Air pollution and global healthcare use for atopic dermatitis: A systematic review

Increasing air pollution is common around the world, but the impacts of outdoor air pollution exposure on atopic dermatitis (AD) are unclear. We synthesized the current global epidemiologic evidence for air pollution exposure and associated medical visits for AD among adults and children. This review followed PRISMA guidelines, and searches were conducted on PubMed, MEDLINE, Web of Science and EMBASE databases. The searches yielded 390 studies, and after screening, 18 studies around the world assessing at least 5,197,643 medical visits for AD in total were included for the final analysis. We found that exposure to particulate matter ≤2.5 μm in diameter (PM2.5 ) [(10/11) of studies], particulate matter ≤10 μm in diameter (PM10 ) (11/13), nitrogen dioxide (NO2 ) (12/14) and sulfur dioxide (SO2 ) (10/13) was positively associated with AD visits. Results were equivocal for ozone [(4/8) of studies reported positive association] and limited for carbon monoxide [(1/4) of studies reported positive association]. When stratifying results by patient age, patient sex and season, we found that the associations with particulate matter, NO2 and O3 may be affected by temperature. Exposure to selected air pollutants is associated with AD visits, and increasingly poor worldwide air quality may increase global healthcare use for AD.

Using a peptide-based mass spectrometry approach to quantitate proteolysis of an intact heterogeneous procollagen substrate by BMP1 for antagonistic antibody screening

Proteases are critical proteins involved in cleaving substrates that may impact biological pathways, cellular processes, or disease progression. In the biopharmaceutical industry, modulating the levels of protease activity is an important strategy for mitigating many types of diseases. While a variety of analytical tools exist for characterizing substrate cleavages, in vitro functional screening for antibody inhibitors of protease activity using physiologically relevant intact protein substrates remains challenging. In addition, detecting such large protein substrates with high heterogeneity using high-throughput mass spectrometry screening has rarely been reported in the literature with concerns for assay robustness and sensitivity. In this study, we established a peptide-based in vitro functional screening assay for antibody inhibitors of mouse bone morphogenic protein 1 (mBMP1) metalloprotease using a heterogeneous recombinant 66-kDa mouse Procollagen I alpha 1 chain (mProcollagen) substrate. We compared several analytical tools including capillary gel electrophoresis Western blot (CE-Western blot), as well as both intact protein and peptide-based mass spectrometry (MS) to quantitate the mBMP1 proteolytic activity and its inhibition by antibodies using this heterogeneous mProcollagen substrate. We concluded that the peptide-based mass spectrometry screening assay was the most suitable approach in terms of throughput, sensitivity, and assay robustness. We then optimized our mBMP1 proteolysis reaction after characterizing the enzyme kinetics using the peptide-based MS assay. This assay resulted in Z' values ranging from 0.6 to 0.8 from the screening campaign. Among over 1200 antibodies screened, IC₅₀ characterization was performed on the top candidate hits, which showed partial or complete inhibitory activities against mBMP1.

A new genetic strategy for targeting microglia in development and disease

As the resident macrophages of the brain and spinal cord, microglia are crucial for the phagocytosis of infectious agents, apoptotic cells and synapses. During brain injury or infection, bone-marrow derived macrophages invade neural tissue, making it difficult to distinguish between invading macrophages and resident microglia. In addition to circulation-derived monocytes, other non-microglial central nervous system (CNS) macrophage subtypes include border-associated meningeal, perivascular and choroid plexus macrophages. Using immunofluorescent labeling, flow cytometry and Cre-dependent ribosomal immunoprecipitations, we describe P2ry12-CreER, a new tool for the genetic targeting of microglia. We use this new tool to track microglia during embryonic development and in the context of ischemic injury and neuroinflammation. Because of the specificity and robustness of microglial recombination with P2ry12-CreER, we believe that this new mouse line will be particularly useful for future studies of microglial function in development and disease.

The impact of nocturnal symptoms associated with gastroesophageal reflux disease on health-related quality of life

BACKGROUND

Two types of reflux episodes have been identified: upright or daytime and supine or nocturnal. The population-based prevalence of symptoms of nocturnal gastroesophageal reflux disease (GERD) and the impact of those symptoms on health-related quality of life (HRQL) have not been established.

METHODS

A national random-sample telephone survey was conducted to estimate the prevalence of frequent GERD and nocturnal GERD-like symptoms and to assess the relationship between HRQL, GERD, and nocturnal GERD symptoms. Respondents were classified as controls, subjects with symptomatic nonnocturnal GERD, and subjects with symptomatic nocturnal GERD. The HRQL was assessed using the Medical Outcomes Study Short-Form 36 Health Survey (SF-36).

RESULTS

The prevalence of frequent GERD was 14%, with an overall prevalence of nocturnal GERD of 10%. Seventy-four percent of those with frequent GERD symptoms reported nocturnal GERD symptoms. Subjects with nonnocturnal GERD had significant decrements on the SF-36 physical and mental component summary scores compared with the US general population. Subjects reporting nocturnal GERD symptoms were significantly more impaired than subjects reporting nonnocturnal GERD symptoms on both the physical component summary (38.94 vs 41. 52; P<.001) and mental component summary (46.78 vs 49.51; P<.001) and all 8 subscales of the SF-36 (P<.001). Subjects with nocturnal GERD demonstrated considerable impairment compared with the US general population and chronic disease populations. Subjects with nocturnal GERD had significantly more pain than those with hypertension and diabetes (P<.001) and similar pain compared with those with angina and congestive heart failure.

CONCLUSIONS

Nocturnal symptoms are commonly experienced by individuals who report frequent GERD symptoms. In addition, HRQL is significantly impaired in those persons who report frequent GERD symptoms, and HRQL impairment is exacerbated in those who report nocturnal GERD symptoms.

Menstrual cycle and headache in a population sample of migraineurs

BACKGROUND

Migraine is three times more common in women than men. There is a clinical impression that migraines are more common and severe around the time of menses.

OBJECTIVES

To determine 1) the distribution of headache attacks by day of the menstrual cycle in women with migraine, 2) if the excess occurrence varies by headache type, and 3) if headache features differ by time in the menstrual cycle.

METHODS

In a population-based sample, 81 menstruating women with clinically diagnosed migraine were enrolled in a 98-day diary study and completed a total of 7219 diary days. The daily diary was used to record the occurrence of menses, headache days, and, on days with headache, associated headache features (i.e., symptoms, quality-of-pain, attack duration, pain intensity, and disability at work, household work, and nonwork activities).

RESULTS

An excess risk of headache occurred perimenstrually and was highest on days 0 and 1 of the cycle (day 0 being the first day of menses). A significantly elevated risk of headache on days 0 and 1 was observed for migraine without aura (OR 2.04; 95% CI 1.49, 2.81) and for tension-type headache (OR 1.67; 95% CI 1.24, 2.25). Elevated risks were also observed in the 2 days before onset of menses for migraine without aura (OR 1.80; 95% CI 1.40, 2.30). A significantly lower risk was observed around the time of ovulation for all headaches (OR 0.44; 95% CI 0.27, 0.72). Few significant differences were observed in headache features (i.e., pain intensity, disability score, symptom score, headache duration) by day of the cycle overall or by headache type. Pain intensity was slightly greater for migraine headaches during the first 2 days of menses.

CONCLUSIONS

Attacks of migraine without aura, but not migraine with aura, were more likely to occur 2 days before onset of menses and on the first 2 days of menses. This study does not support the clinical notion that headaches, regardless of type, are more severe during the perimenstrual period compared to other times in the cycle. Although migraine headaches are significantly more painful during the first 2 days of menses, differences are small.

Epidemiology of constipation (EPOC) study in the United States: relation of clinical subtypes to sociodemographic features

OBJECTIVE

Constipation is a common heterogeneous condition, possibly encompassing different clinical subtypes. Little is known about the comparative epidemiology of constipation subtypes. This study was conducted to estimate the prevalence of constipation subtypes and determine whether subtypes differ by sociodemographic factors.

METHODS

Between June and September 1997, a telephone interview was conducted with individuals about their bowel habits in the preceding 3 months. Survey data on 15 constipation-related symptoms were used to identify individuals who met prespecified symptom criteria for the following mutually exclusive subgroups: functional constipation, irritable bowel syndrome (IBS), outlet obstruction or delay (outlet), both IBS and outlet (IBS-outlet), and frequent laxative users (i.e., at least every other day). A total of 10,018 eligible individuals in the United States 18 yr of age or older completed the interview. Test-retest reliability of reporting symptoms was assessed in a separate national survey. The Spearman's correlation coefficient for reporting symptoms ranged from 0.54 to 0.83; all but three symptoms had correlations above 0.68.

RESULTS

The overall prevalence of constipation was 14.7%. By subtype, prevalence was 4.6% for functional, 2.1% for IBS, 4.6% for outlet, and 3.4% for IBS-outlet. An additional 1.8% of respondents reported laxative use at least every other day. Outlet was the most common subtype among women, whereas functional constipation was the most common subtype among men. The gender ratio varied by subtype, with elevated ratios for outlet (F/M = 1.65) and IBS-outlet (F/M = 2.27) subtypes. The age pattern differed among each of the four subtypes. Prevalence of functional subtype decreased with increasing age. In contrast, outlet subtype did not seem to vary by age, and IBS (both men and women) and IBS-outlet (women only) subtypes increased to age 35 yr and declined thereafter. Prevalence of functional constipation increased with increasing education. Outlet type was more common in nonwhites compared to whites. Finally, 45% of individuals with constipation reported having the condition for 5 yr or more.

CONCLUSIONS

Constipation is a heterogeneous condition. Differences in epidemiological profile by age, sex ratio, and relation to other sociodemographical factors support the distinction of two and possibly more symptom-based subtypes.

Functional decline in older adults: expanding methods of ascertainment

BACKGROUND

There is substantial interest in the prevention of physical disability associated with aging. However, little is known about how to screen for declining function at sufficiently early stages to prevent frank disability. This work provides an initial description and assessment of a new self-report method for measuring function in older adults which complements standard methods and may be sensitive to subtler degrees of disablement than currently employed methods. We operationalize the method and demonstrate that it identifies a meaningful number of people as potentially disabled who are not identified by standard methods; also, we evaluate the method's reliability and validity for identifying subtle functional decline relative to existing methods.

METHODS

This is a cross-sectional, observational study of a volunteer population of 231 adults 59 years and older, evaluated in a multidisciplinary laboratory. Self-reported difficulty and dependency in each of 27 tasks of daily life were assessed as the measure of disability. Those without difficulty were evaluated for other functional change, by self-report, defined as either: (a) modification of method, or (b) decreased frequency of task performance, when due to health rather than change in social circumstances. Prevalence, test-retest reliability, construct, and criterion validity were evaluated.

RESULTS

In a study population in which from 1% to 50% of participants reported difficulty with each of 27 tasks, from 2% to 33% reported modification of task performance while not having difficulty. Few participants reported decreased frequency without modification. Persons with task modifications, particularly in mobility tasks, showed intermediate levels of performance on objectively measured tests and an intermediate number of chronic diseases, compared to those reporting difficulty and those reporting neither difficulty nor modification.

CONCLUSIONS

Cross-sectional evidence supports the ability of the proposed method to identify meaningful numbers of people with functional decline who were not identified by standard self-report methods. In some cases, these were individuals with functional losses comparable to those who did report difficulty. In other cases, these may have been individuals with earlier functional loss, perhaps representing a preclinical stage of disability. Prospective evaluation will identify whether this method predicts the onset of difficulty or disability, and whether it predicts decline with sufficient precision to identify at-risk individuals in a clinical setting.

Visual stabilization of posture in the elderly: fallers vs. nonfallers

BACKGROUND

Postural instability is one of the important contributors to falling in observers aged 65 years and older. In this study we examine the role of vision in the relation between postural stability and falling, as well as in the relation between postural stability and the fear of falling.

METHODS

Community-dwelling adults 65 years and older were administered a questionnaire about their history of falls and fear of falling (N = 185). Postural sway was measured in the same subjects with eyes open and eyes closed. Visual function was assessed by measures of visual acuity and contrast sensitivity.

RESULTS

The 29 subjects who reported falling in the last year showed less of a visual contribution to posture stabilization than those who reported no falls. Controlling for age and gender, there is a 2.13-fold increase in the likelihood of reporting falling for a 0.1 decrement in the visual stabilization index when it is measured within the context of reliable somatosensory feedback. Those who reported a fear of falling and those who reported no fear showed similar visual stabilization. Contrast sensitivity was significantly associated with visual stabilization when it was measured within the context of reliable somatosensory feedback.

CONCLUSIONS

The visual contribution to postural stabilization is significantly greater in nonfallers compared to fallers, and it is significantly associated with contrast sensitivity.

Risk factors for secondary amenorrhea and galactorrhea

OBJECTIVE

Analyses were undertaken to identify factors that may predispose women to secondary amenorrhea or galactorrhea, frequent sources of abnormal reproductive function.

METHODS

Data were gathered from interviews with 252 women with secondary amenorrhea or galactorrhea from four clinical centers, along with neighborhood controls matched to each case. Univariate comparisons were made for clinical and demographic factors of the study subjects.

RESULTS

Patients with amenorrhea and normal prolactin (PRL) levels and their matched controls tended to be younger than those with amenorrhea and elevated PRL or than menstruating patients with galactorrhea alone and their matched controls. Patients with amenorrhea and normal PRL also were significantly more educated and were older at menarche than their controls, while amenorrhea patients with elevated PRL or patients with galactorrhea alone did not differ significantly from their controls in age at menarche or educational level. More patients with galactorrhea alone had reported menstrual pain to their physicians and had significantly longer menstrual periods than their matched controls. Patients with galactorrhea alone also weighed more than their controls 2 years prior to diagnosis, a difference that remained after stratification by parity, although only statistically significant among women who had had one or two pregnancies. Finally, significantly fewer patients with amenorrhea than controls were smokers. Thus, these disorders may not be due to anti-estrogenic effect or to low estrogen levels which have been associated with smoking.

The use of relaxation for the promotion of comfort and pain relief in persons with advanced cancer

The efficacy of a relaxation technique involving deep breathing, muscle relaxation, and imagery was tested as a nursing intervention for the promotion of comfort and pain relief in hospitalized oncology patients. The intervention was implemented in accordance with Orem's self-care approach to nursing practice. Sixty-seven new admissions to an oncology ward were randomly assigned to receive relaxation training by audio tapes, live relaxation training by nurses, or no relaxation training. Relaxation training was conducted twice weekly over a period of three weeks. All subjects were pretested and post-tested with the McGill Pain Questionnaire and Visual Analogue Scale for pain. Analgesic medication was monitored throughout the study. Data analysis showed significant reductions in subjective pain ratings by subjects receiving relaxation training. There was also a significant reduction in non-opiate p.r.n. analgesic intake which suggested a reduced incidence of breakthrough pain.

Comparative epidemiology of selected midline congenital abnormalities

We present comparative epidemiologic characteristics of five congenital abnormalities that have been suggested to result from midline abnormal developmental disturbances: esophageal atresia with or without tracheoesophageal fistula (EA/TEF), imperforate anus with or without fistula (IA/F), omphalocele (OM), bladder exstrophy (BE), and diaphragmatic hernia (DH). The purpose was to assess the extent of epidemiologic similarities among these five defects. Data were collected as part of a population-based case-control study of infants with these defects born to mothers residing in Maryland, Washington, D.C., or Northern Virginia from 1980 through 1987. The estimated annual birth prevalences (per 10,000 live births) and 95% confidence intervals (CI) of these five defects were 0.40 (0.26-0.61) for BE, 1.34 (1.08-1.67) for OM, 1.59 (1.29-1.95) for DH, 2.11 (1.76-2.53) for EA/TEF, and 2.97 (2.55-3.46) for IA/F. The birth prevalence of IA/F and DH increased between 1980 and 1987. In contrast to the other four defects, DH showed a significant male preponderance (rate ratio 1.57, 95% CI 1.03-2.47), a significant white excess (rate ratio white:other, 1.56, 95% CI 1.00-2.48), and a lower proportion of multiple associated defects (30% vs. 46-61%). We concluded from this study that the descriptive epidemiology of diaphragmatic hernia is different from that of the other four defects. This finding may imply differences in etiologic and pathogenetic mechanisms underlying DH.

Volumetric MRI changes in basal ganglia of children with Tourette's syndrome

To define the site of pathology in Tourette's syndrome (TS), we performed a volumetric MRI study of basal ganglia structures and lateral ventricles on 37 children with this disorder and 18 controls. There were no statistically significant differences in the size of the right or left caudate, putamen, globus pallidus, or ventricles in these populations. In contrast, there were significant differences for measures of symmetry in the putamen and the lenticular region. Virtually all controls (17 right- and one left-handed) had a left-sided predominance of the putamen, whereas in 13 of 37 TS subjects, a right predominance exceeded that of any control. Statistical comparisons among TS patients, with (n = 18) or without (n = 19) attention-deficit hyperactivity disorder (ADHD), and controls showed significant differences for the volume of the left globus pallidus and for lenticular asymmetry. Post hoc evaluations showed that in the TS + ADHD group, the volume of the left globus pallidus was significantly smaller than the volume of the right and that lenticular asymmetry was due to a greater right-sided predominance in the TS+ADHD group. This study lends further support to proposals that claim the basal ganglia is involved in the pathogenesis of TS and also suggests that the comorbid problem of ADHD is related to regional changes that differ from those primarily associated with tics.

Genetic-epidemiologic study of omphalocele and gastroschisis: evidence for heterogeneity

On the basis of clinical manifestations, epidemiologic characteristics, and the presence of additional malformations, omphalocele (OM) and gastroschisis (GA) are considered casually and pathogenetically distinct abdominal wall defects. More than 50% of infants with OM have additional defects, but only about 15% of those with GA do. To evaluate whether there is heterogeneity between isolated and multiply affected cases of OM and GA, we analyzed epidemiologic characteristics and familial risks of major defects for 82 OM and 81 GA cases drawn from a population-based study in the Maryland-Washington, DC-Northern Virginia area and born from 1980 through June 1987. We examined year of birth, sex, race, and maternal age distributions after stratifying the infants into isolated and multiple defect groups. We found significant differences in maternal age between cases with isolated OM and GA, but not between cases with GA or OM who had other defects. Using regressive logistic models, we analyzed familial aggregation of birth defects among relatives of infants with OM and GA. An autosomal recessive model of inheritance was found to be the most parsimonious explanation for the families of infants with isolated OM or GA. However, for families of infants with multiple defects, a sporadic or nongenetic model fit best. These findings are not only useful for estimating familial risk of major birth defects, but they also suggest further heterogeneity of infants with OM and GA according to the presence of other malformations.

Body weight as a risk factor in the elderly

To determine whether body weight is a risk factor for mortality among older persons, we analyzed body mass index (weight [kilogram]/height [square meter]) data for 4710 white, National Health and Nutrition Examination Survey respondents who were aged 55 to 74 years during 1971 through 1975, in relation to their survival over an average of 8.7 years of follow-up. In a multivariate analysis that controlled for elevated blood pressure, smoking, and poverty, we found no additional risk associated with weight among women and a statistically significant, but moderate, additional risk (relative risk, 1.1 to 1.2) among men in the upper decile (body mass index, greater than or equal to 30 kg/m2). In contrast, low weight (body mass index, less than 22 kg/m2) was associated with increased mortality (relative risk, 1.3 to 1.6) except for women aged 55 to 64 years. We conclude that the accepted definition of overweight (body mass index, greater than or equal to 27.8 kg/m2 [men] or greater than or equal to 27.3 kg/m2 [women]) lacks specificity and may be inappropriate for older persons who do not have weight-related medical conditions. The low-weight mortality association, consistently demonstrated, deserves serious scrutiny.

Vitamin A, cigarette smoking, and airway obstruction

The hypothesis that vitamin A, or foods rich in vitamin A such as milk, protects against the development of airway obstruction was tested in a subsample of data from the 1971-1975 National Health and Nutrition Examination Survey. The relative risk (estimated by relative odds) of having airway obstruction, defined as a FEV1/FVC less than or equal to 65%, was measured for different levels of nutrient and food group intakes after adjustment for age, sex, Quetelet Index, caloric intake, and cigarette smoking. Among the white respondents (never smokers or current smokers) whose recalled diet could be considered as typical of their usual diet, the relative odds of having airway obstruction was inversely related to vitamin A intake (x2 for trend = 7.2, p less than 0.01). In the analysis by food groups, the adjusted relative odds of airway obstruction for meat and poultry were 2.4 (95% confidence limits: 1.0 to 5.8) and for milk 1.6 (95% confidence limits: 1.0 to 2.5). The association of airway obstruction with lack of vitamin A or milk intake was clearer among smokers. These findings suggest that a diet poor in vitamin A increases the risk of airway obstruction, and are consistent with the previously reported association of chronic bronchitis, milk intake, and smoking.

Diet and opiate addiction: a quantitative assessment of the diet of non-institutionalized opiate addicts

The diet, weight and height of 38 non-institutionalized chronic opiate addicts have been assessed and compared to those of a random sample of the 20-35 year old general population of Canton Geneva, Switzerland. A history questionnaire was administered by specially trained dietitians. Results show that, after adjustment for age and alcohol intake, male addicts have the same caloric intake as non-addicts. However, addicts tend to replace foods that are rich in fat and proteins with foods rich in sucrose and relatively poor in vitamins and minerals. Beer is the major component of their much larger alcohol consumption. On the other hand, the body mass index (kg/m2) of the male addicts is within the normal range, suggesting this may not be a good indicator of their unbalanced diet. This study gives a quantitative assessment, in terms of nutrient intake, of the typical craving for sweet described by opiate addicts.

Heart disease mortality in nonsmokers living with smokers

A private census of Washington County, Maryland, in 1963 obtained information on smoking habits of all adults in the census, and death certificates of all residents who died in the next 12 years were coded for underlying cause of death and matched to the census. Among the white population aged 25 and over, 4,162 men and 14,873 women had never smoked. In this group, death rates from arteriosclerotic heart disease were significantly higher among men (relative risk (RR) = 1.31, 95% confidence interval (CI) 1.1-1.6) and women (RR = 1.24, 95% CI 1.1-1.4) who lived with smokers in 1963, after adjustment for age, marital status, years of schooling, and quality of housing. Among women, the relative risk increased significantly (p less than 0.005) with increasing level of exposure; among men, there was little evidence of a dose-response relation. The relative risks for nonsmokers who lived with smokers were greatest among both men and women who were younger than age 45 in 1963, but the number of deaths in these groups was small, and confidence intervals were broad. These results suggest a small but measurable risk for arteriosclerotic heart disease among nonsmokers who live with smokers.