Effect of extensively hydrolyzed casein vs. conventional formula on the risk of asthma and allergies: The TRIGR randomized clinical trial.

BACKGROUND: The role of hydrolyzed infant formulas in the prevention of asthma and allergies remains inconsistent. We tested whether extensively hydrolyzed casein formula compared to conventional cow's milk-based formula prevented asthma, allergic rhinitis, or atopic eczema. METHODS: In the randomized double-blind Trial to Reduce IDDM in Genetically at Risk (TRIGR), comparing extensively hydrolyzed to standard cow's milk-based infant formula during the first 6-8 months of life, we assessed the effect of the intervention on the incidence of asthma, allergic rhinitis, and eczema when the children were 9- to 11-years old. The asthma, allergic rhinitis, and eczema occurrence was assessed using online standardized and validated ISAAC questionnaire. Of the 1106 children who participated in this Ancillary study, 560 had been randomized to the experimental (extensively hydrolyzed casein formula) and 546 to the control arm (cow's milk-based formula). RESULTS: The risk of persistent asthma, allergic rhinitis, or atopic eczema did not differ by treatment, the hazard ratios (95% CI) being 1.00 (0.66-1.52), 0.95 (0.66-1.38), and 0.89 (0.70-1.15), respectively, in the intention-to-treat analysis. Neither were there any differences in the per-protocol analysis. CONCLUSIONS: Extensively hydrolyzed casein formula did not protect from asthma, rhinitis, or eczema in this population carrying genetic risk for type 1 diabetes.

Association of diabetes-related autoantibodies with the incidence of asthma, eczema and allergic rhinitis in the TRIGR randomised clinical trial.

AIMS/HYPOTHESIS: This paper presents the relationship between islet autoantibodies, precursors of type 1 diabetes, and the development of persistent asthma, allergic rhinitis and atopic eczema. METHODS: A total of 2159 newborns who had a first-degree relative with type 1 diabetes and selected HLA genotypes were followed until the youngest participant reached 10 years of age. Islet cell antibodies (ICA) were detected using indirect immunofluorescence. Autoantibodies to insulin (IAA), GAD (GADA), the tyrosine phosphatase-related insulinoma-associated 2 molecule (IA-2A) and zinc transporter 8 (ZnT8A) were quantified with the use of specific radiobinding assays. As an ancillary study, the incidence of asthma, allergic rhinitis and eczema was assessed in 1106 of these children using the International Study of Asthma and Allergies in Childhood (ISAAC) core questionnaire when the children were 9-11 years old. HRs with 95% CIs were calculated to depict the incidence of these diseases following seroconversion to autoantibody positivity. RESULTS: The cumulative incidence of atopic eczema, allergic rhinitis and persistent asthma were 22%, 9% and 7.5%, respectively, by 9-11 years of age. The occurrence of diabetes-related autoantibodies showed a protective association with subsequently reported incidence of asthma and eczema. The incidence of rhinitis was not significantly related to the occurrence of IAA or GADA (statistical power was limited), but demonstrated the same inverse relationship as did the other diseases with ICA or when multiple autoantibodies first appeared together. CONCLUSIONS/INTERPRETATION: The findings add evidence to the relationships between these atopic diseases and diabetes-related autoimmunity and also suggest that, for eczema, the interaction depends upon which autoantibody appeared first. TRIAL REGISTRATION: ClinicalTrials.gov NCT00179777 Graphical abstract.

Sleep duration, obesity, and asthma, in Florida adolescents: analysis of data from the Florida Youth Risk Behavior Survey (2009-2013).

PURPOSE: To examine the association between sleep duration and asthma among Florida high school students and whether body mass index (BMI) modifies this association. METHODS: This cross-sectional analysis included 16,728 participants in the Florida Youth Risk Behavior Survey (2009-2013). Using logistic regression, we examined the association between sleep duration and asthma, and, after controlling for potential confounders, analyzed the interaction between sleep duration and BMI. RESULTS: Sleeping for less than 7 h or more than 8 h on school night was associated with increased odds of current asthma. Compared with 7-8 h of sleep per night, sleeping for <7 h had an OR of 1.22 (95% CI 1.07, 1.40), while sleeping for ≥9 h had and OR of 1.31 (1.06, 1.63). When stratified by body mass index (BMI), these associations were significant only in overweight adolescents, with those sleeping for <7 or ≥9 h having approximately twice the odds of having current asthma (OR = 1.75 (1.45, 2.11) and OR = 2.00 (1.32, 3.02) respectively), compared with normal weight adolescents who slept for 7-8 h per night. CONCLUSION: The association between sleep duration and asthma in adolescents is modified by BMI. Short and long sleep durations are associated with asthma in overweight adolescents while no significant association is seen in those with normal BMI.

Engaging Teens with Asthma in Designing a Patient-Centered Mobile App to Aid Disease Self-Management.

BACKGROUND: Despite the growing market of e-health disease self-management tools, few studies have reported the presence of teen patients in all phases of product design. While rates of American teens using mobile Internet grow, an opportunity to deliver disease self-management targeted for teen patients exists. Building on findings from previous investigations with teens with asthma, we explored teens' insights on the development of a patient-centered asthma management application (app). MATERIALS AND METHODS: Two existing asthma apps were used by 16 teen asthmatics for 7-10 days. At the end of the trial period, in-depth interviews were conducted with each participant to gather insights about the user experience. RESULTS: Participants requested more asthma-related content that educates them about their condition. Suggested improvements to currently available apps included a longer list of selectable symptoms to track, medication tracking, and more compelling interface features. CONCLUSIONS: Participants showed interest in using apps for managing their asthma, yet recommended improvements on current design. Whereas national figures point to a more ubiquitous mobile device environment, implementation efforts must respond to participants' recommendations while minding lingering digital divides. Currently available apps lack appealing components that teens seek or desire. Subsequent development should include teens' participation in component design insights.

Treatment of idiopathic pulmonary fibrosis with losartan: a pilot project.

BACKGROUND: Idiopathic pulmonary fibrosis is a progressive interstitial lung disease with no current effective therapies. Treatment has focused on antifibrotic agents to stop proliferation of fibroblasts and collagen deposition in the lung. We present the first clinical trial data on the use of losartan, an antifibrotic agent, to treat idiopathic pulmonary fibrosis. The primary objective was to evaluate the effect of losartan on progression of idiopathic pulmonary fibrosis measured by the change in percentage of predicted forced vital capacity (%FVC) after 12 months. Secondary outcomes included the change in forced expiratory volume at 1 second, diffusing capacity of carbon monoxide, 6-minute walk test distance, and baseline/transition dyspnea index. METHODS: Patients with idiopathic pulmonary fibrosis and a baseline %FVC of ≥50 % were treated with losartan 50 mg by mouth daily for 12 months. Pulmonary function testing, 6-minute walk, and breathlessness indices were measured every 3 months. RESULTS: Twenty participants with idiopathic pulmonary fibrosis were enrolled and 17 patients were evaluable for response. Twelve patients had a stable or improved %FVC at study month 12. Similar findings were observed in secondary end-point measures, including 58, 71, and 65 % of patients with stable or improved forced expiratory volume at 1 second, diffusing capacity for carbon monoxide, and 6-minute walk test distance, respectively. No treatment-related adverse events that resulted in early study discontinuation were reported. CONCLUSION: Losartan stabilized lung function in patients with idiopathic pulmonary fibrosis over 12 months. Losartan is a promising agent for the treatment of idiopathic pulmonary fibrosis and has a low toxicity profile.

Sleep duration patterns from adolescence to young adulthood and the risk of asthma.

PURPOSE: This study examined the association between sleep duration trajectories from adolescence to young adulthood and the risk of asthma into young adulthood. METHODS: Using data from 10,362 participants in the National Longitudinal Study of Adolescent to Adult Health (Add Health) free of asthma at baseline, we constructed trajectories of sleep duration from adolescence (age 13-18 years) to young adulthood (age 24-32 years) and used them to examine the association between sleep duration patterns and the risk of new-onset asthma using a log-binomial regression model after adjusting for potential confounders. RESULTS: The results revealed that 14.4% of nonasthmatic participants had persistent short sleep duration, whereas 80.0% had adequate sleep duration from adolescence through young adulthood. Consistently short-sleepers had 1.52 times the risk of new-onset asthma by age 32 years (95% CI 1.11, 2.10) compared with consistently adequate sleepers. The association was stronger in those with a family history of asthma (aRR = 2.43, 95% CI 1.15, 5.13) than in those without such history (aRR = 1.43, 95% CI 1.05, 1.95). CONCLUSIONS: We conclude that persistent short sleep duration is associated with an increased risk of new-onset asthma in young adults. This association may be more pronounced among those at high risk of asthma because of family history.

The effect of cyproheptadine hydrochloride (periactin) and megestrol acetate (megace) on weight in children with cancer/treatment-related cachexia.

BACKGROUND: Children with cancer frequently have associated cachexia and malnutrition. Failure to thrive affects nearly 40% of oncology patients with advanced or progressive disease. Malnutrition can erode quality of life and adversely impact disease prognosis. Appetite stimulation and increased food intake is 1 approach to combat cancer-related cachexia. MATERIALS AND METHODS: Cyproheptadine hydrochloride (CH), an appetite stimulant, was administered to children with cancer-associated cachexia to prevent further weight loss. All participants started CH and were evaluated for response after 4 weeks. Efficacy of megestrol acetate (MA) was evaluated in patients who did not respond to CH. Medical evaluation, weight measurements, prealbumin, and serum leptin levels were preformed at follow-up visits. RESULTS: Seventy patients were enrolled. Of the 66 evaluable patients, 50 demonstrated a response to CH (average weight gain 2.6 kg and mean weight-for-age z-score change of 0.35, P=0.001). Seven of the 16 nonresponders received MA. Six patients completed 4 weeks of MA, 5 responded (average weight gain of 2.5 kg). The most commonly reported side effect of CH was drowsiness. One patient on MA developed low cortisol levels and hyperlipidemia. CONCLUSIONS: This study demonstrates that CH is a safe and effective way to promote weight gain in children with cancer/treatment-related cachexia.

Sleep Duration Trajectories and Systemic Inflammation in Young Adults: Results From the National Longitudinal Study of Adolescent to Adult Health (Add Health).

Study Objectives: This study examines the effects of short and long sleep duration patterns in young adults on the levels of C-reactive protein (CRP), as well as the potential effect modification by sex. Methods: Using data from waves III (age 18-26) and IV (age 24-32) of the National Longitudinal study of adolescent to adult health, we examined the association between sleep trajectories in young adults, and the risk of elevated high sensitivity-CRP (hs-CRP), a marker of systemic inflammation. Results: Short sleep trajectories were associated with significantly elevated log-transformed hs-CRP (coefficient = 0.11, p-value .03) and with significantly higher odds of having hs-CRP levels > 3 mg/L (OR = 1.86, 95% CI 1.29, 2.67). The association was modified by sex, with the association between short sleep duration and hs-CRP limited to males. Both the continuous (coefficient 0.117, p-value = .0362) and the categorized hs-CRP (OR = 2.21, 95% CI 1.48, 3.30) were significantly elevated with short sleep durations in males, whereas no significant associations were seen in females with short sleep durations. By contrast, log hs-CRP was significantly elevated in females with long sleep durations (coefficient = 0.232, p-value = .0296), with a nonsignificant increase in the odds of having hs-CRP levels greater than 3 mg/L (OR = 1.48, 95% CI 0.75, 2.93), whereas there were no associations with long sleep duration in males. Conclusions: Systemic inflammation, measured by an elevated level of hs-CRP, is seen with persistent short sleep duration in young adult men and persistent long sleep duration in young adult women.

Physicians' perceptions of mobile technology for enhancing asthma care for youth.

This study assessed physicians' receptivity to using mobile technology as a strategy in patient care for adolescents with asthma. Understanding physicians' perceived barriers and benefits of integrating mobile technology in adolescents' asthma care and self-management is an initial step in enhancing overall patient and disease outcomes. We conducted in-depth interviews with second- and third-year pediatric residents and attending physicians who oversee pediatric residents in training (N = 27) at an academic medical center in the southeastern United States. We identified both benefits from and barriers to broader use of mobile technologies for improving asthma outcomes in adolescents. Resident physicians demonstrated greater readiness for integrating these technologies than did attending physicians. Prior to adoption of mobile technologies in the care of adolescent asthma patients, barriers to implementation should be understood. Prior to widespread adoption, such systems will need to be evaluated against traditional care for demonstration of patient outcomes that improve on the current situation.

Adolescent asthma self-management: patient and parent-caregiver perspectives on using social media to improve care.

BACKGROUND: Self-management of asthma can now leverage new media technologies. To optimize implementation they must employ a consumer-oriented developmental approach. This study explored benefits of and barriers to improved asthma self-management and identified key elements for the development of a digital media tool to enhance asthma control. METHODS: Between August 2010 and January 2011, 18 teens with asthma and 18 parent-caregivers participated in semistructured in-depth interviews to identify mechanisms for improving asthma self-management and propose characteristics for developing a digital media tool to aid such efforts. RESULTS: Teens and caregivers enumerated physician-recommended strategies for asthma management as well as currently employed strategies. Both groups thought of a potential digital media solution as positive, but indicated specific design requirements for such a solution to have utility. Whereas most participants perceived mobile platforms to be viable modes to improve asthma self-management, interest in having social networking capabilities was mixed. CONCLUSIONS: A digital media product capable of tracking conditions, triggers, and related asthma activities can be a core element of improved asthma control for youth. Improved asthma control will help decrease school absenteeism.

Neurocognitive impairment in children treated for cancer: how do we measure cognitive outcomes?

As the number of childhood cancer survivors grows, more attention on the identification and management of late effects, such as neurocognitive decline, is needed. This study, investigating treatment with central nervous system (CNS) stimulants for cognitive changes related to pediatric cancer treatment, confirmed a common concern. How should neurocognitive decline be measured and followed up after cancer therapy? Multiple pediatric standardized cognitive tests are available, but there is no consensus on an efficient way to measure the most common areas of decline, specifically impaired concentration, memory, and mental processing speed. The authors' report recognized 12 pediatric patients at risk for cognitive dysfunction, of whom 3 tested positive for early neurocognitive deficits using 3 subscales of the Wechsler Intelligence Scale for Children-III (WISC-III), which measure working verbal memory (Digit Span), mental processing speed (Symbol Search), and psychomotor speed (Coding). To predict the expected level of performance on WISC-III subscales, the patients' IQ was estimated using the Wide Range Achievement Test-3 reading subtest. Patients were treated with long-acting CNS stimulants and followed up serially using the WISC-III subscales.

Intralobar pulmonary sequestration associated with a congenital pulmonary airway malformation type II.

Intralobar pulmonary sequestration (ILPS) is a rare congenital malformation of the lung. It is described as a segment of lung parenchyma with normal pleura and systemic blood supply and it has poor communication with the tracheobronchial tree. Patients usually present in later childhood or adulthood with a history of recurrent pneumonias. The malformation is rarely associated with other congenital anomalies such as a congenital pulmonary airway malformation (CPAM). A CPAM is a congenital cystic lesion of the lung that presents usually in the newborn period as respiratory distress. We describe the case of a 2-month-old female who presented to the local emergency room with the initial diagnosis of pneumonia, surgical diagnosis of ILPS, and a final pathological diagnosis of ILPS with an associated CPAM.