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BACKGROUND: MicroRNAs (miRNAs) represent important post-transcriptional regulators with a dynamic expression profile during health and disease. OBJECTIVES: We explored the miRNA profile of human mast cells (MCs) during sen-sitization with IgE, during activation through IgE, and relat ed it to prostaglandin D2 synthesis and histamine release. METHOD: We investigated the expression pattern of 762 miRNAs during the IgE-mediated sensitization and activation of MCs cultured from CD133+ stem cells that were isolated from allergic asthmatic patients and nonatopic controls. RESULTS: IgE-mediated sensitization increased the expression of miRNA-210 eight-fold. This increase was sustained during IgE-mediated MC activation. Furthermore, we confirmed the increase of the miRNA-132/212 cluster after MC activation. Predicted target genes of miRNA-210/132/212 were enriched in several pathways known to be involved in MC activation. Histamine release was significantly higher in MCs from allergic patients when compared to controls, and a number of miRNAs correlated with histamine release and prostaglandin D2 synthesis during MC activation. CONCLUSION: The miRNAs and analysis presented here can help to elucidate the role of miRNAs in mediator release during MC activation. We speculate that miRNA-210 could be important in MC sensitization that leads to allergic symptoms.
Assuntos
Regulação da Expressão Gênica , Imunoglobulina E/imunologia , Mastócitos/imunologia , Mastócitos/metabolismo , MicroRNAs/genética , Biomarcadores , Degranulação Celular/imunologia , Perfilação da Expressão Gênica , Humanos , Hipersensibilidade/genética , Hipersensibilidade/imunologia , Hipersensibilidade/metabolismoRESUMO
OBJECTIVE: The contribution of affinity, clonality, and concentration of individual IgE species to effector cell response has recently been characterized in a model with recombinant human IgE on passively sensitized basophils. This study extends the dependence of effector cell degranulation on IgE concentration to mast cells cultured with IgE for 2 weeks. METHODS: Human mast cells cultured for 7 weeks from peripheral blood stem cells were matured for 2 weeks with interleukin-4 (IL-4) and recombinant human IgE consisting of two clones specific for Dermatophagoides pteronyssinus 2 (Derp2) (7% + 7%) and unspecific IgE at 0.8, 8, 80, and 800 kU/L. The density of the IgE receptor, FcϵRI, and mast cell function were measured after challenging with recombinant Derp2 at 14 concentrations from 10 fg/mL to 100 pg/mL. CD63 expression, histamine release, and Prostaglandin D2 (PGD(2)) synthesis were measured, and maximal expression and mast cell sensitivity were calculated. RESULTS: At 800 kU/L IgE, FcϵRI expression varied more than at 80, 8, and 0.8 kU/L IgE. There was a trend toward increased maximal expression of CD63, histamine release, and PGD(2) secretion with increasing IgE concentration. At 0.1 kU/L specific IgE, the LC50 increased up to fivefold, least so for PGD(2). CONCLUSIONS: Human mast cells cultured with rhIgE of known composition are a sensitive model for studying factors governing effector cell degranulation that is close to the in vivo situation. This model can be used to study effects of IgE concentration, clonality, and affinity and may help predict the optimal immunologic treatment for a given patient.
Assuntos
Antígenos de Dermatophagoides/imunologia , Degranulação Celular/imunologia , Hipersensibilidade/imunologia , Imunoglobulina E/imunologia , Mastócitos/imunologia , Receptores de IgG/imunologia , Liberação de Histamina/imunologia , Humanos , Leucócitos Mononucleares/imunologia , Prostaglandina D2/imunologia , Estatísticas não Paramétricas , Tetraspanina 30/imunologiaRESUMO
OBJECTIVE: We determined the density of FcεRI on mast cells cultured from cord (CBMC) and peripheral blood (PBMC) and studied the kinetics of the response through FcεRI. METHODS: Mast cells were cultured from CD133+ progenitors from peripheral or cord blood. FcεRI was stabilized by culture with 2 µg/ml IgE. Cells were activated by addition of anti-FcεRI antibody (1 ng/ml-10 µg/ml). Maximal activation, sensitivity, and cooperativity were determined. RESULTS: All cultures were homogeneous for tryptase and metachromasy. All cells expressing FcεRI could be activated by cross-linking FcεRI to upregulate CD63. PBMC bind 203,000 molecules of IgE/cell. Stabilization of FcεRI with IgE doubled the number of CD63+ cells (p = 0.0001) and increased the sensitivity (from 0.083 to 0.013 µg/ml anti-FcεRI) and the slope factor (from 10.8 to 68) of PBMC but not of CBMC. Anti-IgE reversed these effects (p = 0.0002) but did not reduce activation levels below that of cell lines not stabilized with IgE. CONCLUSION: Baseline expression of FcεRI is independent of anti-IgE. The fraction of PBMC that binds high levels of IgE can be activated through FcεRI.
Assuntos
Mastócitos/metabolismo , Receptores de IgE/metabolismo , Anticorpos Anti-Idiotípicos/imunologia , Anticorpos Anti-Idiotípicos/metabolismo , Células Cultivadas , Sangue Fetal/citologia , Células-Tronco Hematopoéticas , Humanos , Imunoglobulina E/imunologia , Imunoglobulina E/metabolismo , Interleucina-4/imunologia , Interleucina-4/metabolismo , Mastócitos/imunologia , Diester Fosfórico Hidrolases/metabolismo , Pirofosfatases/metabolismo , Receptores de IgE/imunologia , Tetraspanina 30/metabolismo , Triptases/metabolismo , Regulação para CimaRESUMO
BACKGROUND: Asthma is the most common chronic disease in childhood. Large variations in hospitalization rates are observed and adherence to and appropriateness of guidelines are often subject of discussion. The aim was to examine if adherence to guidelines concerning use of lung function tests at time of diagnosis and during the first year after the start of medical treatment was associated with risk of hospitalization. RESEARCH DESIGN: A Danish nationwide population-based cohort study was performed for the study period 1999-2004 using data from five nationwide registries linked by a unique personal registration number. METHODS: Risk of hospitalization was examined in relation to whether asthmatic children aged 6-14 had a lung function test at the start of treatment and during the first year of follow-up and a medication ratio of controller-to-total medication of at least 0.5. Cox regression analysis was used to calculate hazard ratios (HRs) adjusted for sex, age, socioeconomic factors, care provider, and severity of disease. RESULTS: A total of 27,193 asthmatic children were followed for at least 1 year after the start of medication. The adjusted HR for hospitalization was 0.64 (95% confidence interval: 0.55-0.74) for having had a lung function test at the start of treatment; 0.82 (0.68-1.00) for having had a lung function test during the first 6 months of follow-up; 0.67 (0.55-0.81) for having a medication ratio of at least 0.5. Children from low-income families and children aged 6-8 had an increased risk of hospitalization. CONCLUSION: Adherence to the guidelines concerning use of lung function test for asthmatic children was associated with a reduced risk of hospitalization. Likewise, a medication ratio of controller-to-total medication of at least 0.5 was associated with a lower risk of hospitalization.
Assuntos
Antiasmáticos/uso terapêutico , Asma/diagnóstico , Medicina Geral/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Adolescente , Antiasmáticos/administração & dosagem , Asma/tratamento farmacológico , Criança , Dinamarca , Feminino , Seguimentos , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Masculino , Cooperação do Paciente/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/estatística & dados numéricos , Testes de Função Respiratória , Fatores de Risco , Índice de Gravidade de DoençaRESUMO
During the last two decades different scientific groups have investigated the phenotype and function of in vitro generated human mast cells (MC). The cells have been shown to display variable surface markers and functional characteristics. The phenotypic differences may reflect different culture conditions, protocols or the use of different progenitors. To investigate the significance of different progenitors, we have compared MC generated from CD133(+) progenitor cells from cord blood (CBMC) or peripheral blood (PBMC). The progenitors were cultured for 7 weeks in the presence of IL-6 and SCF, with addition of IL-3 the first 3 weeks, and FCS during week 7. The phenotype of the established MC was characterized by surface marker expression levels, metachromasia, histamine and tryptase contents and their function was evaluated by receptor-mediated release of histamine and PGD(2). The generated metachromatic (<99%) MC were 75% tryptase(+), regardless of the source of progenitor cell. Expression of c-kit/CD117, CD203c, and FcepsilonRI was comparable. The density of c-kit/CD117 receptors on CBMC was higher that of PBMC (p<0.001). The density of CD203c and FcepsilonRI was higher on PBMC (p<0.001). PBMC contained more histamine (p<0.001), expressed more FcepsilonRI (p<0.001) and released more histamine (p<0.001) and PGD(2) (p<0.001) upon ligation of FcepsilonRI, than CBMC. Culture with IL-4 increased expression of tryptase, FcepsilonRI, CD117 and CD203c, secretion of histamine and PGD(2) of PBMC, and histamine secretion of CBMC. Cord and peripheral blood may give rise to different types of MC. The question addressed should determine the progenitor cell and protocol to be used.
Assuntos
Técnicas de Cultura de Células/métodos , Células-Tronco Hematopoéticas/fisiologia , Mastócitos/fisiologia , Diferenciação Celular , Proliferação de Células , Células Cultivadas , Sangue Fetal/citologia , Células-Tronco Hematopoéticas/citologia , Liberação de Histamina , Humanos , Interleucina-4/farmacologia , Mastócitos/citologia , Diester Fosfórico Hidrolases/metabolismo , Prostaglandina D2/metabolismo , Proteínas Proto-Oncogênicas c-kit/metabolismo , Pirofosfatases/metabolismo , Receptores de IgE/metabolismo , Triptases/metabolismoRESUMO
Functional, mature human mast cells have been generated by in vitro differentiation of CD133(+)/CD34(+) progenitor cells isolated from e.g. cord blood, peripheral blood, bone marrow or fetal liver. However, the protocols published so far require long term cultivation, i.e. up to 15 weeks for mast cell differentiation, which makes such approaches not only laborious but also costly. Here, we have developed a protocol for generating functional human mast cells from peripheral blood already within 7 weeks. Human CD133(+) progenitors were isolated from buffy coat preparations of peripheral blood and cultured in the presence of stem cell factor (SCF) and IL-6 for 7 weeks. IL-3 was added to the culture medium during the first 3 weeks, and fetal calf serum (FCS) added during the last week. In vitro differentiated CD133(+) cells exhibited multiple characteristics of mature mast cells. Thus, cells contained tryptase and expressed functional levels of FcepsilonRI. Anti-IgE stimulation induced significant release of histamine and PGD(2) and also of chemokines including MCP-1, IL-8, MIP-1alpha, and MIP-1beta. The fact that our in vitro differentiated mast cells are derived from a generally available source of progenitor cells makes this novel protocol widely applicable to any patient group, irrespective of age. Moreover, this progenitor source is more readily available than e.g. bone marrow or cord blood-derived progenitors. Consequently, our protocol has great potential in studies on mast cell biology and mast cell pathology, and e.g. on evaluation of drug effects.
Assuntos
Técnicas de Cultura de Células/métodos , Mastócitos/citologia , Mastócitos/metabolismo , Fator de Células-Tronco/metabolismo , Antígeno AC133 , Antígenos CD/imunologia , Antígenos CD/metabolismo , Antígenos CD34/imunologia , Antígenos CD34/metabolismo , Diferenciação Celular , Quimiocinas/biossíntese , Quimiocinas/imunologia , Glicoproteínas/imunologia , Glicoproteínas/metabolismo , Células-Tronco Hematopoéticas/citologia , Liberação de Histamina , Humanos , Interleucina-3/metabolismo , Interleucina-6/metabolismo , Ativação Linfocitária/imunologia , Mastócitos/imunologia , Peptídeos/imunologia , Peptídeos/metabolismo , Células-Tronco Pluripotentes/citologia , Receptores de IgE/imunologia , Receptores de IgE/metabolismo , Fator de Células-Tronco/imunologia , Triptases/metabolismoRESUMO
BACKGROUND: Quality of life is an important parameter in the evaluation of quality and outcome of health care and treatment, especially in patients with chronic disorders. The aim of this study was to assess the validity and reliability of the Danish version of the revised disease-specific health-related quality of life questionnaire for adolescents and adults with cystic fibrosis (CFQ-R14+). METHODS: A total of 196 cystic fibrosis (CF) patients completed the CFQ-R14+ (response rate 71%). Forced expiratory volume in 1 s in percentage of predicted (FEV(1)%) and body mass index (BMI) were included as measures of health status. RESULTS: Internal consistency coefficients ranged from 0.54 to 0.95. Eight out of the twelve scales had alpha coefficients above 0.7. Test-retest correlations ranged from 0.42 to 0.88 and they were significant in eight scales. All the CFQ-R+14 scales except the digestive symptoms scale discriminated significantly (p<0.05) between patients with mild, moderate, and severe disease. Nine out of the twelve scales discriminated significantly (p<0.05) between nourished (BMI> or =19) and malnourished (BMI<19) patients. Significant differences between participants and non-responders were found for age, sex and FEV(1) (higher age, more males and lower FEV(1) among non-responders). All of the scales met standards for floor effects (<15% of the responders with the lowest score) but five of the scales failed to meet standards for ceiling effects (>15% of the responders with the highest score). CONCLUSION: The Danish CFQ-R14+ is a reliable and valid instrument for measuring the health-related quality of life in Danish adolescents and adults with CF, though with the exception from a few of its subscales.
Assuntos
Fibrose Cística , Indicadores Básicos de Saúde , Qualidade de Vida , Inquéritos e Questionários , Adolescente , Adulto , Índice de Massa Corporal , Fibrose Cística/complicações , Fibrose Cística/fisiopatologia , Fibrose Cística/psicologia , Dinamarca , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Estado Nutricional , Reprodutibilidade dos Testes , Comportamento Social , Adulto JovemRESUMO
OBJECTIVES: As young patients with cystic fibrosis (CF) grow up, they are expected to take increasing responsibility for the treatment and care of their disease. The aim of this study was to explore the disease-related challenges faced by young adults with CF and their parents, when they leave home. MATERIALS AND METHODS: A questionnaire survey of Danish patients with CF aged 18-25 years and their parents was conducted. The questionnaires were based on focus-group interviews with young adults with CF and their parents, and addressed challenges faced in the transition phase between childhood and adulthood, including different areas of disease management in everyday life. RESULTS: Among all of the patients invited, 62% (n=58/94) of young adults and 53% (n=99/188) of their parents participated in the study. In total, 40% of the 18- to 25-year-olds were living with their parents, and the parents continued to play an active role in the daily care of their offspring's disease. Among the young adults who had left home, both the patients and their parents reported many difficulties regarding disease management; the young adults reported difficulties in contacting social services and in affording and preparing sufficient CF-focused meals, and their parents reported difficulties in answering questions concerning social rights and CF in general, and in knowing how to give their offspring the best help, how much to interfere, and how to relinquish control of managing their offspring's disease. CONCLUSION: Young adults with CF who have left home have difficulties in handling the disease and their parents have difficulties in knowing how to give them the best help. There is an urgent need for holistic CF transitional care, including ensuring that young adults master the essential skills for self-management as they leave their parents.
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BACKGROUND: Respiratory viral and atypical bacterial infections are associated with pulmonary exacerbations and hospitalisations in cystic fibrosis patients. We wanted to study the impact of such infections on children attending the outpatient clinic. METHODS: Seventy-five children were followed for 12 months at regular clinic visits. Routine sputum/laryngeal aspirations were tested with PCR for 7 respiratory viruses. Antibodies against C. pneumoniae, M. pneumoniae and B. pertussis were measured every 3-4 months. FEV-1, FEF(25-75) and specific airway resistance, "viral" symptoms and bacterial culture were recorded. RESULTS: Ninety-seven viral and 21 atypical bacterial infections were found. FEV-1 was significantly reduced during viral infection (-12.5%, p=0.048), with the exception of rhinovirus infection. A small change in FEV-1 (-3%) was seen during atypical bacterial infection (p=0.039). Viral and atypical bacterial infections caused no change in type and frequency of bacterial culture. Positive predictive value of "viral symptoms" was low (0.64%). Eight patients received "unnecessary" antibiotics because of viral symptoms. CONCLUSIONS: Some viral infections and atypical bacterial infections affect FEV-1 acutely. Viral infections did not precipitate bacterial infection or change of colonisation. Clinical symptoms failed to diagnose viral infection accurately. Routine surveillance for virus or atypical bacteria seems not to be justified in this patient category.
Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , Formas Bacterianas Atípicas/imunologia , Infecções Bacterianas/epidemiologia , Fibrose Cística/complicações , Infecções Respiratórias/epidemiologia , Viroses/epidemiologia , Adolescente , Anticorpos Antibacterianos/análise , Formas Bacterianas Atípicas/isolamento & purificação , Infecções Bacterianas/complicações , Infecções Bacterianas/fisiopatologia , Criança , Pré-Escolar , Fibrose Cística/fisiopatologia , DNA Viral/análise , Ensaio de Imunoadsorção Enzimática , Seguimentos , Volume Expiratório Forçado , Humanos , Incidência , Lactente , Recém-Nascido , Reação em Cadeia da Polimerase , Prognóstico , Infecções Respiratórias/complicações , Infecções Respiratórias/fisiopatologia , Estudos Retrospectivos , Viroses/complicações , Viroses/fisiopatologia , Vírus/genéticaRESUMO
BACKGROUND: Educational and rehabilitation programmes increase the quality-of-life of patients with cystic fibrosis, but patients are discouraged to participate because of the risk of cross-infections. METHODS: Isolates of Pseudomonas aeruginosa, Staphylococcus aureus and Haemophilus influenzae cultured one year before to one year after attendance were investigated by pulsed field gel electrophoresis, multilocus sequence typing and/or spa-typing. RESULTS: We typed 984 bacterial isolates cultured from 46 patients aged 5-18 years attending educational programmes at Aarhus University Hospital during 2009-2011. There were no cross-infections with P. aeruginosa. Six cases of S. aureus or H. influenzae strain replacement with a new strain-type shared with a fellow attendee were found. However, the probability of acquiring a shared strain of S. aureus or H. influenzae was not increased for patients attending educational programmes. CONCLUSIONS: Transmission of P. aeruginosa, S. aureus and H. influenzae related to attendance to the investigated educational programmes could not be documented.
Assuntos
Infecção Hospitalar , Fibrose Cística , Transmissão de Doença Infecciosa , Haemophilus influenzae/isolamento & purificação , Pseudomonas aeruginosa/isolamento & purificação , Staphylococcus aureus/isolamento & purificação , Adolescente , Técnicas de Tipagem Bacteriana , Criança , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/etiologia , Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/transmissão , Fibrose Cística/epidemiologia , Fibrose Cística/microbiologia , Dinamarca/epidemiologia , Transmissão de Doença Infecciosa/prevenção & controle , Transmissão de Doença Infecciosa/estatística & dados numéricos , Eletroforese em Gel de Campo Pulsado/métodos , Humanos , Masculino , Tipagem de Sequências Multilocus/métodos , Avaliação de Resultados em Cuidados de Saúde , Educação de Pacientes como Assunto/métodosRESUMO
BACKGROUND: Serum-free cultures supplemented with stem cell factor (SCF) and IL-6 is reported to support the extensive growth of less functional human cord blood-derived mast cells. OBJECTIVE: To obtain more functional mast cells from cord blood, we developed a culture system combining a serum-free condition for 0-8 weeks of culture, and followed by a serum-supplemented culture condition and examined the function of the cells compared to the cells cultured continuously in serum-free condition. METHODS: Human cord blood progenitors were purified with anti-CD133 antibody. They were cultured in a serum-free medium StemSpan supplemented with SCF at 100 ng/ml and IL-6 at 50 ng/ml for 8 weeks. Then, an aliquot of the cultured cells were cultured in the above condition but further supplemented with 10% fetal calf serum (FCS). RESULTS: The addition of FCS after 8 weeks of culture significantly increased the amount of histamine per mast cell (3.8 pg/cell) when compared to the serum-free condition (0.7 pg/cell). The cells cultured with FCS after 8 weeks expressed more FcvarepsilonRI alpha and released >30% of the histamine content upon anti-IgE stimulation than those cultured without serum. CONCLUSION: It is uncertain why FCS enhanced the functional maturation of mast cells when added after week 8 of culture but suppressed mast cell development when added at day 0 of culture. Yet, the present method combining a serum-free culture system with a serum-supplemented culture system seems to be beneficial for most of the laboratories to obtain functional human mast cells.
Assuntos
Técnicas de Cultura de Células/métodos , Sangue Fetal/citologia , Mastócitos/citologia , Contagem de Células , Degranulação Celular/imunologia , Divisão Celular , Separação Celular , Sobrevivência Celular , Meios de Cultura Livres de Soro , Feminino , Humanos , Mastócitos/imunologia , Gravidez , Receptores de IgERESUMO
Different protocols exist for in vitro development of HuMCs from hematopoietic stem cells, which results in distinct mast cells regarding molecular markers and activation patterns. Here, we introduce a SR profile using immunological, neurogenic, and pharmacological stimuli to characterize cellular functionality. Mast cells were obtained from three culture protocols using two types of PBdMCs (CD34⺠PBdMC or CD133⺠PBdMC) and one type of CBdMC (CD133⺠CBdMC). We analyzed resting cells for specific mast cell markers at protein and mRNA levels, thereby creating a molecular profile. To characterize the SR profile, we stimulated cells with anti-IgE, C3a, C5a, Substance P, or Compound 48/80 and measured the release of histamine and cytokines (IL-10, IL-13, GM-CSF, TNF-α). Molecular profiling revealed that CD133⺠CBdMC expressed less chymase, FcεRIα, and CD203c but more CD117 compared with CD34⺠and CD133⺠PBdMC. The SR profile for histamine release illustrated a functional heterogeneity between PBdMC and CBdMC. PBdMC released >10% histamine upon stimulation with anti-IgE, C3a, Substance P, and Compound 48/80, whereas CBdMC only reacted to C3a. Cytokine secretion was only detected after anti-IgE stimulation. Here, the SR profile identified the CD133⺠PBdMC as the most active cells regarding secretion of IL-10, IL-13, GM-CSF, and TNF-α. Cells from all three culture protocols, however, produced IL-10 spontaneously at comparable levels. We recommend validating mast cell cultures by means of molecular and SR profiles to characterize the mast cells and enhance consensus among studies.
Assuntos
Sangue Fetal/citologia , Mastócitos/fisiologia , Antígeno AC133 , Antígenos CD/análise , Células Cultivadas , Citocinas/metabolismo , Glicoproteínas/análise , Liberação de Histamina , Humanos , Interleucina-10/biossíntese , Peptídeos/análise , Proteínas Proto-Oncogênicas c-kit/análise , Receptores de IgE , TranscriptomaRESUMO
PURPOSE: The mast cell plays a pivotal role in the human immune response. Crosslinking of 2 IgE molecules bound to the high affinity IgE receptor (FcεRI) on the surface of the mast cell results in mast cell degranulation and the release of several proinflammatory mediators. Patients with type-I allergy have increased levels of IgE in the blood compared to healthy individuals. METHODS: In a 6-week culture system of stem cells to human mast cells we investigated the effect of the concentration of IgE. The mast cells were cultured with different concentrations of IgE for the last 10 days of the maturation period. It was observed how the IgE concentration affects the histamine release, FcεRI density on the mast cell surface and the concentration of other mediators. RESULTS: A clear correlation between IgE concentration in culture medium and the release of histamine upon activation was observed. It showed a bell-shaped dose response curve, with maximal response around an IgE-concentration of 250 ng/mL. Furthermore, the sensitivity of the mast cells and surface density of FcεRI on mast cell surface was also influenced by the IgE concentration in the culture medium. CONCLUSIONS: IgE in the culture medium during the last 10 days of mast cell maturation influences the release of the preformed mediator histamine after mast cell activation and the density of FcεRI on the mast cell surface. The release of the de novo synthetized mediator prostaglandin D2 and the expression of chymase and tryptase are not influenced by IgE in culture medium.
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BACKGROUND: When suffering from cystic fibrosis (CF), a number of problems may arise during adolescence; for example, poor adherence. The problems may be attributed to the adolescent being insufficiently prepared for adult life. Research on different ways of parenting adolescents with CF and the influence of different parenting styles on the adolescents' adherence to treatment is still limited. AIM: The aim of this study was to identify the types of parental support that adolescents and young adults with CF want and find helpful in terms of preparing them for adult life. METHODS: Sixteen Danish adolescents with CF, aged 14-25, participated in the study. Two focus group interviews were carried out, one for 14-18-year-olds and one for 19-25-year-olds. Individual interviews were conducted, with three subjects. Using interpretive description strategy, a secondary analysis of the interview data was conducted. RESULTS: The adolescents and young adults wanted their parents educated about the adolescent experience. They wanted their parents to learn a pedagogical parenting style, to learn to trust them, and to learn to gradually transfer responsibility for their medical treatment. Additionally, the adolescents noted that meeting other parents may be beneficial for the parents. CONCLUSION: The findings of this study suggest that adolescents and young adults with CF want their parents to be educated about how to handle adolescents with CF and thereby sufficiently prepare them for adult life.
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BACKGROUND: Treatment adherence is crucial in patients with cystic fibrosis, but poor adherence is a problem, especially during adolescence. Identification of barriers to treatment adherence and a better understanding of how context shapes barriers is of great importance in the disease. Adolescent reports of barriers to adherence have been studied, but studies of their parents' experience of such barriers have not yet been carried out. The aim of the present study was to explore barriers to treatment adherence identified by young patients with cystic fibrosis and by their parents. METHODS: A questionnaire survey of a cohort of young Danish patients with cystic fibrosis aged 14-25 years and their parents was undertaken. RESULTS: Barriers to treatment adherence were reported by 60% of the patients and by 62% of their parents. Patients and parents agreed that the three most common barriers encountered were lack of time, forgetfulness, and unwillingness to take medication in public. We found a significant positive correlation between reported number of barriers and perceived treatment burden. We also found a statistically significant relationship between the reported number of barriers and treatment adherence. A significant association was found between the number of barriers and the reactions of adolescents/young adults and those of their mothers and fathers, and between the number of barriers and the way the family communicated about cystic fibrosis. CONCLUSION: The present study showed that the majority of adolescents with cystic fibrosis and their parents experienced barriers to treatment adherence. Agreement between adolescents and their parents regarding the level and types of barriers indicates an opportunity for close cooperation between adolescents, their parents, and health care professionals in overcoming adolescent adherence problems.
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Corticosteroides/efeitos adversos , Antiasmáticos/efeitos adversos , Asma/tratamento farmacológico , Broncodilatadores/efeitos adversos , Fraturas Espontâneas/induzido quimicamente , Crescimento/efeitos dos fármacos , Osteoporose/induzido quimicamente , Administração por Inalação , Corticosteroides/administração & dosagem , Antiasmáticos/administração & dosagem , Densidade Óssea/efeitos dos fármacos , Broncodilatadores/administração & dosagem , Criança , Humanos , Fatores de RiscoRESUMO
BACKGROUND: Cystic fibrosis (CF) affects the lungs causing infections and inflammation. Surfactant protein D (SP-D) is an innate defense lectin primarily secreted in the lungs. We investigated the influence of the SP-D Met11Thr polymorphism on CF lung function; and serum SP-D as a marker for CF lung disease. METHODS: For 107 CF patients (73 children, and 34 adults) serum SP-D and SP-D Met11Thr genotype were available. Leukocyte count was obtained for a subset of patients. Lung function was measured as forced expiratory volume in one second (FEV-1). RESULTS: Serum SP-D was increased in CF patients compared to healthy controls, positively correlated to leukocyte count, and negatively correlated to FEV-1. We found no correlation between SP-D Met11Thr genotype and FEV-1, and we found corresponding genotype frequencies in CF patients and in healthy controls. CONCLUSION: Serum SP-D in CF patients was increased in parallel with leukocyte count and with reduced FEV-1 and may constitute an alternative biomarker for lung disease, in the clinical setting and in research.
Assuntos
Fibrose Cística/sangue , Fibrose Cística/fisiopatologia , Proteína D Associada a Surfactante Pulmonar/sangue , Adolescente , Adulto , Idoso , Biomarcadores/sangue , Estudos de Casos e Controles , Criança , Feminino , Volume Expiratório Forçado , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único , Proteína D Associada a Surfactante Pulmonar/genética , Adulto JovemRESUMO
INTRODUCTION: In Denmark, asthma is the most widespread chronic childhood disease, imposing great demands on the health services. Considerable variations exist among Danish counties with respect to the percentage of asthmatic children treated by general practitioners and paediatric specialists, which makes it relevant to investigate whether there are differences among Danish counties in admission and readmission rates to hospitals in relation to the capacity of the outpatient clinics. MATERIALS AND METHODS: We performed a cross-sectional study using county-level aggregated data derived from the National Hospital Register and from StatBank Denmark documenting hospital admissions and visits to outpatient clinics in 2001 of children aged 0-4 years and 5-14 years with asthma or bronchitis. The chi2-test was used to calculate the differences by county. RESULTS: The results showed statistically significant differences among the counties in hospital admission rates, readmission rates and number of visits to outpatient clinics. DISCUSSION: The differences among counties in admission rates and number of visits to outpatient clinics indicate that there are considerable variations in the amount of specialist resources being allocated to management of childhood asthma. No study results are available about where asthmatic children are treated most advantageously, which makes further research relevant in view of the large differences in use of resources.