Eczema, rhinitis, and asthma often coexist (comorbidity) in children, but the proportion of comorbidity not attributable to either chance or the role of IgE sensitisation is unknown. We assessed ...these factors in children aged 4-8 years.
In this prospective cohort study, we assessed children from 12 ongoing European birth cohort studies participating in MeDALL (Mechanisms of the Development of ALLergy). We recorded current eczema, rhinitis, and asthma from questionnaires and serum-specific IgE to six allergens. Comorbidity of eczema, rhinitis, and asthma was defined as coexistence of two or three diseases in the same child. We estimated relative and absolute excess comorbidity by comparing observed and expected occurrence of diseases at 4 years and 8 years. We did a longitudinal analysis using log-linear models of the relation between disease at age 4 years and comorbidity at age 8 years.
We assessed 16 147 children aged 4 years and 11 080 aged 8 years in cross-sectional analyses. The absolute excess of any comorbidity was 1·6% for children aged 4 years and 2·2% for children aged 8 years; 44% of the observed comorbidity at age 4 years and 50·0% at age 8 years was not a result of chance. Children with comorbidities at 4 years had an increased risk of having comorbidity at 8 years. The relative risk of any cormorbidity at age 8 years ranged from 36·2 (95% CI 26·8-48·8) for children with rhinitis and eczema at age 4 years to 63·5 (95% CI 51·7-78·1) for children with asthma, rhinitis, and eczema at age 4 years. We did longitudinal assessment of 10 107 children with data at both ages. Children with comorbidities at 4 years without IgE sensitisation had higher relative risks of comorbidity at 8 years than did children who were sensitised to IgE. For children without comorbidity at age 4 years, 38% of the comorbidity at age 8 years was attributable to the presence of IgE sensitisation at age 4 years.
Coexistence of eczema, rhinitis, and asthma in the same child is more common than expected by chance alone-both in the presence and absence of IgE sensitisation-suggesting that these diseases share causal mechanisms. Although IgE sensitisation is independently associated with excess comorbidity of eczema, rhinitis, and asthma, its presence accounted only for 38% of comorbidity, suggesting that IgE sensitisation can no longer be considered the dominant causal mechanism of comorbidity for these diseases.
Background The causal link between body mass index (BMI) or obesity and asthma in children is still being debated. Analyses of large longitudinal studies with a sufficient number of incident cases ...and in which the time-dependent processes of both excess weight and asthma development can be validly analyzed are lacking. Objective We sought to investigate whether the course of BMI predicts incident asthma in childhood. Methods Data from 12,050 subjects of 8 European birth cohorts on asthma and allergies were combined. BMI and doctor-diagnosed asthma were modeled during the first 6 years of life with latent growth mixture modeling and discrete time hazard models. Subpopulations of children were identified with similar standardized BMI trajectories according to age- and sex-specific “World Health Organization (WHO) child growth standards” and “WHO growth standards for school aged children and adolescents” for children up to age 5 years and older than 5 years, respectively (BMI-SDS). These types of growth profiles were analyzed as predictors for incident asthma. Results Children with a rapid BMI-SDS gain in the first 2 years of life had a higher risk for incident asthma up to age 6 years than children with a less pronounced weight gain slope in early childhood. The hazard ratio was 1.3 (95% CI, 1.1-1.5) after adjustment for birth weight, weight-for-length at birth, gestational age, sex, maternal smoking in pregnancy, breast-feeding, and family history of asthma or allergies. A rapid BMI gain at 2 to 6 years of age in addition to rapid gain in the first 2 years of life did not significantly enhance the risk of asthma. Conclusion Rapid growth in BMI during the first 2 years of life increases the risk of asthma up to age 6 years.
Abstract Background: Point-count measures of clinical priority are increasingly put forward for managing waiting lists. However, their development does not consider explicitly the appropriateness of ...the indications. Furthermore, an estimate of their effect in clinical practice is needed, assessing the amount of gains and losses in terms of time waited for patients with different priority scores. Methods: We developed appropriateness criteria for cataract surgery using the RAND method and applied them to a sample of 567 patients consecutively placed on a waiting list for cataract surgery. In addition, clinicians were asked to express the priority attributed to each patient using a 10-cm visual analogue scale, where 0 = minimal priority and 10 = maximum priority. We developed a priority score, using regression analysis to identify the set of clinical characteristics that best predicted clinicians' priority rating and to estimate their individual weight. We used a computer simulation model to compare mean waiting times with management of the waiting list using the priority score and using the “first-come, first-served” approach. Results: Overall, 332 patients (60.8%) were referred for cataract surgery for indications deemed appropriate, and their mean priority rating was 5.9 (95% confidence interval CI 5.7-6.1). The corresponding figures for the 201 (36.8%) uncertain indications and the 13 (2.4%) inappropriate indications were 4.5 (95% CI 4.1-4.7) and 2.6 (95% CI 1.3-3.9) respectively. The clinical characteristics included in the priority score (visual acuity in the operated eye and in the contralateral eye, visual function and ability to live or work independently) accounted for 35% of the variance in clinicians' ratings of priority. In the computer simulation model, patients with the highest priority experienced a variable reduction in mean waiting time (9% to 27%) depending to how time spent waiting was integrated into the clinical score. Interpretation: We conclude that the use of priority ratings in the management of a waiting list for cataract surgery leads to results that maintain the desirable coherence between priority and appropriateness of indication.The results also suggest that the implementation in clinical practice of priority scores may be worth the effort, given the potential reduction in waiting time for patients at high priority.
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