Impact of low birth weight on early childhood asthma in the United States
Pediatrics; risk-factors; prevalence; follow-up; severity; infants; responsiveness; socioeconomic-status; bronchial; chronic lung-disease; respiratory morbidity; school-children born
Objective: To estimate the independent contribution of birth weight to asthma prevalence among children younger than 4 years in the United States and to compare the magnitude of its effect on asthma between African American and white children. Design: Cross-sectional analysis using the 1988 National Maternal-infant Health Survey and 1991 Longitudinal Follow-up Survey. Setting: United States. Patients: Eight thousand seventy-one subjects, selected from a randomized, systematic population-based sample and weighted to be nationally representative, who completed both initial and longitudinal follow-up surveys and reported information on asthma diagnosis. Main Outcome Measures: Birth weight and other sociodemographic factors linked to birth outcome were analyzed for independent association with physician-diagnosed asthma by age 3 years. Results: The prevalence of asthma varied by birth weight category: 6.7% in children 2500 g or more at birth, 10.9% in children 1500 to 2499 g at birth, and 21.9% in children less than 1500 g at birth (very low birth weight [VLBW]) (P<.001). Some of the characteristics shown to be independently associated with asthma included: VLBW (odds ratio [OR], 2.9; 95% confidence interval [CI], 2.3-3.6), moderately low birth weight (OR, 1.4, 95% CI, 1.1-1.8), and African American race (OR, 1.9; 95% CI, 1.6-2.4). In stratified analyses, the independent association between VLBW and asthma in white and African American populations was: ORwhite 3.1 (95% CI, 2.24.3) and ORAfrican American, 2.5 (95% CI, 2.0-3.3). The prevalence of VLBW, however, was tripled in African American compared with white children (1.8% vs 0.6%). Conclusions: These data confirm findings of other studies that identify a strong independent association between low birth weight and asthma. For this 1988 national birth cohort, an estimated 4000 excess asthma cases were attributable to birth weight less than 2500 g. Although the strength of the independent association between VLBW and asthma was smaller in the African American population, the substantially increased prevalence of VLBW in this community may contribute to the disproportionately increased prevalence of asthma among African American children.
Brooks A M; Byrd R S; Weitzman M; Auinger P; McBride J T
Archives of Pediatrics & Adolescent Medicine
2001
2001-03
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1001/archpedi.155.3.401" target="_blank" rel="noreferrer noopener">10.1001/archpedi.155.3.401</a>
Initial Urinary Epinephrine And Cortisol Levels Predict Acute Ptsd Symptoms In Child Trauma Victims
catecholamine; catecholamines; children; combat veterans; cortisol; dexamethasone-suppression; Endocrinology & Metabolism; excretion; Neurosciences & Neurology; pituitary; posttraumatic-stress-disorder; psychiatric diagnoses; Psychiatry; PTSD; severity; survivors; trauma; women
Delahanty D L; Nugent N R; Christopher N C; Walsh M
Psychoneuroendocrinology
2005
2005-02
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1016/j.psyneunen.2004.06.004" target="_blank" rel="noreferrer noopener">10.1016/j.psyneunen.2004.06.004</a>
Metabolism of phenytoin by the gingiva of normal humans: The possible role of reactive metabolites of phenytoin in the initiation of gingival hyperplasia
clinical report; cyclosporine-a; cytochrome P450; enlargement; hepatotoxicity; microsomes; monoclonal-antibodies; overgrowth; Pharmacology & Pharmacy; proteins; severity
Gingival hyperplasia is a well-known complication of therapy with cyclosporine, calcium channel blockers, and phenytoin, It is characterized by the presence of inflammation and a marked fibrotic response. The mechanism of this adverse reaction is unknown, We propose that it may be initiated by the metabolic activation of these drugs to form reactive metabolites, These then cause cellular injury and lead to the gingival hyperplasia, To evaluate this hypothesis we examined phenytoin metabolism and the cytochrome P450 contents of gingival tissues from 10 patients undergoing surgery for various periodontal conditions, We found that microsomes obtained from the gingiva show significant phenytoin hydroxylase activity as determined by the production of 5-(4'-hydroxyphenyl)-5-phenylhydantoin (HPPH) (range, 12.8 pmol HPPH/min . mg microsomal protein to 276.9 pmol HPPH/min . mg microsomal protein; rat control, 133.7+/-11.5 pmol HPPH/min . mg microsomal protein), We also found that CYP1A1, CYP1A2, CYP2C9, CYP2E1, and CYP3A4 were present in these microsomes, We detected no CYP2B6 or CYP2D6. We believe that these data support our hypothesis that the proliferative inflammation observed with drugs such as phenytoin, nifedipine, and cyclosporine may be initiated by the formation of reactive metabolites and that the formation of these metabolites may be catalyzed by one or more CYPs found in the gingiva, These metabolites may then cause cellular injury and induce a reactive inflammatory response, followed by fibroblastic proliferation, This proliferation leads to the excess collagen deposition observed with gingival hyperplasia.
Zhou L X; Pihlstrom B; Hardwick J P; Park S S; Wrighton S A; Holtzman J L
Clinical Pharmacology & Therapeutics
1996
1996-08
Journal Article
<a href="http://doi.org/10.1016/s0009-9236(96)90135-6" target="_blank" rel="noreferrer noopener">10.1016/s0009-9236(96)90135-6</a>
Paramedic judgment of the need for trauma team activation for pediatric patients
assessment; emergency medical technicians; Emergency Medicine; impact; injury; judgment; major trauma; mechanism; Pediatrics; rule; score; severity; system; trauma; triage criteria; victims
Objective: To determine the value of paramedic judgment in determining the need for trauma team activation (TTA) for pediatric blunt trauma patients. Methods: A prospective, observational study was conducted at the ED of Children's Hospital Medical Center of Akron between July 12, 1996, and February 28, 1997, in cooperation with Akron Fire Department emergency medical technician-paramedics (EMT-Ps). The ED provides on-line and off-line medical control for pediatric transports. Patients with minor or no identifiable injuries are released at the scene with the instructions to see a physician. The remainder are transported to the ED. The decision for TTA is based on ED trauma protocols as well as emergency physician judgment of injury severity in combination with the judgment of the treating paramedic. During the study, EMT-Ps were asked (before physician input) whether, based solely on their judgment, a patient needed TTA. Patients 0-14 years old who were involved in motor vehicle crashes, bike crashes, or falls from a height of >10 feet were included in the study. TTA was defined as necessary if the patient was admitted to the intensive care unit (ICU) or operating room (OR) for nonorthopedic surgical procedures. Out-of-hospital, ED, and hospital records were reviewed. Coroners' records as well as medical records of all trauma admissions during the study period were reviewed to ensure that the patients released at the scene were not mistriaged. Results: One hundred ninety-two patients met study criteria. Eighty-five patients (44%) were transported to the ED, of whom 12 had TTA. EMT-Ps requested TTA for 10 of these patients, and 2 patients had TTA per ED trauma protocol. Two of the patients who were judged by EMT-Ps to need TTA were admitted to the ICU/OR, and neither of the patients identified by ED trauma protocol to require TTA were admitted to the ICU/OR. Two initially stable patients who did not have TTA deteriorated after arrival to the ED. Both were admitted to the ICU. The sensitivity and specificity of paramedic judgment of the need for TTA for pediatric blunt trauma patients were 50% (95% CI 9.2-90.8) and 87.7% (95% CI 78.0-93.6), respectively. The positive and negative predictive values were 16.7% (95% CI 2.9-49.1) and 97.3% (95% CI 89.6-99.5). None of the patients released at the scene was mistriaged based on the review of the coroners' and trauma admission records. Conclusion: Results of this investigation indicate that a small percentage of pediatric blunt trauma patients require TTA. EMT-P judgment alone of the need for TTA for pediatric blunt trauma patients is not sufficiently sensitive to be of clinical use. The low sensitivity is explained by the deterioration in the clinical condition of 2 initially stable patients. The paramedic disposition decisions from the scene were always accurate. Nontransport by emergency medical services (EMS) may be acceptable in some uninjured pediatric trauma patients. Injured pediatric trauma patients who appear to be stable may deteriorate shortly after injury. However, if a pediatric patient appears injured, transport from the scene and examination by a trauma specialist are needed. Finally, the role of paramedic judgment must be further defined by larger studies with urban, rural, and suburban EMS systems before it can be used as a sole predictor of TTA.
Qazi K; Kempf J A; Christopher N C; Gerson L W
Academic Emergency Medicine
1998
1998-10
Journal Article
<a href="http://doi.org/10.1111/j.1553-2712.1998.tb02780.x" target="_blank" rel="noreferrer noopener">10.1111/j.1553-2712.1998.tb02780.x</a>
Performance measure of urinary antigen in patients with Streptococcus pneumoniae bacteremia
adults; assay binax; bacteremia; community-acquired pneumonia; diagnosis; etiologic diagnosis; infections; Infectious Diseases; management; Microbiology; pneumococcal pneumonia; rapid diagnosis; severity; sputum culture; Streptococcus pneumoniae; Urinary antigen
The Streptococcus pneumoniae (SP) urinary antigen (UAg) test is a commonly used assay. The purpose cif this study was to evaluate the test's actual performance in the clinical setting and determine the effects of renal function, grade of bacteremia, and severity-of-illness scores on its outcome. Patients with pneumococcal bacteremia were retrospectively identified and stratified on the basis of glomerular filtration rates, number of positive blood cultures, and CURB-65 scores. Logistic regression was used to determine the effect that these 3 variables had on test outcomes. SP UAg testing was performed in 65 of 129 patients with pneumococcal bacteremia and was positive in 42 of 65 (64.5%). Impaired renal function was the only variable to have a significant effect on test outcome (P = 0.03). Test performance was less sensitive than prospective studies indicate. Patients with impaired renal function were significantly more likely to have positive UAg tests. (C) 2010 Elsevier Inc. All rights reserved.
Selickman J; Paxos M; File T M; Seltzer R; Bonilla H
Diagnostic Microbiology and Infectious Disease
2010
2010-06
Journal Article
<a href="http://doi.org/10.1016/j.diagmicrobio.2010.01.005" target="_blank" rel="noreferrer noopener">10.1016/j.diagmicrobio.2010.01.005</a>
The Effect Of Mold Sensitization And Humidity Upon Allergic Asthma
allergic rhinitis; allergy; asthma; bronchial responsiveness; childhood asthma; children; dampness; dry cold-air; exercise-induced asthma; home; humidity; induced bronchoconstriction; mold; pulmonary-function; respiratory health survey; Respiratory System; severity
Introduction: Humidity is commonly associated with increased airway hyperresponsiveness in asthma. Objective: To examine mold sensitization in patients with allergic asthma or allergic rhinitis and self-reports of humidity as exacerbating factors of clinical symptoms. Methods: A retrospective, cross-sectional study at a University hospital outpatient allergy and asthma clinic was performed. A total of 106 patients with either allergic asthma or allergic rhinitis completed standard prick-puncture skin testing with 17 allergens and controls and completed standardized forms addressing trigger factors for clinical symptoms. Results: Allergic asthmatics sensitized to Cladosporium were more likely to have a more severe asthma severity class (odds ratio=4.26, confidence interval=1.3016.93). Sensitization to Alternaria, Cladosporium, Helminthosporium, Aspergillus and Dermatophagoides pteronyssinus in asthma was associated with higher likelihood for previous hospitalization, while sensitization to Cladosporium, Helminthosporium, Aspergillus, Dermatophagoides pteronyssinus and cockroach in asthma was associated with higher likelihood of having reduced pulmonary function based on forced expiratory volume in 1s. Furthermore, allergic asthmatics more commonly reported humidity as an exacerbating factor of symptoms than did patients only with allergic rhinitis (68.42% vs 42.86%, respectively; P<0.05). Conclusion: Mold sensitization is highly associated with more severe asthma, while humidity is more of an exacerbating factor in patients with allergic asthma as compared with allergic rhinitis alone. Further delineation between mold sensitization and humidity is needed to determine whether these are independent factors in asthma. Please cite this paper as: Hayes D Jr, Jhaveri MA, Mannino DM, Strawbridge H and Temprano J. The effect of mold sensitization and humidity upon allergic asthma. Clin Respir J 2013; 7: 135144.
Hayes D; Jhaveri M A; Mannino D M; Strawbridge H; Temprano J
Clinical Respiratory Journal
2013
2013-04
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1111/j.1752-699X.2012.00294.x" target="_blank" rel="noreferrer noopener">10.1111/j.1752-699X.2012.00294.x</a>