Summary
Background
Fat intake has been associated with respiratory diseases, with conflicting results.
Objective
We studied the association between asthma and rhinitis with dietary fats, and their ...food sources in an Italian population.
Methods
Clinical and nutritional information was collected for 871 subjects (aged 20‐84) from the population‐based multi‐case‐control study Genes Environment Interaction in Respiratory Diseases (GEIRD): 145 with current asthma (CA), 77 with past asthma (PA), 305 with rhinitis and 344 controls. Food intake was collected using the EPIC (European Investigation into Cancer and Nutrition) Food Frequency Questionnaire. The associations between fats and respiratory diseases were estimated by multinomial models. Fats and their dietary sources were analysed both as continuous variables and as quartiles.
Results
Monounsaturated fatty acids and oleic acid were associated with a reduced risk of CA in both continuous (RRR = 0.68, 95%CI: 0.48; 0.96; RRR = 0.69; 95%CI: 0.49; 0.97, per 10 g, respectively) and per‐quartile analyses (p for trend = 0.028 and 0.024, respectively). Olive oil was associated with a decreased risk of CA (RRR = 0.80; 95%CI: 0.65; 0.98 per 10 g). An increased risk of rhinitis was associated with moderate total fat and SFA intake.
Conclusions
High dietary intakes of oleic acid and of olive oil are associated with a lower risk of asthma but not of rhinitis.
The global burden of chronic airway diseases represents an important public health concern. The role of oxidative stress and inflammation in the pathogenesis of these diseases is well known. The aim ...of this study is to evaluate the behavior of both inflammatory and oxidative stress biomarkers in patients with chronic bronchitis, current asthma and past asthma in the frame of a population-based study.
For this purpose, data collected from the Gene Environment Interactions in Respiratory Diseases (GEIRD) Study, an Italian multicentre, multicase-control study, was evaluated. Cases and controls were identified through a two-stage screening process of individuals aged 20-65 years from the general population. Out of 16,569 subjects selected from the general population in the first stage of the survey, 2259 participated in the clinical evaluation. Oxidative stress biomarkers such as 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxodG), 8-isoprostane and glutathione and inflammatory biomarkers such as Fractional Exhaled Nitric Oxide (FENO) and white blood cells were evaluated in 1878 subjects.
Current asthmatics presented higher levels of FENO (23.05 ppm), leucocytes (6770 n/µL), basophils (30.75 n/µL) and eosinophils (177.80 n/µL), while subjects with chronic bronchitis showed higher levels of GSH (0.29 mg/mL) and lymphocytes (2101.6 n/µL). The multivariable multinomial logistic regression confirmed high levels of leucocytes (RRR = 1.33), basophils (RRR = 1.48), eosinophils (RRR = 2.39), lymphocytes (RRR = 1.26) and FENO (RRR = 1.42) in subjects with current asthma. Subjects with past asthma had a statistically significant higher level of eosinophils (RRR = 1.78) with respect to controls. Subjects with chronic bronchitis were characterized by increased levels of eosinophils (RRR = 2.15), lymphocytes (RRR = 1.58), GSH (RRR = 2.23) and 8-isoprostane (RRR = 1.23).
In our study, current asthmatics show a greater expression of the inflammatory profile compared to subjects who have had asthma in the past and chronic bronchitis. On the other hand, chronic bronchitis subjects showed a higher rate of expression of oxidative stress biomarkers compared to asthmatic subjects. In particular, inflammatory markers such as circulating inflammatory cells and FENO seem to be more specific for current asthma, while oxidative stress biomarkers such as glutathione and 8-isoprostane appear to be more specific and applicable to patients with chronic bronchitis.
In this study we aimed at identifying main demographic, laboratory and environmental factors influencing the level of urinary biomarkers (DNA-derived 8-oxodG and lipid membrane-derived ...8-isoprostane), and deriving their adjusted 95% reference intervals (RI) in a sample of healthy people from the general population. Data from 281 healthy subjects from the Gene Environment Interactions in Respiratory Diseases survey were used in this study. Generalized additive models for location, scale and shape (GAMLSS) were used to find determinants of the biomarkers among gender, age, season and distance from collection (DFC), and to predict their RI. The RI of the biomarkers stratified by season and adjusted for DFC showed a slight statistically significant decrease in the biomarkers at the increasing DFC in two seasons, except the 8-oxodG during the warm season: median levels at the min and max values of DFC were (ng/mgcreat) 7.0-1.1 in the cold and 3.9-3.9 in the warm seasons for 8-oxodG, 0.7-0.2 in the cold and 1.3-0.6 in the warm seasons for 8-isoprostane. Both the biomarkers should be evaluated in association with the DFC and season in large epidemiological studies. The (semi)parametric GAMLSS method is a useful and flexible technique, which makes it possible to estimate adjusted RI.
Health-related quality of life (HRQL) in respiratory diseases has been generally investigated in clinical settings, focusing on a single disorder. In this study on a general population sample, we ...assessed the relationship between HRQL and several respiratory diseases studied simultaneously (COPD, current (CA) and past (PA) asthma, allergic (AR) and non-allergic (NAR) rhinitis and chronic bronchitis (CB).
Controls (n = 328) and cases of NAR (n = 95), AR (n = 163), CB (n = 48), CA (n = 224), PA (n = 126) and COPD (n = 28) were recruited in the centre of Verona in the frame of the Italian multi-case control GEIRD (Gene Environment Interactions in Respiratory Diseases) study; HRQL was measured through the SF-36 questionnaire. The relationships between HRQL (in terms of Physical (PCS) and Mental Component Scores (MCS)), respiratory diseases, and covariates were evaluated.
With respect to controls, the adjusted PCS median score was worse in subjects suffering from current asthma (- 1.7; 95%CI:-2.8;-0.6), CB (- 3.8; 95%CI:-5.7;-1.9), and COPD (- 5.6; 95%CI:-8.1;-3.1). MCS was worse in current asthmatics (- 2.2; 95%CI:-4.1;-0.3), CB (- 5.5; 95%CI:-8.7;-2.2), and COPD cases (- 4.6; 95%CI:-8.8;-0.5) as well.
To our knowledge, this is the first study in the general population that analyzed HRQL performing a simultaneous comparison of HRLQ in several respiratory disorders. We found that subjects suffering from COPD, CA, and CB had the poorest HRQL. Clinicians should carefully consider the possible impact of respiratory disorders as CB and not only that of CA and COPD.
Abstract
Background
Patient accidental falls in a hospital environment are a serious problem for patient safety, and for the additional costs due to associated medical interventions.
Objective
The ...endpoints of this study were the assessment of the fall incidence in the hospital before and after the implementation of a multidisciplinary care-bundle, along with a cost-effectiveness evaluation.
Design
A stepped-wedge trial was conducted between April 2015 and December 2016 in Bologna University Hospital.
Methods
Incidence rates (IRs) of falls in both the control and intervention periods were calculated. A multilevel mixed-effects generalised linear model with logit link function, adjusted for age, sex, cluster cross-over timing and patients’ clinical severity was used to estimate odds ratios (OR) of fall risk of patients of the intervention group respect to the controls.
Intervention costs associated with the introduction of the care-bundle intervention were spread between patients per cluster-period-group of exposure. Incremental cost-effectiveness ratio was evaluated using total costs in the intervention and control groups.
Results
IRs of falls in control and intervention periods were respectively 3.15 and 2.58 for 1,000 bed-days. After adjustment, the subjects receiving the intervention had a statistically significant reduced risk of falling with respect to those who did not (OR = 0.71, 95% confidence interval: 0.60–0.84). According to the cost-effectiveness analysis, the incremental cost per fall prevented was €873.92 considering all costs, and €1644.45 excluding costs related falls.
Conclusions
Care-bundle had a protective effect on patients, with a statistically significant reduction of the fall risk. This type of intervention appears cost-effective compared to routine practices.
The content of flavonoids, widely found in plant-based foods, might differ depending on which food composition table (FCT) is being used. In this study, we investigated the variation and ...comparability in the flavonoid content of selected foods across four international food composition tables. Flavonoid estimates were derived for all foods available in each table, and comparisons were carried out for foods common between tables. Bias percentage, 95 % limits of agreement, and intra-class correlation coefficients (ICCs; 95 % confidence intervals 95 %CI) were estimated. Phenol-Explorer and Indian FCT showed moderate level of agreement for total flavonoid (ICC 0.50 and 0.57 respectively) when compared to the USDA table. eBASIS for total flavonoids and anthocyanidins (ICC 0.67 and 0.85, respectively), and Indian FCT for flavanols and flavanones (ICC 0.71 and ICC 0.85, respectively) showed moderate-to-good level of agreement, and low level of agreement for other subclasses when compared to Phenol Explorer. Several flavonoid subclasses showed low to moderate levels of agreement between FCTs, whilst others (including total flavonoid intake) had lower levels of agreement. Methodological approaches in the measurement of flavonoid content of foods across tables, and continued efforts to improve harmonization of these databases would contribute to improve quantification of flavonoid content.
•Flavonoid content values of selected foods compared among four international FCTs.•Low to moderate agreement between FCTs was observed for majority comparisons.•There was low or no agreement in flavonols content among the four FCTs compared.•Compared with USDA, flavonoid contents varied from 4.43 % to 133.34 % over other FCTs.
Neurodevelopmental disorders (NDDs) have been suggested to lie on a gradient continuum, all resulting from common brain disturbances, but with different degrees of impairment severity. This ...case-control study aimed to assess postural stability against such hypothesis in 104 children/adolescents aged 5-17, of whom 81 had NDDs and 23 were healthy controls. Compared to healthy controls, Autism Spectrum Disorder (ASD) resulted in the most severely impaired neurodevelopmental condition, followed by Attention Deficit Hyperactive Disorder (ADHD) and Tourette Syndrome (TS). In particular, while ASD children/adolescents performed worse than healthy controls in a number of sensory conditions across all parameters, ADHD children/adolescents performed worse than healthy controls only in the sway area for the most complex sensory conditions, when their vision and somatosensory functions were both compromised, and performance in Tourette Syndrome (TS) was roughly indistinguishable from that of healthy controls. Finally, differences were also observed between clinical groups, with ASD children/adolescents, and to a much lesser extent ADHD children/adolescents, performing worse than TS children/adolescents, especially when sensory systems were not operationally accurate. Evidence from this study indicates that poor postural control may be a useful biomarker for risk assessment during neurodevelopment, in line with predictions from the gradient hypothesis.
To find a possible pathogenetic mechanism of the early sudden infant death occurring in newborns during the skin-to-skin care (SSC), through the examination of neuronal centers regulating the vital ...activities.
This is an in-depth examination of the brain stem in 22 healthy term newborns, suddenly died in the first hour of life without the identification of a cause at autopsy (early sudden infant death syndrome eSIDS), 12 of them concomitantly with SSC, and 10 with age-matched controls died of known pathology.
Developmental alterations of neuronal structures of the brain stem were highlighted in 19 of the 22 eSIDS, but not in control. The hypoplasia of the pontine Kölliker-Fuse nucleus (KFN), an important respiratory center, was diagnosed at the histological examination, validated by morphometric quantifications, in 11 of the 12 eSIDS while they were placed on the mother's chest and in 2 of the 10 SSC unrelated neonatal deaths.
The delayed development of the KFN could represent a specific finding of eSIDS occurring during SSC. Therefore, it is necessary to point out that the SSC represents a further risk factor that must be added to others already known for sudden infant death syndrome. Then this practice needs appropriate monitoring strategies of the infant's conditions.
Introduction
In SERAPHIN, a long-term, event-driven, double-blind randomised controlled trial in pulmonary arterial hypertension (PAH), macitentan 10 mg significantly reduced the risk of ...morbidity/mortality compared with placebo. Its open-label extension study (SERAPHIN OL) further assessed long-term safety and tolerability of macitentan 10 mg in PAH patients.
Methods
Patients in SERAPHIN who completed the double-blind treatment period or experienced a morbidity event during the study could enter SERAPHIN OL. Patients received macitentan 10 mg once daily, and safety and survival were assessed until end of treatment (+ 28 days). Two overlapping sets were analysed for safety: (1) all patients in SERAPHIN OL (OL safety set); (2) patients randomised to macitentan 10 mg in SERAPHIN (long-term safety/survival set). Survival was evaluated as an exploratory endpoint in the latter set.
Results
Of 742 patients randomised in SERAPHIN, 550 (74.1%) entered SERAPHIN OL (OL safety set); 242 patients were randomised to macitentan 10 mg in SERAPHIN (long-term safety/survival set). Median (min, max) exposure to macitentan 10 mg was 40.1 (0.1, 130.5) months (2074.7 patient-years; OL safety set) and 54.7 (0.1, 141.3) months (1151.0 patient-years; long-term safety/survival set). Safety in both analysis sets was comparable to the known safety profile of macitentan. Kaplan-Meier survival estimates (95% CI) at 1, 5, 7 and 9 years were 95.0% (91.3, 97.1), 73.3% (66.6, 78.9), 62.6% (54.6, 69.6) and 52.7% (43.6, 61.0), respectively (long-term safety/survival set; median follow-up: 5.9 years).
Conclusions
This analysis provides the longest follow-up for safety and survival published to date for any PAH therapy. The safety profile of macitentan 10 mg over this extensive treatment period was in line with that observed in SERAPHIN. As the majority of patients were receiving other PAH therapy at macitentan initiation, our study provides additional insight into the long-term safety of macitentan, including as part of combination therapy.
Trial Registration
ClinicalTrials.gov Identifiers: NCT00660179 and NCT00667823.
As part of the multinational Burden of Lung Disease (BOLD) survey, this study investigated the flavonoid content and agreement levels of foods included in BOLD’s food frequency questionnaire (FFQ), ...using four international flavonoid composition tables.
The USDA (American), BioActive Substances in Food Information System (eBASIS; European), Indian Food Composition (IFCT), and Phenol-Explorer (European) Tables were selected for their comparable data on five subclasses of flavonoids (flavan-3-ols, flavanones, flavones, flavonols, and isoflavones). Flavonoid estimates were derived for all foods available in each table (n = 117 USDA; n = 77 eBASIS; n = 69 IFCT; n = 90 Phenol-Explorer), and comparisons were carried out for foods common between tables. Percentage differences of flavonoid content were calculated, and intra-class correlation coefficients (ICCs; 95% confidence intervals 95%CI) estimated. ICC reliability was categorized as low (<0.5), moderate (0.50–0.75), good (0.75–0.90), or excellent (>0.90).
Compared to the USDA Table, total flavonoid content was overestimated by 181.5%, 14.1%, and 26.5%, in the eBASIS, IFCT, and Phenol-Explorer tables, respectively. Compared to Phenol-Explorer, total flavonoid content was overestimated by 53.0% in eBASIS and by 29.6% in IFCT. The reliability for total flavonoid content between the USDA and Phenol-Explorer tables was moderate (ICC 0.51; 95% CI 0.33, 0.65), low between Phenol-Explorer and eBASIS (ICC 0.27; 95% CI 0.02, 0.49), and low between Phenol-Explorer and IFCT (ICC 0.22, 95%CI –0.07, 0.48). There was good-to-excellent reliability between USDA and Phenol-Explorer for flavanones and flavones (ICC 0.93; 95%CI 0.82, 0.98; and ICC 0.86; 95%CI 0.73, 0.93, respectively). Phenol-Explorer and IFCT showed good reliability for flavanone and flavanol subclasses. ICCs for other subclasses was low across tables.
Flavonoid estimates varied considerably across international tables. These differences should be taken into consideration when deriving flavonoid content in population-based surveys.
MAA is funded by the European Union’s Horizon 2020 Research and Innovation Programme (Marie Sklodowska-Curie Grant Agreement). The UK’s Medical Research Council (MR/R011192/1) funds the BOLD stud.
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