RESUMO
Secondhand smoke is associated with a myriad of adverse health outcomes. Therefore, it is essential for clinicians to ask precise questions about exposures, particularly for children. We present 4 questions that incorporate several locations of exposure and provide a more comprehensive account of children's smoke exposures than maternal smoking alone.
Assuntos
Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Inquéritos e Questionários/normas , Poluição por Fumaça de Tabaco/efeitos adversos , Pré-Escolar , Cotinina/análise , Feminino , Seguimentos , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Ontário/epidemiologia , Gravidez , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Efeitos Tardios da Exposição Pré-Natal/metabolismo , Prognóstico , Radioimunoensaio , Fatores Socioeconômicos , Fatores de TempoRESUMO
OBJECTIVE: To examine risk factors for eczema at age 4 years. STUDY DESIGN: Beginning at 1 year of age, infants of atopic parents (n = 636) had annual clinical evaluations and skin prick tests (SPTs) to 15 aeroallergens and milk and egg. Parents completed validated surveys on eczema and environmental exposures. House dust samples were evaluated for allergens and endotoxin. Eczema was defined as a parental report of scratching, and redness, "raised bumps," or dry skin/scaling for 6 of the last 12 months. RESULTS: At age 4 years, a total of 90 children (14%) had eczema. Not having a dog before 1 year of age and being dog SPT+ at 1, 2, or 3 years of age conferred a 4-fold higher risk for eczema at age 4 years (adjusted odds ratio [aOR] = 3.9 [1.6-9.2]; P = .002). Among dog owners, however, dog SPT+ was not associated with significantly increased risk (aOR 1.3 [0.3-6.8]; P = .8). Among children with cats before 1 year of age, cat SPT+ conferred significantly increased risk for eczema (aOR = 13.3 [3.1-57.9]; P < .001). Among non-cat owners, cat SPT+ was not associated with increased risk (aOR = 1.1 [0.5-2.7]; P = .8). CONCLUSION: Dog ownership significantly reduced the risk for eczema at age 4 years among dog-sensitized children, cat ownership combined with cat sensitization significantly increased the risk.
Assuntos
Animais Domésticos/imunologia , Dermatite Atópica/imunologia , Eczema/imunologia , Exposição Ambiental/efeitos adversos , Imunização , Fatores Etários , Alérgenos , Análise de Variância , Animais , Gatos , Pré-Escolar , Estudos de Coortes , Intervalos de Confiança , Dermatite Atópica/diagnóstico , Dermatite Atópica/epidemiologia , Dermatite Atópica/genética , Cães , Eczema/epidemiologia , Eczema/genética , Feminino , Predisposição Genética para Doença , Humanos , Incidência , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Razão de Chances , Prognóstico , Medição de Risco , Testes CutâneosRESUMO
OBJECTIVES: To characterize the seroepidemiological features of Pneumocystis jirovecii infection in healthy Chilean children using overlapping fragments (A, B, C) of the P. jirovecii major surface glycoprotein (Msg). METHODS: Serum antibodies to MsgA, MsgB, and MsgC were measured every 2 months by enzyme-linked immunosorbent assay (ELISA) in 45 Chilean infants from about age 2 months to 2 years. RESULTS: Peak antibody levels (usually reached at age 6 months) and the force (or rate) of infection were somewhat greater for MsgC than for MsgA. Significant seasonal variation in antibody levels was only found with MsgA. Respiratory infections occurred in most children, but nasopharyngeal aspirates were of limited value in detecting the organism. In contrast, serological responses commonly occurred, and higher levels only to MsgC were significantly related to the number of infections. CONCLUSIONS: Serological responses to recombinant Msg fragments provide new insights into the epidemiological and clinical features of P. jirovecii infection of early childhood. MsgA, the amino terminus fragment, is more sensitive in detecting seasonal influences on antibody levels, whereas MsgC is better able to detect changes in antibody levels in response to clinical infection.
Assuntos
Anticorpos Antifúngicos/sangue , Glicoproteínas de Membrana/imunologia , Infecções por Pneumocystis/epidemiologia , Pneumocystis carinii/imunologia , Proteínas Recombinantes/imunologia , Pré-Escolar , Chile/epidemiologia , Proteínas Fúngicas/genética , Proteínas Fúngicas/imunologia , Humanos , Lactente , Glicoproteínas de Membrana/genética , Infecções por Pneumocystis/imunologia , Infecções por Pneumocystis/microbiologia , Proteínas Recombinantes/genética , Estudos SoroepidemiológicosRESUMO
OBJECTIVE: To examine the efficacy of a 3-month clinic-based behavioral nutrition intervention emphasizing a diet high in fruits, vegetables, and low fat dairy (DASH intervention) versus routine outpatient hospital-based nutrition care (RC) on diet and blood pressure (BP) in adolescents with elevated BP. STUDY DESIGN: Fifty-seven adolescents with a clinical diagnosis of prehypertension or hypertension (systolic BP or diastolic BP, 90(th) to 99(th) percentile) were randomly assigned to DASH or RC. SBP, DBP, 3-day diet recall, weight, and height were assessed at pretreatment, post-treatment, and 3 months later (follow-up). RESULTS: In completer analysis, DASH versus RC had a greater decrease in SBP z scores from baseline to post-treatment (P < 0.01) and a trend for a greater decrease in SBP z scores from baseline through follow-up (P = .07). DBP z scores changed similarly for conditions from baseline through follow-up. Relative to RC, DASH had a greater increase in intake of fruits (P < .001), potassium and magnesium (P < .01), and a greater decrease in total fat (P < .05) from baseline to post-treatment. From baseline through follow-up, DASH versus RC had a greater increase in low fat dairy (P < .001). CONCLUSIONS: The DASH intervention proved more effective than RC in improving SBP and diet quality in adolescents with elevated BP.
Assuntos
Dieta , Hipertensão/dietoterapia , Adolescente , Comportamento do Adolescente , Pressão Sanguínea , Índice de Massa Corporal , Criança , Laticínios , Comportamento Alimentar , Feminino , Frutas , Humanos , Masculino , Cooperação do Paciente , Resultado do Tratamento , VerdurasRESUMO
OBJECTIVE: To present methodology to identify atopic parents and determine the prevalence of sensitization to 15 aeroallergens in their infant offspring. STUDY DESIGN: A birth cohort of infants was identified from birth records; an infant was enrolled if 1 of the parents reported allergy respiratory symptoms and had a positive skin prick test (SPT) to a common aeroallergen. At age 1 year, these infants were tested to the same aeroallergens. RESULTS: Of the 680 enrolled infants, 28.4% were SPT+ to 1 or more aeroallergens and/or food, and 18.0% were positive to 1 or more aeroallergens. By category of allergens, 9.7% were sensitized to pollens, 7.5% to molds, 4.3% to house dust mite and/or cockroach, and 3.4% to dog and/or cat. Of the infants who were positive to an aeroallergen, 65.7% remained positive at age 2 years. CONCLUSIONS: Infants born to atopic parents with percutaneous sensitization to aeroallergens are at increased risk for aeroallergen sensitization during infancy, which persists to age 2 years. These findings suggest that current clinical practices, which generally avoid skin testing before age 2 years, be reassessed in this population of high-risk children.