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Biomedical subjects

Elizabeth W Triche

Publications and source records attributed to Elizabeth W Triche.

15 recordsLinked to original sources
PubMed2006

Association of surfactant protein A polymorphisms with otitis media in infants at risk for asthma.

BACKGROUND: Otitis media is one of the most common infections of early childhood. Surfactant protein A functions as part of the innate immune response, which plays an important role in preventing infections early in life. This prospective study utilized a candidate gene approach to evaluate the association between polymorphisms in loci encoding SP-A and risk of otitis media during the first year of life among a cohort of infants at risk for developing asthma. METHODS: Between September 1996 and December 1998, women were invited to participate if they had at least one other child with physician-diagnosed asthma. Each mother was given a standardized questionnaire within 4 months of her infant's birth. Infant respiratory symptoms were collected during quarterly telephone interviews at 6, 9 and 12 months of age. Genotyping was done on 355 infants for whom whole blood and complete otitis media data were available. RESULTS: Polymorphisms at codons 19, 62, and 133 in SP-A1, and 223 in SP-A2 were associated with race/ethnicity. In logistic regression models incorporating estimates of uncertainty in haplotype assignment, the 6A4/1A5haplotype was protective for otitis media among white infants in our study population (OR 0.23; 95% CI 0.07,0.73). CONCLUSION: These results indicate that polymorphisms within SP-A loci may be associated with otitis media in white infants. Larger confirmatory studies in all ethnic groups are warranted.

Alleles↗
PubMed2006

Caffeine metabolites in umbilical cord blood, cytochrome P-450 1A2 activity, and intrauterine growth restriction.

Studies investigating antenatal caffeine consumption and reproductive outcomes show conflicting results, and most studies have used maternal self-reported caffeine consumption to estimate fetal exposure. This study (n=1,606) was specifically designed to test the association of caffeine and its primary metabolites in umbilical cord blood with intrauterine growth restriction (IUGR). Pregnant women were recruited from 56 obstetric practices and 15 clinics affiliated with six hospitals in Connecticut and Massachusetts between September 1996 and January 2000. In an adjusted model including caffeine only, levels in all quartiles were associated with reduced risk of IUGR. In adjusted analyses including paraxanthine and caffeine, serum paraxanthine levels in the highest quartile were associated with increased risk of IUGR (adjusted odds ratio=3.29, 95% confidence interval: 1.17, 9.22); caffeine remained protective. These conflicting findings suggest that cytochrome P-450 1A2 (CYP1A2) metabolic activity may be associated with IUGR, so the ratio of paraxanthine to caffeine was then modeled. The likelihood of IUGR increased 21% for every one standard deviation change in the ratio (adjusted odds ratio=1.21, 95% confidence interval: 1.07, 1.37), suggesting that CYP1A2 activity, and not the absolute levels of paraxanthine, influences fetal growth. No associations were observed between caffeine or any metabolites and preterm delivery.

Adult↗
PubMed2006

The epidemiology of asthma during pregnancy: prevalence, diagnosis, and symptoms.

We demonstrated that asthma remains a common condition among pregnant women and that the prevalence of self-reported asthma in the United States is between 8.4% and 8.8%. In addition, approximately 4.1% of all pregnant women experienced an asthma attack in the previous year. Prevalence rates in other countries seem to be higher or substantially lower; however, further characterization of international trends using nationally representative data is needed. Data from a large prospective cohort study in the northeastern United States and national data demonstrate continued opportunities for population-level improvement in well-managed asthma during pregnancy. Finally, asthma diagnosis and asthma control seem to differ by population characteristics (eg, age, race/ethnicity, socio-economic status), and further research and clinical involvement are needed to ad-dress potentially systematic variation in reporting and management of the disease.

Asthma↗
PubMed2006

Low-level ozone exposure and respiratory symptoms in infants.

OBJECTIVE: Recent studies indicate that the U.S. Environmental Protection Agency (EPA) ozone standards may not protect sensitive individuals. In this study we examined respiratory effects of ozone in infants who may be vulnerable, particularly if they are children of asthmatic mothers. DESIGN: Women delivering babies at one of five hospitals in southwestern Virginia between 1994 and 1996 were invited to participate in a cohort study; 780 women enrolled. Ambient air quality data (ozone and particulate matter) were collected at a central monitoring site. PARTICIPANTS: This analysis is of 691 infants followed for approximately 83 days between 10 June and 31 August 1995 and/or 1996 ; they contributed a total of 52,421 infant-days of follow-up. Mothers were interviewed at enrollment and approximately biweekly to report infants' daily symptoms. Repeated measures logistic regression models were run separately for wheeze, difficulty breathing, and cough. Ozone metrics included 24-hr average, peak 1-hr, and maximum 8-hr average. Analyses were repeated for the 61 infants whose mothers had asthma. RESULTS: For every interquartile-range increase in same-day 24-hr average ozone, likelihood of wheeze increased 37% [95% confidence interval (CI), 2-84%]. Among infants of asthmatic mothers, same-day 24-hr average ozone increased likelihood of wheeze 59% (95% CI, 1-154%) and of difficulty breathing 83% (95% CI, 42-136%). Maximum 8-hr ozone and peak 1-hr ozone were associated with difficulty breathing, but not wheeze, in infants of asthmatic mothers. Ozone was not associated with cough. CONCLUSIONS: At levels of ozone exposure near or below current U.S. EPA standards, infants are at increased risk of respiratory symptoms, particularly infants whose mothers have physician-diagnosed asthma.

Cohort Studies↗
PubMed2005

Association of indoor nitrogen dioxide exposure with respiratory symptoms in children with asthma.

RATIONALE: Chronic exposure to indoor nitrogen dioxide (NO2) is a public health concern. Over half of U.S. households have a source of NO2, and experimental data suggest potential for adverse respiratory effects. OBJECTIVE: To examine associations of indoor NO2 exposure with respiratory symptoms among children with asthma. METHODS: NO2 was measured using Palmes tubes, and respiratory symptoms in the month before sampling were collected during home interviews of mothers of 728 children with active asthma. All were younger than 12 yr, lived at the sampled home for at least 2 mo, and had asthma symptoms or used maintenance medication within the previous year. MEASUREMENTS: Respiratory symptoms (wheeze, persistent cough, shortness of breath, chest tightness). RESULTS: Mean (SD) NO2 was 8.6 (9.1) ppb in homes with electric ranges and 25.9 (18.1) ppb in homes with gas stoves. In models stratified by housing type (a factor associated with socioeconomic status), gas stove presence and elevated NO2 were each significantly associated with respiratory symptoms, controlling for age, ethnicity, medication, mold/mildew, water leaks, and season of sampling. Among children in multifamily housing, exposure to gas stoves increased likelihood of wheeze (odds ratio [OR], 2.27; 95% confidence interval [95% CI], 1.15, 4.47), shortness of breath (OR, 2.33; 95% CI, 1.12, 5.06), and chest tightness (OR, 4.34; 95% CI, 1.76, 10.69), whereas each 20-ppb increase in NO2 increased both likelihood of any wheeze (OR, 1.52; 95% CI, 1.04, 2.21) or chest tightness (OR, 1.61; 95% CI, 1.04, 2.49), and days of wheeze (rate ratio (RR), 1.33; 95% CI, 1.05, 1.68) or chest tightness (RR, 1.51; 95% CI, 1.18, 1.91). CONCLUSION: Exposure to indoor NO2 at levels well below the Environmental Protection Agency outdoor standard (53 ppb) is associated with respiratory symptoms among children with asthma in multifamily housing.

Air Pollution, Indoor↗
PubMed2005

Polymorphisms in the 5' region of the CD14 gene are associated with eczema in young children.

BACKGROUND: Variants in the CD14 gene (CD14) are hypothesized to be associated with atopic disorders. However, most studies have only investigated one polymorphism in this gene. OBJECTIVE: We sought to study the association of 5 single nucleotide polymorphisms (SNPs) in the 5' flanking region of CD14 with eczema and serum IgE levels in young children. METHODS: We genotyped 5 SNPs in an approximately 6.5-kb region in the 5' region of CD14 in 344 2-year-old white children from 2 birth cohorts in the northeastern United States. We examined the relation of both single SNPs and haplotypes in CD14 with the atopic outcomes. RESULTS: Two SNPs were significantly associated with eczema. In dominant models adjusted for potential confounders, SNP rs2569193 was associated with significantly decreased risk for eczema (odds ratio [OR] for CT/TT vs CC, 0.5; 95% CI, 0.3-0.8), whereas SNP rs2569190 (also reported as the C-159T) was associated with significantly increased risk for eczema (OR for CT/TT vs CC, 2.3; 95% CI, 1.4-3.8). The CT/TT genotypes of SNP rs2569190 also had higher geometric means of serum IgE than the CC genotype (24.6 vs 15 IU/mL, P = .025). Haplotype analyses provided results similar to those of the single SNP analyses. CONCLUSIONS: Our results contradict previous reports that have found a protective effect of the T allele of SNP rs2569190 (C-159T) against atopic disorders. Nevertheless, these results confirm the importance of polymorphisms in CD14 in the development of atopy, and future studies of this gene region will need to account for linkage disequilibrium and environmental exposures unique to the study population.

5' Flanking Region↗
PubMed2005

Indoor heating sources and respiratory symptoms in nonsmoking women.

BACKGROUND: Secondary heating appliances are important indoor sources of air pollution, including particulate matter, nitrogen dioxide (NO2), and sulfur dioxide (SO2). We hypothesized that the use of secondary heating sources increases respiratory symptoms in women living in nonsmoking households and specifically that concentrations of SO2 and NO2 emitted from heating sources are associated with respiratory symptoms. METHODS: Mothers who delivered babies at 12 hospitals in Connecticut and Virginia (1993-1996) were enrolled. There were 888 women who contributed symptom and exposure information during the winter heating season (15 October to 15 April), for a total of 9783 reporting periods (median = 12 reporting periods per woman, interquartile range 11-12). Adjusted rate ratios (RRs) of effects of source use and measured concentrations on rate of days with symptoms were obtained using generalized estimating equations for a log-linear Poisson model, controlling age, education, race, history of allergies, number of children, dwelling type, and residence state. RESULTS: In adjusted models, each hour-per-day increase in kerosene heater use is associated with an increase in wheezing (RR = 1.06; 95% confidence interval (CI) = 1.01-1.11). Each hour of fireplace use is associated with increased cough (1.05; 1.01-1.09), sore throat (1.04; 1.00-1.08), and marginally with chest tightness (1.05; 0.99-1.12). Each 10 ppb increase in SO2 (a proxy for sulfate aerosol) is associated with increased wheezing (1.57; 1.10-2.26) and chest tightness (1.32; 1.01-1.71). CONCLUSIONS: Emissions from fireplaces, gas space heaters, and kerosene heaters may contribute to respiratory symptoms in a population of nonsmoking women.

Air Pollution, Indoor↗
PubMed2004

Association of asthma diagnosis, severity, symptoms, and treatment with risk of preeclampsia.

OBJECTIVE: Existing studies relating asthma and preeclampsia provide conflicting results, perhaps due to differences in study populations, varying definitions of asthma, and inadequate control for confounding, particularly asthma medication use. This prospective study examines associations between aspects of asthma (diagnosis, severity, symptoms, and medication use) and risk of preeclampsia. METHODS: A total of 1,708 pregnant women, of whom 656 had asthma diagnosis and 1,052 had no asthma diagnosis, were included in this analysis. Asthma symptoms, treatment, and severity were classified according to Global Initiative for Asthma guidelines. Hospital records were abstracted, and strict criteria were applied to classify women as preeclamptic based on National Heart, Lung, and Blood Institute guidelines. RESULTS: There were 568 of 656 women with diagnosed asthma and 353 of 1,052 women without asthma diagnosis who had symptoms or took asthma medication during pregnancy. Separate adjusted logistic regression models were run for different measures of asthma status: 1) asthma diagnosis; 2) overall Global Initiative for Asthma severity; 3) Global Initiative for Asthma symptom and treatment steps; and 4) Global Initiative for Asthma symptom step and medication type. Women at increased risk of preeclampsia were those classified as Global Initiative for Asthma symptom step 3/4 compared with no symptoms (odds ratio 3.36, 95% confidence interval 1.24-9.14) and theophylline users (odds ratio 1.16 for every dose/month increase in use, 95% confidence interval 1.02-1.33). In contrast, neither a history of physician-diagnosed asthma nor Global Initiative for Asthma treatment step was associated with preeclampsia status. CONCLUSION: Our findings suggest that women with moderate to severe asthma symptoms, regardless of asthma diagnosis or treatment, are at increased risk of preeclampsia compared with women with no symptoms.

Adult↗
PubMed2004

Infant otitis media and the use of secondary heating sources.

BACKGROUND: This prospective study investigated the association of exposure to indoor secondary heating sources with otitis media and recurrent otitis media risk in infants. STUDY DESIGN: We enrolled mothers living in nonsmoking households and delivering babies between 1993 and 1996 in 12 Connecticut and Virginia hospitals. Biweekly telephone interviews during the first year of life assessed diagnoses from doctors' office visits and use of secondary home heating sources, air conditioner use, and day care. Otitis media episodes separated by more than 21 days were considered to be unique episodes. Recurrent otitis media was defined as 4 or more episodes of otitis media. Repeated-measures logistic regression modeling evaluated the association of kerosene heater, fireplace, or wood stove use with otitis media episodes while controlling for potential confounders. Logistic regression evaluated the relation of these secondary heating sources with recurrent otitis media. RESULTS: None of the secondary heating sources were associated with otitis media or with recurrent otitis media. Otitis media was associated with day care, the winter heating season, birth in the fall, white race, additional children in the home, and a maternal history of allergies in multivariate models. Recurrent otitis media was associated with day care, birth in the fall, white race, and a maternal history of allergies or asthma. CONCLUSION: We found no evidence that the intermittent use of secondary home heating sources increases the risk of otitis media or recurrent otitis media. This study confirms earlier findings regarding the importance of day care with respect to otitis media risk.

Environmental Exposure↗
PubMed2004

Association of early-onset otitis media in infants and exposure to household mould.

Otitis media is one of the most common infections of early childhood. Children who first experience acute otitis media at an early age (before 6 months) are at increased risk for recurrent otitis media. This prospective study investigated exposure to measured levels of airborne household mould and the risk of early otitis media in the first 6 months of life among a cohort of infants at high risk for asthma. Between September 1996 and December 1998, women were invited to participate if they had at least one other child with physician-diagnosed asthma. Mothers were given a standardised questionnaire within 4 months of their infant's birth. Airborne mould samples were also taken at this time, and culturable fungi were categorised into four levels according to the report of the Commission of European Communities: 0 (undetectable), 1-499 colony forming units (CFU)/m(3) (low), 500-999 CFU/m(3) (medium), > or =1000 CFU/m(3) (high). Infant respiratory symptoms were collected during quarterly telephone interviews at 6, 9 and 12 months of age. Of the 806 children in the study, 27.8% experienced otitis media before six months of age. Household levels of Penicillium and Cladosporium were modestly associated with the number of otitis media episodes (P = 0.056 and 0.081 respectively). After controlling for potential confounders, Penicillium and Cladosporium were not associated with early otitis media. High levels of 'other' mould (defined as total spore count minus counts for Penicillium, Cladosporium, and yeast) were associated with early otitis media (OR 3.49; 95% CI [1.38, 8.79]). We also found associations between day-care outside of the home and birth during the summer or fall season with early otitis media. This study is suggestive of a relationship between otitis media and mould that warrants further study.

Age of Onset↗
PubMed2003

Association of low-level ozone and fine particles with respiratory symptoms in children with asthma.

CONTEXT: Exposure to ozone and particulate matter of 2.5 microm or less (PM2.5) in air at levels above current US Environmental Protection Agency (EPA) standards is a risk factor for respiratory symptoms in children with asthma. OBJECTIVE: To examine simultaneous effects of ozone and PM2.5 at levels below EPA standards on daily respiratory symptoms and rescue medication use among children with asthma. DESIGN, SETTING, AND PARTICIPANTS: Daily respiratory symptoms and medication use were examined prospectively for 271 children younger than 12 years with physician-diagnosed, active asthma residing in southern New England. Exposure to ambient concentrations of ozone and PM2.5 from April 1 through September 30, 2001, was assessed using ozone (peak 1-hour and 8-hour) and 24-hour PM2.5. Logistic regression analyses using generalized estimating equations were performed separately for maintenance medication users (n = 130) and nonusers (n = 141). Associations between pollutants (adjusted for temperature, controlling for same- and previous-day levels) and respiratory symptoms and use of rescue medication were evaluated. MAIN OUTCOME MEASURES: Respiratory symptoms and rescue medication use recorded on calendars by subjects' mothers. RESULTS: Mean (SD) levels were 59 (19) ppb (1-hour average) and 51 (16) ppb (8-hour average) for ozone and 13 (8) microg/m3 for PM2.5. In copollutant models, ozone level but not PM2.5 was significantly associated with respiratory symptoms and rescue medication use among children using maintenance medication; a 50-ppb increase in 1-hour ozone was associated with increased likelihood of wheeze (by 35%) and chest tightness (by 47%). The highest levels of ozone (1-hour or 8-hour averages) were associated with increased shortness of breath and rescue medication use. No significant, exposure-dependent associations were observed for any outcome by any pollutant among children who did not use maintenance medication. CONCLUSION: Asthmatic children using maintenance medication are particularly vulnerable to ozone, controlling for exposure to fine particles, at levels below EPA standards.

Air Pollutants↗
PubMed2003

Association of maternal caffeine consumption with decrements in fetal growth.

Whether caffeine consumption during pregnancy represents a fetal hazard remains uncertain. The authors report on a large prospective study designed to examine this question. In 1996-2000, 2,291 mothers with singleton livebirths in Connecticut and Massachusetts were evaluated after their first prenatal visit and were questioned about caffeine consumption and important confounding factors. Urine samples were provided to analyze urinary caffeine, cotinine, and creatinine levels. Mothers were followed throughout pregnancy to monitor changes in consumption. Pregnancy outcomes were obtained from medical records. Self-reports of caffeine consumption in the first and third trimesters were not associated with intrauterine growth retardation, low birth weight, or preterm delivery. For every 1 mg/g creatinine increase in urinary caffeine, risk of intrauterine growth retardation was essentially unchanged (odds ratio (OR) = 0.96, 95% confidence interval (CI): 0.85, 1.08). In contrast, a 0.005 mg/g creatinine increase in urinary cotinine significantly increased risk (OR = 1.003, 95% CI: 1.001, 1.005). Mean birth weight was reduced by reported caffeine consumption (-28 g per 100 mg of caffeine consumed daily, 95% CI: -0.10, -0.46, p = 0.001) but not mean gestational age. Decaffeinated coffee did not increase risk for any perinatal outcome. This small decrease in birth weight, observed for maternal caffeine consumption, is unlikely to be clinically important except for women consuming >/=600 mg of caffeine daily (approximately six 10-ounce (1 ounce = 28.3 g) cups of coffee).

Adult↗
PubMed2003

Asthma symptoms, severity, and drug therapy: a prospective study of effects on 2205 pregnancies.

OBJECTIVE: To prospectively examine in pregnant women whether asthma or asthma therapy influenced preterm delivery, intrauterine grown restriction (IUGR), or birthweight. METHODS: We enrolled 873 pregnant women with a history of asthma, of whom 778 experienced asthma symptoms or took medication, and 1333 women with no asthma history, including 884 women with neither asthma diagnosis nor symptoms and 449 with symptoms but no diagnosis. Asthma symptoms, medication, and severity were classified according to 2002 Global Initiative for Asthma guidelines. RESULTS: Preterm delivery was not associated with asthma diagnosis, severity, or symptoms but was associated with use of controller medications, independent of symptoms, specifically oral steroids and theophylline. Gestation was reduced by 2.22 weeks in women using oral steroids daily (P =.001) and 1.11 weeks after theophylline (P =.002). We observed a 24% (5-47%) increased risk for IUGR with each increased symptom step, which increased further in symptomatic women with no asthma diagnosis (31%, 4-65%) compared with women with neither asthma nor symptoms. CONCLUSIONS: We found no effect of asthma symptoms or severity on preterm delivery but observed increased risks associated with use of oral steroid and theophylline. Intrauterine growth restriction was associated with asthma severity, which possibly reflects a hypoxic fetal effect. Women with asthma symptoms but no diagnosis were at particular risk of undermedication and delivering IUGR infants. These observations support guidelines that advocate active management of pregnant patients with mild or moderate asthma with beta(2) agonists, with oral steroids added only if severity increases. Symptomatic patients without an asthma diagnosis might need to be equally managed.

Adult↗
PubMed2002

Infant respiratory symptoms associated with indoor heating sources.

This study examined the effects of indoor heating sources on infant respiratory symptoms during the heating season of the first year of life. Mothers delivering babies between 1993 and 1996 at 12 hospitals in Connecticut and Virginia were enrolled. Daily symptom and heating source use information about their infant was obtained every 2 weeks during the first year of life. Heating sources included fireplace, wood stove, kerosene heater, and gas space heater use. Four health outcomes were analyzed by reporting period: days of wheeze, episodes of wheeze, days of cough, and episodes of cough. A large percentage of infants had at least one episode of cough (88%) and wheeze (33%) during the heating season of the first year of life. Wood stove, fireplace, kerosene heater, and gas space heater use was intermittent across the study period. In adjusted Poisson regression models controlling for important confounders, gas space heater use was associated with episodes and days of wheeze. Wood stove use was associated with total days of cough, and kerosene heater use was associated with episodes of cough. Fireplace use was not associated with any of the respiratory symptoms. Use of some heating sources appears related to respiratory symptoms in infants.

Air Pollution, Indoor↗