Month: February 2024

Categories : Cardiovascular Disease Metabolic DisordersTags :

Long-term Blood Pressure Control from Bariatric Surgery is Most Effective

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Sleeve gastrectomy. Credit: Scientific Animations CC4.0

Compared to antihypertensives alone, bariatric surgery is more effective in controlling hypertension rates in people with obesity and uncontrolled hypertension, according to a study published in the Journal of the American College of Cardiology. People who underwent bariatric surgery had lower BMI and were on fewer medications after five years while maintaining normal blood pressure levels than those who only used antihypertensive medications.

“In clinical practice, obesity is an overlooked condition. As a consequence, there is a frequent failure in approaching obesity as a crucial step for mitigating the risk of important cardiovascular risk factors including hypertension,” said Carlos Aurelio Schiavon, MD, FACS, lead author of the study and a surgeon specialising in bariatric surgery at Heart Hospital (hcor) and BP Hospital in Sao Paulo.

Researchers in this study looked at the impact of treating obesity to lower hypertension. While new weight loss drugs exist, long-term adherence to medication can be challenging.

This study looks at bariatric surgery as a better long-term solution to control obesity and, as a result, hypertension.

The GATEWAY trial included 100 people (76% of whom were female) who had a body mass index (BMI) of around 36.9kg/m2. All participants had hypertension and were using at least two medications. People with previous cardiovascular events and poorly controlled Type 2 diabetes were excluded.

Subjects were assigned to either Roux-en-Y gastric bypass with medical therapy or medial therapy alone and the primary outcome was reduction of at least 30% antihypertensive medications while maintaining blood pressure levels less than 140/90mmHg at five years.

At five years, BMI was 28.01kg/m2 for those who received bariatric surgery and 36.40kg/m2 for those on medical therapy alone.

People who had bariatric surgery had an 80.7% reduction in the number of medications they were taking compared to a 13.7% reduction in those only using medical therapy.

Hypertension remission, defined as controlled blood pressure without medications, was 46.9% in those who underwent bariatric surgery compared to 2.4% in those on medical therapy alone.

“Our results underscore the importance of approaching obesity in reducing hypertension rates,” Schiavon said.

Limitations of the study include that it was a single-center, open-label study with a small sample size and there was loss of follow up in some patients.

In an accompanying editorial comment, Michael Hall, MD, MSc, professor and chair of the Department of Medicine at the University of Mississippi Medical Center, said the study provides important long-term data on the benefits of gastric bypass on weight loss and blood pressure control, but questions remain.

“Further studies assessing the threshold for bariatric surgery in people with obesity, optimal timing of bariatric surgery in obese people with cardiometabolic diseases, type of bariatric surgery and comparative studies of obesity pharmacotherapies and bariatric surgery are needed to clarify the optimal treatment pathways for this common and growing disease,” he said.

Source: American College of Cardiology

Categories : Neurology Obstetrics & GynaecologyTags :

Polycystic Ovary Syndrome Tied to Cognitive Problems

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Photo by Sora Shimazaki on Pexels

Those with polycystic ovary syndrome (PCOS) may be more likely to have memory and thinking problems in middle age, according to a study involving over 900 women, 66 of whom had PCOS. The study, published in Neurology, followed the women for 30 years.

PCOS is a hormonal disorder that is defined by irregular menstruation and elevated levels of androgen. Other symptoms may include excess hair growth, acne, infertility and poor metabolic health.

“Polycystic ovary syndrome is a common reproductive disorder that impacts up to 10% of women,” said study author Heather G. Huddleston, MD, of the University of California, San Francisco.

“While it has been linked to metabolic diseases like obesity and diabetes that can lead to heart problems, less is known about how this condition affects brain health. Our results suggest that people with this condition have lower memory and thinking skills and subtle brain changes at midlife. This could impact a person on many levels, including quality of life, career success and financial security.”

The study involved 907 female participants who were 18 to 30 years old at the start of the study.

They were followed for 30 years, at which time they completed tests to measure memory, verbal abilities, processing speed and attention. At the time of testing, 66 participants had polycystic ovary syndrome.

In a test measuring attention, participants looked at a list of words in different colours and were asked to state the colour of the ink rather than read the actual word. For example, the word “blue” could be displayed in red, so the correct response would be red.

Researchers found for this test, people with PCOS had an average score that was approximately 11% lower compared to people without the condition.

After adjusting for age, race and education, researchers found that people with polycystic ovary syndrome had lower scores on three of the five tests that were given, specifically in areas of memory, attention and verbal abilities, when compared to those without this condition.

At years 25 and 30 of the study, a smaller group of 291 participants had brain scans.

Of those, 25 had PCOS. With the scans, researchers looked at the integrity of the white matter pathways in the brain by looking at movement of water molecules in the brain tissue.

Researchers found that people with PCOS had lower white matter integrity, which may indicate early evidence of brain aging.

“Additional research is needed to confirm these findings and to determine how this change occurs, including looking at changes that people can make to reduce their chances of thinking and memory problems,” Huddleston said.

“Making changes like incorporating more cardiovascular exercise and improving mental health may serve to also improve brain aging for this population.”

A limitation of the study was that PCOS diagnosis was not made by a doctor but was based on androgen levels and self-reported symptoms, so participants may not have remembered all the information accurately.

The study was funded by the University of California, San Francisco.

Source: American Academy of Neurology 

Categories : Diseases, Syndromes and Conditions PaediatricsTags :

Rickets in the Industrial Revolution Driven by Low Vitamin D

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Photo by Mayur Gala on Unsplash

Rickets ran rife in children following the Industrial Revolution, but University of Otago-led research has found factory work and polluted cities aren’t entirely to blame for the period’s vitamin D deficiencies.

In a study published in PLOS One, researchers sampled teeth from a cemetery site in industrial era England, looking for microscopic markers of nutritional disease.

Lead author Dr Annie Sohler-Snoddy, Research Fellow in Otago’s Department of Anatomy, says they uncovered some of the first clear evidence of seasonal vitamin D deficiency in an archaeological sample.

She says it has been known for many years that there was an increase in rickets, a childhood bone disease caused by vitamin D deficiency, in 18th and 19th Century Europe.

“It has been assumed that this was due to more people, including children, working long hours indoors, living in crowded housing and in smog-filled environments, all of which reduce the amount of sunlight that reaches a person’s skin, which is the main way humans make vitamin D.”

However, new bioarchaeological methods enabled the researchers to get a much clearer picture of how vitamin D deficiency affected the people living in industrial England, rather than looking at bone deformities alone.

The study, from Otago, Durham University, University of Edinburgh, University of Brighton, and University of Queensland, found markers associated with vitamin D deficiency in the interior part of 76% of the teeth analysed.

In many samples, these occurred regularly, in annual increments.

“This shows clear evidence of seasonal vitamin D deficiency in the teeth of people living in the north of England.

“This is exciting because it highlights that latitude and seasonal lack of sunlight was a major factor in the amount of vitamin D these people could make in their skin – it’s more complicated than the factors associated with the industrial revolution like working indoors more,” Dr Sohler-Snoddy explains.

Poor vitamin D status is associated with several negative health outcomes including increased risk for infectious diseases, cardiovascular disease, and cancers.

Vitamin D deficiency has been an ongoing problem in society and Dr Sohler-Snoddy believes it is important to study what happened in the past in order to inform modern approaches to the ailment.

“We tend to think of archaeological human remains as belonging to a different world, but our biology hasn’t changed in the last 200 years.

“Teeth provide a really important source of information for archaeologists as they form in a very precise chronology and, importantly, their tissues do not change over the lifespan. This means that they lock in a record of a person’s development and this stays with them until they die, or the tooth is lost.

“Understanding how vitamin D deficiency impacted past populations and why gives us an important deep-time perspective on the disease,” she says.

Source: University of Otago

Categories : Medical IndustryTags :

What can South Africans Expect from Medical Aid Schemes this Year?

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Leo Dlamini – Bestmed CEO & Principal Officer

The medical aid industry is at a crucial turning point, driven by innovative technologies, and an ever-growing need for inclusive and affordable healthcare solutions.

According to Bestmed CEO and Principal Officer, Leo Dlamini, this sector is likely to witness the emergence of a more collaborative ecosystem as a result of partnerships between tech businesses, insurance companies and healthcare providers – those that offer an integrated experience – to align to shifting consumer demands.

“In fact, there are several pressure points that continue to challenge the industry,” says Dlamini. “Compliance, with its evolving regulations and policies, including those related to data protection and member privacy, are high on the list, along with balancing the budget within a tight economic environment remain key priorities.”

Increasing health costs

The cost of providing healthcare cover is increasing faster than the economic growth rate and the consumer price index (CPI) which renders medical scheme membership unaffordable for the majority of South Africans. “Balancing the rising costs of healthcare and affordability for members is delicate and critical aspect of a running a sustainable medical scheme,” adds Dlamini. “Driving the increase in costs of healthcare is also the utilisation rate (claims ratio) by the members. This is partly due to a rise in elective procedures post-COVID and the more aggressive clinical interventions. Much of this, we believe, is a consequence of people neglecting their regular health screenings, which is now translating into more serious health issues that require deeper intervention, more exploratory procedures and specialised treatment.”

The biggest cost driver in healthcare in 2024 continues to be hospitals, followed by specialists. “Although the number of hospital admissions are currently lower than they were in 2019/2020, the average cost of admission has risen substantially. This is why it is very important to establish collaborative ecosystems that are inclusive and beneficial to all stakeholders.”

Personalised prevention over cure

Now more than ever, consumers are demanding transparency, simplicity and responsiveness when it comes to their medical aid, says Dlamini, which means a focus on more digitally integrated platforms for easier access to service, information and support. “Digital health technologies, including telemedicine, AI-driven diagnostics and personalised medicine options are increasingly shaping the medical landscape, allowing for more efficient and tailored healthcare solutions.”

“There is also a growing trend towards preventive healthcare,” adds Dlamini. “Medical schemes are, therefore, focusing more on wellness programmes, health screenings and preventive measures to improve members costs and reduce downstream / future costs. This also includes recognising the importance of mental health, and providing broader coverage and services, which include access to counselling, psychiatric treatments and support programmes.”

Retaining control while innovating for the future

2024 will see Bestmed mark 60 years since inception.  Bestmed is South Africa’s fourth largest open medical scheme and the country’s largest self-administered entity.

“As we celebrate our 60th anniversary, it’s an opportune time to take stock of how we’ve fared thus far and what the future outlook is,” adds Dlamini. “Embracing technological advancements to create an integrated healthcare ecosystem, as well as focus on delivering innovative health solutions that are competitively priced are key.  Equally important is the ability to adapt our offering to the changing healthcare needs of our members whilst also maintaining our Personally Yours brand promise.”

Bestmed achieved over 20% growth rate over the last few years which Dlamini attributes to the organisation’s ability to retain existing members, attract new ones (members) with our value-for-money product offering as well as being responsiveness to members’ needs.  “As a self-administering medical scheme, we pride ourselves with being more agile and responsive to members whilst also ensuring that every interaction is not transactional but personal,” adds Dlamini.

As for healthcare advice this year, Dlamini urges consumers to take control. “Do not neglect regular screenings, particularly as you grow into the senior years. Committing to these does not only prove life-saving, but also ensures that your money is not consumed unnecessarily and that your medical scheme is able to safeguard your contributions (reserves) to cover future medical expenses. Make sure that every procedure recommended is necessary and relevant to your condition.”

“It is going to be a tough year as economic growth remains flat and disposable income under sustained pressure from high interest rates and inflation.  The national election and the outcomes therefrom will most likely impact all of us in some form or other.  As medical schemes we must remain focused on providing value–for–money from our offerings and actively working to improve the health of members,” concludes Dlamini. 

Categories : Antibiotics Diseases, Syndromes and ConditionsTags :

Antibiotic-resistant Bacteria can Persist in the Body for Years

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Photo by CDC on Unsplash

People with pre-existing conditions in particular can carry resistant germs and suffer from repeated infections for years, according to a study in the scientific journal Nature Communications.

Some bacteria have developed the ability to break down beta-lactam antibiotics like penicillins and cephalosporins, making them ineffective.

Once a patient’s body has been colonised by these resistant bacteria, they can persist for a long time, reports Professor Sarah Tschudin Sutter’s research group at the Department of Clinical Research of the University of Basel and University Hospital Basel.

The researchers looked at a much longer period of time than previous studies and focused on older people with pre-existing conditions, analysing multiple samples taken from over 70 individuals over a period of ten years.

Their key question: whether and how resistant Klebsiella pneumoniae and Escherichia coli bacteria in the body change over this long period and how they differ in various parts of the body.

Recurring illness

DNA analysis indicates that the bacteria initially adapt quite quickly to the conditions in the colonized parts of the body, but undergo few genetic changes thereafter.

The resistant bacteria could still be detected in the patients up to nine years later.

“These patients not only repeatedly become ill themselves, they also act as a source of infection for other people — a reservoir for these pathogens,” says Dr Lisandra Aguilar Bultet, the study’s lead author.

“This is crucial information for choosing a treatment,” explains Professor Tschudin Sutter.

If someone has previously been infected with resistant bacteria and later requires another course of treatment because of a new infection, there is a risk that standard antibiotics will again fail to work.

Transmission of resistance

In addition, the researchers found that in some patients, bacterial strains of the same species, as well as of different species (specifically, Klebsiella pneumoniae and Escherichia coli), share identical genetic mechanisms of resistance through what are known as mobile genetic elements (such as plasmids). The most likely explanation is that they have transmitted these elements to each other.

Hospitals use special protective measures if a patient has been infected with resistant bacteria in the past.

In everyday life, however, it is difficult to reduce the risk of pathogen transmission.

These findings about the bacterial genetic diversity expected to develop in individual patients over time are a valuable basis for future studies to analyse factors found in both bacteria and patients that correlate with duration of colonisation and progression from colonisation to infection.

Source: University of Basel

Categories : GeneticsTags :

Single Gene-editing Therapy Slashes Symptoms of Hereditary Disorder by 95%

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Source: Pixabay CC0

A group of patients with a hereditary angioedema disorder have had their lives transformed by a single treatment of a breakthrough gene-editing therapy, according to the lead researcher of the trial published in the New England Journal of Medicine.

The patients from New Zealand, the Netherlands and the UK have hereditary angioedema, a genetic disorder characterised by severe, painful and unpredictable swelling attacks. These interfere with daily life and can affect airways and prove fatal.

Now researchers from the University of Auckland, Amsterdam University Medical Center and Cambridge University Hospitals have successfully treated more than ten patients with the CRISPR/Cas9 therapy, with interim results just published in a leading journal.

“It looks as if the single-dose treatment will provide a permanent cure for my hereditary angioedema patients’ very disabling symptoms,” says principal investigator Dr Hilary Longhurst, who is both a clinical immunologist at Auckland Hospital Te Toku Tumai and an honorary associate professor at the University of Auckland.

“Plus, of course, there is huge potential for development of similar CRISPR/Cas9 treatments for other genetic disorders.”

Globally, it is estimated one in 50 000 people have hereditary angioedema, however, because it is rare, it is often not correctly diagnosed.

In the Phase 1 study, there were no serious or lasting side-effects from the single infusion, which took place over two to four hours under clinical supervision from late 2021 and onwards.

The investigational therapy, called NTLA-2002, utilises in vivo CRISPR/Cas9 technology to target the KLKB1 gene, which is responsible for producing plasma prekallikrein.

By editing this gene, the therapy reduces the levels of total plasma kallikrein, effectively preventing angioedema (swelling) attacks. The trial demonstrated dose-dependent reduction in total plasma kallikrein protein with reductions of up to 95% achieved. A mean reduction of 95% in angioedema attacks was observed across all patients through to the latest follow-up.

The patients from the initial study will be followed up for a further 15 years to continue to assess long-term safety and efficacy.

A larger and more robust, double-blinded, placebo-controlled phase two trial is under way and a Phase 3 trial is planned to start in the second half of 2024.

Dr Danny Cohn, from the Department of Vascular Medicine at the Amsterdam University Medical Center says these promising results are a step forward for this group of patients.

“We’ve never been closer to the ultimate treatment goal of normalising hereditary angioedema patients’ lives and offering total control of the disease,” says Dr Cohn.

Dr Padmalal Gurugama, consultant in clinical immunology and allergy at Cambridge University Hospitals, UK says the gene editing therapy has the potential to significantly improve patients’ lives.

“Hereditary angioedema can cause patients severe swellings and intense pain which can be life-threatening as well as restricting normal activities, such as going to work or school.

“Because it is often misdiagnosed, many patients undergo unnecessary treatments and invasive procedures.”

The therapy affects only the patient and is not passed onto their children, who still have an even chance of inheriting the disorder.

The studies have been funded by US company Intellia Therapeutics, which chose New Zealand to lead the research as, at that time (late 2021) it had relatively fewer COVID cases than other countries.

So far, the only approved CRISPR therapy, CASGEVY, is for sickle cell disease and beta thalassemia.

However, CASGEVY is an ex vivo CRISPR therapy, where the cells are taken from the patient and edited outside of the body and then reinfused, whereas NTLA-2002 is an in vivo CRISPR therapy, where the targeted gene editing occurs directly within the body.

CRISPR technologies are being used to develop treatment for a wide range of diseases, such as genetic disease, cardiovascular disease, cancer and autoimmune diseases.

Source: University of Auckland

Categories : Mental HealthTags :

Higher Than Expected Levels of Psychosis Spectrum Symptoms among Youth

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Photo by Andrew Neel on Unsplash

A new study published in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging has found evidence that Psychosis Spectrum Symptoms (PSS) are often present in youth accessing mental health services.

From a profile of the initial 417 youth aged 11–24 participating in the study, 50% were shown to meet the threshold for Psychosis Spectrum Symptoms, a number that study co-lead Associate Professor Kristin Cleverley says was higher than expected, meaning there is a large number of children with these symptoms accessing mental health services.

Cleverley, of the Lawrence Bloomberg Faculty of Nursing Cleverley, says that what is novel about this study is that researchers are assessing early indicators that might predict whether someone is more at risk of developing Psychosis Spectrum Disorder, and examine whether there is a point at which earlier intervention for that youth could be more effective.

“Traditionally, early psychosis care starts when there is a serious presentation of psychotic symptoms, which usually occurs in the late teen years,” says Cleverley. “The current approach to identifying children at risk of developing a psychotic disorder is only about five percent effective, but with this study we can start to assess certain patterns or changes in function that can signal if an earlier intervention may be beneficial.”

Psychosis Spectrum Disorder can be extremely disabling, and is linked to cognitive impairment, long-term disability, and higher rates of death by suicide than other mental illnesses. Even without a diagnosis of psychosis, Psychosis Spectrum Symptoms can severely affect youth.

This study is one of three projects being led as part of the Toronto Adolescent and Youth (TAY) Cohort Study that is set to follow 1500 youth over the course of five years. The goal of the cohort study is to better understand the populations of youth seeking mental health treatment, how their mental health symptoms and functioning change over time, and whether early predictors of psychosis spectrum disorder can be determined.

This study was co-designed with patient and caregivers in addition to involving extensive engagement from clinicians. A novel aspect of the TAY Cohort Study is youth are given access to a patient-facing dashboard of their research results that is also integrated into their clinical record.

“We wanted to ensure that the study was embedded in the clinical program so that research assessments could be immediately utilised within clinical practice, including supporting decisions about interventions or services,” says Cleverley.

This longitudinal study will include a follow-up every six months, and will provide researchers access to information about whether symptoms in these youth become chronic or episodic, and whether these changes are related to developmental milestones or environmental stressors, or changes to mental health services.

“Our goal with this research is really to characterise this population better so that we can identify new strategies that will complement existing strategies for early identification of youth at risk of psychosis,” says Cleverley. “It also creates an important opportunity for graduate students and researchers to develop sub-studies for this sample that will enable further research to improve youth mental health outcomes.”

Source: University of Toronto

Categories : Genetics PaediatricsTags :

Gene Identified for Rare Disorder Involving Extra Fingers and Toes

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Photo by Jonathan Borba on Unsplash

A rare disorder which causes babies to be born with extra fingers and toes and a range of birth defects has been identified in new research published in the American Journal of Human Genetics. The disorder, which has not yet been named, is caused by a genetic mutation in a gene called MAX.

As well as extra digits – polydactyly — it leads to a range of symptoms relating to ongoing brain growth, such as autism. The research marks the first time this genetic link has been identified. It has also found a molecule that could potentially be used to treat some of the neurological symptoms and prevent any worsening of their condition. However, more research is needed to test this molecule before it can be used as a treatment.

Co-led by the University of Leeds, the study focuses on three individuals with a rare combination of physical traits, namely polydactyly, and a much larger than average head circumference – known as macrocephaly.

The individuals share some other characteristics, including delayed development of their eyes which results in problems with their vision early in life.

The researchers compared the DNA of these individuals and found they all carried the shared genetic mutation causing their birth defects.

The latest research was co-led by Dr James Poulter from the University of Leeds; Dr Pierre Lavigne at Université de Sherbrooke in Québec and Professor Helen Firth at Cambridge University.

As with many rare disorders, the disorder currently has no treatments – but in this case, the researchers identified one already undergoing clinical trials which might reverse some of the mutation’s effects.

The study team has highlighted the importance of interdisciplinary research into rare diseases in giving understanding and hope of a treatment to families who often face many years of uncertainty about their child’s condition and prognosis.

The researchers now plan to look for additional patients with mutations in MAX to better understand the disorder and investigate whether the potential treatment improves the symptoms caused by the mutation.

Source: University of Leeds

Categories : Cardiovascular Disease Diseases, Syndromes and ConditionsTags :

SGLT-2 Inhibitor Use Associated with Decreased Risk of Kidney Stones

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Photo by Robina Weermeijer on Unsplash

Type 2 diabetes is associated with increased risk of kidney stones, but some forms of treatment for this condition may also have the benefit of lowering risk of kidney stones. In a study led by investigators from Mass General Brigham, researchers found that there was an association between the use of sodium-glucose cotransporter 2 (SGLT2) inhibitors and a lower risk of developing kidney stones. Their findings are reported in JAMA Internal Medicine.

Rates of kidney stones are on the rise in the United States and around the world. Type 2 diabetes is associated with increased risk of kidney stones, but some forms of treatment for this condition may also have the benefit of lowering risk of kidney stones.

The study included data from three nationwide databases of patients with type 2 diabetes who were seen in routine clinical practice.

The team analysed information from 716,406 adults with type 2 diabetes who had started taking an SGLT2 inhibitor or two other classes of diabetes medications known as GLP1 receptor agonists or dipeptidyl peptidase 4 (DPP4) inhibitors.

Patients who began taking SGLT2 inhibitors had a 30% lower risk of developing kidney stones than those taking GLP1 agonists and about a 25% lower risk than those taking DPP4 inhibitors.

The findings were consistent across sex, race/ethnicity, history of chronic kidney disease and obesity.

“Our findings could help inform clinical decision making for patients with diabetes who are at risk for developing kidney stones,” said corresponding author Julie Paik, MD, ScD, MPH, of the Division of Pharmacoepidemiology and Pharmacoeconomics and the Division of Renal (Kidney) Medicine at Brigham and Women’s Hospital.

Source: Mass General Brigham

Materials provided by Mass General Brigham. Note: Content may be edited for style and length.

Journal Reference:

  1. Julie M. Paik, Helen Tesfaye, Gary C. Curhan, Heidi Zakoul, Deborah J. Wexler, Elisabetta Patorno. Sodium-Glucose Cotransporter 2 Inhibitors and Nephrolithiasis Risk in Patients With Type 2 Diabetes. JAMA Internal Medicine, 2024; DOI: 10.1001/jamainternmed.2023.7660
Categories : Paediatrics Respiratory DiseasesTags :

Appeasing the Wheezing: Determinants and Outcomes of Respiratory Disease in Childhood

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Credit: Pixabay CC0

Asthma and cystic fibrosis are diseases which affect the lungs of children and adults. Previous research has shown that genetic and environmental factors during pregnancy and early childhood can contribute to the way children and young adults are affected by these lung diseases.

In her thesis, Emma Caffrey Osvald, PhD student at Karolinska Institutet looked for new factors that may influence the development and outcomes of asthma and cystic fibrosis. In the four included studies, Emma used data from a clinical cohort and national health and demographic registers and a quality register on individuals born in Sweden to shed light on potential factors which impact the course of asthma and cystic fibrosis. Her findings should be useful when creating clinical guidelines and policies for the prevention and management of respiratory disease in children and young adults.

What are the most important results in your thesis?

“In my first study, we show that mothers with asthma have an increased likelihood of having a child with asthma and that higher lung function in pregnancy is associated with a decreased likelihood of having a child with asthma. However, asthma or lung function in the mother does not impact childhood growth. In the second study, we see that parental social standing (socioeconomic status, measured as parents’ education and income) is associated with the onset of asthma in childhood. By comparing the social standing and onset of asthma among first cousins we see that parental education may be directly linked to the onset of asthma. In the third study, we also show that there is a connection between having asthma in childhood or young adulthood and death between 1 to 25 years of age. The likelihood of death between 1 to 25 years of age is higher if the person also has a life-limiting disease but not altered by the parents social standing at the child’s birth. In the final study, we see some association between low parental social standing and severe disease and lung function decline among persons with cystic fibrosis, however low parental social standing does not impact growth. So we found that there are factors in the parents (including during the pregnancy and social standing) which impacts the onset of asthma. Asthma increases the risk of mortality between 1 to 25 years and low parental social standing is shown to be associated with severe disease and lung function decline in persons with cystic fibrosis.”

Why did you become interested in this topic?

“I have wanted to learn more about epidemiology ever since my ex-job project as a medical student and these PhD projects have allowed me, as a paediatric pulmonologist, to explore the factors which influence onset and outcomes for children and young adults with respiratory disease. Asthma and CF are two chronic diseases which we meet as part of our routine clinical practice and for me it has been really interesting to avail of both clinical data and national register data and a variety of statistical methods to further our understanding of these diseases.“

What do you think should be done in future research?

“Areas which will interest me in my future research continues to be the determinants and outcomes of respiratory disease in childhood. For me, the future of register-based research lies in the combining of clinical data with register data. There is more to explore in regards to risk factors for acute respiratory disease such as severe pneumonia and empyema, but also the outcomes for persons with asthma and CF, such as presence of comorbidity or educational attainment.”

Doctoral thesis: Appeasing the wheezing: determinants and outcomes of respiratory disease in childhood.

Source: Karolinska Institutet