Infections and antibiotics during fetal life and childhood and their relationship to juvenile idiopathic arthritis: a prospective cohort study

Abstract Background The aetiology of juvenile idiopathic arthritis (JIA) is poorly understood. It has been shown that use of antibiotics is associated with JIA. However, whether the association is due to increased occurrence of infection in these individuals is unknown. The purpose of this investigation was to measure the association between number of infections and use of antibiotics during childhood with development of JIA. Methods In ABIS (All Babies in Southeast Sweden) a population-based prospective birth cohort of 17,055 children, data were collected on infections and antibiotic exposure during pregnancy and childhood. 102 individuals with JIA were identified. Multivariable logistic regression analyses were performed, adjusting for confounding factors. Results Exposure to antibiotics during the periods 1–12 months, 1–3 years and 5–8 years was significantly associated with increased risk for JIA. The odds of developing JIA were three times higher in those exposed to antibiotics during the first 3 years of life compared with those not exposed (aOR 3.17; 95% CI 1.11–9.03, p = 0.031), and more than twice as high in those exposed to antibiotics during the first 5 years of life compared with those not exposed (aOR 2.18; 95% CI 1.36–3.50, p = 0.001). The odds of developing JIA were 78% higher in those exposed to antibiotics during the first 8 years of life compared with those not exposed (aOR 1.78; 95% CI 1.15–2.73, p = 0.009). Occurrence of infection during fetal life or childhood showed no significant association with the risk of developing JIA, after confounder adjustment. The cumulative number of courses of antibiotics was significantly higher during childhood for the individuals who developed JIA (p < 0.001). Penicillins were more frequently used than non-penicillins, but both had an equal effect on the risk of developing JIA. Conclusions Exposure to antibiotics early in life is associated with later onset of JIA in a large birth cohort from the general population. The relationship was dose dependent. These results suggest that further, more restrictive, antibiotic policies during the first years of life would be advisable.

Download Full-text

Adolescent cannabis use, baseline prodromal symptoms and the risk of psychosis

The British Journal of Psychiatry ◽

10.1192/bjp.2017.52 ◽

2018 ◽

Vol 212 (4) ◽

pp. 227-233 ◽

Cited By ~ 21

Author(s):

Antti Mustonen ◽

Solja Niemelä ◽

Tanja Nordström ◽

Graham K. Murray ◽

Pirjo Mäki ◽

...

Keyword(s):

Substance Use ◽

General Population ◽

Birth Cohort ◽

Psychotic Disorders ◽

Temporal Order ◽

Population Based ◽

Cannabis Use ◽

Prodromal Symptoms ◽

Increased Risk ◽

Icd 10

BackgroundThe association between cannabis use and the risk of psychosis has been studied extensively but the temporal order still remains controversial.AimsTo examine the association between cannabis use in adolescence and the risk of psychosis after adjustment for prodromal symptoms and other potential confounders.MethodThe sample (n = 6534) was composed of the prospective general population-based Northern Finland Birth Cohort of 1986. Information on prodromal symptoms of psychosis and cannabis use was collected using questionnaires at age 15–16 years. Participants were followed up for ICD-10 psychotic disorders until age 30 years using nationwide registers.ResultsThe risk of psychosis was elevated in individuals who had tried cannabis five times or more (hazard ratio, (HR) = 6.5, 95% CI 3.0–13.9). The association remained statistically significant even when adjusted for prodromal symptoms, other substance use and parental psychosis (HR = 3.0, 95% CI 1.1–8.0).ConclusionsAdolescent cannabis use is associated with increased risk of psychosis even after adjustment for baseline prodromal symptoms, parental psychosis and other substance use.Declaration of interestNone.

Download Full-text

Obstetric oxytocin exposure and ADHD and ASD among Danish and Finnish children

International Journal of Epidemiology ◽

10.1093/ije/dyaa076 ◽

2020 ◽

Author(s):

Lonny Stokholm ◽

Mette Juhl ◽

Nicole M Talge ◽

Mika Gissler ◽

Carsten Obel ◽

...

Keyword(s):

Population Based ◽

Autism Spectrum ◽

Labour Induction ◽

Prenatally Exposed ◽

Hyperactivity Disorder ◽

Diagnostic Codes ◽

Increased Risk ◽

Specific Association ◽

And Gender ◽

Confounder Adjustment

Abstract Background Some studies have indicated an increased risk of attention deficit hyperactivity disorder (ADHD) and a small, sex-specific association with autism spectrum disorder (ASD) among children prenatally exposed to obstetric oxytocin. Since oxytocin is widely used in the obstetric ward, these potentially deleterious effects are of concern. Thus, we aimed to examine whether obstetric oxytocin treatment for labour induction or augmentation is associated with ADHD and ASD in offspring born in a two-country design based on data from Denmark and Finland. Methods This population-based study used data from national registers in Denmark and Finland. Singletons born in Denmark 2000–10 (n = 577 380) and Finland 1991–2010 (n = 945 543), who survived infancy, were followed until 31 December 2015. ADHD and ASD were defined using diagnostic codes. For ADHD, we also included information on prescribed and redeemed ADHD medication in the definition. Hazards ratios (HRs) with 95% confidence intervals (CI), modelled with age as the underlying time scale, were calculated to estimate the associations. Results Oxytocin was used in 31% and 46% of the included deliveries in Denmark and Finland, respectively. In crude analyses, prenatal oxytocin was associated with an approximately 20% increased risk of ADHD and ASD, but confounder adjustment attenuated the association. The adjusted HR was 1.03, 95% CI 1.01–1.05, for ADHD and 1.05, 95% CI 1.02–1.08, for ASD. The results were similar in across country and gender. Conclusions We found an association between synthetic oxytocin and ADHD or ASD which is unlikely to reflect a causal association and thus should not support the concern of clinical use. Our results help to allay concerns of obstetric use of oxytocin causing ADHD or ASD.

Download Full-text

Antibiotic Treatments During Infancy, Changes in Nasal Microbiota, and Asthma Development: Population-based Cohort Study

Clinical Infectious Diseases ◽

10.1093/cid/ciaa262 ◽

2020 ◽

Cited By ~ 3

Author(s):

Laura Toivonen ◽

Linnea Schuez-Havupalo ◽

Sinikka Karppinen ◽

Matti Waris ◽

Kristi L Hoffman ◽

...

Keyword(s):

Cohort Study ◽

Birth Cohort ◽

Population Based ◽

Rrna Gene ◽

Nasal Airway ◽

Absolute Increase ◽

Longitudinal Changes ◽

Causal Mediation ◽

Increased Risk ◽

Nasal Microbiota

Abstract Background Early-life exposures to antibiotics may increase the risk of developing childhood asthma. However, little is known about the mechanisms linking antibiotic exposures to asthma. We hypothesized that changes in the nasal airway microbiota serve as a causal mediator in the antibiotics–asthma link. Methods In a population-based birth-cohort study in Finland, we identified longitudinal nasal microbiota profiles during age 2–24 months using 16S rRNA gene sequencing and an unsupervised machine learning approach. We performed a causal mediation analysis to estimate the natural direct effect of systemic antibiotic treatments during age 0–11 months on risks of developing physician-diagnosed asthma by age 7 years and the natural indirect (causal mediation) effect through longitudinal changes in nasal microbiota. Results In our birth cohort of 697 children, 8.0% later developed asthma. Exposure to ≥2 antibiotic treatments during age 0–11 months was associated with a 4.0% increase in the absolute risk of developing asthma (absolute increase, 95% CI, .9–7.2%; P = .006). The unsupervised clustering approach identified 6 longitudinal nasal microbiota profiles. Infants with a larger number of antibiotic treatments had a higher risk of having a profile with early Moraxella sparsity (per each antibiotic treatment, adjusted RRR, 1.38; 95% CI, 1.15–1.66; P < .001). This effect of antibiotics on asthma was partly mediated by longitudinal changes in the nasal microbiota (natural indirect effect, P = .008), accounting for 16% of the total effect. Conclusions Early exposures to antibiotics were associated with increased risk of asthma; the effect was mediated, in part, by longitudinal changes in the nasal airway microbiota.

Download Full-text

Both low birthweight and high birthweight are associated with cognitive impairment in persons with schizophrenia and their first-degree relatives

Psychological Medicine ◽

10.1017/s0033291713000032 ◽

2013 ◽

Vol 43 (11) ◽

pp. 2361-2367 ◽

Cited By ~ 9

Author(s):

M. Torniainen ◽

A. Wegelius ◽

A. Tuulio-Henriksson ◽

J. Lönnqvist ◽

J. Suvisaari

Keyword(s):

Low Birthweight ◽

Neuropsychological Test ◽

Estimating Equation ◽

Population Based ◽

Continuous Variable ◽

First Degree Relatives ◽

Increased Risk ◽

Axis I ◽

Persons With Schizophrenia ◽

The Relationship

BackgroundBoth low birthweight and high birthweight have been associated with an increased risk for schizophrenia and cognitive impairments in the general population. We assessed the association between birthweight and cognitive performance in persons with schizophrenia and their unaffected first-degree relatives.MethodWe investigated a population-based family sample comprising persons with schizophrenia (n = 142) and their unaffected first-degree relatives (n = 277). Both patients and relatives were interviewed with the Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCID-CV) and a comprehensive neuropsychological test battery was administered. Information on birthweight was obtained from obstetric records. We used generalized estimating equation (GEE) models to investigate the effect of birthweight, as a continuous variable, on cognitive functioning, adjusting for within-family correlation and relevant covariates.ResultsBoth low birthweight and high birthweight were associated with lower performance in visuospatial reasoning, processing speed, set-shifting and verbal and visual working memory among persons with schizophrenia and their unaffected first-degree relatives compared to individuals with birthweight in the intermediate range. The group × birthweight interactions were non-significant.ConclusionsBoth low birthweight and high birthweight are associated with deficits in cognition later in life. Schizophrenia does not seem to modify the relationship between birthweight and cognition in families with schizophrenia.

Download Full-text

Helicobacter pyloriInfection in Ontario: Prevalence and Risk Factors

Canadian Journal of Gastroenterology ◽

10.1155/2007/462804 ◽

2007 ◽

Vol 21 (8) ◽

pp. 501-506 ◽

Cited By ~ 35

Author(s):

Farah Naja ◽

Nancy Kreiger ◽

Terrence Sullivan

Keyword(s):

Developed Countries ◽

Population Based ◽

World Health ◽

Type I ◽

Inverse Association ◽

Place Of Birth ◽

Increased Risk ◽

H Pylori ◽

Health Organization ◽

The Relationship

BACKGROUND:Helicobacter pylorihas been classified by the World Health Organization as a type I carcinogen. Nearly 50% of the world’s population is estimated to be infected withH pylori. Prevalence patterns of the infection are different between developing and developed countries. The present study had two objectives – to estimate the prevalence ofH pyloriinfection in Ontario, and to evaluate the relationship between the infection and various demographic characteristics and selected lifestyle factors.METHODS: Ten microlitres of plasma were aliquoted from stored blood of 1306 men and women, 50 to 80 years of age, from Ontario. The blood samples belonged to control patients of a colorectal cancer population-based study group. Serological testing was used to detectH pyloriinfection; information was obtained on dietary intake and lifestyle habits, as well as past and present medical history, education, income, number of siblings, ethnicity and place of birth.RESULTS: The overall weighted seroprevalence ofH pyloriwas 23.1% (95% CI 17.7% to 29.5%), with men having higher infection rates (29.4%, 95% CI 21.1% to 39.3%) than women (14.9%, 95% CI 10.1% to 21.4%). Seroprevalence of the infection increased significantly with age and number of siblings. Increased risk was also associated with being nonwhite, being born outside of Canada and immigrating at 20 years of age or older. An inverse association with seroprevalence was found for education and alcohol consumption.CONCLUSION: The prevalence ofH pyloriinfection in Ontario is comparable with that of other developed countries. Age, sex, number of siblings, ethnicity, place of birth and age at immigration are among the factors associated withH pyloriinfection.

Download Full-text

Phosphodiesterase type 5 inhibitors (PDE5i) and prostate cancer recurrence.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.2_suppl.55 ◽

2016 ◽

Vol 34 (2_suppl) ◽

pp. 55-55

Author(s):

Stacy Loeb ◽

Yasin Folkvaljon ◽

David Robinson ◽

Thorsten Schlomm ◽

Hans Garmo ◽

...

Keyword(s):

Prostate Cancer ◽

Biochemical Recurrence ◽

Conditional Logistic Regression ◽

Population Based ◽

Incidence Density ◽

Cumulative Number ◽

Phosphodiesterase Type 5 Inhibitors ◽

Drug Register ◽

Increased Risk ◽

Phosphodiesterase Type

55 Background: Phosphodiesterase type 5 inhibitors are commonly used for management of erectile dysfunction after prostate cancer (CaP) treatment. Single-institution studies have reported conflicting data on PDE5i use and recurrence after radical prostatectomy (RP). We re-evaluated the association between PDE5i use after RP and RT with biochemical recurrence in a nationwide, population-based registry. Methods: We performed a nested case-control study using data from the National Prostate Cancer Register of Sweden (including >98% prostate cancer cases nationwide), linked to the national Prescribed Drug Register. Among men with localized CaP who underwent primary RT or RP from 2006-2007 with 5 years of follow-up, we identified those with biochemical recurrence (n=293 cases). For each case, we identified 20 controls who were recurrence-free at the event date of the index case, using incidence density sampling stratified by age and treatment (n=5,767 controls). Multivariable conditional logistic regression was used to examine the relationship between overall PDE5i use and cumulative pill number with biochemical recurrence. Results: Among men treated by RT, PDE5i were not associated with BCR (OR 0.97, 95% CI 0.48-1.94), adjusting for marital status, education, income, PSA, clinical stage, Gleason score, and proportion of positive biopsies. As shown in the table, PDE5i were not associated with biochemical recurrence after RP adjusting for clinical features (OR 0.79, 95% CI 0.60-1.05), or with additional adjustment for surgical pathology (OR 0.83, 95% CI 0.62-1.10). Men whose cumulative number of PDE5i pills was above the median had a slightly lower risk of biochemical recurrence in the clinical model, and no difference in risk of biochemical recurrence after adjustment for RP features. Conclusions: Our results from a population-based setting suggest against an increased risk of biochemical recurrence among men using PDE5i after CaP treatment. [Table: see text]

Download Full-text

Cause and effect in studies on unemployment, mental health and suicide: a meta-analytic and conceptual review

Psychological Medicine ◽

10.1017/s0033291713001621 ◽

2013 ◽

Vol 44 (5) ◽

pp. 909-917 ◽

Cited By ~ 80

Author(s):

A. Milner ◽

A. Page ◽

A. D. LaMontagne

Keyword(s):

Mental Health ◽

Meta Analysis ◽

Population Based ◽

Future Research ◽

Temporal Relationships ◽

Causal Assumptions ◽

Confounder Adjustment ◽

Past Experiences ◽

Study Designs ◽

The Relationship

BackgroundThere are ongoing questions about whether unemployment has causal effects on suicide as this relationship may be confounded by past experiences of mental illness. The present review quantified the effects of adjustment for mental health on the relationship between unemployment and suicide. Findings were used to develop and interpret likely causal models of unemployment, mental health and suicide.MethodA random-effects meta-analysis was conducted on five population-based cohort studies where temporal relationships could be clearly ascertained.ResultsResults of the meta-analysis showed that unemployment was associated with a significantly higher relative risk (RR) of suicide before adjustment for prior mental health [RR 1.58, 95% confidence interval (CI) 1.33–1.83]. After controlling for mental health, the RR of suicide following unemployment was reduced by approximately 37% (RR 1.15, 95% CI 1.00–1.30). Greater exposure to unemployment was associated with higher RR of suicide, and the pooled RR was higher for males than for females.ConclusionsPlausible interpretations of likely pathways between unemployment and suicide are complex and difficult to validate given the poor delineation of associations over time and analytic rationale for confounder adjustment evident in the revised literature. Future research would be strengthened by explicit articulation of temporal relationships and causal assumptions. This would be complemented by longitudinal study designs suitable to assess potential confounders, mediators and effect modifiers influencing the relationship between unemployment and suicide.

Download Full-text

Child Maltreatment Among Singletons and Multiple Births in Japan: A Population-Based Study

Twin Research and Human Genetics ◽

10.1017/thg.2015.67 ◽

2015 ◽

Vol 18 (6) ◽

pp. 806-811 ◽

Cited By ~ 4

Author(s):

Yoshie Yokoyama ◽

Terumi Oda ◽

Noriyo Nagai ◽

Masako Sugimoto ◽

Kenji Mizukami

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Child Maltreatment ◽

Personal Information ◽

Population Based ◽

Multiple Births ◽

Population Based Study ◽

Factors Associated ◽

Increased Risk ◽

The Relationship

Background: The occurrence of multiple births has been recognized as a risk factor for child maltreatment. However, few population-based studies have examined the relationship between multiple births and child maltreatment. This study aimed to evaluate the degree of risk of child maltreatment among singletons and multiple births in Japan and to identify factors associated with increased risk. Methods: Using population-based data, we analyzed the database of records on child maltreatment and medical checkups for infants aged 1.5 years filed at Nishinomiya City Public Health Center between April 2007 and March 2011. To protect personal information, the data were transferred to anonymized electronic files for analysis. Results: After adjusting by logistic regression for each associated factor and gestation number, multiples themselves were not associated with the risk of child maltreatment. However, compared with singletons, multiples had a significantly higher rate of risk factors for child maltreatment, including low birth weight and neural abnormality. Moreover, compared with mothers of singleton, mothers of twins had a significantly higher rate of poor health, which is a risk factor of child maltreatment. Conclusion: Multiples were not associated with the risk of child maltreatment. However, compared with singletons, multiples and their mothers had a significantly higher rate of risk factors of child maltreatment.

Download Full-text

Adults with persistent ADHD: Gender and psychiatric comorbidities – a population-based longitudinal study

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.219 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S136-S137 ◽

Cited By ~ 1

Author(s):

K. Yoshimasu ◽

W.J. Barbaresi ◽

R.C. Colligan ◽

R.G. Voigt ◽

J.M. Killian ◽

...

Keyword(s):

Psychiatric Disorders ◽

Birth Cohort ◽

Internalizing Disorders ◽

Externalizing Disorders ◽

Population Based ◽

Psychiatric Interview ◽

Psychiatric Comorbidities ◽

Childhood Adhd ◽

Comorbid Psychiatric Disorders ◽

Increased Risk

ObjectiveTo evaluate in adults the associations between persistent ADHD and comorbid psychiatric disorders and gender differences, among subjects from a population-based birth cohort.MethodSubjects were recruited from a birth cohort of all children born during 1976–1982 who remained in Rochester, MN after five years of age. Participating subjects with research-identified childhood ADHD (n = 232; mean age 27.0 years; 72% men) and non-ADHD controls (n = 335; mean age 28.6 years; 63% men) were administered a structured psychiatric interview (MINI-International Neuropsychiatric Interview) to assess current ADHD status and comorbid psychiatric disorders.ResultsAmong the 232 with research-identified childhood ADHD, 68 (49 men and 19 women) had persistent adult ADHD. Compared to subjects without childhood ADHD, adults with persistent ADHD were significantly more likely to have any (81% vs. 35%, P < 0.001) as well as each of the specific psychiatric comorbidities. The associations retained significance when stratified by gender and there were no significant gender by ADHD interactions on psychiatric disorders except for dysthymia with which ADHD was more strongly associated in women than men. Among subjects with persistent ADHD, externalizing psychiatric disorders were more common in men (73%) and internalizing disorders were more common in women (53%).ConclusionPersistent ADHD is associated with an increased risk of comorbid psychiatric disorders in both adult men and women. Clinicians treating adults with persistent ADHD need to be aware of comorbid psychiatric disorders, especially externalizing disorders for men and internalizing disorders for women.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Download Full-text

Children With Appendectomy Have Increased Risk of Future Sepsis: Real-world Data in Taiwan

10.22541/au.161248697.75690035/v1 ◽

2021 ◽

Author(s):

Liao Tzu-Han ◽

Meng Che Wu ◽

Cheng-Li Lin ◽

Chien-Heng Lin ◽

James Cheng-Chung Wei

Keyword(s):

Cox Regression ◽

Propensity Score Analysis ◽

Population Based ◽

Research Database ◽

Real World Data ◽

Parental Occupation ◽

Increased Risk ◽

Future Risk ◽

The Relationship

Backgrounds Appendectomy is one of the most commonly performed surgeries worldwide. Sepsis is an major etiology of morbidity and mortality in children. Our preliminary research revealed a positive correlation among appendectomy and future risk of sepsis in adults. However, to date, the relationship among appendectomy and future risk of sepsis in children remains unknown. The aim of this research was to investigate the relationship among appendectomy and hazard of future sepsis in children. Methods We applied a nationwide population-based cohort to assess whether children who received appendectomy were at increased risk of subsequent sepsis. Overall, 57261 subjects aged below 18 undergoing appendectomy as appendectomy group and 57261 matched controls were identified as non-appendectomy group from the National Health Insurance Research Database in Taiwan. We use propensity score analysis to match age, sex, urbanization level, and parental occupation at the ratio to 1:1. Multiple Cox regression and stratified analyses were used to appraise the adjusted hazard ratio (aHR) for developing sepsis in children. Results Children who received appendectomy had a 2.63 times higher risk of developing sepsis than those who did not, and the risk was even higher in children aged under 6 years. Patients with <1 year follow-up showed a 5.64-fold risk of sepsis in the appendectomy cohort. Patients with 1–4 and ≥5 years’ follow-up showed a 2.41- and 2.02-times risk of sepsis. Conclusion Appendectomy was correlative to a 2.63-fold increased future sepsis risk in children, and the risk in younger patients aged <6 years was even higher. More studies to interpret the possible biological mechanisms of the associations among sepsis and appendectomy are warrant

Download Full-text