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1.
Artigo em Inglês | MEDLINE | ID: mdl-33349970

RESUMO

BACKGROUND: Exhaled nitric oxide and blood eosinophils are clinical asthma T-helper type 2 markers in use. Immunoglobulin E (IgE) is often involved in the inflammation associated with atopic asthma. The effect of both blood eosinophils and allergen-specific IgE on exhaled nitric oxide levels is not completely understood. Twin-design studies can improve understanding of the underlying contribution of genetically and/or environmentally driven inflammation markers in asthma. Our aim was to disentangle the covariance between asthma and exhaled nitric oxide into genetic and environmental contributions that can account for inflammation markers in a paediatric population. METHODS: This population-based, cross-sectional twin study enrolled 612 monozygotic (MZ) and same-sex dizygotic (DZ) schoolchildren. Multivariate structural equation modelling was utilized to separate the covariance between asthma and exhaled nitric oxide into genetic and/or environmental effects, taking allergen-specific IgE level and blood eosinophil count into account while controlling for confounding factors. RESULTS: The cross-twin/cross-trait correlations had a higher magnitude in the MZ twins than in the DZ twins, indicating that genes affect the association. The likelihood ratio test for model fitting resulted in the AE model (ie additive genetic effects, A, and non-shared environmental effects, E) as the most parsimonious. A majority, 73%, of the phenotypic correlation between asthma and exhaled nitric oxide, r = .19 (0.05-0.33), was attributable to genetic effects which mainly was due to the allergen-specific IgE level. CONCLUSIONS: This study indicates that the association between asthma and exhaled nitric oxide in children is to a large extent explained by genetics via allergen-specific IgE level and not blood eosinophils. This might partly explain the clinical heterogeneity in this group. A next step could be to include allergen-specific IgE level in multivariate omic studies.

2.
Lancet Gastroenterol Hepatol ; 5(11): 986-995, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32818437

RESUMO

BACKGROUND: Use of antibiotics in early life has been linked with childhood inflammatory bowel disease (IBD), but data for adults are mixed, and based on smaller investigations that did not compare risk among siblings with shared genetic or environmental risk factors. We aimed to investigate the association between antibiotic therapy and IBD in a large, population-based study. METHODS: In this prospective case-control study, we identified people living in Sweden aged 16 years or older, with a diagnosis of IBD based on histology and at least one diagnosis code for IBD or its subtypes (ulcerative colitis and Crohn's disease). We identified consecutive patients with incident IBD from the ESPRESSO (Epidemiology Strengthened by histoPathology Reports in Sweden) study, cross-referenced with the Swedish Patient Register and the Prescribed Drug Register. We accrued data for cumulative antibiotic dispensations until 1 year before time of matching for patients and up to five general population controls per patient (matched on the basis of age, sex, county, and calendar year). We also included unaffected full siblings as a secondary control group. Conditional logistic regression was used to estimate multivariable-adjusted odds ratios (aORs) and 95% CIs for diagnosis of incident IBD. FINDINGS: We identified 23 982 new patients with IBD (15 951 ulcerative colitis, 7898 Crohn's disease, 133 unclassified IBD) diagnosed between Jan 1, 2007, and Dec 31, 2016. 117 827 matched controls and 28 732 siblings were also identified. After adjusting for several risk factors, aOR in patients who had used antibiotics versus those who had never used antibiotics was 1·88 (95% CI 1·79-1·98) for diagnosis of incident IBD, 1·74 (1·64-1·85) for ulcerative colitis, and 2·27 (2·06-2·49) for Crohn's disease. aOR was higher in patients who had received one antibiotic dispensation (1·11, 1·07-1·15), two antibiotic dispensations (1·38, 1·32-1·44), and three or more antibiotic dispensations (1·55, 1·49-1·61) than patients who had none. Increased risk was noted for ulcerative colitis (aOR with three or more antibiotic dispensations 1·47, 95% CI 1·40-1·54) and Crohn's disease (1·64, 1·53-1·76) with higher estimates corresponding to broad-spectrum antibiotics. Similar but attenuated results were observed when siblings were used as the reference group, with an aOR of 1·35 (95% CI 1·28-1·43) for patients who had received three or more dispensations, compared with general population controls. INTERPRETATION: Higher cumulative exposure to systemic antibiotic therapy, particularly treatments with greater spectrum of microbial coverage, may be associated with a greater risk of new-onset IBD and its subtypes. The association between antimicrobial treatment and IBD did not appear to differ when predisposed siblings were used as the reference controls. Our findings, if substantiated by longer-term prospective studies in humans or mechanistic preclinical investigations, suggest the need to further emphasise antibiotic stewardship to prevent the rise in dysbiosis-related chronic diseases, including IBD. FUNDING: National Institutes of Health. Crohn's and Colitis Foundation.


Assuntos
Antibacterianos , Disbiose , Doenças Inflamatórias Intestinais , Adolescente , Adulto , Idade de Início , Antibacterianos/classificação , Antibacterianos/uso terapêutico , Gestão de Antimicrobianos , Biópsia/estatística & dados numéricos , Estudos de Casos e Controles , Sistemas de Informação em Farmácia Clínica/estatística & dados numéricos , Disbiose/induzido quimicamente , Disbiose/prevenção & controle , Feminino , Humanos , Doenças Inflamatórias Intestinais/epidemiologia , Doenças Inflamatórias Intestinais/patologia , Masculino , Estudos Prospectivos , Medição de Risco/métodos , Fatores de Risco , Irmãos , Suécia/epidemiologia
3.
Gut ; 68(2): 218-225, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29321166

RESUMO

OBJECTIVE: Earlier studies on antibiotics exposure and development of IBD (Crohn's disease (CD) and ulcerative colitis (UC)) may have been biased by familial factors and gastroenteritis. We aimed to estimate the association between antibiotics during pregnancy or infantile age and very early onset (VEO) IBD. DESIGN: In this cohort study of 827 239 children born in Sweden between 2006 and 2013, we examined the link between exposure to systemic antibiotics and VEO-IBD (diagnosis <6 years of age), using Cox proportional hazard regression models. Information on antibiotics and IBD was retrieved from the nationwide population-based Swedish Prescribed Drug Register and the National Patient Register. We specifically examined potential confounding from parental IBD and gastroenteritis. RESULTS: Children exposed to antibiotics during pregnancy were at increased risk of IBD compared with general population controls (adjusted HR (aHR) 1.93; 95% CI 1.06 to 3.50). Corresponding aHRs were 2.48 (95% CI 1.01 to 6.08) for CD and 1.25 (95% CI 0.47 to 3.26) for UC, respectively. For antibiotics in infantile age, the aHR for IBD was 1.11 (95% CI 0.57 to 2.15); for CD 0.72 (95% CI 0.27 to 1.92) and 1.23 (95% CI 0.45 to 3.39) for UC. Excluding children with gastroenteritis 12 months prior to the first IBD diagnosis retained similar aHR for antibiotics during pregnancy and CD, while the association no longer remained significant for IBD. CONCLUSION: We found that exposure to antibiotics during pregnancy, but not in infantile age, is associated with an increased risk of VEO-IBD regardless of gastroenteritis. The risk increase for exposure in pregnancy may be due to changes in the microbiota.


Assuntos
Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Feto/efeitos dos fármacos , Doenças Inflamatórias Intestinais/induzido quimicamente , Pré-Escolar , Feminino , Microbioma Gastrointestinal/efeitos dos fármacos , Humanos , Lactente , Recém-Nascido , Doenças Inflamatórias Intestinais/epidemiologia , Masculino , Gravidez , Sistema de Registros , Fatores de Risco , Suécia/epidemiologia
4.
Twin Res Hum Genet ; 20(5): 380-388, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28975873

RESUMO

BACKGROUND: An association between childhood asthma and IgE sensitization has been established, but our understanding of the genetic and environmental contribution to it is incomplete. Our aim was to estimate the associations and dose-response relationship between asthma and sensitization to airborne allergens in Swedish 9- to 14-year-old twins. Additionally, we aimed to explore the importance of familial confounding from shared genes and environment using co-twin controls. METHODS: In the STOPPA cohort, 752 same-sex twin children were screened with Phadiatop® (Thermo Fisher Scientific; Pharmacia, Uppsala, Sweden); if positive further analysis of IgE antibodies to airborne allergens of pets (cat, horse, dog), pollens (birch, timothy, mugwort), mites, and mold were performed. The associations between asthma and airborne allergens were assessed with generalized estimating equations. The co-twin control analysis was performed by conditional logistic regression. RESULTS: Children with positive Phadiatop® had more than doubled odds of asthma (OR 2.53, 95% CI [1.74, 3.70]). Sensitization to pet allergens was associated with increased odds of asthma; for example, cat OR 4.15 (95% CI [2.67, 6.45]), with similar estimates for pollens; for example, birch OR 3.22 (95% CI [2.12, 4.91]). Associations persisted with sensitization as a categorical variable and for trend, indicating a dose-response relationship. Results remained in the co-twin analyses; for example, cat OR 4.75 (95% CI [1.62, 14.0]) and birch OR 5.00 (95% CI [1.45, 17.3]). CONCLUSION: The association between childhood asthma and sensitization to airborne allergens remains in co-twin analyses, indicating they are not due to confounding from shared environmental or genetic factors.


Assuntos
Alérgenos , Asma , Imunoglobulina E/sangue , Rinite Alérgica Sazonal , Gêmeos Dizigóticos , Gêmeos Monozigóticos , Adolescente , Adulto , Animais , Asma/sangue , Asma/genética , Gatos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Animais de Estimação , Rinite Alérgica Sazonal/sangue , Rinite Alérgica Sazonal/genética
5.
Twin Res Hum Genet ; 20(4): 330-337, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28724478

RESUMO

BACKGROUND: The link between asthma and exhaled nitric oxide (FENO) is not completely understood. The aim of this study was to estimate the association between FENO and asthma, taking genetics, sensitization, and inhaled corticosteroids (ICS) into account. METHODS: A total of 681 twins (53% monozygotic [MZ] and 47% dizygotic [DZ]) from the population-based STOPPA study (mean age 12.6 years) were recruited and information on FENO (parts per billion), parental report of current asthma, sensitization to airborne allergens (Phadiatop; IgE ≥0.35 kUA/l), and ICS-treatment was collected. We estimated the association between FENO and asthma, sensitization, and ICS in all twins and within pairs (DZ and MZ) to address shared genetic and environmental factors. Linear regression of log-transformed FENO was used and results presented as exponentiated regression coefficients (exp[ß]), with 95% confidence interval (CI). RESULTS: We found an association between asthma and FENO in all twins, exp(ß) 1.31 [1.11, 1.54]. In within-pairs analysis, the association was stronger within DZ pairs discordant for FENO, exp(ß) 1.50 [1.19, 1.89], compared to MZ pairs, exp(ß) 1.07 [0.84, 1.37], p = .049. There was no difference in FENO in non-sensitized children with asthma, compared to children with neither asthma nor sensitization, exp(ß) 0.89 [0.77, 1.03]. However, increased FENO was associated with sensitization, exp(ß) 1.48 [1.30, 1.69], and with sensitization together with asthma, exp(ß) 1.98 [1.57, 2.51], in all twins and within DZ pairs discordant for FENO, but not in MZ pairs. The FENO asthma association remained in DZ pairs without regular ICS-treatment. CONCLUSIONS: The association between FENO and asthma is explained by genetics and sensitization.


Assuntos
Asma/genética , Asma/metabolismo , Expiração , Óxido Nítrico/genética , Óxido Nítrico/metabolismo , Gêmeos Dizigóticos , Gêmeos Monozigóticos , Criança , Feminino , Humanos , Masculino
7.
Ann Am Thorac Soc ; 14(7): 1147-1153, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28398078

RESUMO

RATIONALE: Associations between fetal growth restriction and lung function impairment could be due to gestational age as well as shared (familial) genetic and environmental factors. OBJECTIVES: To study the association between fetal growth and lung function in childhood while taking gestational age and familial factors into account. METHODS: First, full-cohort analyses of twins were performed to study the association between birth weight, gestational age, fetal growth, and lung function (FEV1, FVC, and FEV1/FVC) in z-scores before (n = 520) and after (n = 539) bronchodilator treatment. Second, to control for gestational age and familial factors, within-twin-pair analyses were performed. RESULTS: Regarding full-cohort post-bronchodilator treatment, FEV1 was significantly associated with a decrease in birth weight (-0.16 z-score per 500 g; 95% confidence interval [CI], -0.28 to -0.04) and fetal growth (-0.15 z-score per 1 SD decrease; 95% CI, -0.26 to -0.04), and similar and significant associations for FVC with birth weight and fetal growth were also seen. Nonsignificant associations for FEV1 and FVC with gestational age were found. The direction of effect was similar in pre-bronchodilator analyses, although with somewhat less strong and nonsignificant effect estimates for both FEV1 and FVC with fetal growth. No associations were found between any of the exposure variables and FEV1/FVC either pre- or post-bronchodilator. In the within-twin-pair analyses, the direction of effect appeared similar to that of the whole cohort, but the CIs were wider. CONCLUSIONS: Our results suggest that there is a significant association between restricted fetal growth and post-bronchodilator FEV1 and FVC, but not FEV1/FVC, in childhood that may be independent of gestational age and shared familial factors.


Assuntos
Asma/prevenção & controle , Desenvolvimento Fetal/fisiologia , Pulmão/fisiologia , Asma/fisiopatologia , Pré-Escolar , Previsões , Humanos , Testes de Função Respiratória , Suécia
8.
PLoS One ; 11(10): e0164126, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27716779

RESUMO

AIM: To investigate how 1) maternal delivery mode and 2) prematurity in infants are associated to antibiotic treatment and length of hospital stay. METHODS: Women having given birth and infants 0-12 months discharged from hospital between July 2005 and November 2011 were identified from the Swedish National Patient Register. Medical records were reviewed for 203 women and 527 infants. The risk ratio (RR) between antibiotic treatment and 1) delivery mode in women; 2) prematurity in infants was calculated. Length of stay and days of antibiotic therapy were compared by Wilcoxon rank-sum test. RESULTS: Women: There was an association between emergency caesarean section (CS) and antibiotic treatment (RR 5.0 95% confidence interval (CI) 2.2-11.5), but not for elective CS. Length of stay was longer for CS (emergency and elective) compared to vaginal delivery (p<0.01). Infants: RR for antibiotic treatment in preterm compared to term infants was 1.4 (95% CI 1.0-1.9). Length of stay (p<0.01), but not days of therapy (p = 0.17), was higher in preterm compared to term infants. CONCLUSION: We found that emergency CS increased the probability of maternal antibiotic treatment during hospitalisation, but no difference was found between term and preterm infants. The results are well aligned with current guidelines and may be considered in future studies on the effects of antibiotics.


Assuntos
Antibacterianos/efeitos adversos , Tempo de Internação/estatística & dados numéricos , Parto/efeitos dos fármacos , Adulto , Cesárea/estatística & dados numéricos , Estudos Transversais , Parto Obstétrico/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Gravidez
10.
JAMA Pediatr ; 169(11): e153219, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26523822

RESUMO

IMPORTANCE: The association between early exposure to animals and childhood asthma is not clear, and previous studies have yielded contradictory results. OBJECTIVE: To determine whether exposure to dogs and farm animals confers a risk of asthma. DESIGN, SETTING AND PARTICIPANTS: In a nationwide cohort study, the association between early exposure to dogs and farm animals and the risk of asthma was evaluated and included all children born in Sweden from January 1, 2001, to December 31, 2010 (N = 1,011,051), using registry data on dog and farm registration, asthma medication, diagnosis, and confounders for parents and their children. The association was assessed as the odds ratio (OR) for a current diagnosis of asthma at age 6 years for school-aged children and as the hazard ratio (HR) for incident asthma at ages 1 to 5 years for preschool-aged children. Data were analyzed from January 1, 2007, to September 30, 2012. EXPOSURES: Living with a dog or farm animal. MAIN OUTCOMES AND MEASURES: Childhood asthma diagnosis and medication used. RESULTS: Of the 1,011,051 children born during the study period, 376,638 preschool-aged (53,460 [14.2%] exposed to dogs and 1729 [0.5%] exposed to farm animals) and 276,298 school-aged children (22,629 [8.2%] exposed to dogs and 958 [0.3%] exposed to farm animals) were included in the analyses. Of these, 18,799 children (5.0%) in the preschool-aged children's cohort experienced an asthmatic event before baseline, and 28,511 cases of asthma and 906,071 years at risk were recorded during follow-up (incidence rate, 3.1 cases per 1000 years at risk). In the school-aged children's cohort, 11,585 children (4.2%) experienced an asthmatic event during the seventh year of life. Dog exposure during the first year of life was associated with a decreased risk of asthma in school-aged children (OR, 0.87; 95% CI, 0.81-0.93) and in preschool-aged children 3 years or older (HR, 0.90; 95% CI, 0.83-0.99) but not in children younger than 3 years (HR, 1.03; 95% CI, 1.00-1.07). Results were comparable when analyzing only first-born children. Farm animal exposure was associated with a reduced risk of asthma in both school-aged children and preschool-aged children (OR, 0.48; 95% CI, 0.31-0.76, and HR, 0.69; 95% CI, 0.56-0.84), respectively. CONCLUSIONS AND RELEVANCE: In this study, the data support the hypothesis that exposure to dogs and farm animals during the first year of life reduces the risk of asthma in children at age 6 years. This information might be helpful in decision making for families and physicians on the appropriateness and timing of early animal exposure.


Assuntos
Asma/etiologia , Exposição Ambiental/efeitos adversos , Animais , Animais Domésticos , Asma/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Cães , Feminino , Humanos , Incidência , Masculino , Razão de Chances , Sistema de Registros , Fatores de Risco , Suécia/epidemiologia
11.
Twin Res Hum Genet ; 18(3): 273-80, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25900604

RESUMO

Asthma is a common childhood disease and several risk factors have been identified; however, the impact of genes and environment is not fully understood. The aim of the Swedish Twin study On Prediction and Prevention of Asthma (STOPPA) is to identify environmental (birth characteristics and early life) and genetic (including epigenetic) factors as determinants for asthmatic disease. Based on the Child and Adolescent Twin Study in Sweden (CATSS) (parental interview at 9 or 12 years, N ~23,900) and an asthma and/or wheezing algorithm, we identified a sample of monozygotic (MZ) and dizygotic (DZ) same-sexed twin pairs. The twin pairs were classified as asthma concordant (ACC), asthma discordant (ADC) and healthy concordant (HCC). A sample of 9- to 14-year-old twins and their parents were invited to participate in a clinical examination. Background characteristics were collected in questionnaires and obtained from the National Health Registers. A clinical examination was performed to test lung function and capacity (spirometry with reversibility test and exhaled nitric oxide) and collect blood (serology and DNA), urine (metabolites), feces (microbiota), and saliva (cortisol). In total, 376 twin pairs (752 individual twins) completed the study, response rate 52%. All participating twins answered the questionnaire and >90% participated in lung function testing, blood-, and saliva sampling. This article describes the design, recruitment, data collection, measures, and background characteristics, as well as ongoing and planned analyses in STOPPA. Potential gains of the study include the identification of biomarkers, the emergence of candidates for drug development, and new leads for prevention of asthma and allergic disease.


Assuntos
Asma/epidemiologia , Doenças em Gêmeos/epidemiologia , Gêmeos Dizigóticos/estatística & dados numéricos , Gêmeos Monozigóticos/estatística & dados numéricos , Adolescente , Algoritmos , Asma/genética , Asma/prevenção & controle , Testes Respiratórios , Criança , DNA/sangue , Doenças em Gêmeos/genética , Doenças em Gêmeos/prevenção & controle , Eicosanoides/urina , Fezes/microbiologia , Feminino , Seguimentos , Testes Hematológicos , Humanos , Hidrocortisona/análise , Estilo de Vida , Masculino , Microbiota , Óxido Nítrico/análise , Pais , Puberdade , Sistema de Registros , Projetos de Pesquisa , Sons Respiratórios , Fatores de Risco , Saliva/química , Espirometria , Estresse Psicológico/epidemiologia , Inquéritos e Questionários , Suécia , Gêmeos Dizigóticos/psicologia , Gêmeos Monozigóticos/psicologia
12.
Twin Res Hum Genet ; 18(3): 256-65, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25900713

RESUMO

INTRODUCTION: Non-random selection into a study population due to differences between consenters and non-consenters may introduce participation bias. Past investigations of factors predicting consent to collection of medical health records for research imply that age, sex, health status, and education are of importance for participation, but disagree on the direction of effects. Very little is known about influences on consent from adolescents. METHODS: Two cohorts of Swedish 15-year-old twins (total n = 4,611) previously invited to the Child and Adolescent Twin Study in Sweden (CATSS) responded to a questionnaire with information on sex, individual's health, height, weight, and parental factors. The questionnaire included a question for consent to collection of medical health records. Predictors for consent were analyzed using logistic regression. Additionally, regional differences in the collection of health records of consenters were evaluated. RESULTS: Males were significantly less likely to consent compared to females (OR 0.74, 95% CI 0.64-0.85). The twin siblings' decision to consent was strongly associated with consent (OR 10.9, 95% CI 8.76-13.5), and individuals whose parents had responded to the original CATSS study were more likely to consent to record collection at age 15 (OR 2.2, 95% CI 1.81-2.75). Results of the subsequent collection of consenters' medical health records varied between geographical regions of Sweden. CONCLUSION: We identified several predictors for adolescents' consent to collection of their medical health records. Further selection was introduced through the subsequent record collection. Whether this will induce participation bias in future studies depends on the research questions' relationship to the identified predictors.


Assuntos
Comportamento do Adolescente , Comportamento Cooperativo , Consentimento Livre e Esclarecido , Registros Médicos , Psicologia do Adolescente , Pesquisa , Gêmeos Dizigóticos/psicologia , Gêmeos Monozigóticos/psicologia , Adolescente , Adulto , Antropometria , Viés , Estudos de Coortes , Coleta de Dados , Doenças em Gêmeos/epidemiologia , Escolaridade , Feminino , Humanos , Masculino , Idade Materna , Pessoa de Meia-Idade , Pais/educação , Idade Paterna , Recusa de Participação , Serviços de Saúde Escolar/estatística & dados numéricos , Fatores Sexuais , Irmãos , Inquéritos e Questionários , Suécia/epidemiologia , Gêmeos Dizigóticos/estatística & dados numéricos , Gêmeos Monozigóticos/estatística & dados numéricos , Adulto Jovem
13.
BMJ ; 349: g6979, 2014 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-25432937

RESUMO

OBJECTIVE: To investigate the association between exposure to antibiotics in fetal and early life and asthma in childhood, with adjustment for confounding factors. DESIGN: Nationwide prospective population based cohort study, including sibling control design. SETTING: Swedish population identified from national demographic and health registers. PARTICIPANTS: 493,785 children born 2006-10; 180,894 of these were eligible for sibling analyses. MAIN OUTCOME MEASURE: Asthma defined as having both an asthma diagnosis and dispensed asthma drugs. The association between antibiotic exposure and asthma was investigated in the whole cohort with Cox proportional hazard regression. A stratified proportional hazards model conditional on sibling group was used to adjust for shared factors within families. Confounding by respiratory infections was assessed by investigating whether specific groups of antibiotics were associated with asthma. RESULTS: Antibiotic exposure in fetal life was associated with an increased risk of asthma in cohort analyses (hazard ratio 1.28, 95% confidence interval 1.25 to 1.32), but not in sibling analyses (0.99, 0.92 to 1.07). In cohort analyses, antibiotics used to treat respiratory infections in childhood were associated with a more pronounced increased risk of asthma (4.12, 3.78 to 4.50) than antibiotics used for urinary tract and skin infections (1.54, 1.24 to 1.92). In sibling analyses, the excess risks after exposure to antibiotics for respiratory infections decreased (2.36, 1.78 to 3.13) and disappeared for antibiotics for urinary tract and skin (0.85, 0.47 to 1.55). CONCLUSIONS: Previous positive associations between exposure to antibiotics in fetal and early life and subsequent childhood asthma could have been caused by confounding by shared familial factors, in addition to confounding by respiratory infections.


Assuntos
Antibacterianos/uso terapêutico , Asma/epidemiologia , Complicações Infecciosas na Gravidez/tratamento farmacológico , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Infecções Respiratórias/tratamento farmacológico , Irmãos , Dermatopatias Bacterianas/tratamento farmacológico , Infecções Urinárias/tratamento farmacológico , Adolescente , Adulto , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Masculino , Gravidez , Modelos de Riscos Proporcionais , Estudos Prospectivos , Infecções Respiratórias/epidemiologia , Suécia/epidemiologia , Adulto Jovem
14.
Pharmacoepidemiol Drug Saf ; 22(8): 850-60, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23754713

RESUMO

PURPOSE: Validated measures of asthma and eczema at the population level remain a challenge. Our aim was to ascertain if register-based information on asthma/eczema medication can function as a proxy for an asthma/eczema diagnosis and to validate register-based asthma diagnoses. METHODS: Information was requested on all 0-45-year-old individuals with reported asthma/eczema medication and/or diagnoses in the Swedish Prescribed Drug Register and National Patient Register, between July 2005 and December 2009 (N = 250 691). Medical records for 1952 randomly selected individuals were reviewed to estimate the proportion of individuals with the following: (1) asthma/eczema medication that fulfilled predefined criteria of asthma/eczema (positive predictive value (PPV)) and (2) a register-based asthma diagnosis verified as asthma by predefined criteria. RESULTS: Positive predictive value for asthma by predefined criteria ranged between 0.75 (95%CI: 0.70-0.78) to 0.94 (95%CI: 0.91-0.96), depending on age group. In pre-school children, PPV for asthma in combination with obstructive bronchitis was 0.87 (95%CI: 0.83-0.90), and PPV for eczema was estimated to 0.45 (95%CI: 0.38-0.51). Eighty percent of children 0-4.5 years and 99% of children >4.5-17 years with a register-based diagnosis of asthma were verified as asthmatics. CONCLUSION: Asthma medication is a suitable proxy for asthma in older children and adults; the same approach is insufficient for eczema. This validation study of two Swedish registers opens for future large nation-wide register-based studies on asthma.


Assuntos
Antiasmáticos/uso terapêutico , Asma/epidemiologia , Fármacos Dermatológicos/uso terapêutico , Eczema/epidemiologia , Adolescente , Adulto , Fatores Etários , Asma/diagnóstico , Asma/tratamento farmacológico , Bronquite/diagnóstico , Bronquite/tratamento farmacológico , Bronquite/epidemiologia , Criança , Pré-Escolar , Eczema/diagnóstico , Eczema/tratamento farmacológico , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Sistema de Registros/estatística & dados numéricos , Suécia/epidemiologia , Adulto Jovem
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