This thesis studied environmental factors in relation to asthma and respiratory symptoms among schoolchildren in two countries. In Sweden, 1014 pupils (5-14 year) in 8 schools participated. Wheeze was reported by 7.8%, current asthma by 5.9%, doctor-diagnosed asthma by 7.7%, cat allergy by 6.8% and dog allergy by 4.8%. Current asthma was less common among those consuming more fresh milk and fish. Doctor-diagnosed asthma was less common among those consuming olive oil. Cat, dog and horse allergens were common in settled dust and related to respiratory symptoms. Pupils consuming butter and fresh milk had less respiratory symptoms in relation to allergen exposure. In schools with increased levels of microbial volatile organic compounds and selected plasticizers (Texanol and TXIB) asthma and respiratory symptoms were more common. In Korea, 2365 pupils (9-11 year) in 12 schools participated (96%). In total, wheeze was reported by 8.0%, current asthma by 5.7%, doctor-diagnosed asthma by 5.4%, cat allergy by 2.6% and dog allergy by 4.9%. Contamination of dog and mite (Dermatophagoides farinae) allergen was common while cat allergen was uncommon. Remodelling, changing floor and building dampness at home were positively associated with asthma and respiratory symptoms. The strongest associations were found for floor dampness. Indoor/outdoor concentration of NO2, formaldehyde and ultrafine particles (UFP) at schools were positively associated with asthma and respiratory symptoms. When comparing Sweden and Korea, Korean pupils had more breathlessness and asthma but reported less cat and pollen allergy. Swedish schools had CO2-levels below 1000 ppm, while most Korean schools exceeded this standard. Since both home and school environment may affect pupil’s asthma and respiratory symptoms, air quality should be an important health issue. Moreover, changes in dietary habits may be beneficial to decrease asthma and allergies. Furthermore, interaction between diet and environment needs to be further investigated.

Food allergies are an important health problem and affect up to 2% of the adult population and 8% of children worldwide. Under the Food Allergen Labeling and Consumer Protection Act (FALCPA) of 2004, foods that contain or derive from the "Big 8" allergens (milk, egg, finfish, crustacean shellfish, tree nuts, peanuts, wheat, and soybeans) must be declared and the "common or usual name" of the allergen source must be printed on the label of the food product. Currently, the most common used detection methods for food allergens are enzyme-linked immunosorbent assay (ELISA) based. ELISA, a protein-based method, targets specific allergen(s) and detects by colorimetric reaction following binding with a specific-enzyme labeled antibody. However, studies have demonstrated that matrix interference and heat treatment can interfere with the detectability of commercial ELISA kits. An alternative approach to targeting the allergen in soy is to use deoxyribonucleic acid (DNA) as a unique marker that can be used to indicate the presence of soy in food. According to FALCPA the source of an allergen should be declared on the label, therefore identifying an allergen, such as soy, by DNA detection could be a valid means of meeting FALCPA requirements. Real-time polymerase chain reaction (real-time PCR), a DNA-based method, can identify the presence of soy through amplification of specific sequences of DNA through the use of primers. However, the sensitivity of real-time PCR can be influenced by the amplification protocol, primer design and DNA extraction methods. Thus, the main objectives of this study were to 1) verify the specificity of primers designed to detect soy DNA from different soy products, 2) optimize the previously developed real-time PCR protocol to detect soy DNA, 3) investigate the application of two commercially available DNA recovery systems (column and magnetic beads) to recover soy DNA from different forms of soy products using real-time PCR and 4) determine the effect of food matrices and thermal processing on soy detection using DNA and ELISA methods. In this study, Wizard Magnetic DNA Purification system kit (Promega, Madison, WI) was selected as the column DNA recovery system while DNeasy mericon Food Kit (Qiagen, Valencia, CA) was selected as the magnetic beads system. Neogen Veratox for soy allergen was selected as the ELISA system. The evaluations of both DNA recovery systems were conducted on soy protein isolates (SPI), powdered soybean and soymilk. The effect of thermal processing in soy detection was conducted on four different food matrices (protein, fat, carbohydrate and water). Each food matrix was spiked with 10% soy protein isolates and heated at 95ºC for an hour. Both DNA (column and magnetic beads DNA recovery system) and ELISA detection methods were used to detect soy in heated and non-heated food matrices. The limit of detection for column DNA recovery method in soybean, SPI and soymilk can be as low as 20 ppm, while magnetic beads DNA method was matrix dependent. The magnetic beads methods demonstrated a lower detection for soybean sample (1.33 ppm) but higher for soymilk (133.3 ppm). The soy percent recovery for non-heated food matrices was higher in ELISA methods and lower in magnetic beads DNA method. For heated food matrices, percent recovery for both DNA methods was higher than ELISA method. Overall, heat treatment can significantly reduce the ability of the ELISA method to detect soy in all food matrices. However, for DNA methods (column and magnetic beads), water and ranch matrices were the only two that were significantly affected by thermal processing. In terms of food matrices, water matrix (heated and non-heated) has the highest percent recovery of soy for all detection methods. However, percent recovery of soy in flour matrix (non-heated) was the lowest using both DNA methods. / Graduation date: 2013

published_or_final_version / Paediatrics and Adolescent Medicine / Master / Master of Medical Sciences

Background & Objectives: There has been few investigation of the association between the farming related activities or specific characteristics and atopic disease in rural Canadian children. In population-based studies, assuring the quality of information from questionnaires is of concern. We conducted this study in order to: first, identify the prevalence and risk factors of atopy and allergic conditions among school-age children in a rural region of Canada. Also, we sought to evaluate the validity and reliability of a questionnaire report of allergy to assess in this population. Methods: As part of a longitudinal study of lung health in rural residents, we conducted a cross-sectional baseline study in rural Saskatchewan, Canada. This included an initial survey phase followed by a clinical testing phase. A sub-sample of 584 children (grades 1-8) completed skin prick testing to assess atopic status. Of these, 480 children completed a questionnaire report of allergy and atopic outcomes and participated in skin prick testing (SPT). Atopy was defined as a positive reaction to any of 6 allergens (local grasses, wheat dust, cat dander, house dust mite, Alternaria, Clasdosporium)≥3mm compared to the negative control. Agreement between questionnaire report and objective measures of atopy was considered overall and between the specific allergens tested on SPT and those assessed on questionnaire. We considered percent concordance, Kappa, sensitivity, specificity, and the positive and negative predictive values of reported allergies or allergic conditions in comparison to SPT as the gold standard. Results: The prevalence of atopy as well as allergen-specific sensitizations was similar between farm and non-farm children but supported the notion that livestock farming is protective against atopy. Also, we found that 25.0% of children reported a history of allergic conditions by questionnaire and 19.4% were atopic detected by skin pick test. In our study, the agreement between questionnaire report of specific allergic triggers and atopy measured by SPT was high (83.0% - 89.5%). Conclusion: In children, livestock exposure has a protective effect on SPT positivity.The agreement between questionnaire report of allergic symptoms and atopy measured by SPT was high and the agreement between atopy and report of allergic conditions was moderate.

As we gain increased understanding of genetic disorders and gene regulation more focus has turned towards complex interactions. Combinations of genes or gene and environmental factors have been suggested to explain the missing heritability behind complex diseases. Furthermore, gene activation and splicing seem to be governed by a complex machinery of histone modification (HM), transcription factor (TF), and DNA sequence signals. This thesis aimed to apply and develop multivariate machine learning methods for use on such biological problems. Monte Carlo feature selection was combined with rule-based classification to identify interactions between HMs and to study the interplay of factors with importance for asthma and allergy. Firstly, publicly available ChIP-seq data (Paper I) for 38 HMs was studied. We trained a classifier for predicting exon inclusion levels based on the HMs signals. We identified HMs important for splicing and illustrated that splicing could be predicted from the HM patterns. Next, we applied a similar methodology on data from two large birth cohorts describing asthma and allergy in children (Paper II). We identified genetic and environmental factors with importance for allergic diseases which confirmed earlier results and found candidate gene-gene and gene-environment interactions. In order to interpret and present the classifiers we developed Ciruvis, a web-based tool for network visualization of classification rules (Paper III). We applied Ciruvis on classifiers trained on both simulated and real data and compared our tool to another methodology for interaction detection using classification. Finally, we continued the earlier study on epigenetics by analyzing HM and TF signals in genes with or without evidence of bidirectional transcription (Paper IV). We identified several HMs and TFs with different signals between unidirectional and bidirectional genes. Among these, the CTCF TF was shown to have a well-positioned peak 60-80 bp upstream of the transcription start site in unidirectional genes.

[Truncated abstract] The last few decades have witnessed an increase in the prevalence, morbidity and economic burden associated with asthma and allergic disease. This rising incidence cannot be completely explained by changes in genetic factors or by improvements in diagnostic procedures. Environmental factors, particularly those associated with a westernised lifestyle, are considered to be involved in this increase. In the late 1980’s Strachan was the first to link environmental factors with allergic disease, this theory became to be known as the ‘hygiene hypothesis’. This hypothesis links the “cleaner” more “healthy ” environment we now live in, with an increased risk of developing allergic disease. This effect is highlighted by studies linking farm and animal exposure (rich in microbial compounds) during early life with a decrease in allergic disease. Since then numerous studies have been undertaken to ascertain the factors present in the microbe rich environment, which elicit this protective effect. Many studies have revolved around endotoxin, however microbial components (mainly from Gram-positive bacteria) which signal through Toll-like receptor 2 (TLR2), have also shown that they can alter the allergic immune response. In mice models TLR2 has been shown to both exacerbate and inhibit allergic disease. The above research highlights the need for further studies into the effect of TLR2 ligands, and to define the mechanisms by which they exert their effects in human allergic disease. These mechanisms will be relevant to understanding the pathogenesis of allergy, but also might provide novel ways to treat allergy. The aims of the study outlined in this thesis were to determine whether in vitro exposure to TLR2 ligands could modify the established immune response to house dust mite allergen (HDM), and to examine the mechanisms by which this occurs. ... The addition of glucocorticoids to LTA enhanced the ability of this TLR2 ligand to inhibit IL-5 and IL-13 production by HDM-activated blood mononuclear cells. In conclusion, this study shows that TLR2 ligands have the ability to inhibit the Th2 response to mite allergen in previously sensitized individuals by an as yet unknown mechanism. However the findings described herein do provide an impetus for future studies designed to uncover novel mechanisms by which allergic responses can be ameliorated, and may open new treatment modalities.

Thesis (M.S.) -- University of Texas Southwestern Medical Center at Dallas, 2005. / Not embargoed. Vita. Bibliography: 58-64.

Σύμφωνα με τα ευρήματα τεσσάρων καταγραφών που έγιναν στην Πάτρα κατά την περίοδο 1978-2003, ο επιπολασμός του πρόσφατου (διαγνωσμένου στα 2 τελευταία χρόνια) και του οποτεδήποτε διαγνωσμένου κατά τη διάρκεια της ζωής συριγμού/άσθματος παιδιών σχολικής ηλικίας έχει αυξηθεί, αν και με επιβραδυνόμενο ρυθμό. Ανάλογη αύξηση παρατηρήθηκε και στον επιπολασμό της ρινοεπιπεφυκίτιδας και του εκζέματος όπως καταγράφηκε σε τρεις αποτυπώσεις στο διάστημα 1991-2003. Σκοπός: Διερευνήθηκε ο επιπολασμός του συριγμού/άσθματος, της ρινοεπιπεφυκίτιδας και του εκζέματος στο ίδιο αστικό περιβάλλον το 2008. Μέθοδος: Χρησιμοποιώντας πανομοιότυπη μεθοδολογία με τις προηγούμενες συγχρονικές αποτυπώσεις, μοιράσθηκε γραπτό ερωτηματολόγιο που απευθυνόταν στους γονείς παιδιών Τρίτης και Τετάρτης τάξης Δημοτικού Σχολείου (8-9 ετών) το 2008 και υπολογίσθηκε ο πρόσφατος και ο οποτεδήποτε διαγνωσμένος κατά τη διάρκεια της ζωής επιπολασμός των τριών νοσημάτων. Τα ευρήματα συγκρίθηκαν με εκείνα των προηγούμενων καταγραφών (1978: N=3003, 1991: N=2417, 1998: N=3076 και 2003: N=2725). Αποτελέσματα: Ο επιπολασμός του πρόσφατου άσθματος κατά τα έτη 1978, 1991, 1998, 2003 και 2008 (Ν=2688) ήταν 1.5%, 4.6%, 6.0%, 6.9% και 6.9% αντίστοιχα (p τάσης διακύμανσης διορθωμένο ως προς το φύλο <0.001). Οι αντίστοιχες τιμές για συριγμό/άσθμα οποτεδήποτε κατά τη διάρκεια της ζωής στις καταγραφές της περιόδου 1991-2008 ήταν 8.0%, 9.6%, 12.4% και 12.6% (p τάσης διακύμανσης διορθωμένο ως προς το φύλο <0.001). Ανεξαρτήτως φύλου, το διαγνωσμένο άσθμα ελαττώθηκε στα παιδιά με πρόσφατο συριγμό/άσθμα κατά 17% (p <0.001) την περίοδο 2003-2008, όμως δε συνέβη το ίδιο σε εκείνα με αποδραμόντα συριγμό/άσθμα (6.6%, p=0.16). Ο επιπολασμός της ρινοεπιπεφυκίτιδας οποτεδήποτε κατά τη διάρκεια της ζωής τα έτη 1991, 1998, 2003 και 2008 ήταν 2.1%, 3.4%, 4.6% και 5.1% αντίστοιχα (p τάσης διακύμανσης διορθωμένο ως προς το φύλο <0,001). Οι αντίστοιχες τιμές για έκζεμα οποτεδήποτε κατά τη διάρκεια της ζωής ήταν 4.5%, 6.3%, 9.5% και 10.8% (p τάσης διακύμανσης διορθωμένο ως προς το φύλο <0.001). Η αναλογία αγόρια:κορίτσια του πρόσφατου και οποτεδήποτε κατά τη διάρκεια της ζωής συριγμού/άσθματος, ρινοεπιπεφυκίτιδας και εκζέματος αυξήθηκε κατά τη διάρκεια των 30 ετών παρακολούθησης του άσθματος και των 17 ετών παρακολούθησης της αλλεργίας (p τάσης διακύμανσης <0.001). Επίσης παρατηρήθηκε αύξηση της ρινοεπιπεφυκίτιδας και του εκζέματος στα παιδιά με πρόσφατο συριγμό/άσθμα (p τάσης διακύμανσης διορθωμένο ως προς το φύλο <0.001) κατά την περίοδο 1991-2008. Το ποσοστό του συριγμού/άσθματος που μπορεί να αποδοθεί στην αλλεργία (πρόσφατος συριγμός/άσθμα με ρινοεπιπεφυκίτιδα ή/και έκζεμα οποτεδήποτε στη διάρκεια της ζωής) αυξήθηκε περαιτέρω κατά την περίοδο 2003-2008 (p <0.05, p τάσης διακύμανσης <0.001 για την περίοδο 1991-2008). Συμπεράσματα: Ο επιπολασμός του συριγμού και του άσθματος κορυφώθηκε κατά την περίοδο 2003-2008 στην Πάτρα, ενώ η αναλογία αγόρια:κορίτσια αυξήθηκε. Αντίθετα, παρατηρήθηκε συνεχής αύξηση του επιπολασμού των αλλεργικών εκδηλώσεων –ρινοεπιπεφυκίτιδα και έκζεμα– στο διάστημα 1991-2008. Η συχνότητα του συριγμού/άσθματος που μπορεί να αποδοθεί στην αλλεργία, μετά από μια απότομη κλιμάκωση κατά την περίοδο 1991-2003, συνέχισε να αυξάνεται στο διάστημα 2003-2008, αλλά με βραδύτερο ρυθμό, παρά τη διατήρηση του επιπολασμού του συριγμού/άσθματος σταθερού στη διάρκεια αυτής της πενταετίας. / According to four surveys conducted in the city of Patras, Greece, during 1978-2003, the prevalence of current (diagnosed in the last 2 years) and lifetime wheeze/asthma at schoolage has risen, albeit at a decelerating rate. A similar increase occurred in the prevalence of lifetime rhinoconjunctivitis and eczema in the three more recent surveys during 1991-2003. Aim: We examined the prevalence of wheeze/asthma, rhinoconjunctivitis and eczema in the same urban environment in 2008. Methods: Using identical methodology with the previously conducted cross-sectional surveys, a parental written questionnaire was distributed in 2008 to Third and Fourth grade schoolchildren (8-9 year-old) and the current and lifetime sex-specific prevalence of the three diseases was calculated and compared with the findings of the previous surveys (1978: N=3003; 1991: N=2417; 1998: N=3076; and 2003: N=2725). Results: The prevalence rates of current wheeze/asthma in 1978, 1991, 1998, 2003 and 2008 (N=2688) were 1.5%, 4.6%, 6.0%, 6.9% and 6.9%, respectively (sex-adjusted p for trend <0.001). Respective values for lifetime (ever had) wheeze/asthma in the 1991-2008 surveys were 8.0%, 9.6%, 12.4% and 12.6% (sex-adjusted p for trend <0.001). Irrespective of sex, diagnosed asthma declined during 2003-2008 among current wheezers by 17% (p<0.001); however, this was not the case among non-current wheezers (6.7%, p=0.16). The prevalence rates of lifetime rhinoconjunctivitis in 1991, 1998, 2003 and 2008 were 2.1%, 3.4%, 4.6% and 5.1%, respectively (sex-adjusted p for trend <0.001). The respective values for lifetime eczema were 4.5%, 6.3%, 9.5% and 10.8% (sex-adjusted p for trend <0.001). The male:female ratio of current and lifetime wheeze/asthma, rhinoconjunctivitis and eczema increased during the 30-year surveillance period of wheeze/asthma and the 17-year surveillance period for allergic disease (p for trend <0.001). Among current wheezers/asthmatics there was an increase in lifetime rhinoconjunctivitis and lifetime eczema (sex-adjusted p for tend <0.001) over the period 1991-2008. The proportion of wheeze/asthma attributable to allergy (current wheeze/asthma with lifetime rhinoconjunctivitis and/or eczema) increased further during 2003-2008 (p <0.05, p for trend during 1991-2008 <0.001). Conclusions: Childhood wheeze and asthma have reached plateau during the 2003-2008 period in Patras, Greece. The diagnosis of asthma declined among schoolage but not preschool wheezers during the same period, while the male:female ratio increased. On the other hand, there was a continuous increase in the prevalence of allergic manifestations, i.e. rhinoconjunctivitis and eczema, during 1991-2008. The frequency of wheeze/asthma attributable to allergy, after a steep rise in 1991-2003, continued to increase during 2003-2008 –albeit at a decelerating rate–despite the wheeze/asthma plateau which occurred over this 5-year period.

No description available.

The thesis examines the nursing care of children diagnosed with bronchial asthma. The thesis has three objectives. Firstly, it aims to identify differences in the care of asthmatic children in hospitals and outside hospital-type medical facilities; it also seeks to point out the most common problems of asthmatic children in each age category. Lastly, it examines the awareness of asthma amongst children and parents. Both quantitative and qualitative research was carried out to achieve the above objectives, using questionnaire and semi-structured interview techniques, respectively. The research part of the thesis was divided into two parts (two research samples). The first research sample consisted of children diagnosed with asthma and their parents, the other experimental group included nurses from selected hospitals and children's sanatoria/spas.