An approach to the asthma-protective farm effect by geocoding: Good farms and better farms.

BACKGROUND: The highly consistent association of growing up on a farm with a reduced asthma risk has so far been attributed to direct farm exposure. In contrast, geographic determinants of the larger environment have never been assessed. In this study, the effects of proximity to farms and environmental variables in relation to the residential address on asthma and atopy were assessed. METHODS: Addresses of 2265 children of the Bavarian arm of the GABRIELA study were converted into geocodes. Proximity to the nearest cow farm was calculated, and environmental characteristics were derived from satellite data or terrestrial monitoring. Bacterial diversity in mattress dust samples was assessed in 501 children by sequencing of the 16S rRNA amplicons. Logistic regression models were used to calculate associations between outcomes and exposure variables. RESULTS: Asthma and atopy were inversely associated with the presence of a farm within a radius of maximum 100 m. The environmental variables greenness, tree cover, soil sealing, altitude, air pollution differed not only between farm and non-farm children but also between farm children with and without another farm nearby. The latter distinction revealed strong associations with characteristics of traditional farms including a broader diversity of microbial exposure, which mainly contributed to the protective effect on asthma. In non-farm children, the protective effect of a farm nearby was completely explained by consumption of farm milk. CONCLUSIONS: Clustering of farms within a neighborhood of 100 m is strongly associated with the protective effect on asthma and may represent a more traditional style of farming with broader microbial exposure.

Diet in pregnancy-more than food.

High food quality, together with adequate macro- and micronutrient intake in pregnancy, is crucial for the health status of the mother and child. Recent findings suggest that it could also be beneficial or harmful in the context of the well-being of the whole future population. According to the developmental origins of health and disease hypothesis, most conditions that occur in adulthood originate in foetal life. Moreover, some epigenetic events, modified inter alia by diet, impact more than one generation. Still, the recommendations in most countries are neither popularised nor very detailed. While it seems to be important to direct diet trends towards a healthier lifestyle, the methods of preventing specific disorders like diabetes or asthma are not yet established and require further investigation. CONCLUSION: In this review, we will summarise the recommendations for diet composition in pregnancy, focusing on both diet quality and quantity. What is Known • High food quality, together with adequate macro- and micronutrient intake in pregnancy, is crucial for the health status of the mother and child. What is New • Recent findings suggest that the diet could be beneficial or harmful in the context of the well-being of the whole future population. Most conditions that occur in adulthood originate in foetal life. • Moreover, some epigenetic events, modified by diet impact more than one generation.

Changes in the prevalence of cigarette smoking and quitting smoking determinants in adult inhabitants of rural areas in Poland between 2003 and 2012.

OBJECTIVES: We investigate trends in the prevalence of cigarette smoking among adults at all ages in two time points 9 years apart in two neighbouring rural populations and examine social and respiratory health determinants of quitting smoking. STUDY DESIGN: Repeated cross-sectional study. METHODS: Two cross-sectional surveys were conducted in the same rural area of lower Silesia in Poland in 2003 and 2012. A total of 1328 (91% of adult eligible individuals) in 2003 and 1449 (92% of eligible) in 2012 adult inhabitants were surveyed, 908 people (560 villagers and 348 town inhabitants) participated in both surveys. Participants completed a questionnaire on smoking behaviour, education level and respiratory diseases. RESULTS: Current smoking was higher in the villages than the town, among men than women and those with a middle level of education. The prevalence of current smokers decreased over time, although this decline was much more pronounced in the town than in the villages (30.2% vs 23% and 35.5% vs 33.7%, respectively). Men were more likely to stop smoking than women both in villages and in town. The prevalence of current smokers among village women even increased between the two surveys from 27.6% to 29.3%. Respiratory diseases did not influence quitting smoking. CONCLUSIONS: The degree of decreasing trend in smoking prevalence varied considerably within neighbouring populations. It was mainly seen in the town and among younger people. Men and those better educated were more willing to quit smoking. The discrepancies between two close rural populations indicates the need for an individual approach when designing programs of tobacco control.

Changes in atopy prevalence and sibship effect in rural population at all ages.

BACKGROUND: We examined the associations of family size and birth order with atopy prevalence in rural Poland at two time periods. METHODS: Two cross-sectional surveys were conducted in the same villages and a small town of lower Silesia at an interval of 9 years. In 2003, 1700 (88% of eligible individuals), and in 2012, 1730 (86%) inhabitants aged 5 years or more completed a questionnaire and had a skin prick test for atopy. RESULTS: There was an inverse association between family size and atopy in the village population in 2003; the prevalence of atopy was the highest for those with no siblings (15.2%) and decreased to 5.4% for those with three and more siblings (OR = 0.22; 0.07-0.66). In contrast, there was little or no such protective effect in the town population where the prevalence of atopy was much higher (7.3% in the villages, 20.0% in the town). Nine years later, the prevalence of atopy had increased in the village to be similar to that in the town (19.6% and 19.9% respectively), and the protective effects of family size and birth order in the villages were much weaker (OR = 0.64; 95% CI 0.33-1.27 for three or more siblings). Both protective effects were strongest among children. CONCLUSIONS: The protective effects of family size and birth order on atopy were much stronger in children than in adults and among those living in a village. They largely disappeared with the steep increase in atopy prevalence at all ages; this followed environmental changes on the village farms.

Asthma and allergies: is the farming environment (still) protective in Poland? The GABRIEL Advanced Studies.

BACKGROUND: Evidence exists that a farming environment in childhood may provide protection against atopic respiratory disease. In the GABRIEL project based in Poland and Alpine regions of Germany, Austria and Switzerland, we aimed to assess whether a farming environment in childhood is protective against allergic diseases in Poland and whether specific exposures explain any protective effect. METHODS: In rural Poland, 23 331 families of schoolchildren completed a questionnaire enquiring into farming practices and allergic diseases (Phase I). A subsample (n = 2586) participated in Phase II involving a more detailed questionnaire on specific farm exposures with objective measures of atopy. RESULTS: Farming differed between Poland and the Alpine centres; in the latter, cattle farming was prevalent, whereas in Poland 18% of village farms kept ≥1 cow and 34% kept ≥1 pig. Polish children in villages had lower prevalences of asthma and hay fever than children from towns, and in the Phase II population, farm children had a reduced risk of atopy measured by IgE (aOR = 0.72, 95% CI 0.57, 0.91) and skin prick test (aOR = 0.65, 95% CI 0.50, 0.86). Early-life contact with grain was inversely related to the risk of atopy measured by IgE (aOR = 0.66, 95% CI 0.47, 0.92) and appeared to explain part of the farming effect. CONCLUSION: While farming in Poland differed from that in the Alpine areas as did the exposure-response associations, we found in communities engaged in small-scale, mixed farming, there was a protective farming effect against objective measures of atopy potentially related to contact with grain or associated farm activities.

Opinions of children about participation in medical genetic research.

AIMS: The objective was to evaluate children's opinions about their participation in a large research project. METHODS: Polish children between 6 and 14 years of age completed a questionnaire about their participation in the Polish Gabriel study (which aims to identify genetic and environmental causes of asthma). In total 706 questionnaires were collected. RESULTS: Children's main motivation for participation was wanting to know whether they were healthy or not. Most children could think of no reasons to reconsider participation. Children aged 6-10 years might reconsider participating because they did not know what was going to happen. A third of the children were not informed by anybody about the study. Especially the youngest children indicated a need for a tailored letter (42%). The youngest children were less often asked for their opinion about participation. All children preferred that both parents and children are asked for consent or assent. Children who were not informed or not asked for their opinion seemed less emotionally involved in the study. CONCLUSION: While researchers and parents tend to focus their information provision to older children and include them in decision-making, especially the younger children expressed a need for more tailored information and involvement in their participation in research.

Atopy and asthma in rural Poland: a paradigm for the emergence of childhood respiratory allergies in Europe.

BACKGROUND: We hypothesized that, in south-west Poland, a 'rural' protective effect on atopy and respiratory allergies would be most pronounced among children but that at all ages would be stronger among those with a rural background. METHODS: A cross-sectional survey of the inhabitants (age >5 years, n = 1657) of Sobotka, a town of 4000 people in south-west Poland: and seven neighbouring villages. We measured and analysed responses to skin prick tests (atopy) and to a standard questionnaire (asthma and hayfever). RESULTS: Atopy was very uncommon (7%) among villagers at all ages but not among townspeople (20%, P < 0.001); the differences were most marked among those aged under 40 years. Asthma and hayfever were similarly distributed, both being very rare among villagers. The differences appear to be explained by the cohort effect of a communal move away from rural life. This interpretation is supported by an ecological correlation (rho = -0.59) between rural populations and childhood wheeze in 22 European countries. CONCLUSION: The very striking differences in the prevalence of allergy between these two neighbouring communities of central Europe reflect the pan-continental population movements that may have been responsible for the emergence of childhood allergies in Europe.

Tacrolimus ointment does not affect the immediate response to vaccination, the generation of immune memory, or humoral and cell-mediated immunity in children.

BACKGROUND: Concern exists that the prolonged application of immunomodulators to treat atopic dermatitis may cause systemic immunosuppression. AIMS: In a 7-month, multicentre, randomised, controlled trial, we investigated the equivalence of response to vaccination against meningococcal serogroup C disease with a protein-conjugate vaccine in children (2-11 years) with moderate to severe atopic dermatitis, by applying either 0.03% tacrolimus ointment (TAC-O; n = 121[corrected]) or a hydrocortisone ointment regimen (HC-O; n = 111). METHODS: TAC-O was applied twice daily (bid) for 3 weeks, and thereafter daily until clearance. 1% hydrocortisone acetate (HA) for head/neck and 0.1% hydrocortisone butyrate ointment for trunk/limbs was applied bid for 2 weeks; thereafter HA was applied bid to all affected areas. At week 1, patients were vaccinated with protein-conjugate vaccine against meningococcal serogroup C, and challenged at month 6 with low dose meningococcal polysaccharide vaccine. The control group (44 non-atopic dermatitis children) received the primary vaccination and challenge dose. Assessments were made at baseline, weeks 1 and 5, and months 6 and 7. The primary end point was the percentage of patients with a serum bactericidal antibody (SBA) titre > or = 8 at the week 5 visit. RESULTS: The response rate (patients with SBA titre > or = 8) was 97.5% (confidence interval (CI) approximately 97.3 to 100), 99.1% (94.8 to 100) and 97.7% (93.3 to 100) in the TAC-O, HC-O and control groups, respectively. CONCLUSIONS: The immune response to vaccination against meningococcal serogroup C in children with atopic dermatitis applying either 0.03% TAC-O or HC is equivalent. Ointment application does not affect the immediate response to vaccination, generation of immune memory or humoral and cell-mediated immunity.

[Undesirable pharmacokinetic interactions of theophylline]. / Niepozadane interakcje farmakokinetyczne teofiliny.

Theophylline and other methylxanthines are the strongest and most widely used antiasthmatic drugs. Mechanism of theophylline effect is complicated. The first observations of this way, depend on inhibition of phosphodiesterase by increase of cAMP what is the reason of bronchorelaxation. As a results a theophylline action we can observe induction of adenosine receptors, inhibition of the some prostaglandin synthesis or allergic reaction mediatores and decrease of the level of calcium in muscles cells. It is probably (especially in bronchial asthma or acute lymphoblastic leukemia-ALL) that the one important effect of theophylline is the some cells apoptosis. For the good results of the therapeutics effect apart of important factors deciding of the theophylline metabolism (age of patients, kind of the diet, period of menstruation and smoking), we always should consider interactions of theophylline with other drugs. In this paper we presented the most often reasons of interactions between theophylline and others drugs.

[The level of RANTES and interleukin-8 in serum of children with bronchial asthma after an exercise test]. / Poziom RANTES i interleukiny-8 w surowicy dzieci chorych na astme oskrzelowa podddanych testowi wysilkowemu.

The study was carried out on 20 children with bronchial asthma. After the exercise induced test we observed decreased serum level of RANTES both in children with positive and negative results of the test. Serum level of IL-8 was increased in all examined group. We found strong correlation between serum level of RANTES and peripheral blood eosinophil counts in children with positive result of the test before and after the exercise.

[Serum levels of sCD23 and IL-4 concentration in stimulated PBMC in children with atopic diseases]. / Poziomy sCD23 w surowicy oraz stezenia IL-4 w stymulowanych hodowlach komórek jednojadrzastych u dzieci ze schorzeniami atopowymi.

In this study we estimated the correlation between IgE and sCD23 serum levels, and the concentration of IL-4 in PHA-stimulated PBMC cultures in children with atopic diseases. Children with atopic dermatitis showed a high degree of correlation between sCD23-IgE while in the control group no such relationship was found. We also found no relationship between IL-4 and sCD23 in children with atopic asthma, relationship at children with atopic dermatitis, and no relationship in healthy children. Looking for relationship between IL-4 in PHA-stimulated PBMC and IgE serum levels we discovered a weak negative correlation in children with atopic asthma, a highly positive correlation in children with atopic dermatitis and no relationship in the control group.

[The role of interferon-gamma and interleukin-4 in the pathogenesis of atopic diseases]. / Udzial interferonu-gamma i interleukiny-4 w patogenezie schorzen atopowych.

The role of interferon-gamma and interleukin-4 are presented according to actual knowledge in this field. Some clinical implication indicate an importance of above mentioned proteins in reactions observed in patients with atopic diseases.

[Evaluation of soluble components of receptors with weak affinity for IgE (sCD23) in children with pollinosis given specific immunotherapy]. / Ocena rozpuszczalnej skladowej receptora o slabym powinowactwie dla IgE (sCD23) u dzieci z pylkowica poddanych immunoterapii swoistej.

The aim of this study was the evaluation of the measurement of sCD23 and IgE levels before and after immunotherapy. The research was conducted in a group of 23 children aged 6 to 18 years with pollinosis diagnosed on the basis of the patient's history, increased IgE level and positive skin tests with pollen allergens. The control group consisted of 10 healthy children in the same age with normal IgE level. The treated children were examined before and 6 weeks after immunotherapy. Before immunotherapy in both groups of children (with the high and medium IgE level) the sCD23 concentration was statistically higher (level of significance p < 0.001) compared to the sCD23 level in the healthy children. After immunotherapy we observed significant decrease of the sCD23 level. We did not found correlation between sCD23 and IgE in children with pollinosis before and after immunotherapy.

[Effect of immunotherapy on selected immunologic indices in children with pollinosis]. / Wplyw odczulania swoistego na wybrane wskazniki immunologiczne u dzieci z pylkowica.

The study was carried out on 15 children with pollinosis. The children were treated with "Pollinex-Bencard" before the pollen season. We looked for changes of serum IgE levels and percentages of T (CD3) cells and their subsets CD4, CD8. After immunotherapy we observed a significant decrease of CD3, CD4 and CD8 cells, whereas no statistical difference was observed in the CD4/CD8 ratio. Three months after immunotherapy, serum IgE levels were significantly elevated, while after 9 months, markedly decreased.

T-lymphocyte subpopulations (CD4, CD8), IL-4 and IFN-gamma concentration in stimulated cell culture (PBMC) in children with atopic dermatitis.

The study was carried out on a group of children with atopic dermatitis. We were looking for a correlation between the percentages of CD4, CD8 lymphocytes and IFN-gamma and IL-4 concentrations in stimulated PHA cells cultures (PBMC). On the ground of obtained results, a statistically significant increase of IL-4 concentration in children with atopic dermatitis and a correlation between CD4 cells and IFN-gamma concentration was found.

Specific IgE against milk allergens in children with insulin dependent diabetes mellitus.

Cow's milk has been considered as a possible trigger of the autoimmune response that destroys pancreatic B-cells, thus causing insulin dependent diabetes mellitus. We investigated 46 children with IDDM. In this group we showed an increased total IgE in 58.6% of cases and the presence of specific IgE antibodies induced by milk allergens in 32.5% of cases. These results suggests that antibodies probably play an important role in IDDM pathogenesis.

[Preliminary evaluation of efficacy for the preparation DNCG-compositum in treatment of atopic bronchial asthma in children]. / Wstepna ocena skutecznosci preparatu DNCG-compositum w leczeniu atopowej astmy oskrzelowej u dzieci.

Preparations, in which composition disodium cromoglycate goes into, have been for many years the admitted way of bronchial asthma treatment. The introduction, to the therapy, of preparation that contains reproterol as well makes possible the early remission of disease symptoms. The aim of the study was the estimation of the effectiveness of DNCG-comp. preparation. Twenty one children, aged 7-17 years, with recognized bronchial asthma were examined. The atopic basis of the disease was found on the ground of results of skin prick tests, and elevated concentration of serum IgE and positive atopic family interview. We resigned the hitherto treatment for 3 days, carried out the spirometric measurements (PEF, FEV1, FEV1%VC, MEF25,50,75). DNCG-comp. was given 4-times per twenty-four hours in 2 inhalations at each time, for three weeks. Every day, the PEF value and the score of disease symptoms were established. After the study, side effects were not observed and final results of spirometric estimation evidence the possibility of wide application of DNCG-comp. preparation in the treatment of bronchial asthma in childhood.

[Pulmonary miliary tuberculosis in a 14-year old boy]. / Gruzlica prosówkowa pluc u 14-letniego chlopca.

A case is presented of a rare form of pulmonary miliary tuberculosis in a 14-year-old boy beginning with dramatic symptoms with negative the test and negative result of bacterioscopy. The preliminary diagnosis was made on the basis of clinical observation and radiological examination. Confirmation was achieved after obtaining of a positive result of bacteriological examination.