Does LEAP change the screening paradigm for food allergy in infants with eczema?

The LEAP randomized controlled trial provides the first direct evidence that delayed introduction of peanut in an infant's diet significantly increases the risk of peanut allergy. However, as often is the case in ground‐breaking research, the LEAP study raises almost as many questions as it resolves. Although the quality of design and excellence in study execution is unquestioned, the particular difficulty this study raises is how to generalize results from a trial of high‐risk infants, which screened infants for the presence of peanut allergy prior to peanut introduction, to the general population. Although many existing infant feeding guidelines already allow for the introduction of allergenic foods from 4 to 6 months of age irrespective of co‐existent risk factors for peanut allergy, these will now need to be revised to more strongly state that avoidance may be harmful. Interim guidelines have already been published which incorporate these recommendations. However, the question as to how to achieve timely introduction of peanut into an infant's diet in a safe and cost‐effective way, particularly in high‐risk infants, remains unresolved.     

Is BDNF‐Val66Met polymorphism associated with psychotic experiences and psychotic disorder outcome? Evidence from a 6 years prospective population‐based cohort study

There is little research on genetic risk for the extended psychosis phenotype ranging from psychotic experiences (PEs) to psychotic disorders (PDs). In this general population‐based prospective cohort study, the longitudinal associations between BDNF‐Val66Met polymorphism and the different levels of the extended psychosis phenotype were investigated. Addresses were contacted in a multistage clustered probability sampling frame covering 11 districts and 302 neighborhoods at baseline (n = 4011). A nested case‐control study (n = 366) recruited individuals with PEs and PDs as well as individuals with no psychotic symptoms. In this subgroup, blood sampling for genetic analysis and assessment of environmental exposures were carried out, followed by clinical re‐appraisal at follow‐up 6 years later (n = 254). The BDNF‐Val66Met polymorphism was significantly associated with the extended psychosis phenotype. The pattern of the association was that the BDNF‐Val66Met polymorphism impacted in a dose‐response but extra‐linear fashion, with stronger impact at the PD end of the extended psychosis phenotype. Associations were still significant after adjusting for sociodemographic factors and environmental exposures including life events, childhood adversity, socioeconomic status, urbanicity, and cannabis use. The BDNF‐Val66Met polymorphism may index susceptibility to expression of psychosis along a spectrum.     

Can we identify patients at risk of life‐threatening allergic reactions to food?

Anaphylaxis has been defined as a ‘severe, life‐threatening generalized or systemic hypersensitivity reaction’. However, data indicate that the vast majority of food‐triggered anaphylactic reactions are not life‐threatening. Nonetheless, severe life‐threatening reactions do occur and are unpredictable. We discuss the concepts surrounding perceptions of severe, life‐threatening allergic reactions to food by different stakeholders, with particular reference to the inclusion of clinical severity as a factor in allergy and allergen risk management. We review the evidence regarding factors that might be used to identify those at most risk of severe allergic reactions to food, and the consequences of misinformation in this regard. For example, a significant proportion of food‐allergic children also have asthma, yet almost none will experience a fatal food‐allergic reaction; asthma is not, in itself, a strong predictor for fatal anaphylaxis. The relationship between dose of allergen exposure and symptom severity is unclear. While dose appears to be a risk factor in at least a subgroup of patients, studies report that individuals with prior anaphylaxis do not have a lower eliciting dose than those reporting previous mild reactions. It is therefore important to consider severity and sensitivity as separate factors, as a highly sensitive individual will not necessarily experience severe symptoms during an allergic reaction. We identify the knowledge gaps that need to be addressed to improve our ability to better identify those most at risk of severe food‐induced allergic reactions.     

Is delivery by cesarean section a risk factor for food allergy?

BACKGROUND: Cesarean delivery might delay the colonization of the newborn intestine. A delayed or aberrant colonization process has been offered as an explanation for the increase in allergic diseases. OBJECTIVE: The aim of this study was to examine whether cesarean delivery and the use of antibiotics were associated with subsequent food allergy. METHODS: In a population-based birth cohort of 2803 children, information regarding mode of delivery, maternal or infant use of antibiotics, and information on potential confounders was obtained prospectively from parental reports and the Norwegian Birth Registry. Parentally perceived reactions to egg, fish, or nuts, as well as objectively confirmed reactions to egg at the age of 2 1/2 years, were chosen as outcomes. RESULTS: Among children whose mothers were allergic, cesarean section was associated with a 7-fold increased risk of parentally perceived reactions to egg, fish, or nuts (odds ratio, 7.0; CI, 1.8-28; P =.005) and a 4-fold increased risk of confirmed egg allergy (odds ratio, 4.1; CI, 0.9-19; P =.08) in a logistic regression analysis, adjusting for pregnancy complications, birth weight, gestational length, and socioeconomic factors. Among children whose mothers were not allergic, the association was much weaker and not significant. Maternal or infant use of antibiotics was not associated with an increased risk of food allergy. CONCLUSION: The results indicate that in predisposed children cesarean section might increase the risk of development of food allergy, which supports the theory that factors interfering with the colonization process might play a role in the development of food allergy.     

Short sleep—poor sleep? A polysomnographic study in a large population‐based sample of women

There is a lack of studies on the association between total sleep time (TST) and other polysomnographical parameters. A key question is whether a short sleep is an expression of habitual short sleep, or whether it reflects temporary impairment. The purpose of the present study was to investigate the association between TST and amount of sleep stages and sleep continuity measures, in a large population‐based sample of women (n = 385), sleeping at home in a normal daily life setting. The results show that sleep efficiency, N1 (min), N2 (min), REM (min), REM% and proportion of long sleep segments, increased with increasing TST, whereas the number of awakenings/hr, the number of arousals/hr, N1% and REM intensity decreased. In addition, longer sleep was more associated with TST being perceived as of “usual” duration and with better subjective sleep quality. TST was not associated with habitual reported sleep duration. It was concluded that short TST of a recorded sleep in a real‐life context may be an indicator of poor objective sleep quality for that particular sleep episode. Because individuals clearly perceived this reduction, it appears that self‐reports of poor sleep quality often may be seen as indicators of poor sleep quality. It is also concluded that PSG‐recorded sleep duration does not reflect habitual reported sleep duration in the present real‐life context.     

Are the effects of risk factors for timing of menopause modified by age? Results from a British birth cohort study

OBJECTIVES: This study investigated the influence of mother's age at menopause, early life and adult behavioral factors on the timing of menopause until age 57 years, and whether these effects vary according to the women's age at menopause. DESIGN: A nationally representative cohort of 1,583 British women born in March 1946 with prospective data across the life course. For factors that vary with age at menopause, analyses were stratified by age at menopause younger than 50 years or 50 years or older. RESULTS: Cox regression models indicated that for women with earlier menopause, those who were heaviest at 2 years had a 59% lower hazard ratio for menopause than those who were the lightest (hazard ratio [HR]=0.41, 95% CI: 0.16-1.01), whereas this figure was 35% lower (HR=0.65; 95% CI: 0.42-1.00) for the later menopause group. For women in the earlier group with parental divorce during childhood, the HR was 6.5 (95% CI: 2.021.3) times higher than that of other women. This rate decreased to 2.5 (95% CI: 1.5-4.2) for those with later menopause. In both groups, increasing mother's age at menopause was associated with decreasing HR (P<0.0001). For all women, being breast-fed (P=0.05), increasing cognitive ability (P=0.009), and increasing parity (P=0.001) delayed menopause. CONCLUSIONS: This study found that the impact of weight at 2 years, parental divorce during childhood, and mother's age at menopause varied according to the women's age at menopause. There was further evidence that being breast-fed, higher childhood cognitive ability, and increasing parity delayed menopause. These results suggest the interaction of genetic and environmental factors in determining age at menopause.     

Which is the function of a martin‐gruber connection?

Clinical and diagnostic variations may occur due to the variable presence of a connection between the median and ulnar nerves in the forearm (Martin‐Gruber anastomosis). This incidence has a wide range at 7%–40%. Most commonly, the connection between the nerves is considered to be composed of motor fibers; although, a sensory role has also been described. It is important to note that the number of axons, or the nature of the fibers in this connection, have not yet been elucidated. Fifty upper limbs were examined evaluating morphometric characteristics of the Martin Gruber connection, dissected out, sectioned, and immunohistochemically stained for choline acetyltransferase (ChAT) and analyzed with ImageJ^©. The connection was observed in 32% of all cases (16/50). The nerve connections were identified as those in Pattern 1 group (12%‐type 1b, 19%‐type 1a, and 69%‐type 1c) and contained motor (ChAT positive) fibers (40.42 ± 10.5% per connection) with three to four fascicles in each. No statistically significant differences were found according to sex, side, or laterality. There were statistically significant differences in the percentages of ChAT positive fibers; however, this was dependent on the distribution being greater in those not distributed zonally. The presence of this connection is prevalent in almost a third of the cadavers dissected; the understanding of this complex composition in sensory and motor fibers allows for the optimization of diagnosis and treatment of certain median‐ulnar nerve injuries. Clin. Anat. 32:501–508, 2019. © 2019 Wiley Periodicals, Inc.     

Does insomnia predict a high risk of cancer? A systematic review and meta‐analysis of cohort studies

Recently, emerging studies on the relationship between insomnia, the most common sleep disorder, and cancer have been published, but with inconsistent results. With the development of society and the accelerated pace of life, more and more people experience insomnia. Therefore, it is important to clarify the association. Relevant literature was obtained through a search of seven databases and supplementary searches. After a strict screening, eight cohort studies (seven prospective and one retrospective) involving 578,809 participants and 7,451 cancer events were incorporated into our analysis. The results demonstrate a modest 24% overall increased risk of cancer for individuals with insomnia in comparison to those without insomnia. The sensitivity analysis shows that the correlation between the two is stable. Subgroup analyses show that the risk of developing cancer was significantly higher in studies conducted in women (HR = 1.24; 95% CI, 1.01–1.53), but not in men (HR = 1.28; 95% CI, 0.90–1.80). Similarly, in terms of specific cancer types, the pooled HR was only significantly higher in thyroid cancer (HR = 1.36; 95% CI, 1.12–1.65) and not in other types of cancer (p > 0.05). Our findings suggest that insomnia may serve as an early warning sign of the onset of cancer and provide an opportunity for early detection and early intervention. Our findings should be treated with caution because of the limited number of included studies and potential bias. More additional studies are warranted to provide more information on the carcinogenic effect of insomnia.     

How can autoantibodies predict the long-term outcome of patients with interstitial lung disease? Results from a retrospective cohort study

Objectives

This study aimed to investigate whether positive serum autoantibodies (AAbs) have any impact on survival and time evolution of radiological findings and pulmonary function indices in patients with interstitial lung disease (ILD).

Why are children born to teen mothers at risk for adverse outcomes in young adulthood? Results from a 20-year longitudinal study

This 20-year longitudinal study showed that the young adult offspring of teen mothers are at risk for a range of adverse outcomes including early school leaving, unemployment, early parenthood, and violent offending. We tested how much the effect of teen childbearing on offspring outcomes could be accounted for by social selection (in which a woman's characteristics that make her an inadequate parent also make her likely to bear children in her teens) versus social influence (in which the consequences of becoming a teen mother also bring harm to her children, apart from any characteristics of her own). The results provided support for both mechanisms. Across outcomes, maternal characteristics and family circumstances together accounted for approximately 39% of the effect of teen childbearing on offspring outcomes. Consistent with a social-selection hypothesis, maternal characteristics accounted for approximately 18% of the effect of teen childbearing on offspring outcomes; consistent with a social-influence hypothesis, family circumstances accounted for 21% of the teen childbearing effect after controlling for maternal characteristics. These results suggest that public policy initiatives should be targeted not only at delaying childbearing in the population but at supporting individual at-risk mothers and their children.     

Overview of oral tolerance induction for prevention of food allergy—Where are we now?

Oral tolerance induction through early introduction of allergenic food has proven effective in randomized controlled trials. This new approach to weaning has been incorporated into many national and international infants’ feeding guidelines. However, there are questions that require further discussion, such as, which foods should be introduced early, should the intervention be targeted to infants at high-risk or to the general population, and what is the ideal timing for early food introduction. This review examines the extent to which recent trials address these critical questions and highlights areas where further research is required.