004326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND World Health Organization proposed 7 warning signs to identify the risk of severe dengue in 2009. This study aimed to evaluate the value of these warning signs in detecting severe dengue in children. MATERIAL AND METHODS A cross-sectional study was conducted utilizing data of children with clinical dengue infection obtained from medical records between January 2009 and December 2018 in Jakarta. Children with confirmed dengue were analyzed and stratified into 3 age groups: infants less than 1 year old, children 1-14 years and adolescents 15-18 years of age. Positive predictive value, negative predictive value (NPV), sensitivity and specificity of each warning sign present or absent on admission in detecting severe dengue were computed. RESULTS Six hundred ninety-nine children with clinical dengue infection were enrolled, among whom 614 (87.8%) had confirmed dengue infection, either by antigen or antibody serological tests. Severe dengue occurred in 211/614 (34.4%) cases. In infants, important warning signs on admission to detect or exclude severe dengue were liver enlargement (NPV 80.8%) and clinical fluid accumulation (NPV 75%). In children and adolescents, warning sign with highest NPV (in children 76.6% and in adolescents 91.9%) was increase in hematocrit concurrent with a rapid decrease in platelet count. Other warning signs with high NPV values in children were abdominal pain (72%), vomiting (70%), clinical fluid accumulation (69.3%), and in adolescents' abdominal pain (80.7%), vomiting (75.7%), clinical fluid accumulation (82.7%). NPVs increase with more than 1 warning sign in all age groups. CONCLUSION In infants, liver enlargement or clinical fluid accumulation are important warning signs for severe dengue, when both are absent, severe dengue is unlikely. In older children and adolescents, an increase in hematocrit with the concurrent rapid decrease in platelet count is most discriminative; followed by the absence of abdominal pain, vomiting or fluid accumulation are unlikely severe dengue.
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Affiliation(s)
- Mulya Rahma Karyanti
- From the Department of Child Health, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Cuno S P M Uiterwaal
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Sri Rezeki Hadinegoro
- From the Department of Child Health, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Indah Suci Widyahening
- Department of Community Medicine, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Siti Rizny F Saldi
- Clinical Epidemiology and Evidence-Based Medicine Unit, Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - J A P Hans Heesterbeek
- Department of Population Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Arno W Hoes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Patricia Bruijning-Verhagen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
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Soesanti F, Hoek G, Brunekreef B, Meliefste K, Chen J, Idris NS, Putri ND, Uiterwaal CSPM, Grobbee DE, Klipstein-Grobusch K. Perinatal exposure to traffic related air pollutants and the risk of infection in the first six months of life: a cohort study from a low-middle income country. Int Arch Occup Environ Health 2024:10.1007/s00420-024-02064-0. [PMID: 38632139 DOI: 10.1007/s00420-024-02064-0] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/02/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVE There is limited study from low-and-middle income countries on the effect of perinatal exposure to air pollution and the risk of infection in infant. We assessed the association between perinatal exposure to traffic related air pollution and the risk of infection in infant during their first six months of life. METHODS A prospective cohort study was performed in Jakarta, March 2016-September 2020 among 298 mother-infant pairs. PM2.5, soot, NOx, and NO2 concentrations were assessed using land use regression models (LUR) at individual level. Repeated interviewer-administered questionnaires were used to obtain data on infection at 1, 2, 4 and 6 months of age. The infections were categorized as upper respiratory tract (runny nose, cough, wheezing or shortness of breath), lower respiratory tract (pneumonia, bronchiolitis) or gastrointestinal tract infection. Logistic regression models adjusted for covariates were used to assess the association between perinatal exposure to air pollution and the risk of infection in the first six months of life. RESULTS The average concentrations of PM2.5 and NO2 were much higher than the WHO recommended levels. Upper respiratory tract infections (URTI) were much more common in the first six months of life than diagnosed lower respiratory tract or gastro-intestinal infections (35.6%, 3.5% and 5.8% respectively). Perinatal exposure to PM2.5 and soot suggested increase cumulative risk of upper respiratory tract infection (URTI) in the first 6 months of life per IQR increase with adjusted OR of 1.50 (95% CI 0.91; 2.47) and 1.14 (95% CI 0.79; 1.64), respectively. Soot was significantly associated with the risk of URTI at 4-6 months age interval (aOR of 1.45, 95%CI 1.02; 2.09). All air pollutants were also positively associated with lower respiratory tract infection, but all CIs include unity because of relatively small samples. Adjusted odds ratios for gastrointestinal infections were close to unity. CONCLUSION Our study adds to the evidence that perinatal exposure to fine particles is associated with respiratory tract infection in infants in a low-middle income country.
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Affiliation(s)
- Frida Soesanti
- Department of Child Health, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Gerard Hoek
- Environmental and Occupational Health Group Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands
| | - Bert Brunekreef
- Environmental and Occupational Health Group Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands
| | - Kees Meliefste
- Environmental and Occupational Health Group Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands
| | - Jie Chen
- Environmental and Occupational Health Group Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, USA
| | - Nikmah S Idris
- Department of Child Health, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Nina D Putri
- Department of Child Health, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Cuno S P M Uiterwaal
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Yu A, Jansen MAC, Dalmeijer GW, Bruijning-Verhagen P, van der Ent CK, Grobbee DE, Burgner DP, Uiterwaal CSPM. Childhood infection burden, recent antibiotic exposure and vascular phenotypes in preschool children. PLoS One 2023; 18:e0290633. [PMID: 37713433 PMCID: PMC10503770 DOI: 10.1371/journal.pone.0290633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 08/11/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Severe childhood infection has a dose-dependent association with adult cardiovascular events and with adverse cardiometabolic phenotypes. The relationship between cardiovascular outcomes and less severe childhood infections is unclear. AIM To investigate the relationship between common, non-hospitalised infections, antibiotic exposure, and preclinical vascular phenotypes in young children. DESIGN A Dutch prospective population-derived birth cohort study. METHODS Participants were from the Wheezing-Illnesses-Study-Leidsche-Rijn (WHISTLER) birth cohort. We collected data from birth to 5 years on antibiotic prescriptions, general practitioner (GP)-diagnosed infections, and monthly parent-reported febrile illnesses (0-1 years). At 5 years, carotid intima-media thickness (CIMT), carotid artery distensibility, and blood pressure (BP) were measured. General linear regression models were adjusted for age, sex, smoke exposure, birth weight z-score, body mass index, and socioeconomic status. RESULTS Recent antibiotic exposure was associated with adverse cardiovascular phenotypes; each antibiotic prescription in the 3 and 6 months prior to vascular assessment was associated with an 18.1 μm (95% confidence interval, 4.5-31.6, p = 0.01) and 10.7 μm (0.8-20.5, p = 0.03) increase in CIMT, respectively. Each additional antibiotic prescription in the preceding 6 months was associated with an 8.3 mPa-1 decrease in carotid distensibility (-15.6- -1.1, p = 0.02). Any parent-reported febrile episode (compared to none) showed weak evidence of association with diastolic BP (1.6 mmHg increase, 0.04-3.1, p = 0.04). GP-diagnosed infections were not associated with vascular phenotypes. CONCLUSIONS Recent antibiotics are associated with adverse vascular phenotypes in early childhood. Mechanistic studies may differentiate antibiotic-related from infection-related effects and inform preventative strategies.
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Affiliation(s)
- Angela Yu
- Department of Paediatrics, Monash University, Clayton, Australia
| | - Maria A. C. Jansen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Geertje W. Dalmeijer
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Patricia Bruijning-Verhagen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Cornelis K. van der Ent
- Department of Pediatric Pulmonology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Diederick E. Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - David P. Burgner
- Department of Paediatrics, Monash University, Clayton, Australia
- Murdoch Children’s Research Institute, Parkville, Australia
- Department of Paediatrics, Melbourne University, Parkville, Australia
| | - Cuno S. P. M. Uiterwaal
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Soesanti F, Uiterwaal CSPM, Meliefste K, Chen J, Brunekreef B, Idris NS, Grobbee DE, Klipstein-Grobusch K, Hoek G. The effect of exposure to traffic related air pollutants in pregnancy on birth anthropometry: a cohort study in a heavily polluted low-middle income country. Environ Health 2023; 22:22. [PMID: 36843017 PMCID: PMC9969650 DOI: 10.1186/s12940-023-00973-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Ambient air pollution has been recognized as one of the most important environmental health threats. Exposure in early life may affect pregnancy outcomes and the health of the offspring. The main objective of our study was to assess the association between prenatal exposure to traffic related air pollutants during pregnancy on birth weight and length. Second, to evaluate the association between prenatal exposure to traffic related air pollutants and the risk of low birth weight (LBW). METHODS Three hundred forty mother-infant pairs were included in this prospective cohort study performed in Jakarta, March 2016-September 2020. Exposure to outdoor PM2.5, soot, NOx, and NO2 was assessed by land use regression (LUR) models at individual level. Multiple linear regression models were built to evaluate the association between air pollutants with birth weight (BW) and birth length (BL). Logistic regression was used to assess the risk of low birth weight (LBW) associated with all air pollutants. RESULTS The average PM2.5 concentration was almost eight times higher than the current WHO guideline and the NO2 level was three times higher. Soot and NOx were significantly associated with reduced birth length. Birth length was reduced by - 3.83 mm (95% CI -6.91; - 0.75) for every IQR (0.74 × 10- 5 per m) increase of soot, and reduced by - 2.82 mm (95% CI -5.33;-0.30) for every IQR (4.68 μg/m3) increase of NOx. Outdoor air pollutants were not significantly associated with reduced birth weight nor the risk of LBW. CONCLUSION Exposure to soot and NOx during pregnancy was associated with reduced birth length. Associations between exposure to all air pollutants with birth weight and the risk of LBW were less convincing.
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Affiliation(s)
- Frida Soesanti
- Department of Child Health, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Cuno S P M Uiterwaal
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Kees Meliefste
- Environmental and Occupational Health Group Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands
| | - Jie Chen
- Environmental and Occupational Health Group Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands
| | - Bert Brunekreef
- Environmental and Occupational Health Group Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands
| | - Nikmah S Idris
- Department of Child Health, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gerard Hoek
- Environmental and Occupational Health Group Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands
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Song CV, Yip CH, Mohd Taib NA, See MH, Teoh LY, Monninkhof EM, Saad M, Uiterwaal CSPM, Bhoo-Pathy N. Association Between Adherence to Clinical Practice Guidelines for Adjuvant Therapy for Breast Cancer and Survival in a Resource-Limited Setting. JCO Glob Oncol 2022; 8:e2100314. [PMID: 35245099 PMCID: PMC8920448 DOI: 10.1200/go.21.00314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Addressing unwarranted clinical variation in oncology practices is expected to lead to improved cancer outcomes. Particularly, the application and impact of treatment guidelines on breast cancer outcomes are poorly studied in resource-limited settings. We measured adherence to a set of locally developed adjuvant treatment guidelines in a middle-income setting. Importantly, the impact of guidelines adherence on survival following breast cancer was determined. METHODS Data of 3,100 Malaysian women with nonmetastatic breast cancer diagnosed between 2010 and 2017 were analyzed. Adherence to the Malaysian Clinical Practice Guidelines for Management of Breast Cancer second Edition was measured. Outcomes comprised overall survival and event-free survival. RESULTS Guideline adherence for chemotherapy, radiotherapy, hormonal therapy, and targeted therapy were 61.7%, 79.2%, 85.1%, and 26.2%, respectively. Older age was generally associated with lower adherence to guidelines. Compared with patients who were treated according to treatment guidelines, overall survival and event-free survival were substantially lower in patients who were not treated accordingly; hazard ratios for all-cause mortality were 1.69 (95% CI, 1.29 to 2.22), 2.59 (95% CI, 1.76 to 3.81), 3.08 (95% CI, 1.94 to 4.88), and 4.48 (95% CI, 1.98 to 10.13) for chemotherapy, radiotherapy, hormone therapy, and targeted therapy, respectively. Study inferences remain unchanged following sensitivity analyses. CONCLUSION Our study findings appear to suggest that adherence to treatment guidelines that have been adapted for resource-limited settings may still provide effective guidance in improving breast cancer outcomes. Non-adherence to local breast cancer CPG worsens survival in Malaysia.![]()
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Affiliation(s)
- Chin Vern Song
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Lembah Pantai, Kuala Lumpur, Malaysia.,Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht University, Heidelberglaan, Utrecht, the Netherlands
| | - Cheng-Har Yip
- Ramsay Sime Darby Health Care, Subang Jaya, Malaysia
| | | | - Mee Hoong See
- Department of Surgery, Universiti Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Li Ying Teoh
- Department of Surgery, Universiti Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Evelyn M Monninkhof
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht University, Heidelberglaan, Utrecht, the Netherlands
| | - Marniza Saad
- Department of Clinical Oncology, Universiti Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Cuno S P M Uiterwaal
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht University, Heidelberglaan, Utrecht, the Netherlands
| | - Nirmala Bhoo-Pathy
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
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Subramaniam S, Kong YC, Zaharah H, Uiterwaal CSPM, Richard A, Taib NA, Deniel A, Chee KH, Bustamam RS, See MH, Fong A, Yip CH, Bhoo-Pathy N. Baseline cardiovascular comorbidities, and the influence on cancer treatment decision-making in women with breast cancer. Ecancermedicalscience 2021; 15:1293. [PMID: 34824616 PMCID: PMC8580595 DOI: 10.3332/ecancer.2021.1293] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose To measure the baseline prevalence of cardiovascular disease (CVD), its modifiable and non-modifiable risk factors in breast cancer patients, and determine their association with adjuvant treatment decision-making. Method From 2016 to 2017, 2,127 women newly-diagnosed with breast cancer were prospectively recruited. Participants’ cardiovascular biomarkers were measured prior to adjuvant treatment decision-making. Clinical data and medical histories were obtained from hospital records. Adjuvant treatment decisions were collated 6–8 months after recruitment. A priori risk of cardiotoxicity was predicted using the Cardiotoxicity Risk Score. Results Mean age was 54 years. Eighty-five patients had pre-existing cardiac diseases and 30 had prior stroke. Baseline prevalence of hypertension was 47.8%. Close to 20% had diabetes mellitus, or were obese. Dyslipidaemia was present in 65.3%. The proportion of women presenting with ≥2 modifiable CVD risk factors at initial cancer diagnosis was substantial, irrespective of age. Significant ethnic variations were observed. Multivariable analyses showed that pre-existing CVD was consistently associated with lower administration of adjuvant breast cancer therapies (odds ratio for chemotherapy: 0.32, 95% confidence interval: 0.17–0.58). However, presence of multiple risk factors of CVD did not appear to influence adjuvant treatment decision-making. In this study, 63.6% of patients were predicted to have high risks of developing cardiotoxicities attributed to a high baseline burden of CVD risk factors and anthracycline administration. Conclusion While recent guidelines recommend routine assessment of cardiovascular comorbidities in cancer patients prior to initiation of anticancer therapies, this study highlights the prevailing gap in knowledge on how such data may be used to optimise cancer treatment decision-making.
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Affiliation(s)
- Shridevi Subramaniam
- Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia.,Centre of Clinical Epidemiology, Institute for Clinical Research, National Institutes of Health, Setia Alam, 40170 Shah Alam, Malaysia
| | - Yek-Ching Kong
- Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia.,Centre for Epidemiology and Evidence-Based Practice, Faculty of Medicine, Universiti Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia
| | - Hafizah Zaharah
- Department of Radiotherapy & Oncology, National Cancer Institute, 62250 Putrajaya, Malaysia
| | - Cuno S P M Uiterwaal
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | - Andrea Richard
- Centre of Clinical Epidemiology, Institute for Clinical Research, National Institutes of Health, Setia Alam, 40170 Shah Alam, Malaysia
| | - Nur Aishah Taib
- Department of Surgery, Faculty of Medicine, Universiti Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia
| | - Azura Deniel
- Department of Radiotherapy and Oncology, Hospital Kuala Lumpur, 50586 Kuala Lumpur, Malaysia
| | - Kok-Han Chee
- Cardiology Unit, Department of Medicine, Faculty of Medicine, Universiti Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia
| | - Ros Suzanna Bustamam
- Department of Radiotherapy and Oncology, Hospital Kuala Lumpur, 50586 Kuala Lumpur, Malaysia
| | - Mee-Hoong See
- Department of Surgery, Faculty of Medicine, Universiti Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia
| | - Alan Fong
- Sarawak Heart Centre, 94300 Kota Samarahan, Sarawak, Malaysia
| | - Cheng-Har Yip
- Subang Jaya Medical Centre, 47500 Subang Jaya, Selangor, Malaysia
| | - Nirmala Bhoo-Pathy
- Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia.,Centre for Epidemiology and Evidence-Based Practice, Faculty of Medicine, Universiti Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia
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Rusmawatiningtyas D, Rahmawati A, Makrufardi F, Mardhiah N, Murni IK, Uiterwaal CSPM, Savitri AI, Kumara IF, Nurnaningsih. Factors associated with mortality of pediatric sepsis patients at the pediatric intensive care unit in a low-resource setting. BMC Pediatr 2021; 21:471. [PMID: 34696763 PMCID: PMC8543407 DOI: 10.1186/s12887-021-02945-0] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background Sepsis is the leading cause of death worldwide in pediatric populations. Studies in low-resource settings showed that the majority of pediatric patients with sepsis still have a high mortality rate. Methods We retrospectively collected records from 2014 to 2019 of patients who had been diagnosed with sepsis and admitted to PICU in our tertiary hospital. Cox proportional hazard regression modeling was used to evaluate associations between patient characteristics and mortality. Results Overall, 665 patients were enrolled in this study, with 364 (54.7%) boys and 301 (46.3%) girls. As many as 385 patients (57.9%) died during the study period. The median age of patients admitted to PICU were 1.8 years old with interquartile range (IQR) ±8.36 years and the median length of stay was 144 h (1–1896 h). More than half 391 patients (58.8%) had a good nutritional status. Higher risk of mortality in PICU was associated fluid overload percentage of > 10% (HR 9.6, 95% CI: 7.4–12.6), the need of mechanical ventilation support (HR 2.7, 95% CI: 1.6–4.6), vasoactive drugs (HR 1.5, 95% CI: 1.2–2.0) and the presence of congenital anomaly (HR 1.4, 95% CI: 1.0–1.9). On the contrary, cerebral palsy (HR 0.3, 95% CI: 0.1–0.5) and post-operative patients (HR 0.4, 95% CI: 0.3–0.6) had lower mortality. Conclusion PICU mortality in pediatric patients with sepsis is associated with fluid overload percentage of > 10%, the need for mechanical ventilation support, the need of vasoactive drugs, and the presence of congenital anomaly. In septic patients in PICU, those with cerebral palsy and admitted for post-operative care had better survival.
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Affiliation(s)
- Desy Rusmawatiningtyas
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia.
| | - Arini Rahmawati
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia
| | - Firdian Makrufardi
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia
| | - Nurul Mardhiah
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia
| | - Indah Kartika Murni
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia
| | - Cuno S P M Uiterwaal
- Clinical Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands
| | - Ary I Savitri
- Clinical Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands
| | - Intan Fatah Kumara
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia
| | - Nurnaningsih
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia
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Safari D, Gultom SM, Tafroji W, Azzahidah A, Soesanti F, Khoeri MM, Prayitno A, Pimenta FC, da Gloria Carvalho M, Uiterwaal CSPM, Putri ND. Prevalence, serotype and antibiotic susceptibility of Group B Streptococcus isolated from pregnant women in Jakarta, Indonesia. PLoS One 2021; 16:e0252328. [PMID: 34043711 PMCID: PMC8158947 DOI: 10.1371/journal.pone.0252328] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/13/2021] [Indexed: 01/31/2023] Open
Abstract
Group B Streptococcus (GBS) is a bacterial pathogen which is a leading cause of neonatal infection. Currently, there are limited GBS data available from the Indonesian population. In this study, GBS colonization, serotype distribution and antimicrobial susceptibility profile of isolates were investigated among pregnant women in Jakarta, Indonesia. Demographics data, clinical characteristics and vaginal swabs were collected from 177 pregnant women (mean aged: 28.7 years old) at 29–40 weeks of gestation. Bacterial culture identification tests and latex agglutination were performed for GBS. Serotyping was done by conventional multiplex PCR and antibiotic susceptibility testing by broth microdilution. GBS colonization was found in 53 (30%) pregnant women. Serotype II was the most common serotype (30%) followed by serotype III (23%), Ia and IV (13% each), VI (8%), Ib and V (6% each), and one non-typeable strain. All isolates were susceptible to vancomycin, penicillin, ampicillin, cefotaxime, daptomycin and linezolid. The majority of GBS were resistant to tetracycline (89%) followed by clindamycin (21%), erythromycin (19%), and levofloxacin (6%). The serotype III was more resistant to erythromycin, clindamycin, and levofloxacin and these isolates were more likely to be multidrug resistant (6 out of 10) compared to other serotypes. This report provides demographics of GBS colonization and isolate characterization in pregnant women in Indonesia. The results may facilitate preventive strategies to reduce neonatal GBS infection and improve its treatment.
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Affiliation(s)
- Dodi Safari
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Septiani Madonna Gultom
- Faculty of Medicine, Department of Child Health, Universitas Indonesia/Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Wisnu Tafroji
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | | | - Frida Soesanti
- Faculty of Medicine, Department of Child Health, Universitas Indonesia/Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | | | - Ari Prayitno
- Faculty of Medicine, Department of Child Health, Universitas Indonesia/Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Fabiana C. Pimenta
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Maria da Gloria Carvalho
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Cuno S. P. M. Uiterwaal
- Julius Center for Health Sciences and Primary Care, Julius Global Health, University Medical Center, Utrecht, the Netherlands
| | - Nina Dwi Putri
- Faculty of Medicine, Department of Child Health, Universitas Indonesia/Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
- * E-mail:
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9
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Arafuri N, Murni IK, Idris NS, Uiterwaal CSPM, Savitri AI, Nugroho S, Noormanto N. Survival of Left-to-Right Shunt Repair in Children with Pulmonary Arterial Hypertension at a Tertiary Hospital in a Low-to-Middle-Income Country. Glob Heart 2021; 16:25. [PMID: 34040938 PMCID: PMC8064284 DOI: 10.5334/gh.831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 03/24/2021] [Indexed: 01/22/2023] Open
Abstract
Background In low-to-middle-income countries, repair of the left-to-right shunts congenital heart disease (CHD) are often done with existing pulmonary arterial hypertension (PAH). Long-term outcomes data of this condition in either low-to-middle or high-income countries are limited. We conducted a study to evaluate the outcomes of children with PAH related to left-to-right shunt CHD who underwent surgical or transcatheter repair. Methods All cases of PAH related to left-to-right shunt CHD repairs from 2015-2018 were retrospectively reviewed with additional new patients who underwent repair within our study period (2019-2020). Cases with complex congenital heart disease and incomplete hemodynamic echocardiography or catheterization measurements were excluded. Kaplan-Meier curves, log-rank test, Cox regression with Firth's correction and restricted mean survival time were used for survival analysis. Results Of the 118 patients, 103 patients were enrolled and 15 patients were excluded due to complex congenital heart disease and missing hemodynamic measurements prior to repair. Overall, median age at intervention was 44 months, mPAP mean was 43.17 ± 16.05 mmHg and Pulmonary Vascular Resistance index (PVRi) mean was 2.84 ± 2.09 (WU.m2). Nine patients died after repair. The survival rate for patients with PAH-CHD at 1 day, 30 days and 1400 days (4 years) was 96.1%, 92.1%, and 91.0% respectively. Patients with persisting PAH after correction had -476.1 days (95% confidence interval [CI]: -714.4, -237,8) shorter survival over 4 years of follow up compared to patients with reversed PAH. PVRi was found to be the influencing covariate of the difference of restricted mean survival time between these groups. Conclusion In low-to-middle income settings, with accurate PAH reversibility assessment prior to intervention, repair of left-to-right shunt CHD with existing PAH in children has a favourable outcome. Inferior survival is found in patients with persistence of PAH. PVRi at baseline predicts between-group survival difference.
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Affiliation(s)
- Nadya Arafuri
- Department of Pediatrics, Dr. Sardjito Hospital, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, ID
| | - Indah K. Murni
- Department of Pediatrics, Dr. Sardjito Hospital, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, ID
| | - Nikmah S. Idris
- Pulmonary Hypertension Department, Great Ormond Street Hospital for Children, London, GB
| | - Cuno S. P. M. Uiterwaal
- Clinical epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, NL
| | - Ary I. Savitri
- Clinical epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, NL
| | - Sasmito Nugroho
- Department of Pediatrics, Dr. Sardjito Hospital, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, ID
| | - Noormanto Noormanto
- Department of Pediatrics, Dr. Sardjito Hospital, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, ID
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10
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Anindyajati G, Wiguna T, Murtani BJ, Christian H, Wigantara NA, Putra AA, Hanafi E, Minayati K, Ismail RI, Kaligis F, Savitri AI, Uiterwaal CSPM, Diatri H. Anxiety and Its Associated Factors During the Initial Phase of the COVID-19 Pandemic in Indonesia. Front Psychiatry 2021; 12:634585. [PMID: 33790817 PMCID: PMC8006395 DOI: 10.3389/fpsyt.2021.634585] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 02/15/2021] [Indexed: 01/20/2023] Open
Abstract
Introduction: Coronavirus disease 2019 (COVID-19) is caused by a novel coronavirus which has not been identified previously in humans. The disease leads to respiratory problems, systemic disorders, and death. To stop the virus transmission, physical distancing was strongly implemented, including working and school from home (WFH & SFH). The limitation altered daily routines and needs advanced to adapt. Many have felt uncomfortable and this could have triggered anxiety symptoms. This study aimed to evaluate the proportion of significant anxiety symptoms and its association with COVID-19-related situations in an Indonesian context during the initial months of the pandemic. Methods: An online community survey was distributed through social media and communication platforms, mainly WhatsApp, targeting people >18 years old in Indonesia. Anxiety symptoms were assessed using Generalized Anxiety Disorder-7 (Indonesian Version). Demographical data and information on social situation related to the COVID-19 pandemic were collected. The proportion of clinically significant anxiety symptoms was calculated and the association with demographic and social factors was assessed using chi square test (χ2) and logistic regression for multivariate analysis. Results: Out of 1215 subjects that completed the survey, 20.2% (n = 245) exhibited significant anxiety symptoms. Several factors, such as age (AOR = 0.933 CI 95% = 0.907-0.96), sex (AOR = 1.612 CI 95% = 1.097-2.369), medical workers (AOR = 0.209 CI 95% = 0.061-0.721), suspected case of COVID-19 (AOR = 1.786 CI 95% = 1.001-3.186), satisfaction level of family support (AOR = 3.052 CI 95% = 1.883-4.946), and satisfaction level of co-workers (AOR = 2.523 CI 95% = 1.395-4.562), were associated with anxiety. Conclusion: One out of five Indonesian people could have suffered from anxiety during the COVID-19 pandemic. The riskiest group being young females, people who had suspected cases of COVID-19, and those with less satisfying social support. Nevertheless, health workers were found to have a lesser risk of developing anxiety. Accessible information and healthcare, social connection, supportive environment, and mental health surveillance are important to prevent bigger psychiatric problems post-pandemic.
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Affiliation(s)
- Gina Anindyajati
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia—Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Tjhin Wiguna
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia—Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Belinda Julivia Murtani
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia—Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Hans Christian
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia—Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Ngurah Agung Wigantara
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia—Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Anggi Aviandri Putra
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia—Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Enjeline Hanafi
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia—Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Kusuma Minayati
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia—Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Raden Irawati Ismail
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia—Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Fransiska Kaligis
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia—Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Ary I. Savitri
- The Center for Clinical Epidemiology and Evidence-Based Medicine Faculty of Medicine, Universitas Indonesia—Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Cuno S. P. M. Uiterwaal
- Julius Global Health/Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Hervita Diatri
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia—Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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11
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Mappangara I, Qanitha A, Uiterwaal CSPM, Henriques JPS, de Mol BAJM. Tele-ECG consulting and outcomes on primary care patients in a low-to-middle income population: the first experience from Makassar telemedicine program, Indonesia. BMC Fam Pract 2020; 21:247. [PMID: 33250059 PMCID: PMC7702690 DOI: 10.1186/s12875-020-01325-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 11/18/2020] [Indexed: 11/18/2022]
Abstract
Background Telemedicine has been a popular tool to overcome the lack of access to healthcare facilities, primarily in underprivileged populations. We aimed to describe and assess the implementation of a tele-electrocardiography (ECG) program in primary care settings in Indonesia, and subsequently examine the short- and mid-term outcomes of patients who have received tele-ECG consultations. Methods ECG recordings from thirty primary care centers were transmitted to Makassar Cardiac Center, Indonesia from January to July 2017. We cross-sectionally measured the performance of this tele-ECG program, and prospectively sent a detailed questionnaire to general practitioners (GPs) at the primary care centers. We performed follow-up at 30 days and at the end of the study period to assess the patient outcomes. Results Of 505 recordings, all (100%) ECGs were qualified for analysis, and about half showed normal findings. The mean age of participants was 53.3 ± 13.6 years, and 40.2% were male. Most (373, 73.9%) of these primary care patients exhibited manifested CVD symptom with at least one risk factor. Male patients had more ischemic ECGs compared to women (p < 0.01), while older age (> 55 years) was associated with ischemic or arrhythmic ECGs (p < 0.05). Factors significantly associated with a normal ECG were younger age, female gender, lower blood pressure and heart rate, and no history of previous cardiovascular disease (CVD) or medication. More patients with an abnormal ECG had a history of hypertension, known diabetes, and were current smokers (p < 0.05). Of all tele-consultations, GPs reported 95% of satisfaction rate, and 296 (58.6%) used tele-ECG for an expert opinion. Over the total follow-up (14 ± 6.6 months), seven (1.4%) patients died and 96 (19.0%) were hospitalized for CVD. Of 88 patients for whom hospital admission was advised, 72 (81.8%) were immediately referred within 48 h following the tele-ECG consultation. Conclusions Tele-ECG can be implemented in Indonesian primary care settings with limited resources and may assist GPs in immediate triage, resulting in a higher rate of early hospitalization for indicated patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-020-01325-4.
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Affiliation(s)
- Idar Mappangara
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Andriany Qanitha
- Department of Physiology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia. .,Department of Cardio-thoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands.
| | - Cuno S P M Uiterwaal
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jose P S Henriques
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Bastianus A J M de Mol
- Department of Cardio-thoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
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12
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Hartog ID, Zomers ML, van Thiel GJMW, Leget C, Sachs APE, Uiterwaal CSPM, van den Berg V, van Wijngaarden E. Prevalence and characteristics of older adults with a persistent death wish without severe illness: a large cross-sectional survey. BMC Geriatr 2020; 20:342. [PMID: 32943009 PMCID: PMC7495831 DOI: 10.1186/s12877-020-01735-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 08/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Some older persons develop a persistent death wish without being severely ill, often referred to as "completed life" or "tiredness of life". In the Netherlands and Belgium, the question whether these persons should have legal options for euthanasia or physician-assisted suicide (EAS) is intensely debated. Our main aim was to investigate the prevalence and characteristics of older adults with a persistent death wish without severe illness, as the lack of this knowledge is a crucial problem in de debate. METHODS We conducted a survey among a representative sample of 32,477 Dutch citizens aged 55+, comprising questions about health, existential issues and the nature of the death wish. Descriptive statistics were used to describe the group with a persistent death wish and no severe illness (PDW-NSI) and several subgroups. RESULTS A total of 21,294 respondents completed the questionnaire (response rate 65.6%). We identified 267 respondents (1.25%) as having a persistent death wish and no severe illness (PDW-NSI). PDW-NSI did not only occur among the oldest old. Although qualifying themselves as "not severely ill", those with PDW-NSI reported considerable health problems. A substantial minority of the PDW-NSI-group reported having had a death wish their whole lives. Within the group PDW-NSI 155 (0.73%) respondents had an active death wish, of which 36 (0.17% of the total response) reported a wish to actually end their lives. Thus, a death wish did not always equal a wish to actually end one's life. Moreover, the death wishes were often ambiguous. For example, almost half of the PDW-NSI-group (49.1%) indicated finding life worthwhile at this moment. CONCLUSIONS The identified characteristics challenge the dominant "completed life" or "tiredness of life" image of healthy persons over the age of 75 who, overseeing their lives, reasonably decide they would prefer to die. The results also show that death wishes without severe illness are often ambiguous and do not necessarily signify a wish to end one's life. It is of great importance to acknowledge these nuances and variety in the debate and in clinical practice, to be able to adequately recognize the persons involved and tailor to their needs.
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Affiliation(s)
- Iris D Hartog
- Department of Care Ethics, University of Humanistic Studies, Utrecht, The Netherlands
| | - Margot L Zomers
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center, P.O. Box 85060, 3508 AB, Utrecht, The Netherlands.
| | - Ghislaine J M W van Thiel
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center, P.O. Box 85060, 3508 AB, Utrecht, The Netherlands
| | - Carlo Leget
- Department of Care Ethics, University of Humanistic Studies, Utrecht, The Netherlands
| | - Alfred P E Sachs
- Department of Family Medicine, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
| | - Cuno S P M Uiterwaal
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
| | - Vera van den Berg
- Department of Care Ethics, University of Humanistic Studies, Utrecht, The Netherlands
| | - Els van Wijngaarden
- Department of Care Ethics, University of Humanistic Studies, Utrecht, The Netherlands
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13
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Gunning MN, Sir Petermann T, Crisosto N, van Rijn BB, de Wilde MA, Christ JP, Uiterwaal CSPM, de Jager W, Eijkemans MJC, Kunselman AR, Legro RS, Fauser BCJM. Cardiometabolic health in offspring of women with PCOS compared to healthy controls: a systematic review and individual participant data meta-analysis. Hum Reprod Update 2020; 26:103-117. [PMID: 31867675 PMCID: PMC7007319 DOI: 10.1093/humupd/dmz036] [Citation(s) in RCA: 45] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 07/28/2019] [Accepted: 08/08/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Women diagnosed with polycystic ovary syndrome (PCOS) suffer from an unfavorable cardiometabolic risk profile, which is already established by child-bearing age. OBJECTIVE AND RATIONALE The aim of this systematic review along with an individual participant data meta-analysis is to evaluate whether cardiometabolic features in the offspring (females and males aged 1–18 years) of women with PCOS (OPCOS) are less favorable compared to the offspring of healthy controls. SEARCH METHODS PubMed, Embase and gray literature databases were searched by three authors independently (M.N.G., M.A.W and J.C.) (last updated on 1 February 2018). Relevant key terms such as ‘offspring’ and ‘PCOS’ were combined. Outcomes were age-specific standardized scores of various cardiometabolic parameters: BMI, blood pressure, glucose, insulin, lipid profile and the sum scores of various cardiometabolic features (metabolic sum score). Linear mixed models were used for analyses with standardized beta (β) as outcome. OUTCOMES Nine relevant observational studies could be identified, which jointly included 1367 children: OPCOS and controls, originating from the Netherlands, Chile and the USA. After excluding neonates, duplicate records and follow-up screenings, a total of 885 subjects remained. In adjusted analyses, we observed that OPCOS (n = 298) exhibited increased plasma levels of fasting insulin (β = 0.21(95%CI: 0.01–0.41), P = 0.05), insulin-resistance (β = 0.21(95%CI: 0.01–0.42), P = 0.04), triglycerides (β = 0.19(95%CI: 0.02–0.36), P = 0.03) and high-density lipoprotein (HDL)-cholesterol concentrations (β = 0.31(95%CI: 0.08–0.54), P < 0.01), but a reduced birthweight (β = −116(95%CI: −195 to 38), P < 0.01) compared to controls (n = 587). After correction for multiple testing, however, differences in insulin and triglycerides lost their statistical significance. Interaction tests for sex revealed differences between males and females when comparing OPCOS versus controls. A higher 2-hour fasting insulin was observed among female OPCOS versus female controls (estimated difference for females (βf) = 0.45(95%CI: 0.07 to 0.83)) compared to the estimated difference between males ((βm) = −0.20(95%CI: −0.58 to 0.19)), with interaction-test: P = 0.03. Low-density lipoprotein–cholesterol differences in OPCOS versus controls were lower among females (βf = −0.39(95%CI: −0.62 to 0.16)), but comparable between male OPCOS and male controls (βm = 0.27(95%CI: −0.03 to 0.57)), with interaction-test: P < 0.01. Total cholesterol differences in OPCOS versus controls were also lower in females compared to the difference in male OPCOS and male controls (βf = −0.31(95%CI: −0.57 to 0.06), βm = 0.28(95%CI: −0.01 to 0.56), interaction-test: P = 0.01). The difference in HDL-cholesterol among female OPCOS versus controls (βf = 0.53(95%CI: 0.18–0.88)) was larger compared to the estimated mean difference among OPCOS males and the male controls (βm = 0.13(95%CI: −0.05−0.31), interaction-test: P < 0.01). Interaction test in metabolic sum score revealed a significant difference between females (OPCOS versus controls) and males (OPCOS versus controls); however, sub analyses performed in both sexes separately did not reveal a difference among females (OPCOS versus controls: βf = −0.14(95%CI: −1.05 to 0.77)) or males (OPCOS versus controls: βm = 0.85(95%CI: −0.10 to 1.79)), with P-value < 0.01. WIDER IMPLICATIONS We observed subtle signs of altered cardiometabolic health in OPCOS. Therefore, the unfavorable cardiovascular profile of women with PCOS at childbearing age may—next to a genetic predisposition—influence the health of their offspring. Sensitivity analyses revealed that these differences were predominantly observed among female offspring aged between 1 and 18 years. Moreover, studies with minimal risk of bias should elucidate the influence of a PCOS diagnosis in mothers on both sexes during fetal development and subsequently during childhood.
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Affiliation(s)
- Marlise N Gunning
- Department of Reproductive Medicine, Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Teresa Sir Petermann
- Endocrinology and Metabolism, University of Chile, Santiago, Chile.,Unit of Endocrinology, Clinica Las Condes, Santiago, Chile
| | - Nicolas Crisosto
- Endocrinology and Metabolism, University of Chile, Santiago, Chile.,Unit of Endocrinology, Clinica Las Condes, Santiago, Chile
| | - Bas B van Rijn
- Department of Obstetrics and Gynecology, Erasmus Medical Center, University Medical Center Rotterdam, The Netherlands.,Department of Obstetrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Marlieke A de Wilde
- Department of Reproductive Medicine, Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jacob P Christ
- Department of Reproductive Medicine, Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - C S P M Uiterwaal
- Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wilco de Jager
- Department of Pediatric Immunology, Centre for Molecular and Cellular Intervention, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marinus J C Eijkemans
- Department of Reproductive Medicine, Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Allen R Kunselman
- Department of Obstetrics and Gynecology, Penn State University College of Medicine, Hershey, PA, USA
| | - Richard S Legro
- Department of Obstetrics and Gynecology, Penn State University College of Medicine, Hershey, PA, USA
| | - Bart C J M Fauser
- Department of Reproductive Medicine, Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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14
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Soesanti F, Idris NS, Klipstein-Grobusch K, Hendarto A, Grobbee DE, Uiterwaal CSPM. The effect of non-organophosphate household pesticides exposure during pregnancy on infants birth sizes and growth rate: a cohort study. BMC Pregnancy Childbirth 2020; 20:476. [PMID: 32819320 PMCID: PMC7441723 DOI: 10.1186/s12884-020-03162-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 08/10/2020] [Indexed: 12/17/2022] Open
Abstract
Background To date, there is limited evidence on the effect of antenatal exposure to non-organophosphate household pesticides on infant health. Our hypothesis is that antenatal exposure to non-organophosphate household pesticides will be associated with birth sizes and infant growth rate. Methods In this prospective cohort study, 284 mother-infant pairs were studied. Mothers were recruited at the third trimester in two primary care centers and one private hospital in Jakarta, Indonesia. Mothers filled out questionnaires about exposure to non-organophosphate household pesticides at the 3rd trimester of pregnancy. Birth weight and length were measured at birth. Afterwards, the weight, height, and head circumference (HC) were measured at 7 days, 1, 2, 4, and 6 months of age. Linear mixed modeling and linear regression was performed to calculate growth rate of each infant. Multivariable linear regression adjusted for confounders was used to assess the association between household pesticides exposure and birth sizes and infant growth rate. Results Based on self-report questionnaires, 133 (46.8%) mothers were exposed to household pesticides during pregnancy. The mean HC at day 7 in the exposed group was − 7.1 mm (95%CI -13.1;-1.2) lower than in the non-exposed group. The difference was more prominent in the non-mosquito pesticide group (linear regression coefficient: − 22.1 mm, 95%CI -36.5;-7.6). No material associations were found between antenatal exposure to household pesticides with other growth measures, including weight gain, length gain, HC increment and weight-to-length gain rates. No modification of effects by breastfeeding was found. Conclusions Our findings suggest that antenatal exposure to household non-organophosphate pesticides is associated with smaller head circumference at birth.
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Affiliation(s)
- Frida Soesanti
- Department of Child Health, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo General Hospital, Jakarta, Indonesia. .,Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands.
| | - Nikmah S Idris
- Department of Child Health, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.,Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands.,Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Aryono Hendarto
- Department of Child Health, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Cuno S P M Uiterwaal
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands
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15
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Pollet V, Castelein RM, van de Sande M, Witbreuk M, Mostert AK, Besselaar A, van Bergen C, Beek E, Uiterwaal CSPM, Sakkers RJB. Abduction treatment in stable hip dysplasia does not alter the acetabular growth: results of a randomized clinical trial. Sci Rep 2020; 10:9647. [PMID: 32541874 PMCID: PMC7296030 DOI: 10.1038/s41598-020-66634-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 05/22/2020] [Indexed: 11/09/2022] Open
Abstract
Background The effect of bracing over natural history of stable dysplastic hips is not well known. This multicenter randomized trial aimed at objectifying the effect of abduction treatment versus active surveillance in infants of 3 to 4 months of age. Methods Patients were randomized to either Pavlik harness or active surveillance group. Ultrasound was repeated at 6 and 12 weeks post randomization. The primary outcome was the degree of dysplasia using the Graf α-angle at 6 months of age. The measurement of the acetabular index (AI) on plain pelvis X-rays was used to identify persistent dysplasia after 9 months and walking age (after 18 months). Findings The Pavlik harness group (n = 55) and active surveillance group (n = 49) were comparable for predictors of outcome. At 12 weeks follow-up the mean α-angle was 60.5° ± 3.8° in the Pavlik harness group and 60.0° ± 5.6° in the active surveillance group. (p = 0.30). Analysis of secondary outcomes (standard of care) showed no treatment differences for acetabular index at age 10 months (p = 0.82) and walking age (p = 0.35). Interpretation Pavlik harness treatment of stable but sonographic dysplastic hips has no effect on acetabular development. Eighty percent of the patients will have a normal development of the hip after twelve weeks. Therefore, we recommend observation rather than treatment for stable dysplastic hips.
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Affiliation(s)
- V Pollet
- Royal Manchester Children's hospital, Department of Pediatric Orthopedics and Traumatology, Manchester, United Kingdom.
| | - R M Castelein
- University Medical Center Utrecht, Department of Orthopedics, Utrecht, The Netherlands
| | - M van de Sande
- Leiden University Medical Center, Leiden, The Netherlands
| | - M Witbreuk
- Amsterdam Medical University Center, Amsterdam, The Netherlands
| | | | - A Besselaar
- Maxima Medical Center, Eindhoven, The Netherlands
| | - C van Bergen
- University Medical Center Utrecht, Department of Orthopedics, Utrecht, The Netherlands
| | - E Beek
- University Medical Center Utrecht, Department of Radiology, Utrecht, The Netherlands
| | - C S P M Uiterwaal
- University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - R J B Sakkers
- University Medical Center Utrecht, Department of Orthopedics, Utrecht, The Netherlands
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16
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Qanitha A, Uiterwaal CSPM, Henriques JPS, Mappangara I, Amir M, Saing SG, de Mol BAJM. Adherence to guideline recommendations for coronary angiography in a poor South-East Asian setting: Impact on short- and medium-term clinical outcomes. Sci Rep 2019; 9:19163. [PMID: 31844078 PMCID: PMC6915772 DOI: 10.1038/s41598-019-55299-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 11/25/2019] [Indexed: 11/09/2022] Open
Abstract
In South-East Asian populations and particularly in Indonesia, access to coronary angiography (CAG) is limited. We aimed to assess the adherence for undergoing CAG for indicated patients, according to the guideline recommendations. We then examined whether this adherence would have an impact on patients' short- and medium-term mortality and morbidity. We consecutively enrolled 474 patients with acute and stable coronary artery disease who had indication for CAG at Makassar Cardiac Center, Indonesia from February 2013 to December 2014. We found that adherence to CAG recommendation in poor South-East Asian setting is low. Of 474 recommended patients, only 273 (57.6%) underwent the procedure. Factors for not undergoing CAG were: older age, female gender, low educational and socio-economic status, and insurance type. While reasons for patients refusing CAG and subsequent intervention included fear, symptoms reduction, and lack of trust concerning the procedure benefit. During follow-up (median 19 (IQR 6-39.3) months), 155 (32.7%) patients died, and 259 (54.6%) experienced at least one adverse event. Adherence to CAG recommendation was associated with a significantly lower short- and medium-term mortality, independent of revascularization and other potential confounders. In sub-group analysis, adhered patients "with revascularization" had significantly better outcomes compared to the "non-revascularization" and "not adhere" groups.
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Affiliation(s)
- Andriany Qanitha
- Department of Cardio-thoracic Surgery, AMC Heart Center, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands. .,Department of Physiology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
| | - Cuno S P M Uiterwaal
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jose P S Henriques
- Department of Cardiology, AMC Heart Center, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Idar Mappangara
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Muzakkir Amir
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Sumarsono G Saing
- Makassar Cardiac Center, Catheterization Laboratory Unit, DR. Wahidin Sudirohusodo Hospital, Makassar, Indonesia
| | - Bastianus A J M de Mol
- Department of Cardio-thoracic Surgery, AMC Heart Center, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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17
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Idris NS, Uiterwaal CSPM, Burgner DP, Grobbee DE, Kurniati N, Cheung MMH. Effects of HIV Infection on Pulmonary Artery Pressure in Children. Glob Heart 2019; 14:367-372. [PMID: 31611153 DOI: 10.1016/j.gheart.2019.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 08/20/2019] [Accepted: 08/24/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Pulmonary hypertension may complicate human immunodeficiency virus (HIV) infection and result in right ventricular (RV) failure and premature death. There are limited data of the effects of childhood HIV infection or antiretroviral therapy (ART) on pulmonary artery pressure (PAP). OBJECTIVES To establish if there is an association between childhood HIV infection or its treatment and pulmonary artery pressure. METHODS The study conducted a cross-sectional study of 102 HIV-infected (48 ART-naïve, 54 ART-exposed) and 51 HIV-uninfected children in Jakarta, Indonesia, to estimate PAP using echocardiography parameters: tricuspid regurgitation peak velocity (TRV), left ventricular systolic index and diastolic eccentricity index (EI), and RV systolic function, assessed by tricuspid annulus plane systolic excursion. The association between either ART-naive or ART-exposed HIV and PAP was explored using general linear modelling adjusted for potential confounders. RESULTS ART-exposed HIV-infected children had higher TRV (adjusted difference: 0.36 m/s; 95% confidence interval [CI]: 0.12 to 0.60; p = 0.003) and diastolic EI (adjusted difference 0.06; 95% CI: 0.01 to 0.11; p = 0.02) than did uninfected children. The EI in ART-exposed children was significantly higher than normal. ART-naive HIV-infected children had a lower tricuspid annulus plane systolic excursion (adjusted difference: -2.2 mm; 95% CI: -3.73 to -0.71; p = 0.004), despite no difference in TRV (adjusted difference: 0.18 m/s; 95% CI: -0.06 to 0.43 m/s; p = 0.14). Seven (13%) ART-exposed and 4 (8.3%) ART-naïve HIV-infected children had pulmonary hypertension. Within-HIV group comparisons showed that accounting for lower respiratory tract infections attenuated the lower RV systolic function in ART-naïve children but not in ART-exposed children (difference: -1.1 mm; 95% CI:-2.8 to 0.7 mm; p = 0.22), but not the higher left ventricular eccentricity indexes in the ART-exposed children (systolic difference: 0.07; 95% CI: 0.02 to 0.12; p = 0.007; diastolic difference: 0.08; 95% CI: 0.02 to 0.14; p = 0.006). CONCLUSIONS ART-exposed HIV infection is associated with higher estimated PAP. Reduced RV systolic function is seen in ART-naïve HIV infection. Lower respiratory tract infection partly explains lower systolic RV function in ART-naïve relative to ART-exposed HIV infection.
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Affiliation(s)
- Nikmah S Idris
- Department of Child Health, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia; Department of Paediatrics, University of Melbourne/Royal Children's Hospital Melbourne/Heart Research Group Murdoch Children's Research Institute, Parkville, Victoria, Australia; Julius Global Health/Julius Center for Primary Care and Health Sciences, University Medical Center Utrecht, the Netherlands
| | - Cuno S P M Uiterwaal
- Julius Global Health/Julius Center for Primary Care and Health Sciences, University Medical Center Utrecht, the Netherlands.
| | - David P Burgner
- Department of Paediatrics, University of Melbourne/Royal Children's Hospital Melbourne/Heart Research Group Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, Monash University, Clayton, Australia
| | - Diederick E Grobbee
- Julius Global Health/Julius Center for Primary Care and Health Sciences, University Medical Center Utrecht, the Netherlands
| | - Nia Kurniati
- Department of Child Health, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Michael M H Cheung
- Department of Paediatrics, University of Melbourne/Royal Children's Hospital Melbourne/Heart Research Group Murdoch Children's Research Institute, Parkville, Victoria, Australia
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18
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Soesanti F, Uiterwaal CSPM, Grobbee DE, Hendarto A, Dalmeijer GW, Idris NS. Antenatal exposure to second hand smoke of non-smoking mothers and growth rate of their infants. PLoS One 2019; 14:e0218577. [PMID: 31220162 PMCID: PMC6586334 DOI: 10.1371/journal.pone.0218577] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 06/04/2019] [Indexed: 11/30/2022] Open
Abstract
Objectives There is limited evidence on the effect of exposure to second hand smoke (SHS) in non-smoking pregnant mothers and infant health. We assessed the effects of maternal antenatal exposure to SHS on infant growth rate, and secondarily, on birth weight, birth length and head circumference at birth. Methods In this prospective cohort, 305 mother-infant pairs were studied. Mothers filled out questionnaires about exposure to SHS in pregnancy at the 3rd trimester of pregnancy. Infant anthropometry was performed at birth, day 7, and months 1, 2, 4, and 6, postnatally. Linear mixed modeling and linear regression were used to calculate growth rates over the first 6 months. The association between SHS-exposure with growth rate and birth sizes was assessed using multivariate linear regression adjusted for confounders, with SHS as both number of cigarettes and as groups (no exposure, SHS < 23 cigarettes, SHS ≥ 23 cigarettes). Results Seventy-three mothers were not exposed and 232 were exposed. SHS exposure (per cigarette) was not related to gain in weight, length, head circumference, and weight for length. However, infants born to mothers exposed to ≥ 23 cigarettes/d had lower head circumference gain (-0.32 mm/m, 95% CI -0.60, -0.03) than those born to non-exposed mothers. SHS exposure (per cigarette) was not related to birth weight, length, and head circumference, but exposure to ≥ 23 cigarettes was related to lower head circumference at birth (-11.09 mm, -20.03, -2.16). Conclusions Heavy antenatal exposure to SHS in non-smoking mothers results in reduced neonatal head circumference at birth and head circumference gain over the first 6 months of life. Our findings show no clear relations between exposure to SHS during pregnancy and other markers of neonatal growth and birth size.
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Affiliation(s)
- Frida Soesanti
- Department of Child Health, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
- Julius Center for Health Sciences and Primary Care, Julius Global Health, University Medical Center, Utrecht, the Netherlands
- * E-mail:
| | - Cuno S. P. M. Uiterwaal
- Julius Center for Health Sciences and Primary Care, Julius Global Health, University Medical Center, Utrecht, the Netherlands
| | - Diederick E. Grobbee
- Julius Center for Health Sciences and Primary Care, Julius Global Health, University Medical Center, Utrecht, the Netherlands
| | - Aryono Hendarto
- Department of Child Health, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Geertje W. Dalmeijer
- Julius Center for Health Sciences and Primary Care, Julius Global Health, University Medical Center, Utrecht, the Netherlands
| | - Nikmah Salamia Idris
- Department of Child Health, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
- Julius Center for Health Sciences and Primary Care, Julius Global Health, University Medical Center, Utrecht, the Netherlands
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19
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Kansen HM, Le TM, Meijer Y, Uiterwaal CSPM, Knulst AC, van der Ent CK, van Erp FC. Perceived triggers of asthma impair quality of life in children with asthma. Clin Exp Allergy 2019; 49:980-989. [PMID: 31038823 PMCID: PMC6851977 DOI: 10.1111/cea.13407] [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] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/15/2019] [Accepted: 04/20/2019] [Indexed: 12/29/2022]
Abstract
Background Data on the impact of the number and nature of perceived asthma triggers on health‐related quality of life (HRQL) in children are scarce. Objective To investigate the impact of perceived asthma triggers on both asthma‐specific and generic HRQL in children. Methods A cross‐sectional study was conducted among children (7‐18 years) with asthma in secondary and tertiary care. Children were screened with electronic questionnaires regarding respiratory and allergic symptoms. Asthma‐specific HRQL was assessed using the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) (score range 1‐7) and generic HRQL using the RAND questionnaire (score range 7‐32). The Kruskal‐Wallis test and one‐way ANOVA were used to test the difference of, respectively, the PAQLQ and RAND scores across the number of perceived asthma triggers (0, 1‐2, 3‐4, or ≥ 5). Univariable and multivariable linear regression analyses were performed to evaluate the association between individual triggers and HRQL. Results A total of 527 children with a mean (SD) age of 12.1 (2.9) years were included. Children with a higher number of perceived triggers had significantly lower PAQLQ and RAND scores (ie poorer HRQL). The difference in PAQLQ scores was clinically relevant between children with 0 versus 3‐4 or ≥ 5 triggers and 1‐2 versus ≥ 5 triggers (mean difference 0.66, 1.02 and 0.63, respectively). Especially, non‐allergic triggers (physical exercise, the weather, (cigarette) smoke and emotions) were significantly associated with reduced PAQLQ scores. Emotions and food/drinks were associated with reduced RAND scores. Conclusion and Clinical Relevance A higher number of perceived triggers of asthma were associated with reduced HRQL in children with asthma. Especially, non‐allergic triggers were associated with reduced HRQL.
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Affiliation(s)
- Hannah M Kansen
- Department of Pediatric Pulmonology and Allergology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.,Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Thuy-My Le
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Yolanda Meijer
- Department of Pediatric Pulmonology and Allergology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Cuno S P M Uiterwaal
- Julius Center for Health Science and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - André C Knulst
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Cornelis K van der Ent
- Department of Pediatric Pulmonology and Allergology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Francine C van Erp
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
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20
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Versteege T, Karyanti MR, Septiani W, Widjanarko AL, Idris NS, Hendarto A, Grobbee DE, Burgner D, Uiterwaal CSPM, Bruijning-Verhagen PCJL. Increased Carotid Intima-Media Thickness in Children with a History of Dengue Hemorrhagic Fever. Am J Trop Med Hyg 2019; 100:630-634. [PMID: 30675845 DOI: 10.4269/ajtmh.18-0672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We assessed carotid intima-media thickness (cIMT) and arterial stiffness in 28 children and adolescents with previous dengue hemorrhagic fever (DHF) (mean interval between DHF and cardiovascular assessment, 8.4 years), and 34 controls in a low-resource setting. Participants with previous DHF had an adjusted increased cIMT of 42.6 µm (95% confidence interval [CI]: 10.0-75.3, P = 0.01), and 61.7 µm (95% CI: 21.5-102.0, P < 0.01) in a subgroup analysis on dengue shock syndrome. There were no differences in arterial stiffness. In this first exploratory study, children and adolescents with a history of DHF had an increased cIMT, which may be modulated by dengue severity.
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Affiliation(s)
- Tom Versteege
- Julius Global Health/Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mulya R Karyanti
- Department of Pediatrics, Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Witri Septiani
- Department of Pediatrics, Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Annisa L Widjanarko
- Department of Pediatrics, Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Nikmah S Idris
- Department of Pediatrics, Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.,Julius Global Health/Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Aryono Hendarto
- Department of Pediatrics, Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Diederick E Grobbee
- Julius Global Health/Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - David Burgner
- Department of Pediatrics, Monash University, Victoria, Australia.,Department of Pediatrics, University of Melbourne, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
| | - Cuno S P M Uiterwaal
- Julius Global Health/Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Patricia C J L Bruijning-Verhagen
- Julius Global Health/Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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21
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Karyanti MR, Uiterwaal CSPM, Hadinegoro SR, Jansen MAC, Heesterbeek JAPH, Hoes AW, Bruijning-Verhagen P. Clinical Course and Management of Dengue in Children Admitted to Hospital; A 5 Years Prospective Cohort Study in Jakarta, Indonesia. Pediatr Infect Dis J 2019; Publish Ahead of Print. [PMID: 30640199 DOI: 10.1097/inf.0000000000002277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Dengue incidence is rising globally which was estimated 100 million per year, whereas in Indonesia was estimated 7.5 million per year. Dengue clinical course varies from mild dengue fever (DF) to dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS). Patients, clinicians and care facilities would benefit if reliable predictors can determine at admission which cases with clinically suspected dengue will progress to DHF or DSS. METHODS From 2009 through 2013, a cohort of 496 children admitted with clinically suspected dengue at a tertiary care hospital in Jakarta, Indonesia in, was followed until discharge. We evaluated the clinical course and disease outcome of admitted patients, and estimated the burden of dengue cases hospitalized over time. RESULTS Of all 496 children, 185 (37%) were classified at admission as DF, 158 (32%) as DHF and 153 (31%) as DSS. Of DF patients, 52 (28%) progressed to DHF or DSS, 10 (5%) had other viral diseases. Of DHF patients, 9(6%) progressed to DSS. No patients died. Of 33 routinely collected parameters at admission, duration of fever ≤ 4 days was the only significant predictor of disease progression (p= 0.01). Between 2009 and 2013, annual dengue admissions declined, while the distribution of disease severity remained stable. CONCLUSIONS Almost a third of children admitted to tertiary care with clinically suspected DF progress to DHF or DSS. Among routinely collected parameters at admission, only fever duration was significantly associated with clinical progression, emphasizing the unpredictability of dengue disease course from parameters currently routinely collected.
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22
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Arjadi R, Nauta MH, Scholte WF, Hollon SD, Chowdhary N, Suryani AO, Uiterwaal CSPM, Bockting CLH. Internet-based behavioural activation with lay counsellor support versus online minimal psychoeducation without support for treatment of depression: a randomised controlled trial in Indonesia. Lancet Psychiatry 2018; 5:707-716. [PMID: 30006262 DOI: 10.1016/s2215-0366(18)30223-2] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/07/2018] [Accepted: 06/01/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Depression is one of the leading contributors to the global burden of disease. However, treatment availability is often very poor in low-income and middle-income countries. In a randomised clinical trial, we investigated the efficacy of internet-based behavioural activation with lay counsellor support compared with online minimal psychoeducation without support for depression in Indonesia (a middle-income country). METHODS We did a community-based, two-group, randomised controlled trial in Indonesia. Eligible participants were aged 16 years or older, scored 10 or above on the Patient Health Questionnaire 9 (PHQ-9), met the criteria for major depressive disorder or persistent depressive disorder based on the Structured Clinical Interview for DSM-5, were proficient in Bahasa Indonesia, and could use the internet. Participants were randomly allocated (1:1) by a research assistant using a web-based randomisation program to online behavioural activation with lay support (termed Guided Act and Feel Indonesia [GAF-ID]) or online psychoeducation without further support. Randomisation was done within a random permuted block design and was stratified by sex and depression severity (ie, PHQ-9 10-14 vs ≥15). The primary outcome was self-reported PHQ-9 score at 10 weeks from baseline. Research assistants were masked to group allocation until after the assessment of the primary outcome. Interventions were described to participants during the consent procedure and after randomisation, but no indication was given as to which was the intervention of interest and which was the control. Analysis was by intention to treat. The trial was registered in the Netherlands Trial Register, number NTR5920. It is closed to new particpants, and follow-up has been completed. FINDINGS Between Sept 6, 2016, and May 1, 2017, 313 participants were enrolled and randomly assigned, 159 to the GAF-ID group and 154 to the online psychoeducation group. At 10 weeks, PHQ-9 scores were significantly lower in the GAF-ID group than in the online psychoeducation group (mean difference -1·26 points [95% CI -2·29 to -0·23]; p=0·017), and participants in the GAF-ID group had a 50% higher chance of remission at 10 weeks (relative risk 1·50 [95% CI 1·19 to 1·88]; p<0·0001). An effect size of 0·24 for the GAF-ID group compared with the control group at 10 weeks was sustained over time (effect size 0·24 at 3 months, and 0·27 at 6 months). No adverse events were reported in either group. INTERPRETATION To our knowledge, ours is the first adequately powered randomised clinical trial of an internet-based intervention for depression in a low-income or middle-income country. Online behavioural activation with lay counsellor support efficaciously reduced symptoms of depression, and could help to bridge the mental health gap in low-income and middle-income countries. FUNDING Indonesia Endowment Fund for Education, University of Groningen.
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Affiliation(s)
- Retha Arjadi
- Faculty of Psychology, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia; Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands
| | - Maaike H Nauta
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands
| | - Willem F Scholte
- Amsterdam University Medical Centres, Department of Psychiatry, University of Amsterdam, Amsterdam, Netherlands; Equator Foundation, Diemen, Netherlands
| | - Steven D Hollon
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | | | - Angela O Suryani
- Faculty of Psychology, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Cuno S P M Uiterwaal
- Julius Centre for Health Sciences and Primary Care, Julius Global Health, University Medical Centre, Utrecht, Netherlands
| | - Claudi L H Bockting
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands; Amsterdam University Medical Centres, Department of Psychiatry, University of Amsterdam, Amsterdam, Netherlands.
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23
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Qanitha A, Uiterwaal CSPM, Henriques JPS, Mappangara I, Idris I, Amir M, de Mol BAJM. Predictors of medium-term mortality in patients hospitalised with coronary artery disease in a resource-limited South-East Asian setting. Open Heart 2018; 5:e000801. [PMID: 30057767 PMCID: PMC6059341 DOI: 10.1136/openhrt-2018-000801] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/24/2018] [Accepted: 06/13/2018] [Indexed: 01/30/2023] Open
Abstract
Objective To measure medium-term outcomes and determine the predictors of mortality in patients with coronary artery disease (CAD) both during and after hospitalisation in a resource-limited South-East Asian setting. Methods From February 2013 to December 2014, we conducted a prospective observational cohort study of 477 patients admitted to Makassar Cardiac Center, Indonesia, with acute coronary syndrome and stable CAD. We actively obtained data on clinical outcomes and after-discharge management until April 2017. Multivariable Cox proportional hazard analysis was performed to examine predictors for our primary outcome, all-cause mortality. Results From hospital admission, patients were followed over a median of 18 (IQR 6-36) months; in total 154 (32.3%) patients died. More patients with acute myocardial infarction died in the hospital compared with patients with unstable and stable angina (p=0.002). Over the total follow-up, there was a difference in mortality between non-ST-segment elevation myocardial infarction (n=41, 48.2%), ST-segment elevation myocardial infarction (n=65, 30.8%), unstable angina (n=18, 26.5%) and stable coronary artery disease (n=30, 26.5%) groups (p=0.007). The independent predictors of all-cause mortality were hyperglycaemia on admission (HR 1.55 (95% CI 1.12 to 2.14), p=0.008), heart failure/Killip class ≥2 (HR 2.50 (95% CI 1.76 to 3.56), p<0.001), estimated glomerular filtration rate <60 mL/min (HR 1.77 (95% CI 1.26 to 2.50), p=0.001), no revascularisation (percutaneous coronary intervention/coronary artery bypass grafting) (HR 2.38 (95% CI 1.31 to 4.33), p=0.005) and poor adherence to after-discharge medications (HR 10.28 (95% CI 5.52 to 19.16), p<0.001). Poor medication adherence predicted postdischarge mortality and did so irrespective of underlying CAD diagnosis (p interaction=0.88). Conclusions Patients with CAD in a poor South-East Asian setting experience high in-hospital and medium-term mortality. The initial severity of the disease, lack of access to guidelines-recommended therapy and poor adherence to after-discharge medications are the main drivers for excess mortality. Improved access to early and late hospital care and patient education should be prioritised for better survival.
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Affiliation(s)
- Andriany Qanitha
- Department of Cardio-thoracic Surgery, AMC Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Physiology, Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia
| | - Cuno S P M Uiterwaal
- Julius Center for Health Sciences and Primary Care, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - Jose P S Henriques
- Department of Cardiology, AMC Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Idar Mappangara
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia
| | - Irfan Idris
- Department of Physiology, Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia
| | - Muzakkir Amir
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia
| | - Bastianus A J M de Mol
- Department of Cardio-thoracic Surgery, AMC Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Mocking M, Savitri AI, Uiterwaal CSPM, Amelia D, Antwi E, Baharuddin M, Grobbee DE, Klipstein-Grobusch K, Browne JL. Does body mass index early in pregnancy influence the risk of maternal anaemia? An observational study in Indonesian and Ghanaian women. BMC Public Health 2018; 18:873. [PMID: 30005609 PMCID: PMC6045841 DOI: 10.1186/s12889-018-5704-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 06/12/2018] [Indexed: 11/24/2022] Open
Abstract
Background Anaemia is common among pregnant women, especially in low- and middle-income countries (LMICs). While body mass index (BMI) relates to many risk factors for anaemia in pregnancy, little is known about the direct relation with anaemia itself. This is particularly relevant in Southeast Asia and Sub-Saharan Africa where the prevalence of anaemia in pregnancy and the associated adverse outcomes is among the highest worldwide. This study aimed to assess the association between early pregnancy BMI and anaemia at first antenatal care visit in Indonesian and Ghanaian women. In addition, the associations between early pregnancy anaemia and adverse birth outcomes was assessed. Methods Prospective cohort studies of women in early pregnancy were conducted in Jakarta, Indonesia (n = 433) and in Accra, Ghana (n = 946), between 2012 and 2014. Linear regression analysis was used to assess relations between early pregnancy BMI and pregnancy haemoglobin levels at booking. Logistic regression analyses were used to assess associations between early pregnancy anaemia as defined by the World Health Organization (WHO) criteria and a composite of adverse birth outcomes including stillbirth, low birth weight and preterm birth. Results Indonesian women had lower BMI than Ghanaian women (23.0 vs 25.4 kg/m2, p < 0.001) and higher mean haemoglobin levels (12.4 vs 11.1 g/dL, p < 0.001), corresponding to anaemia prevalence of 10 and 44%, respectively. Higher early pregnancy BMI was associated with higher haemoglobin levels in Indonesian (0.054 g/dL/kg/m2, 95% CI 0.03 to 0.08, p < 0.001) and Ghanaian women (0.044 g/dL/kg/m2, 0.02 to 0.07, p < 0.001). Accordingly, risk for anaemia decreased with higher early pregnancy BMI for Indonesians (adjusted OR 0.88, 0.81 to 0.97, p = 0.01) and Ghanaians (adjusted OR 0.95, 0.92 to 0.98, p < 0.001). No association between anaemia and the composite of adverse birth outcomes was observed. Conclusion Higher BMI in early pregnancy is associated with higher haemoglobin levels at antenatal booking and with a reduced risk of anaemia in Indonesian and Ghanaian women. Electronic supplementary material The online version of this article (10.1186/s12889-018-5704-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Martina Mocking
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ary I Savitri
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cuno S P M Uiterwaal
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | | | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Joyce L Browne
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
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25
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Qanitha A, Uiterwaal CSPM, Henriques JPS, Alkatiri AH, Mappangara I, Mappahya AA, Patellongi I, de Mol BAJM. Characteristics and the average 30-day and 6-month clinical outcomes of patients hospitalised with coronary artery disease in a poor South-East Asian setting: the first cohort from Makassar Cardiac Center, Indonesia. BMJ Open 2018; 8:e021996. [PMID: 29950477 PMCID: PMC6020938 DOI: 10.1136/bmjopen-2018-021996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To provide a detailed description of characteristics at hospital admission and clinical outcomes at 30-day and 6-month follow-up in patients hospitalised with coronary artery disease (CAD) in a poor South-East Asian setting. DESIGN Prospective observational cohort study. SETTING From February 2013 to December 2014, in Makassar Cardiac Center, Indonesia. PARTICIPANTS 477 patients with CAD (acute coronary syndrome and stable CAD). OUTCOME MEASURES All-cause mortality and major adverse cardiovascular events (MACE). RESULTS Out of 477 patients with CAD, the proportion of young age (<60 years) was 53.9% and 72.7% were male. At admission, 44.2% of patients were diagnosed with ST-segment elevation myocardial infarction (STEMI), 38.6% with diagnosis or signs of heart failure and 75.1% had previous hypertension. Out of 211 patients with STEMI, only 4.7% had been treated with primary percutaneous coronary intervention (PCI) and 6.2% received thrombolysis. The time lapse from symptom onset to hospital admission was 26.8 (IQR 10.0-48.0) hours, and 19.1% of all patients had undergone either PCI or coronary artery bypass graft. The survival rate at 6 months was 78.9%. The rates of all-cause mortality at 30 days and 6 months were 13.4% and 7.3%, respectively; the rate of composite MACE at 30 days was 26.2% and 18.0% at 6 months. CONCLUSIONS Patients with CAD from a poor South-East Asian setting present themselves with predominantly unstable conditions of premature CAD. These patients show relatively severe illness, have significant time delay from symptom onset to admission or intervention, and most do not receive the guidelines-recommended treatment. Awareness of symptoms, prompt initial management of acute CVD, well-established infrastructures and resources both in primary and secondary hospital for CVD should be improved to reduce the high rates of 30-day and 6-month mortality and adverse outcomes in this population.
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Affiliation(s)
- Andriany Qanitha
- Department of Cardiothoracic Surgery, AMC Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Department of Physiology, Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia
| | - Cuno S P M Uiterwaal
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jose P S Henriques
- Department of Cardiology, AMC Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Abdul Hakim Alkatiri
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia
| | - Idar Mappangara
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia
| | - Ali Aspar Mappahya
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia
| | - Ilhamjaya Patellongi
- Department of Physiology, Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia
| | - Bastianus A J M de Mol
- Department of Cardiothoracic Surgery, AMC Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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26
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Arabkhazaeli A, Ahmadizar F, Leusink M, Arets HGM, Raaijmakers JAM, Uiterwaal CSPM, van der Ent CK, Maitland-van der Zee AH, Vijverberg SJH. The association between a genetic risk score for allergy and the risk of developing allergies in childhood-Results of the WHISTLER cohort. Pediatr Allergy Immunol 2018; 29:72-77. [PMID: 29047167 DOI: 10.1111/pai.12824] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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] [Accepted: 10/15/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Several genetic variants have been associated with the susceptibility to allergic disease in adults, but it remains unclear whether these genetic variants are also associated with the onset of allergic disease early in life. The aim of this study was to develop a genetic risk score (GRS) for allergy based on findings in adults and study its predictive capacity for allergy in children. METHODS A GRS was constructed based on 10 SNPs previously associated with allergies in adults. The GRS was tested in children who participated in a population-based newborn cohort (WHISTLER) and were followed from birth to school age. Logistic regression analysis was used to study the association between the GRS and the parental-reported allergies at age 5 (based on a reported allergy to ≥1 of the following allergens: pollen, house dust mites, or pets). A Cox regression model was used to study the association between GRS and a physician-diagnosed allergy during follow-up (allergic conjunctivitis, allergic rhinitis, and eczema/dermatitis). Cohen's kappa coefficient was calculated to study the agreement between physician-diagnosed allergy and parental-reported allergy at age 5. RESULTS The GRS was significantly associated with parental-reported allergy (odds ratio: 15.9, 95% confidence interval (CI): 1.07-233.73) at age 5, as well as with a physician-diagnosed allergy during follow-up (hazard ratio: 1.89, 95% CI: 1.05-3.41). The overall agreement between physician-diagnosed and parental-reported allergies was 70.5% (kappa: 0.10, 95% CI: 0.03-0.18). CONCLUSIONS An adult-derived GRS for allergy predicts the risk of developing allergies in childhood.
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Affiliation(s)
- Ali Arabkhazaeli
- Division of Pharmacoepidemiology & Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands
| | - Fariba Ahmadizar
- Division of Pharmacoepidemiology & Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands
| | - Maarten Leusink
- Division of Pharmacoepidemiology & Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hubertus G M Arets
- Department of Pediatric Pulmonology, WKZ, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Jan A M Raaijmakers
- Division of Pharmacoepidemiology & Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands
| | - Cuno S P M Uiterwaal
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cornelis K van der Ent
- Department of Pediatric Pulmonology, WKZ, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Anke-Hilse Maitland-van der Zee
- Division of Pharmacoepidemiology & Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands.,Department of Respiratory Medicine, Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, The Netherlands
| | - Susanne J H Vijverberg
- Division of Pharmacoepidemiology & Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands.,Department of Respiratory Medicine, Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, The Netherlands
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27
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Wilde MAD, Eising JB, Gunning MN, Koster MPH, Evelein AMV, Dalmeijer GW, Uiterwaal CSPM, Eijkemans MJC, Ent CKVD, Meijboom FJ, Fauser BCJM. Cardiovascular and Metabolic Health of 74 Children From Women Previously Diagnosed With Polycystic Ovary Syndrome in Comparison With a Population-Based Reference Cohort. Reprod Sci 2018; 25:1492-1500. [PMID: 29320957 DOI: 10.1177/1933719117749761] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Women with polycystic ovary syndrome (PCOS) have compromised cardiovascular health profiles and an increased risk of pregnancy complications. In order to evaluate potential consequences, we aim to compare the cardiovascular and metabolic health of the children from women with PCOS with a population-based reference cohort. We included children from women with PCOS between the age of 2.5 to 4 years (n = 42) and 6 to 8 years (n = 32). The reference groups consisted of 168 (3-4 years old) and 130 children (7-8 years old). In an extensive cardiovascular screening program, we measured anthropometrics and blood pressure (all children), heart function and vascular rigidity (young children), metabolic laboratory assessment and carotid intima thickness (old age-group). Results showed that young PCOS offspring have a significantly lower diastolic blood pressure (β = 2.3 [95% confidence interval, CI: 0.5-4.0]) and higher aortic pulse pressure (β = -1.4 [95% CI: -2.5 to -0.2]), compared to the reference population. Furthermore, a higher left ventricle internal diameter but a lower tissue Doppler imaging of the right wall in systole compared to the reference group was found. Older offspring of women with PCOS presented with a significantly lower breast and abdominal circumference, but higher triglycerides (β = -0.1 [95% CI: -0.2 to -0.1]), LDL-cholesterol (β = -0.4 [95% CI: -0.6 to -0.1]), and higher carotid intima-media thickness (β = -31.7 [95% CI: -46.6 to -16.9]) compared to the reference group. In conclusion, we observe subtle but distinct cardiovascular and metabolic abnormalities already at an early age in PCOS offspring compared to a population-based reference group, despite a lower diastolic blood pressure, breast, and abdominal circumference. These preliminary findings require confirmation in independent data sets.
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Affiliation(s)
- Marlieke A de Wilde
- 1 Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jacobien B Eising
- 2 Department of Paediatric Pulmonology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marlise N Gunning
- 1 Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Maria P H Koster
- 1 Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Annemieke M V Evelein
- 3 Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Geertje W Dalmeijer
- 3 Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Cuno S P M Uiterwaal
- 3 Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marinus J C Eijkemans
- 1 Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,3 Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Cornelis K van der Ent
- 2 Department of Paediatric Pulmonology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Folkert J Meijboom
- 4 Department of Paediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Bart C J M Fauser
- 1 Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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28
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Pluymen LPM, Dalmeijer GW, Smit HA, Uiterwaal CSPM, van der Ent CK, van Rossem L. Long-chain polyunsaturated fatty acids in infant formula and cardiovascular markers in childhood. Matern Child Nutr 2017; 14:e12523. [PMID: 28949070 DOI: 10.1111/mcn.12523] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 06/09/2017] [Accepted: 08/30/2017] [Indexed: 11/29/2022]
Abstract
To investigate whether children who consumed infant formula supplemented with long-chain polyunsaturated fatty acids (LCPUFAs) had a more favourable cardiovascular profile than children who consumed formula without these fatty acids, we used the Wheezing Illnesses Study Leidsche Rijn, a birth cohort that included 2,468 newborns between 2001 and 2014. Data on infant feeding were obtained by questionnaires. At age 5, blood pressure, carotid intima-media thickness (CIMT), and carotid distension were measured. We used multivariable linear regression analysis to compare levels of cardiovascular markers in formula-fed children born before and after the LCPUFA supplementation. To account for secular trends, we compared levels of cardiovascular markers in a control group of breastfed children from the same cohort born before and after the supplementation. Formula-fed children born after the LCPUFA supplementation (n = 48) had no different systolic blood pressure (-2.58 mmHg, 95% confidence interval, CI [-5.5, 0.30]), diastolic blood pressure (-0.13 mmHg, 95% CI [-2.3, 2.1]), or carotid distension (24.8 MPa-1 , 95% CI [-47.1, 96.6]) and had a higher CIMT (18.6 μm, 95% CI [3.7, 33.5]) than formula-fed children born before the supplementation (n = 163). In the control group, children born after the LCPUFA supplementation (n = 98) had no different systolic- or diastolic-blood pressure, or CIMT, and a higher carotid distension than children born before the supplementation (n = 142). In conclusion, children who consumed infant formula supplemented with LCPUFAs did not have a more favourable cardiovascular profile in early childhood than children who consumed formula without LCPUFAs.
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Affiliation(s)
- Linda P M Pluymen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Geertje W Dalmeijer
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Henriëtte A Smit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cuno S P M Uiterwaal
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cornelis K van der Ent
- Department of Paediatric Pulmonology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lenie van Rossem
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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29
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Qanitha A, de Mol BAJM, Burgner DP, Kabo P, Pabittei DR, Yusuf I, Uiterwaal CSPM. Pregnancy-related conditions and premature coronary heart disease in adult offspring. Heart Asia 2017; 9:90-95. [PMID: 29259659 PMCID: PMC5730950 DOI: 10.1136/heartasia-2017-010896] [Citation(s) in RCA: 4] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 03/17/2017] [Accepted: 03/21/2017] [Indexed: 12/29/2022]
Abstract
Objective To investigate the association between complications during pregnancy and premature coronary heart disease in adult offspring. Methods We conducted a population-based case-control study of 153 Indonesian patients with a first acute coronary syndrome (ACS) (age ≤55 years) and 153 age-matched and sex-matched controls. Data on complications during pregnancy (high blood pressure, preterm delivery) and maternal infections in pregnancy were obtained, together with sociodemographic data, clinical profiles, laboratory measurements and adulthood cardiovascular disease (CVD) risk factors at hospital admission or enrolment. Conditional logistic regression was performed to assess the association between overall pregnancy complications, and specific groupings of complications and premature ACS. Results Pregnancy-related hypertension and infection were more common in mothers of cases than controls. Pregnancy complications were associated with premature offspring ACS (OR 2.9, 95% CI 1.4 to 6.0, p=0.004), and the association persisted in fully adjusted analyses (ORadjusted 4.5, 1.1 to 18.1, p=0.036). In subgroup analyses, pregnancy-related high blood pressure (ORadjusted 5.0, 1.0 to 24.7, p=0.050) and maternal infections (ORadjusted 5.2, 1.1 to 24.2, p=0.035) were associated with offspring ACS. Conclusions Offspring of mothers with complications during pregnancy have an increased risk for premature ACS in adulthood, which may be of particular relevance in populations in transition, where the incidence of both pregnancy-related morbidity and CVD are high.
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Affiliation(s)
- Andriany Qanitha
- Department of Cardio-thoracic Surgery, AMC Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Physiology, Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia
| | - Bastianus A J M de Mol
- Department of Cardio-thoracic Surgery, AMC Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - David P Burgner
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Peter Kabo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia
| | - Dara R Pabittei
- Department of Cardio-thoracic Surgery, AMC Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Physiology, Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia
| | - Irawan Yusuf
- Department of Physiology, Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia
| | - Cuno S P M Uiterwaal
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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30
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van der Hoeven T, Browne JL, Uiterwaal CSPM, van der Ent CK, Grobbee DE, Dalmeijer GW. Antenatal coffee and tea consumption and the effect on birth outcome and hypertensive pregnancy disorders. PLoS One 2017; 12:e0177619. [PMID: 28520809 PMCID: PMC5433714 DOI: 10.1371/journal.pone.0177619] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 04/28/2017] [Indexed: 12/02/2022] Open
Abstract
Background and objective Coffee and tea are commonly consumed during pregnancy. While several of their components, like caffeine, have strong pharmacological effects, the effect on the unborn fetus remains unclear. Caffeine intake has been associated with abortion, preterm birth and fetal growth restriction, but a general consensus on caffeine restriction is still lacking. We aimed to investigate antenatal coffee, tea and caffeine consumption and the effect on birth weight and length, gestational age at birth and hypertensive disorders in pregnancy. Methods A total of 936 healthy pregnancies from the WHISTLER birth cohort with data on coffee and tea consumption were included. Maternal and child characteristics as well as antenatal coffee and tea consumption were obtained through postpartum questionnaires. Reported consumption was validated using available preconceptional data. Caffeine intake was calculated from coffee and tea consumption. Linear and logistic regression was used to assess the association with birth outcome and hypertensive disorders. Results After adjustment for smoking and maternal age, a daily consumption of more than 300mg of caffeine compared to less than 100mg of caffeine was significantly associated with an increased gestational age (linear regression coefficient = 2.00 days, 95%CI = 0.12–4.21, P = 0.03). Tea consumption was significantly related to a higher risk of pregnancy induced hypertension (OR = 1.13, 95%CI = 1.04–1.23, P = 0.004). No associations concerning coffee consumption or birth weight and birth length were observed. Conclusions Daily caffeine consumption of more than 300mg is possibly associated with an increase in gestational age at birth. A possible relation between high tea consumption and increased risk for pregnancy induced hypertension warrants further research. For most outcomes, we found no significant associations with coffee or tea intake.
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Affiliation(s)
- Timothy van der Hoeven
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
- * E-mail:
| | - Joyce L. Browne
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Cuno S. P. M. Uiterwaal
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Cornelis K. van der Ent
- Department of Pediatric Pulmonology, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Diederick E. Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Geertje W. Dalmeijer
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
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31
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Koudijs HM, Savitri AI, Browne JL, Amelia D, Baharuddin M, Grobbee DE, Uiterwaal CSPM. Hyperemesis gravidarum and placental dysfunction disorders. BMC Pregnancy Childbirth 2016; 16:374. [PMID: 27884114 PMCID: PMC5123279 DOI: 10.1186/s12884-016-1174-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 11/18/2016] [Indexed: 12/27/2022] Open
Abstract
Background Evidence about the consequence of hyperemesis gravidarum (HG) on pregnancy outcomes is still inconclusive. In this study, we evaluated if occurrence of hyperemesis gravidarum is associated with placental dysfunction disorders and neonatal outcomes. Methods A prospective cohort study was conducted in a maternal and child health primary care referral center, Budi Kemuliaan Hospital and its branch, in Jakarta, Indonesia. 2252 pregnant women visiting the hospital for regular antenatal care visits from July 2012 until October 2014 were included at their first clinic visit. For women without, with mild and with severe hyperemesis, placental dysfunction disorders (gestational hypertension, preeclampsia (PE), stillbirth, miscarriage), neonatal outcomes (birth weight, small for gestational age (SGA), low birth weight (LBW), Apgar score at 5 min, gestational age at delivery) and placental outcomes (placental weight and placental-weight-to-birth-weight ratio (PW/BW ratio)) were studied. Results Compared to newborns of women without hyperemesis, newborns of women with severe hyperemesis had a 172 g lower birth weight in adjusted analysis (95%CI -333.26; -10.18; p = 0.04). There were no statistically significant effects on placental dysfunction disorders or other neonatal outcome measures. Conclusions The results of our study suggest that hyperemesis gravidarum does not seem to induce placental dysfunction disorders, but does, if severe lead to lower birth weight.
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Affiliation(s)
- Heleen M Koudijs
- Julius Center for Health Sciences and Primary Care, Global Health, University Medical Center Utrecht, Huispost Str. 6.131, PO Box 855500, 3508, GA, Utrecht, The Netherlands
| | - Ary I Savitri
- Julius Center for Health Sciences and Primary Care, Global Health, University Medical Center Utrecht, Huispost Str. 6.131, PO Box 855500, 3508, GA, Utrecht, The Netherlands.
| | - Joyce L Browne
- Julius Center for Health Sciences and Primary Care, Global Health, University Medical Center Utrecht, Huispost Str. 6.131, PO Box 855500, 3508, GA, Utrecht, The Netherlands
| | | | | | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, Global Health, University Medical Center Utrecht, Huispost Str. 6.131, PO Box 855500, 3508, GA, Utrecht, The Netherlands
| | - Cuno S P M Uiterwaal
- Julius Center for Health Sciences and Primary Care, Global Health, University Medical Center Utrecht, Huispost Str. 6.131, PO Box 855500, 3508, GA, Utrecht, The Netherlands
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32
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te Molder M, de Hoog MLA, Uiterwaal CSPM, van der Ent CK, Smit HA, Schilder AGM, Damoiseaux RAMJ, Venekamp RP. Antibiotic Treatment for First Episode of Acute Otitis Media Is Not Associated with Future Recurrences. PLoS One 2016; 11:e0160560. [PMID: 27632355 PMCID: PMC5025241 DOI: 10.1371/journal.pone.0160560] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 07/21/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Antibiotic treatment of acute otitis media (AOM) has been suggested to increase the risk of future AOM episodes by causing unfavorable shifts in microbial flora. Because current evidence on this topic is inconclusive and long-term follow-up data are scarce, we wanted to estimate the effect of antibiotic treatment for a first AOM episode occurring during infancy on AOM recurrences and AOM-related health care utilization later in life. METHODS We obtained demographic information and risk factors from data of the Wheezing Illnesses Study Leidsche Rijn, a prospective birth cohort study in which all healthy newborns born in Leidsche Rijn (between 2001 and 2012), The Netherlands, were enrolled. These data were linked to children's primary care electronic health records up to the age of four. Children with at least one family physician-diagnosed AOM episode before the age of two were included in analyses. The exposure of interest was the prescription of oral antibiotics (yes vs no) for a child's first AOM episode before the age of two years. RESULTS 848 children were included in analyses and 512 (60%) children were prescribed antibiotics for their first AOM episode. Antibiotic treatment was not associated with an increased risk of total AOM recurrences (adjusted rate ratio: 0.94, 95% CI: 0.78-1.13), recurrent AOM (≥3 episodes in 6 months or ≥4 in one year; adjusted risk ratio: 0.79, 95% CI: 0.57-1.11), or with increased AOM-related health care utilization during children's first four years of life. CONCLUSIONS Oral antibiotic treatment of a first AOM episode occurring during infancy does not affect the number of AOM recurrences and AOM-related health care utilization later in life. This information can be used when weighing the pros and cons of various AOM treatment options.
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Affiliation(s)
- Marthe te Molder
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marieke L. A. de Hoog
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- * E-mail:
| | - Cuno S. P. M. Uiterwaal
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cornelis K. van der Ent
- Department of Pediatric Pulmonology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Henriette A. Smit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anne G. M. Schilder
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Otorhinolaryngology, University Medical Center Utrecht, Utrecht, The Netherlands
- Ear Institute, University College London, London, United Kingdom
| | - Roger A. M. J. Damoiseaux
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roderick P. Venekamp
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Otorhinolaryngology, University Medical Center Utrecht, Utrecht, The Netherlands
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Zegers MJ, Hukkelhoven CWPM, Uiterwaal CSPM, Kollée LAA, Groenendaal F. Changing Dutch approach and trends in short-term outcome of periviable preterms. Arch Dis Child Fetal Neonatal Ed 2016; 101:F391-6. [PMID: 26728314 DOI: 10.1136/archdischild-2015-308803] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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] [Received: 04/16/2015] [Accepted: 11/30/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND In 2006, the Dutch guideline for active treatment of extremely preterm neonates advised to lower the gestational age threshold for active intervention from 26 0/7 to 25 0/7 weeks gestation. OBJECTIVE To evaluate the association between the guideline modification and early neonatal outcome. DESIGN National cohort study, using prospectively collected data from The Netherlands Perinatal Registry. PATIENTS The study population consisted of 9713 infants with a gestational age between 24 0/7 and 29 6/7 weeks, born between 2000 and 2011. Three gestational age subgroups were analysed: 24 0/7 to 24 6/7 weeks (n=269), 25 0/7 to 25 6/7 weeks (n=852) and 26 0/7 to 29 6/7 weeks (n=8592). MAIN OUTCOME MEASURES Neonatal intensive care unit (NICU) admission, live births, neonatal in-hospital mortality, morbidity and favourable outcome (no mortality or morbidity) before (2000-2005; period 1) and after (2007-2011; period 2) introduction of the modified guideline, using χ(2) tests and univariable and multivariable logistic regression analyses. RESULTS In the second period, the proportion of live births and NICU admissions increased and the proportion of neonatal and in-hospital mortality decreased significantly in all subgroups. Morbidity in surviving infants of 25 weeks increased significantly, although the association between guideline modification and morbidity became non-significant after case-mix adjustment. Overall, favourable outcome did not change significantly after guideline modification in all subgroups when adjusted for variation in case-mix. CONCLUSIONS Overall, the trend in mortality gradually declined at all gestational ages, starting before 2006. This suggests that the guideline modification was a formalisation of already existing daily practice.
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Affiliation(s)
- Maria J Zegers
- Department of Neonatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Cuno S P M Uiterwaal
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
| | - Louis A A Kollée
- Department of Neonatology, Radboud University Medical Centre, Nijmegen, The Netherlands
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Abstract
OBJECTIVES To evaluate if pre-pregnancy body mass index (BMI) determines blood pressure throughout pregnancy and to explore the role of gestational weight gain in this association. In addition, the effects of pre-pregnancy BMI and gestational weight gain on the occurrence of gestational hypertension and pre-eclampsia were investigated. DESIGN Prospective cohort study. SETTING Maternal and child health primary care referral centre, Jakarta, Indonesia. POPULATION AND MEASUREMENTS 2252 pregnant women visiting Budi Kemuliaan Hospital and its branch for regular antenatal care visits from July 2012 to April 2015. Pre-pregnancy BMI (kg/m(2)) was based on self-reported pre-pregnancy weight and measured height at first visit. Gestational weight gain was calculated as weight at the day of delivery minus the pre-pregnancy weight. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured during pregnancy at every visit. Linear mixed models were used to analyse this relation with repeated blood pressure measures as the outcome and pre-pregnancy BMI as the predictor. When looking at gestational hypertension and pre-eclampsia as outcomes, (multiple) logistic regression was used in the analysis. RESULTS Independent of pre-pregnancy BMI, SBP and DBP increased by 0.99 mm Hg/month and 0.46 mm Hg/month, respectively. Higher pre-pregnancy BMI was associated with higher pregnancy SBP (0.25 mm Hg/kg/m(2); 95% CI 0.17 to 0.34; p<0.01) and DBP (0.18 mm Hg/kg/m(2); 0.13 to 0.24; p<0.01) in adjusted analysis. Every 1 kg/m(2) higher pre-pregnancy BMI was associated with 6% and 9% higher odds for gestational hypertension (adjusted OR (aOR) 1.06; 95% CI 1.03 to 1.09; p<0.01) and pre-eclampsia (aOR 1.09; 1.04 to 1.14; p<0.01). Accounting for gestational weight gain did not attenuate these associations. CONCLUSIONS Pre-pregnancy BMI determines the level, but not the change, of blood pressure in pregnancy and is linked to higher odds for gestational hypertension and pre-eclampsia, independent of gestational weight gain.
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Affiliation(s)
- Ary I Savitri
- Julius Center for Health Sciences and Primary Care, Julius Global Health, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter Zuithoff
- Julius Center for Health Sciences and Primary Care, Julius Global Health, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joyce L Browne
- Julius Center for Health Sciences and Primary Care, Julius Global Health, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, Julius Global Health, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cuno S P M Uiterwaal
- Julius Center for Health Sciences and Primary Care, Julius Global Health, University Medical Center Utrecht, Utrecht, The Netherlands
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Savitri AI, Idris NS, Indawati W, Saldi SRF, Amelia D, Baharuddin M, Sastroasmoro S, Grobbee DE, Uiterwaal CSPM. BReastfeeding Attitude and Volume Optimization (BRAVO) trial: study protocol for a randomized controlled trial. Trials 2016; 17:271. [PMID: 27250730 PMCID: PMC4890480 DOI: 10.1186/s13063-016-1397-y] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 05/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A growing body of evidence shows the short-term benefits of breastfeeding, which include protection against infections, allergies, and lung diseases. However, evidence on the long-term benefits of breastfeeding is scarce and often conflicting. The BReastfeeding Attitude and Volume Optimization (BRAVO) trial is designed to study the effect of breastfeeding on early signs of later chronic diseases, particularly cardiovascular, respiratory, and metabolic risks later in life. In addition, the effectiveness of breastfeeding empowerment in promoting breastfeeding will also be evaluated. METHODS/DESIGN This study is an ongoing randomized trial in Jakarta, Indonesia, that began in July 2012. Pregnant women are being screened for their breastfeeding plan in the third trimester, and those with low intention to breastfeed are randomly allocated to either receiving an add-on breastfeeding-optimization program or usual care. Primary outcomes include breastfeeding rate, lung function, and blood pressure during the first year of life and vascular/cardiac characteristics, which will be measured at the age of 4 to 5 years. Child growth and infection/illness episodes are measured, whereas cognitive testing is planned for the children at 5 years of age. DISCUSSION To date, 784 women (80 %) have been randomized of the 1,000 planned, with satisfactory completeness of the 1-year follow up (90.1 %). Included mothers are of lower socioeconomic status and more often have blue-collar jobs, similar to what was observed in the pilot study. TRIAL REGISTRATION ClinicalTrials.gov, NCT01566812 . Registered on 27 March 2012.
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Affiliation(s)
- Ary I Savitri
- Julius Center for Health Sciences and Primary Care, Julius Global Health, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nikmah S Idris
- Julius Center for Health Sciences and Primary Care, Julius Global Health, University Medical Center Utrecht, Utrecht, The Netherlands. .,Department of Child Health/Center for Clinical Epidemiology and Evidence Based Medicine (CEEBM) Faculty of Medicine Universitas Indonesia/Cipto Mangunkusumo National General Hospital, Jl. Salemba 6, Jakarta, Pusat, 10430, Indonesia.
| | - Wahyuni Indawati
- Julius Center for Health Sciences and Primary Care, Julius Global Health, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Child Health/Center for Clinical Epidemiology and Evidence Based Medicine (CEEBM) Faculty of Medicine Universitas Indonesia/Cipto Mangunkusumo National General Hospital, Jl. Salemba 6, Jakarta, Pusat, 10430, Indonesia
| | - Siti Rizny F Saldi
- Department of Child Health/Center for Clinical Epidemiology and Evidence Based Medicine (CEEBM) Faculty of Medicine Universitas Indonesia/Cipto Mangunkusumo National General Hospital, Jl. Salemba 6, Jakarta, Pusat, 10430, Indonesia
| | | | | | - Sudigdo Sastroasmoro
- Department of Child Health/Center for Clinical Epidemiology and Evidence Based Medicine (CEEBM) Faculty of Medicine Universitas Indonesia/Cipto Mangunkusumo National General Hospital, Jl. Salemba 6, Jakarta, Pusat, 10430, Indonesia
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, Julius Global Health, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cuno S P M Uiterwaal
- Julius Center for Health Sciences and Primary Care, Julius Global Health, University Medical Center Utrecht, Utrecht, The Netherlands
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Eikendal ALM, Groenewegen KA, Bots ML, Peters SAE, Uiterwaal CSPM, den Ruijter HM. Relation Between Adolescent Cardiovascular Risk Factors and Carotid Intima-Media Echogenicity in Healthy Young Adults: The Atherosclerosis Risk in Young Adults (ARYA) Study. J Am Heart Assoc 2016; 5:JAHA.115.002941. [PMID: 27172911 PMCID: PMC4889174 DOI: 10.1161/jaha.115.002941] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Background Echogenicity is an ultrasound measure that reflects arterial wall composition. In adult populations, lower carotid intima‐media echogenicity relates to an unfavorable cardiovascular risk burden yet appears to reflect a different aspect of arterial wall remodeling than carotid intima‐media thickness (CIMT). Since studies on carotid intima‐media echogenicity earlier in life are lacking, we investigated associations between adolescent cardiovascular risk factors and young adulthood carotid intima‐media echogenicity and compared this to CIMT. Methods and Results In 736 participants of the Atherosclerosis Risk in Young Adults study, information on adolescent anthropometrics, puberty stage, and systolic blood pressure (SBP) was available. In young adulthood, demographics, anthropometrics, and fasting plasma samples were collected. Common CIMT and echogenicity, quantified as gray‐scale median (GSM), were evaluated using B‐mode ultrasonography. Lower and higher GSM values, respectively, represented lower and higher echogenicity. Associations of adolescent body mass index and SBP with young adulthood GSM and CIMT were evaluated using linear regression analysis. Mean age was 13.5 years in adolescence and 28.4 years in young adulthood (difference: 14.9 years). After full adjustment, adolescent body mass index related to GSM (β=−1.62/SD; 95% CI: −2.79, −0.46; P=0.006), independent of CIMT. Adolescent SBP did not relate to GSM. Moreover, adolescent body mass index (β=8.06 μm/SD [95% CI: 4.12, 11.99], P<0.001) and SBP (β=4.69 μm/SD [95% CI: 0.84, 8.54], P=0.02) related to CIMT. Conclusions Adolescent body mass index related to GSM and CIMT in young adulthood; SBP only related to CIMT. Hence, carotid intima‐media echogenicity appears to be involved in arterial wall remodeling, yet may mimic a different facet of this process than CIMT.
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Affiliation(s)
- Anouk L M Eikendal
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Karlijn A Groenewegen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sanne A E Peters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands The George Institute for Global Health, University of Oxford, United Kingdom
| | - Cuno S P M Uiterwaal
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hester M den Ruijter
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
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Hullegie S, Bruijning-Verhagen P, Uiterwaal CSPM, van der Ent CK, Smit HA, de Hoog MLA. First-year Daycare and Incidence of Acute Gastroenteritis. Pediatrics 2016; 137:peds.2015-3356. [PMID: 27244798 DOI: 10.1542/peds.2015-3356] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Daycare attendance has been associated with increased acute gastroenteritis (AGE) incidence in the first years of life. We investigated the effects of first-year daycare attendance on AGE incidence and primary care contact rate up to age 6 years. METHODS Children enrolled in the Wheezing Illnesses Study Leidsche Rijn cohort were managed until age 6 years. Data on primary care diagnosed AGE episodes and number of associated contacts per episode were collected from health records. Children were categorized according to first year daycare attendance and age-month at entry when applicable. Generalized estimating equations were used to assess associations between first-year daycare and AGE incidence or primary care contact rate. RESULTS A total of 1344 out of 2220 children (83%) attended daycare before age 1 year. Overall, the 6-year primary care AGE incidence rate (IR) among first-year daycare attendees and nonattendees was comparable (IR: 12.2/100 vs 13.3/100 child-years). First-year daycare attendees had a higher AGE incidence during the first year (IRR: 1.13; 95% confidence interval: 1.06-1.21) and lower during the third to sixth year of age compared with nonattendees (P < .001). The daycare-associated increase in AGE incidence was most pronounced during the first 12 months after enrollment into daycare and demonstrated clear seasonality. A similar pattern was observed for primary care contact rate per AGE episode. CONCLUSIONS First-year daycare attendance advances the timing of AGE infections, resulting in increased AGE disease burden in the first year and relative protection thereafter. Protection against AGE infection persists at least up to age 6 years. Future studies should address whether this protective effect persists during later childhood.
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Affiliation(s)
| | - Patricia Bruijning-Verhagen
- Julius Center for Health Sciences and Primary Care, and National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | | | - Cornelis K van der Ent
- Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands; and
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Sittig JS, Uiterwaal CSPM, Moons KGM, Russel IMB, Nievelstein RAJ, Nieuwenhuis EES, van de Putte EM. Value of systematic detection of physical child abuse at emergency rooms: a cross-sectional diagnostic accuracy study. BMJ Open 2016; 6:e010788. [PMID: 27006346 PMCID: PMC4809108 DOI: 10.1136/bmjopen-2015-010788] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The aim of our diagnostic accuracy study Child Abuse Inventory at Emergency Rooms (CHAIN-ER) was to establish whether a widely used checklist accurately detects or excludes physical abuse among children presenting to ERs with physical injury. DESIGN A large multicentre study with a 6-month follow-up. SETTING 4 ERs in The Netherlands. PARTICIPANTS 4290 children aged 0-7 years attending the ER because of physical injury. All children were systematically tested with an easy-to-use child abuse checklist (index test). A national expert panel (reference standard) retrospectively assessed all children with positive screens and a 15% random sample of the children with negative screens for physical abuse, using additional information, namely, an injury history taken by a paediatrician, information provided by the general practitioner, youth doctor and social services by structured questionnaires, and 6-month follow-up information. MAIN OUTCOME MEASURE Physical child abuse. SECONDARY OUTCOME MEASURE Injury due to neglect and need for help. RESULTS 4253/4290 (99%) parents agreed to follow-up. At a prevalence of 0.07% (3/4253) for inflicted injury by expert panel decision, the positive predictive value of the checklist was 0.03 (95% CI 0.006 to 0.085), and the negative predictive value 1.0 (0.994 to 1.0). There was 100% (93 to 100) agreement about inflicted injury in children, with positive screens between the expert panel and child abuse experts. CONCLUSIONS Rare cases of inflicted injury among preschool children presenting at ERs for injury are very likely captured by easy-to-use checklists, but at very high false-positive rates. Subsequent assessment by child abuse experts can be safely restricted to children with positive screens at very low risk of missing cases of inflicted injury. Because of the high false positive rate, we do advise careful prior consideration of cost-effectiveness and clinical and societal implications before de novo implementation.
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Affiliation(s)
- Judith S Sittig
- Department of Paediatrics, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
- Mental Health Care ‘GGZ Centraal’, Hilversum, The Netherlands
| | - Cuno S P M Uiterwaal
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Karel G M Moons
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Ingrid M B Russel
- Department of Paediatrics, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Rutger A J Nievelstein
- Department of Paediatric Radiology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Edward E S Nieuwenhuis
- Department of Paediatrics, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Elise M van de Putte
- Department of Paediatrics, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
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Idris NS, Cheung MMH, Grobbee DE, Burgner D, Kurniati N, Djer MM, Uiterwaal CSPM. Effects of paediatric HIV infection on electrical conduction of the heart. Open Heart 2016; 3:e000340. [PMID: 27042320 PMCID: PMC4800758 DOI: 10.1136/openhrt-2015-000340] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 12/15/2015] [Accepted: 12/20/2015] [Indexed: 01/08/2023] Open
Abstract
Objective To investigate the effects of HIV infection in children on heart electrical conduction, particularly to delineate the effects of HIV infection from treatment. Methods On a 12-lead ECG, available for 37 antiretroviral therapy (ART) naïve, 42 ART-exposed vertically-acquired HIV-infected and 50 healthy children in Jakarta, Indonesia, we measured cardiac conduction parameters: PR, QRS, and QTc (corrected using Bazett's formula) intervals. The associations between HIV infection/treatment status and ECG intervals were evaluated using general linear modelling with further adjustment for potential confounders or intermediary variables. Findings are presented as (adjusted) mean differences between each of the two HIV groups and healthy children. Results Although not exceeding the clinical threshold for long QT (QTc >460 ms for girls and >440 ms for boys) compared to healthy children, mean QTc intervals were longer in ART-naïve (difference 18.2 ms, 95% CI 7.0 to 29.3) and, to greater extent, in ART-exposed HIV-infected children (difference 28.9 ms, 19.3 to 38.5). Following adjustment for RR interval, age and height, prolongation of PR interval was seen only in ART-naïve HIV-infected children (difference 12.9 ms, 2.4 to 23.3). Cardiac mass/function, high-sensitive C reactive protein, cholesterol and glycated haemoglobin levels, systolic and diastolic blood pressures, or postnatal parental smoking exposure did not affect these associations. No difference in the QRS interval was observed between groups. Conclusions Prolongation of the QTc interval occurs in ART-naïve HIV-infected children and, to a greater extent, in the ART-exposed children, whereas a longer PR interval appears to be seen only among ART-naïve HIV-infected children.
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Affiliation(s)
- Nikmah S Idris
- Faculty of Medicine University of Indonesia-Cipto Mangunkusumo Hospital, Department of Child Health, Jakarta, Indonesia; Julius Global Health, Julius Centre for Health Sciences and Primary Care, the University Medical Centre Utrecht, Utrecht, The Netherlands; Department of Paediatrics, University of Melbourne, Murdoch Childrens Research Institute; Royal Children's Hospital, Melbourne, Australia
| | - Michael M H Cheung
- Department of Paediatrics , University of Melbourne, Murdoch Childrens Research Institute; Royal Children's Hospital , Melbourne , Australia
| | - Diederick E Grobbee
- Julius Global Health , Julius Centre for Health Sciences and Primary Care, the University Medical Centre Utrecht , Utrecht , The Netherlands
| | - David Burgner
- Department of Paediatrics, University of Melbourne, Murdoch Childrens Research Institute; Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, Monash University, Victoria, Australia
| | - Nia Kurniati
- Faculty of Medicine University of Indonesia-Cipto Mangunkusumo Hospital, Department of Child Health, Jakarta , Indonesia
| | - Mulyadi M Djer
- Faculty of Medicine University of Indonesia-Cipto Mangunkusumo Hospital, Department of Child Health, Jakarta , Indonesia
| | - Cuno S P M Uiterwaal
- Julius Global Health , Julius Centre for Health Sciences and Primary Care, the University Medical Centre Utrecht , Utrecht , The Netherlands
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Idris NS, Cheung MMH, Grobbee DE, Burgner D, Kurniati N, Uiterwaal CSPM. Cardiac Effects of Antiretroviral-Naïve versus Antiretroviral-Exposed HIV Infection in Children. PLoS One 2016; 11:e0146753. [PMID: 26789522 PMCID: PMC4720403 DOI: 10.1371/journal.pone.0146753] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 12/20/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Cardiac involvement in HIV infected children has been frequently reported, but whether this is due to HIV infection itself or to antiretroviral treatment (ART) is unknown. METHODS This cross sectional study involved 114 vertically-acquired HIV-infected (56 ART-naive, 58 ART-exposed) and 51 healthy children in Jakarta, Indonesia. Echocardiography was performed to measure dimensions of the left ventricle (LV) and systolic functions. We applied general linear modeling to evaluate the associations between HIV infection/treatment status and cardiac parameters with further adjustment for potential confounders or explanatory variables. Findings are presented as (adjusted) mean differences between each of the two HIV groups and healthy children, with 95% confidence intervals and p values. RESULTS Compared to healthy children, ART-naïve HIV-infected children did not show significant differences in age-and-height adjusted cardiac dimensions apart from larger LV internal diameter (difference 2.0 mm, 95%CI 0.2 to 3.7), whereas ART exposed HIV infection showed thicker LV posterior walls (difference = 1.1 mm, 95%CI 0.5 to 1.6), larger LV internal diameter (difference = 1.7 mm, 95%CI 0.2 to 3.2) and higher LV mass (difference = 14.0 g, 7.4 to 20.5). With respect to systolic function, reduced LV ejection fraction was seen in both ART-naïve HIV infected (adjusted difference = -6.7%, -11.4 to -2.0) and, to a lesser extent, in ART-exposed HIV infected children (difference = -4.5%, -8.5 to -0.4). Inflammation level seemed to be involved in most associations in ART-exposed HIV-infected, but few, if any, for decreased function in the ART-naive ones, whereas lower hemoglobin appeared to partially mediate chamber dilation in both groups and reduced function, mainly in ART-exposed children. CONCLUSIONS ART-naive HIV infected children have a substantial decrease in cardiac systolic function, whereas the ART-exposed have thicker ventricular walls with larger internal diameter and higher mass, but less functional impairment.
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Affiliation(s)
- Nikmah S. Idris
- Department of Child Health, Faculty of Medicine University of Indonesia - Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, the University Medical Centre Utrecht, Utrecht, Netherlands
- Department of Pediatrics, University of Melbourne; Heart Research Group, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Melbourne, Australia
- * E-mail:
| | - Michael M. H. Cheung
- Department of Pediatrics, University of Melbourne; Heart Research Group, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Melbourne, Australia
| | - Diederick E. Grobbee
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, the University Medical Centre Utrecht, Utrecht, Netherlands
| | - David Burgner
- Department of Pediatrics, University of Melbourne; Heart Research Group, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Melbourne, Australia
| | - Nia Kurniati
- Department of Child Health, Faculty of Medicine University of Indonesia - Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Cuno S. P. M. Uiterwaal
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, the University Medical Centre Utrecht, Utrecht, Netherlands
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Idris NS, Grobbee DE, Burgner D, Cheung MMH, Kurniati N, Uiterwaal CSPM. Effects of paediatric HIV infection on childhood vasculature. Eur Heart J 2016; 37:3610-3616. [PMID: 26746627 DOI: 10.1093/eurheartj/ehv702] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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] [Received: 07/03/2015] [Revised: 09/24/2015] [Accepted: 12/01/2015] [Indexed: 11/14/2022] Open
Abstract
AIMS Human immunodeficiency virus (HIV) infection may alter childhood vascular properties and influence future cardiovascular risk. Whether vascular changes are associated with HIV infection per se or antiretroviral therapy (ART) is unknown. We investigated the effects of ART-naive or ART-exposed HIV infection in children on childhood vascular characteristics. METHODS AND RESULTS We performed vascular ultrasound to measure carotid intima media thickness (cIMT), distensibility, and elastic modulus on 114 children with vertically acquired HIV infection (56 ART-naive, 58 ART treated) and 51 healthy children in Jakarta, Indonesia. Children also underwent clinical and blood examinations. We used general linear modelling to estimate associations between HIV infection/treatment status and vascular characteristics with adjustment for confounders or possible mediators. Vascular measurements were successful in 42 ART-naive HIV-infected [median age 4.0 years (min 0.4-max 11.5)]; 53 ART-treated HIV infected [5.7 years (0.6-12.2), median ART duration 2.4 years (0.1-9.9)]; and 48 healthy children, 6.5 years (2.4-14.0). The ART-naive HIV infected had thicker cIMT (difference 70.4 µm, 95% CI 32.1-108.7, P < 0.001), adjusted for age, sex, socioeconomic status, parental smoking, body mass index, systolic and diastolic blood pressure, LDL cholesterol, and HbA1c. Addition of high-sensitivity C-reactive protein (hs-CRP) level to the model did not affect the results (71.6 µm, 31.9-111.2, P = 0.001). The ART-exposed children had similar cIMT dimensions to healthy children. Distensibility was not significantly different between HIV infected, either ART-naive or -exposed, and healthy children, but adjusted analysis including only ART-exposed children with controlled HIV (CD4+ ≥200/mm3 or CD4+ ≥15%) showed that the ART-exposed had an increased elastic modulus (difference 37.9 kPa, 95% CI 6.5-69.3, P = 0.02), and following adjustment for hs-CRP (35.5 kPa, 95% CI 4.2-66.8, P = 0.03). CONCLUSION ART-naive HIV infection in children is associated with increased cIMT. Children with ART-controlled HIV may have increased arterial stiffness, although further confirmation is required.
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Affiliation(s)
- Nikmah S Idris
- Department of Child Health, Faculty of Medicine, University of Indonesia-Cipto Mangunkusumo National General Hospital, Jl. Diponegoro No. 71, Jakarta 10430, Indonesia .,Julius Global Health, Julius Centre for Health Sciences and Primary Care, The University Medical Centre Utrecht, Utrecht, The Netherlands.,Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Melbourne, Victoria, Australia
| | - Diederick E Grobbee
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, The University Medical Centre Utrecht, Utrecht, The Netherlands
| | - David Burgner
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Melbourne, Victoria, Australia.,Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Michael M H Cheung
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Melbourne, Victoria, Australia
| | - Nia Kurniati
- Department of Child Health, Faculty of Medicine, University of Indonesia-Cipto Mangunkusumo National General Hospital, Jl. Diponegoro No. 71, Jakarta 10430, Indonesia.,Julius Global Health, Julius Centre for Health Sciences and Primary Care, The University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Cuno S P M Uiterwaal
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, The University Medical Centre Utrecht, Utrecht, The Netherlands
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42
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Sittig JS, Uiterwaal CSPM, Moons KGM, Russel IMB, Nievelstein RAJ, Nieuwenhuis EES, van de Putte EM. [Systematic detection of physical child abuse at emergency rooms]. Ned Tijdschr Geneeskd 2016; 160:D672. [PMID: 27848908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The aim of our diagnostic accuracy study Child Abuse Inventory at Emergency Rooms (CHAIN-ER) was to establish whether a widely used checklist accurately detects or excludes physical abuse among children presenting to ERs with physical injury. DESIGN A large multicentre study with a 6-month follow-up in 4 ERs in The Netherlands. METHOD Participants were 4290 children aged 0-7 years, attending the ER because of physical injury. All children were systematically tested with an easy-to-use child abuse checklist (index test). A national expert panel (reference standard) retrospectively assessed all children with positive screens and a 15% random sample of the children with negative screens for physical abuse, using additional information, namely, an injury history taken by a paediatrician, information provided by the general practitioner, youth doctor and social services by structured questionnaires, and 6-month follow-up information. Our main outcome measure was physical child abuse; secondary outcome measure was injury due to neglect and need for help. RESULTS 4253/4290 (99%) parents agreed to follow-up. At a prevalence of 0.07% (3/4253) for inflicted injury by expert panel decision, the positive predictive value of the checklist was 0.03 (95% CI 0.006 to 0.085), and the negative predictive value 1.0 (0.994 to 1.0). There was 100% (93 to 100) agreement about inflicted injury in children, with positive screens between the expert panel and child abuse experts. CONCLUSION Rare cases of inflicted injury among preschool children presenting at ERs for injury are very likely captured by easy-to-use checklists, but at very high false-positive rates. Subsequent assessment by child abuse experts can be safely restricted to children with positive screens at very low risk of missing cases of inflicted injury. Because of the high false positive rate, we do advise careful prior consideration of cost-effectiveness and clinical and societal implications before de novo implementation.
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Affiliation(s)
- J S Sittig
- *Dit onderzoek werd eerder gepubliceerd in BMJ Open (2016;6:e010788) met als titel 'Value of systematic detection of physical child abuse at emergency rooms: a cross-sectional diagnostic accuracy study'. Afgedrukt met toestemming
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43
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Eikendal ALM, Evelein AMV, Uiterwaal CSPM, van der Ent CK, Visseren FLJ, Bots ML, Hoefer IE, den Ruijter HM, Dalmeijer GW. Relation Between Circulating Inflammatory Chemokines and Vascular Characteristics in Healthy, Young Children. J Am Heart Assoc 2015; 4:JAHA.115.002346. [PMID: 26675251 PMCID: PMC4845277 DOI: 10.1161/jaha.115.002346] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Atherosclerosis begins in childhood with the occurrence of inflammatory vascular wall alterations that are detectable with B‐mode ultrasound. Chemokines appear to be involved in the development of these alterations given that they occur early in the atherosclerotic pathway as mediators of vascular inflammation. However, this has not extensively been investigated. Therefore, we studied in healthy young children whether chemokines monocyte chemotactic protein 1 (MCP‐1), regulated on activation normal T‐cell expressed and secreted (RANTES), and vascular and intercellular adhesion molecules (VCAM and ICAM) related to vascular characteristics of the carotid artery. Methods and Results We obtained demography, anthropometry, and overnight fasting plasma of 139 eight‐year‐old children of the Wheezing Illnesses Study Leidsche Rijn birth cohort. Carotid intima‐media thickness (CIMT), distensibility, and Young's Elastic Modulus (YEM) of the common carotid artery were measured sonographically. Chemokine plasma levels were assessed using a multiplex assay. We studied the relation between the chemokines and vascular characteristics using multivariable linear regression analyses with adjustments for sex, systolic blood pressure, homeostasis model assessment of insulin resistance, triglycerides, low‐density lipoprotein‐ and high‐density lipoprotein‐cholesterol. Of the studied chemokines, RANTES related to common carotid distensibility and YEM. One standard deviation increase in RANTES level related to a 5.45‐MPA−1 (95% confidence interval [CI], −9.43, −1.39; P=0.01) decrease in distensibility and to a 5.55‐kPa increase in YEM (95% CI, 0.40, 10.85; P=0.03). RANTES did not relate to CIMT. MCP‐1, VCAM, and ICAM did not relate to any of the studied vascular characteristics. Conclusion RANTES appears to be involved in the development of preatherosclerotic inflammatory vascular alterations already in healthy, young children. This may provide further insight into the early‐life origins of atherosclerosis.
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Affiliation(s)
- Anouk L M Eikendal
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.M.E.)
| | - Annemieke M V Evelein
- Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands (A.V.E., C.K.E.)
| | - Cuno S P M Uiterwaal
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (C.M.U., M.L.B., G.W.D.)
| | - Cornelis K van der Ent
- Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands (A.V.E., C.K.E.)
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands (F.J.V.)
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (C.M.U., M.L.B., G.W.D.)
| | - Imo E Hoefer
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands (I.E.H., H.M.R.)
| | - Hester M den Ruijter
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands (I.E.H., H.M.R.)
| | - Geertje W Dalmeijer
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (C.M.U., M.L.B., G.W.D.)
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Eising JB, Uiterwaal CSPM, van der Ent CK. Maternal body mass index, neonatal lung function and respiratory symptoms in childhood. Eur Respir J 2015; 46:1342-9. [PMID: 26293499 DOI: 10.1183/13993003.00784-2014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 06/02/2015] [Indexed: 11/05/2022]
Abstract
Recent studies have shown that maternal obesity is associated with increased risk of wheezing in the offspring. We assessed whether impaired neonatal lung function could explain this association. We measured neonatal lung function in 2606 children of our prospective birth cohort. Information about daily symptoms of wheezing was obtained using questionnaires. Consultations and prescriptions for wheezing illnesses were derived from general practitioner patient files. Higher maternal body mass index (BMI) was associated with increased risk of wheezing in the first year of life and more consultations and prescriptions for wheezing illnesses until the age of 5 years. Lung function could partially explain the association with wheezing in the first year of life. Adding respiratory resistance to the model decreased the incidence rate ratio from 1.023 (95% CI 1.008-1.039) to 1.015 (95% CI 0.998-1.032). Anthropometrics of the 5-year-olds largely explained the association with consultations. Intermediates or confounders could not explain the association with prescriptions. There is an association between higher maternal BMI and increased risk of wheezing illnesses. In the first year of life, it is largely explained by an impaired lung function in early life, especially in children of nonatopic mothers. At the age of 5 years, infant lung function is of minor influence in this association.
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Affiliation(s)
- Jacobien B Eising
- Dept of Paediatric Pulmonology, Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
| | - Cuno S P M Uiterwaal
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
| | - Cornelis K van der Ent
- Dept of Paediatric Pulmonology, Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
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45
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Boshuisen K, van Schooneveld MMJ, Uiterwaal CSPM, Cross JH, Harrison S, Polster T, Daehn M, Djimjadi S, Yalnizoglu D, Turanli G, Sassen R, Hoppe C, Kuczaty S, Barba C, Kahane P, Schubert-Bast S, Reuner G, Bast T, Strobl K, Mayer H, de Saint-Martin A, Seegmuller C, Laurent A, Arzimanoglou A, Braun KPJ. Intelligence quotient improves after antiepileptic drug withdrawal following pediatric epilepsy surgery. Ann Neurol 2015; 78:104-14. [DOI: 10.1002/ana.24427] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Revised: 04/07/2015] [Accepted: 04/12/2015] [Indexed: 01/28/2023]
Affiliation(s)
- Kim Boshuisen
- Department of Child Neurology; Brain Center Rudolf Magnus, University Medical Center Utrecht; Utrecht the Netherlands
| | | | - Cuno S. P. M. Uiterwaal
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; Utrecht the Netherlands
| | - J. Helen Cross
- Clinical Neurosciences; University College London Institute of Child Health, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London and Young Epilepsy; Lingfield United Kingdom
| | - Sue Harrison
- Neuroscience Department; University College London Institute of Child Health and Great Ormond Street Hospital for Children National Health Service Trust; London United Kingdom
| | | | | | | | - Dilek Yalnizoglu
- Department of Pediatric Neurology; Hacettepe University Children's Hospital; Ankara Turkey
| | - Guzide Turanli
- Department of Pediatric Neurology; Hacettepe University Children's Hospital; Ankara Turkey
| | | | | | | | - Carmen Barba
- Pediatric Neurology Unit; A. Meyer Children's Hospital-University of Florence; Florence Italy
| | - Philippe Kahane
- Neurology Department; Michallon Hospital, Grenoble Alpes University; Grenoble France
| | | | - Gitta Reuner
- University Children's Hospital; Heidelberg Germany
| | - Thomas Bast
- University Children's Hospital; Heidelberg Germany
- Kork Epilepsy Center; Kehl Germany
| | | | | | | | | | - Agathe Laurent
- Department of Epilepsy; Sleep, and Pediatric Neurophysiology, Woman Mother Child Hospital, University Hospitals of Lyon; Lyon France
| | - Alexis Arzimanoglou
- Department of Epilepsy; Sleep, and Pediatric Neurophysiology, Woman Mother Child Hospital, University Hospitals of Lyon; Lyon France
- Brain Dynamics and Cognition Team; Lyon Neuroscience Research Center; Lyon France
| | - Kees P. J. Braun
- Department of Child Neurology; Brain Center Rudolf Magnus, University Medical Center Utrecht; Utrecht the Netherlands
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46
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Fortanier AC, Venekamp RP, de Hoog MLA, Uiterwaal CSPM, van der Gugten AC, van der Ent CK, Hoes AW, Schilder AGM. Parent-reported symptoms of acute otitis media during the first year of life: what is beneath the surface? PLoS One 2015; 10:e0121572. [PMID: 25849847 PMCID: PMC4388588 DOI: 10.1371/journal.pone.0121572] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 02/17/2015] [Indexed: 11/24/2022] Open
Abstract
Background Most estimates of the incidence of acute otitis media (AOM) are based on general practitioner (GP) or pediatrician diagnoses. It is likely that these figures underestimate the community incidence of AOM since parents do not visit their doctor every time their child suffers from acute ear symptoms. The impact of these symptom episodes may be substantial since they affect the child’s quality of life and parents’ productivity. Methods To determine AOM symptoms in the community, we measured parent-reported AOM symptoms daily for 12 consecutive months in 1,260 children participating in a prospective birth cohort in the Netherlands. The mean age of these children was at study enrollment 0.9 months (standard deviation 0.6). A parent-reported AOM symptom episode was defined as fever (temperature 38˚C or above) plus at least one of the following symptoms: ear pain and ear discharge. These febrile AOM symptom episodes were linked to GP-consultations and diagnoses in the GP electronic health records. Results With an estimated 624 parent-reported symptom episodes per 1,000 child-years (95% CI: 577 to 674) incidence of febrile AOM symptoms during the child’s first year is high. The GP was consulted in half of these symptom episodes and AOM was diagnosed in 49% of these consultations. Conclusions and Relevance The incidence of febrile AOM symptoms in the first year of life is high in Dutch children and leads to a GP-consultation in only half of the cases. This suggests that AOM symptomatology in the community is underestimated when focusing on GP-diagnosed AOM episodes alone, since a considerable proportion of febrile AOM symptom episodes are treated symptomatically by parents at home and do not come to the attention of the GP. Having data on community AOM symptomatology available for each country is important when the potential impact of preventive and therapeutic interventions for AOM are studied.
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Affiliation(s)
- Alexandre C. Fortanier
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roderick P. Venekamp
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Otorhinolaryngology, University Medical Center Utrecht, Utrecht, The Netherlands
- * E-mail:
| | - Marieke L. A. de Hoog
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cuno S. P. M. Uiterwaal
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anne C. van der Gugten
- Department of Pediatric Pulmonology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cornelis K. van der Ent
- Department of Pediatric Pulmonology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Arno W. Hoes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anne G. M. Schilder
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Otorhinolaryngology, University Medical Center Utrecht, Utrecht, The Netherlands
- Ear Institute, University College London, London, United Kingdom
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Sanikini H, Dik VK, Siersema PD, Bhoo-Pathy N, Uiterwaal CSPM, Peeters PHM, González CA, Zamora-Ros R, Overvad K, Tjønneland A, Roswall N, Boutron-Ruault MC, Fagherazzi G, Racine A, Kühn T, Katzke V, Boeing H, Trichopoulou A, Trichopoulos D, Lagiou P, Palli D, Grioni S, Vineis P, Tumino R, Panico S, Weiderpass E, Skeie G, Braaten T, Huerta JM, Sánchez-Cantalejo E, Barricarte A, Sonestedt E, Wallstrom P, Nilsson LM, Johansson I, Bradbury KE, Khaw KT, Wareham N, Huybrechts I, Freisling H, Cross AJ, Riboli E, Bueno-de-Mesquita HB. Total, caffeinated and decaffeinated coffee and tea intake and gastric cancer risk: results from the EPIC cohort study. Int J Cancer 2015; 136:E720-30. [PMID: 25236393 DOI: 10.1002/ijc.29223] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 06/17/2014] [Revised: 08/12/2014] [Accepted: 08/15/2014] [Indexed: 01/13/2023]
Abstract
Prospective studies examining the association between coffee and tea consumption and gastric cancer risk have shown inconsistent results. We investigated the association between coffee (total, caffeinated and decaffeinated) and tea consumption and the risk of gastric cancer by anatomical site and histological type in the European Prospective Investigation into Cancer and Nutrition study. Coffee and tea consumption were assessed by dietary questionnaires at baseline. Adjusted hazard ratios (HRs) were calculated using Cox regression models. During 11.6 years of follow up, 683 gastric adenocarcinoma cases were identified among 477,312 participants. We found no significant association between overall gastric cancer risk and consumption of total coffee (HR 1.09, 95%-confidence intervals [CI]: 0.84-1.43; quartile 4 vs. non/quartile 1), caffeinated coffee (HR 1.14, 95%-CI: 0.82-1.59; quartile 4 vs. non/quartile 1), decaffeinated coffee (HR 1.07, 95%-CI: 0.75-1.53; tertile 3 vs. non/tertile 1) and tea (HR 0.81, 95%-CI: 0.59-1.09; quartile 4 vs. non/quartile 1). When stratified by anatomical site, we observed a significant positive association between gastric cardia cancer risk and total coffee consumption per increment of 100 mL/day (HR 1.06, 95%-CI: 1.03-1.11). Similarly, a significant positive association was observed between gastric cardia cancer risk and caffeinated coffee consumption (HR 1.98, 95%-CI: 1.16-3.36, p-trend=0.06; quartile 3 vs. non/quartile 1) and per increment of 100 mL/day (HR 1.09, 95%-CI: 1.04-1.14). In conclusion, consumption of total, caffeinated and decaffeinated coffee and tea is not associated with overall gastric cancer risk. However, total and caffeinated coffee consumption may be associated with an increased risk of gastric cardia cancer. Further prospective studies are needed to rule out chance or confounding.
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Affiliation(s)
- Harinakshi Sanikini
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands; Inserm, Centre for research in Epidemiology and Population Health (CESP), U1018, Environmental Epidemiology of Cancer Team, Villejuif, Paris, France; Univ Paris Sud, UMRS 1018, Villejuif, Paris, France
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48
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Bhoo-Pathy N, Peeters PHM, Uiterwaal CSPM, Bueno-de-Mesquita HB, Bulgiba AM, Bech BH, Overvad K, Tjønneland A, Olsen A, Clavel-Chapelon F, Fagherazzi G, Perquier F, Teucher B, Kaaks R, Schütze M, Boeing H, Lagiou P, Orfanos P, Trichopoulou A, Agnoli C, Mattiello A, Palli D, Tumino R, Sacerdote C, van Duijnhoven FJB, Braaten T, Lund E, Skeie G, Redondo ML, Buckland G, Pérez MJS, Chirlaque MD, Ardanaz E, Amiano P, Wirfält E, Wallström P, Johansson I, Nilsson LM, Khaw KT, Wareham N, Allen NE, Key TJ, Rinaldi S, Romieu I, Gallo V, Riboli E, van Gils CH. Coffee and tea consumption and risk of pre- and postmenopausal breast cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort study. Breast Cancer Res 2015; 17:15. [PMID: 25637171 PMCID: PMC4349221 DOI: 10.1186/s13058-015-0521-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 01/20/2015] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Specific coffee subtypes and tea may impact risk of pre- and post-menopausal breast cancer differently. We investigated the association between coffee (total, caffeinated, decaffeinated) and tea intake and risk of breast cancer. METHODS A total of 335,060 women participating in the European Prospective Investigation into Nutrition and Cancer (EPIC) Study, completed a dietary questionnaire from 1992 to 2000, and were followed-up until 2010 for incidence of breast cancer. Hazard ratios (HR) of breast cancer by country-specific, as well as cohort-wide categories of beverage intake were estimated. RESULTS During an average follow-up of 11 years, 1064 premenopausal, and 9134 postmenopausal breast cancers were diagnosed. Caffeinated coffee intake was associated with lower risk of postmenopausal breast cancer: adjusted HR=0.90, 95% confidence interval (CI): 0.82 to 0.98, for high versus low consumption; Ptrend=0.029. While there was no significant effect modification by hormone receptor status (P=0.711), linear trend for lower risk of breast cancer with increasing caffeinated coffee intake was clearest for estrogen and progesterone receptor negative (ER-PR-), postmenopausal breast cancer (P=0.008). For every 100 ml increase in caffeinated coffee intake, the risk of ER-PR- breast cancer was lower by 4% (adjusted HR: 0.96, 95% CI: 0.93 to 1.00). Non-consumers of decaffeinated coffee had lower risk of postmenopausal breast cancer (adjusted HR=0.89; 95% CI: 0.80 to 0.99) compared to low consumers, without evidence of dose-response relationship (Ptrend=0.128). Exclusive decaffeinated coffee consumption was not related to postmenopausal breast cancer risk, compared to any decaffeinated-low caffeinated intake (adjusted HR=0.97; 95% CI: 0.82 to 1.14), or to no intake of any coffee (HR: 0.96; 95%: 0.82 to 1.14). Caffeinated and decaffeinated coffee were not associated with premenopausal breast cancer. Tea intake was neither associated with pre- nor post-menopausal breast cancer. CONCLUSIONS Higher caffeinated coffee intake may be associated with lower risk of postmenopausal breast cancer. Decaffeinated coffee intake does not seem to be associated with breast cancer.
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Affiliation(s)
- Nirmala Bhoo-Pathy
- Julius Center for Health Sciences and Primary Care, University Medical Center, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands.
- Department of Social and Preventive Medicine, Faculty of Medicine, Julius Centre University of Malaya, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia.
- National Clinical Research Centre, Kuala Lumpur Hospital, Ministry of Health, Kuala Lumpur, Malaysia.
| | - Petra H M Peeters
- Julius Center for Health Sciences and Primary Care, University Medical Center, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands.
- School of Public Health, Imperial College London, London, UK.
| | - Cuno S P M Uiterwaal
- Julius Center for Health Sciences and Primary Care, University Medical Center, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands.
| | - H Bas Bueno-de-Mesquita
- Department of Social and Preventive Medicine, Faculty of Medicine, Julius Centre University of Malaya, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia.
- School of Public Health, Imperial College London, London, UK.
- National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
- Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands.
| | - Awang M Bulgiba
- Department of Social and Preventive Medicine, Faculty of Medicine, Julius Centre University of Malaya, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia.
| | - Bodil Hammer Bech
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark.
| | - Kim Overvad
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark.
| | - Anne Tjønneland
- Danish Cancer Society, Institute of Cancer Epidemiology, Copenhagen, Denmark.
| | - Anja Olsen
- Danish Cancer Society, Institute of Cancer Epidemiology, Copenhagen, Denmark.
| | - Françoise Clavel-Chapelon
- Inserm, Centre for Research in Epidemiology and Population Health (CESP), U1018, "Nutrition, Hormones, and Women's Health" Team, Institut Gustave Roussy, F-94805, Villejuif, France.
- Université Paris Sud 11, UMRS 1018, F-94807, Villejuif, France.
| | - Guy Fagherazzi
- Inserm, Centre for Research in Epidemiology and Population Health (CESP), U1018, "Nutrition, Hormones, and Women's Health" Team, Institut Gustave Roussy, F-94805, Villejuif, France.
- Université Paris Sud 11, UMRS 1018, F-94807, Villejuif, France.
| | - Florence Perquier
- Inserm, Centre for Research in Epidemiology and Population Health (CESP), U1018, "Nutrition, Hormones, and Women's Health" Team, Institut Gustave Roussy, F-94805, Villejuif, France.
- Université Paris Sud 11, UMRS 1018, F-94807, Villejuif, France.
| | - Birgit Teucher
- Department of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany.
| | - Rudolf Kaaks
- Department of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany.
| | - Madlen Schütze
- Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbruecke, Germany.
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbruecke, Germany.
| | - Pagona Lagiou
- Department of Hygiene, Epidemiology and Medical Statistics, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School, 75 M. Asias Avenue, Goudi, GR-115 27, Athens, Greece.
| | - Philippos Orfanos
- Department of Hygiene, Epidemiology and Medical Statistics, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School, 75 M. Asias Avenue, Goudi, GR-115 27, Athens, Greece.
| | - Antonia Trichopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School, 75 M. Asias Avenue, Goudi, GR-115 27, Athens, Greece.
- Hellenic Health Foundation, 10-12 Tetrapoleos Street, GR-115 27, Athens, Greece.
| | - Claudia Agnoli
- Nutritional Epidemiology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Via Venezian, 1, 20133, Milan, Italy.
| | - Amalia Mattiello
- Dipartimento di Medicina Clinica e Chirurgia, University of Naples Federico II, Via Pansini, 5 80131, Naples, Italy.
| | - Domenico Palli
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy.
| | - Rosario Tumino
- Cancer Registry and Histopathology Unit, "Civile - M.P.Arezzo" Hospital, ASP 7, Ragusa, Italy.
| | | | - Franzel J B van Duijnhoven
- National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.
| | - Tonje Braaten
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway.
| | - Eiliv Lund
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway.
| | - Guri Skeie
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway.
| | - María-Luisa Redondo
- Public Health and Participation Directorate, Health and Health Care Services Council, Asturias, Spain.
| | - Genevieve Buckland
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain.
| | - Maria José Sánchez Pérez
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria de Granada (Granada.ibs), Granada, Spain.
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), Madrid, Spain.
| | - Maria-Dolores Chirlaque
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), Madrid, Spain.
- Department of Epidemiology, Murcia Health Council, Murcia, Spain.
| | - Eva Ardanaz
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), Madrid, Spain.
- Navarre Public Health Institute, Pamplona, Spain.
| | - Pilar Amiano
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), Madrid, Spain.
- Public Health Division of Gipuzkoa, Instituto Investigación Sanitaria, San Sebastian, Spain.
| | - Elisabet Wirfält
- Department of Clinical Sciences in Malmö/Nutrition Epidemiology, Lund University, Malmö, Sweden.
| | - Peter Wallström
- Department of Clinical Sciences in Malmö/Nutrition Epidemiology, Lund University, Malmö, Sweden.
| | | | - Lena Maria Nilsson
- Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umea, Sweden.
| | - Kay-Tee Khaw
- University of Cambridge School of Clinical Medicine, Cambridge, UK.
| | - Nick Wareham
- Medical Research Council, Epidemiology Unit, Cambridge, UK.
| | - Naomi E Allen
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford, OX3 7LF, UK.
| | - Timothy J Key
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford, OX3 7LF, UK.
| | - Sabina Rinaldi
- International Agency for Research on Cancer, Lyon, France.
| | | | - Valentina Gallo
- School of Public Health, Imperial College London, London, UK.
- Centre for Primary Care and Public Health, Barts and The London School of Medicine, Queen Mary University of London, London, UK.
| | - Elio Riboli
- School of Public Health, Imperial College London, London, UK.
| | - Carla H van Gils
- Julius Center for Health Sciences and Primary Care, University Medical Center, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands.
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Idris NS, Grobbee DE, Burgner D, Cheung MMH, Kurniati N, Sastroasmoro S, Uiterwaal CSPM. Cardiovascular manifestations of HIV infection in children. Eur J Prev Cardiol 2014; 22:1452-61. [PMID: 25398702 DOI: 10.1177/2047487314560086] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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] [Received: 08/30/2014] [Accepted: 10/28/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND HIV infection in children is now considered as a chronic condition, in which various non-infectious complications may occur, including those affecting the developing cardiovascular system. As children are expected to survive well into adulthood, understanding childhood as well as potential future cardiovascular complications is of major importance. METHODS AND RESULTS We reviewed published literature on childhood cardiac manifestations and longer term effects of pediatric HIV infection on the cardiovascular system. Evidence gaps that should be prioritized in research are highlighted. Through poorly understood mechanisms, HIV infection may cause various cardiac complications already manifesting in childhood, such as structural and functional myocardial derangements, pulmonary hypertension, pericardial effusion and possibly endocarditis. Evidence indicates that HIV infection in children also has unfavorable effects on the vasculature and cardiovascular biomarkers, such as increased intima-media thickness and decreased flow-mediated dilation, a marker of endothelial function. However, studies are small and predominantly include antiretroviral therapy-treated children, so that it is difficult to differentiate between effects of HIV infection per se and antiretroviral therapy treatment, reported in adults to have cardiovascular side effects. CONCLUSIONS HIV infection in children may greatly impact the cardiovascular system, including effects on the heart, which tend to manifest early in childhood, and on the vasculature. The underlying mechanisms, essential for targeted prevention, are poorly understood. Current evidence largely stems from research in adults. However, as modes of infection, immune maturity, growth and development, and treatment are markedly different in children, specific pediatric research, accounting for the complex interplay of normal growth and development, HIV infection and treatment, is clearly warranted.
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Affiliation(s)
- Nikmah S Idris
- Department of Child Health/Centre for Clinical Epidemiology and Evidence Based Medicine (CEEBM), Faculty of Medicine University of Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia Julius Global Health, Julius Center for Health Science and Primary Care, The University Medical Center, Utrecht, The Netherlands Department of Pediatrics, University of Melbourne, Australia Murdoch Children Research Institute, Royal Children's Hospital, Melbourne, Australia
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Science and Primary Care, The University Medical Center, Utrecht, The Netherlands
| | - David Burgner
- Department of Pediatrics, University of Melbourne, Australia Murdoch Children Research Institute, Royal Children's Hospital, Melbourne, Australia Department of Paediatrics, Monash University, Australia
| | - Michael M H Cheung
- Department of Pediatrics, University of Melbourne, Australia Murdoch Children Research Institute, Royal Children's Hospital, Melbourne, Australia
| | - Nia Kurniati
- Department of Child Health/Centre for Clinical Epidemiology and Evidence Based Medicine (CEEBM), Faculty of Medicine University of Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Sudigdo Sastroasmoro
- Department of Child Health/Centre for Clinical Epidemiology and Evidence Based Medicine (CEEBM), Faculty of Medicine University of Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Cuno S P M Uiterwaal
- Julius Global Health, Julius Center for Health Science and Primary Care, The University Medical Center, Utrecht, The Netherlands
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50
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van der Gugten AC, van der Ent CK, Uiterwaal CSPM. Infant lung function and wheeze in later childhood in the Southampton Women's Survey. Eur Respir J 2014; 43:921-2. [PMID: 24585874 DOI: 10.1183/09031936.00172013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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