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Biomedical subjects

F D Martinez

Publications and source records attributed to F D Martinez.

At least 91 records · Page 5Linked to original sources
PubMed1995

The relationship between parental and children's serum IgE and asthma.

This paper examines the familial aggregation of physician-diagnosed asthma in relation to the age- and sex-standardized total serum IgE levels of children and their parents in a sample of the general population in Tucson, Arizona, that has been followed in a longitudinal study for over 20 yr. There were 591 nuclear families containing 1,177 children who provided information about the presence or absence of a physician diagnosis of asthma. The serum IgE data were less complete: both parents and one or more of their children in 251 of the nuclear families, containing 468 children, had serum IgE levels measured. There was a very strong tendency for asthmatic patients to have asthmatic children, but only a small part of this appeared to be related to the familial aggregation of total serum IgE. In the absence of an asthmatic parent, there was a slight but significantly higher prevalence of asthma in children of whom both parents had IgE levels in the highest tertile. Very high rates of children's asthma depended on there being an asthmatic parent who also had at least moderate levels of serum IgE. It was also shown that asthmatic children have considerably higher total IgE levels than would be expected on the basis of their parents' IgE levels alone. The data appear compatible with several familial-aggregation hypotheses and a strong environmental influence determining which children are likely to develop asthma. We speculate that the inflammation in the airways of asthmatic patients itself tends to increase the serum IgE level, possibly secondary to mediators that it generates.

Adolescent↗
PubMed1995

Viral infections and the development of asthma.

The possible role of viral infections in the inception of asthma has been the matter of considerable debate. Older data suggested that viral respiratory infections occurring during early life could alter the lungs and the immune system, thus starting the process leading to allergic sensitization and persistent bronchial responsiveness. More recent studies suggest that infants who wheeze belong to two distinct groups, which at present can only be differentiated by the evolution of their illness. Most of these infants have a transitory tendency to wheeze during viral infections, and their lung function shortly after birth is significantly lower than that of infants who will not wheeze during similar infections. Most of these children become symptom-free during the preschool years, and their condition is not associated with higher serum IgE levels. A smaller group of children who wheeze as infants will still have wheezing episodes during the early school years. The factors that determine which infants will become persistent wheezers are not well understood, but viral infections per se are likely to play a minor role, if any. Early sensitization to aeroallergens in subjects genetically predisposed to having high serum IgE levels seems to be the main risk factor for this condition.

Asthma↗
PubMed1995

Air pollution and upper respiratory symptoms in children from East Germany.

Whereas evidence of adverse effects of air pollution on lower respiratory tract illnesses in children is increasing, little is known about the effects of high and moderate levels of air pollution on the incidence of upper respiratory illnesses. 9 to 11 year old schoolchildren (n = 1,854) living in Leipzig, East Germany were studied. The presence of upper respiratory symptoms was documented by a physician. Daily mean and maximum concentrations of SO2, particulate matter (PM) and NOx, as well as temperature and humidity, were measured. Furthermore, a self-administered questionnaire was distributed to the parents to assess confounding factors. Parents of 1,500 (81%) children returned the questionnaire. When controlling for paternal education, passive smoke exposure, number of siblings, temperature and humidity, increased risks for the development of upper respiratory symptoms were found in the winter months for SO2 mean concentrations (odds ratio (OR) = 1.72; 95% confidence interval (95% CI) 1.19-2.49). NOx mean concentrations (OR = 1.53; 95% CI 1.01-2.31) and PM maximum values (OR = 1.62; 95% CI 1.08-2.45). In the summer months, only NOx mean concentrations were associated with a significantly increased risk (OR = 1.82; 95% CI 1.21-2.73). A combination of high mean levels of different pollutants resulted in the highest risk (OR = 2.10; 95% CI 1.30-3.37 in the winter, and OR = 2.16; 95% CI 1.23-3.81 in the summer). We conclude that high concentrations of SO2, and moderate levels of particulate matters and NOx are associated with an increased risk of developing upper respiratory symptoms in childhood.(ABSTRACT TRUNCATED AT 250 WORDS)

Air Pollutants↗
PubMed1995

Passive smoke exposure and otitis media in the first year of life. Group Health Medical Associates.

OBJECTIVE: This study examined, in a health maintenance organization population of children, the associations between parents' smoking and otitis media (OM) in their children while controlling for other known risk factors. METHODS: Healthy newborns (1246) in a large health maintenance organization were enrolled at birth, and 1013 (81%) were followed prospectively for the first year of life. Their medical records were reviewed for the diagnosis of otitis media. Information on risk factors for recurrent OM (ROM) was collected, including a number of variables related to parental smoking. RESULTS: After controlling for other known risk factors for ROM including gender, day care, other siblings in the home, parental history of hay fever, and method of feeding, it was found that heavy maternal smoking of 20 or more cigarettes per day was a significant risk factor for ROM but not for nonrecurrent otitis. Heavy maternal smoking was associated with a threefold risk for ROM if the infant weighed less than the mean at birth (3.5 kg) after controlling for other risk factors. No association was found with paternal smoking. CONCLUSIONS: Heavy maternal smoking is a significant risk factor for ROM in the first year of life. This smoking effect seems to be stronger among infants of lower birth weight.

Analysis of Variance↗
PubMed1994

Skin test reactivity and number of siblings.

OBJECTIVE: To investigate the relation between skin test reactivity in children and number of siblings. DESIGN: Cross sectional survey among schoolchildren aged 9-11 years. Skin prick tests in the children and self completion of written questionnaire by their parents. SUBJECTS: 5030 children in Munich and 2623 children in Leipzig and Halle, Germany. MAIN OUTCOME MEASURES: Atopic status assessed by skin prick tests. RESULTS: After possible confounders were controlled for, the prevalence of atopic sensitisation decreased linearly with increasing number of siblings (odds ratio = 0.96 for one sibling, 0.67 for five or more siblings; P = 0.005). In atopic children the severity of the skin test reaction as assessed by the weal size was not associated with the number of siblings. CONCLUSIONS: Factors directly or indirectly related to the number of siblings may decrease the susceptibility of children to become atopic. Thus, declining family size may in part contribute to the increased prevalence of atopic diseases reported in Western countries over the past few decades.

Child↗
PubMed1994

Prevalence of asthma and atopy in two areas of West and East Germany.

The German reunification offers a unique opportunity to study the impact of environmental factors on the development of childhood respiratory and allergic disorders in ethnically similar populations. We investigated the prevalence of asthma, hay fever, atopy, and bronchial hyperresponsiveness (BHR) in 9- to 11-year old children in West Germany (n = 5,030) and East Germany (n = 2,623). A self-administered questionnaire was distributed to the parents. Children underwent cold air challenge and allergy skin prick tests. Atopic sensitization was considerably more frequent in West German children than in their peers in East Germany (36.7% versus 18.2%; odds ratio [OR] = 2.6, p < 0.0001). The prevalence of current asthma and hay fever was significantly higher in West Germany when compared with that in East Germany (5.9% versus 3.9%; OR = 1.5, p < 0.0001 and 8.6% versus 2.7%; OR = 3.4, p < 0.0001, respectively). Bronchitis, however, was more prevalent in East Germany than in the western part of the country. The prevalence of BHR as assessed by cold air challenge was higher in West Germany compared with that in East Germany (8.3% versus 5.5%, OR = 1.6, p < 0.001). Logistic regression showed that the West German study area was no longer a significant independent determinant of asthma once sensitization to mites, cats, and pollen was taken into account. We conclude that sensitization to aeroallergens is strikingly more frequent in West Germany than in East Germany and this may explain the differences in the prevalence of asthma and hay fever between the two parts of the country.

Asthma↗
PubMed1994

Relationship between cotinine levels, household and personal smoking habit and season in 9-14 year old children.

The aim of this study was to determine the relationship of salivary cotinine levels with individual and household smoking habits and with the season in a sample (n = 146) of Italian schoolchildren aged 9-14 yrs. Active smoking and environmental tobacco smoke were measured by means of a confidential standardized interview with each participating child and by a self-reported questionnaire administered to the parents. Saliva samples were obtained twice: during winter from all children and during spring from a randomly selected subgroup. "Active smokers" were significantly more likely to be males and to live with smoking family members. Frequency of detectable cotinine both in "nonsmokers" and "active smokers" was significantly correlated with the number of cigarettes smoked by household members. However, for any level of smoking by parents detectable cotinine was more likely to be found in "active smokers" than in "nonsmokers". In "nonsmokers", the proportion of subjects with detectable cotinine decreased significantly in spring compared to winter, a finding not observed in "active smokers". In conclusion, we have demonstrated that passive smoking produces most effect in winter, and is linked to the amount and style of the parents' smoking, mainly related to smoking in presence of children. Conversely, salivary cotinine detected in spring appears to be derived mainly from active smoking.

Adolescent↗
PubMed1994

The effect of paternal smoking on the birthweight of newborns whose mothers did not smoke. Group Health Medical Associates.

We examined the relationship of paternal smoking habits to birthweight in a cohort of infants enrolled at birth (n = 1219). To assess validity of parental smoking reports, cord serum levels of cotinine were measured in 175 newborns. A mean birthweight deficit of 88 g was found in newborns of nonsmoking mothers whose fathers smoked more than 20 cigarettes/day. Only 2 of 138 newborns whose mothers said they were nonsmokers had cotinine levels indicating that their mothers were active smokers. Among infants of nonsmoking mothers, detectability of cotinine in cord blood was significantly correlated with the number of cigarettes smoked daily by fathers. These data suggest that fetal growth may be adversely affected when the mother is passively exposed to tobacco smoke during pregnancy.

Adult↗
PubMed1994

Epidemiology of physician-diagnosed allergic rhinitis in childhood.

OBJECTIVE: To investigate the natural history of and risk factors for allergic rhinitis in the first 6 years of life. METHODS: Parents of 747 healthy children followed from birth completed a questionnaire when the child was 6 years old. Data were obtained regarding physician-diagnosed allergic rhinitis (PDAR), associated symptoms, and age at onset. Risk-factor data were taken from earlier questionnaires, and data regarding immunoglobulin E (IgE) and skin-test reactivity were obtained at age 6. RESULTS: By the age of 6, 42% of children had PDAR. Children whose rhinitis began in the first year of life had more respiratory symptoms at age 6 and were more likely to have a diagnosis of asthma. Early introduction of foods or formula, heavy maternal cigarette smoking in the first year of life, and higher IgE, as well as parental allergic disorders, were associated with early development of rhinitis. Risk factors for PDAR that remained significant in a multivariate model included maternal history of physician-diagnosed allergy (odds ratio: 2.2, 95% confidence interval: 1.35-3.54), asthma in the child (4.06, 2.06-7.99), and IgE greater than 100 IU/mL at age 6 (1.93, 1.18-3.17). The odds for atopic as opposed to nonatopic PDAR were significantly higher only among those with high IgE and those who had dogs. CONCLUSION: Allergic rhinitis developing in the first years of life is an early manifestation of an atopic predisposition, which may be triggered by early environmental mental exposures.

Age of Onset↗
PubMed1994

Evidence for Mendelian inheritance of serum IgE levels in Hispanic and non-Hispanic white families.

Considerable evidence is available suggesting a significant genetic component in the pathogenesis of asthma, but the mechanism of inheritance is not well understood. The main objective of this study was to assess if total serum IgE level, a known intermediate phenotype for asthma, is under the control of a major autosomal gene. We studied nuclear families participating in the Tucson Children's Respiratory Study in Tucson and originally selected because they belonged to a health maintenance organization. One hundred twenty-five Hispanic and 673 non-Hispanic White nuclear families were eligible; 50 Hispanic families (with 191 subjects) and 241 non-Hispanic White families (with 886 subjects) were included. Prevalence of asthma, hay fever, and parental smoking was similar among eligible families who were included and those who were not. Segregation analyses using regressive models for continuous traits showed that the best fit to the data was given by a model of Mendelian codominant inheritance of a major autosomal gene associated with higher serum IgE level. Log-likelihood for this model was not significantly different from that of the best-fitting ("unrestricted") model (P = .3) and was significantly better than log-likelihood for a dominant model (P < .0001) and a recessive model (P < .0001). An environmental model showed significant departure (P < .0001) from the unrestricted model. Tests for genetic heterogeneity showed no significant difference between the two ethnic groups. The data strongly suggest that total serum IgE levels are controlled by a major autosomal codominant gene.

Arizona↗
PubMed1993

Prematurity as a risk factor for asthma in preadolescent children.

Information on long-term respiratory symptoms in prematurely born children is scanty. We studied an unselected population of 9- to 11-year-old schoolchildren. A self-administered questionnaire was distributed to the parents. Children underwent lung function testing, cold air challenge, and skin prick tests. A gestational age < 37 weeks in children with a birth weight < or = 2500 gm was reported by 5% of the parents. Premature girls had significantly more current asthma (odds ratio (OR) 2.6; 95% confidence interval (CI) 1.4, 4.7; p < 0.05), recurrent wheezing (OR 1.7; 95% CI 1.1, 2.7; p < 0.001), recurrent shortness of breath (OR 2.4; 95% CI 1.5, 3.9; p < 0.001), and frequent cough with exercise (OR 1.8; 95% CI 1.1, 2.9; p < 0.05) than term girls, especially if they required mechanical ventilation after birth. No such differences could be shown in boys. More prematurely born children who required mechanical ventilation (OR 3.7; 95% CI 2.2, 6.4; p < 0.0001) had a family history of asthma than children born at term. Significant decrements could be demonstrated for different measurements of lung function in premature girls. These results remained significant after control for confounders in a multivariate regression analysis. No difference was found between groups for bronchial hyperresponsiveness to cold, dry air or for atopic sensitization. We conclude that a family history of asthma may predispose premature children to more severe respiratory disease. Respiratory symptoms and decrements in lung function seen in girls may reflect abnormalities of lung function in survivors of severe neonatal respiratory disease.

Asthma↗
PubMed1993

An alternative method for comparing and describing methacholine response curves.

Tests of nonspecific airway hyperresponsiveness are frequently used in the study of asthma both in the clinical settings and in epidemiologic studies. However, standard methods for characterizing individual tests and comparing results between subgroups have not been established. The most frequently used method of characterizing response curves is to report the dose that results in a 20% fall in FEV1 from the initial or baseline FEV1 value (PD20FEV1). Other investigators have suggested using the response slopes. In this study we demonstrate an alternative method of analysis that uses all of each subject's response data, makes comparisons between subgroups, and can include explanatory covariables. This approach is demonstrated using methacholine challenge data obtained in New Zealand children at 9 and 11 yr of age. The results showed significant differences between the mean dose-response curves of wheezers and nonwheezers, that responsiveness increased with the frequency of reported wheeze, and that initial pulmonary function and serum IgE are significantly related to responsiveness. These factors were not always significant using more traditional methods of analysis, indicating an increased sensitivity with this method of analysis.

Adolescent↗
PubMed1993

Exclusive breast-feeding for at least 4 months protects against otitis media.

OBJECTIVE: This study was designed to assess the relation of exclusive breast-feeding, independent of recognized risk factors, to acute and recurrent otitis media in the first 12 months of life. METHODS: Records of 1220 infants who used a health maintenance organization and who were followed during their first year of life as part of the Tucson Children's Respiratory Study were reviewed. Detailed prospective information about the duration and exclusiveness of breast-feeding was obtained, as was information relative to potential risk factors (socioeconomic status, gender, number of siblings, use of day care, maternal smoking, and family history of allergy). Acute otitis media and recurrent otitis media, defined as three or more episodes of acute otitis media in a 6-month period or four episodes in 12 months, were the outcome variables. RESULTS: Of the 1013 infants followed for their entire first year, 476 (47%) had at least one episode of otitis and 169 (17%) had recurrent otitis media. Infants exclusively breast-fed for 4 or more months had half the mean number of acute otitis media episodes as did those not breastfed at all and 40% less than those infants whose diets were supplemented with other foods prior to 4 months. The recurrent otitis media rate in infants exclusively breast-fed for 6 months or more was 10% and was 20.5% in those infants who breast-fed for less than 4 months. This protection was independent of the risk factors considered. CONCLUSION: These findings suggest that exclusive breast-feeding of 4 or more months protected infants from single and recurrent episodes of otitis media.

Acute Disease↗
PubMed1993

Child day care, smoking by caregivers, and lower respiratory tract illness in the first 3 years of life. Group Health Medical Associates.

BACKGROUND: Day-care attendance has been associated with an increased risk of hospitalization for lower respiratory tract illnesses (LRIs). This study examines, in a health maintenance organization population of children, the associations between child day care and the occurrence of LRIs in the first 3 years of life. Smoking by caregivers and a possible protective effect of longer day-care enrollment in relation to LRIs are also addressed. METHODS: Information on day-care arrangements was elicited from 1006 parents of infants for five age intervals in the first 3 years of life: birth through 3 months, 4 to 6 months, 6 to 12 months, 1 to 2 years, and 2 to 3 years. Data on LRIs in the first 3 years of life were recorded by pediatricians at the time of the acute illnesses. RESULTS: After controlling for other risk factors, the presence of three or more unrelated children in the care setting was associated with significant risks of LRI of up to twofold or more from 4 months of age to 3 years. Type of care setting was not a significant risk factor during this time period. In the third year of life, the risk of wheezing LRI in the presence of a smoking caregiver was more than threefold for those in another residential home setting. No significant protective effect against LRIs in the third year of life associated with longer prior day-care enrollment was demonstrated. CONCLUSION: The presence of three or more unrelated children in the care setting and the presence of a smoking caregiver were significant independent risk factors for LRIs during the first 3 years of life. Prolonged day-care did not protect against LRIs in the third year of life.

Caregivers↗
PubMed1992

Maternal age as a risk factor for wheezing lower respiratory illnesses in the first year of life.

Postneonatal mortality due to respiratory illnesses is known to be inversely related to maternal age, but the possible role of young motherhood as a risk factor for respiratory morbidity in infants has not been thoroughly explored. The authors studied the incidence of lower respiratory tract illnesses during the first year of life, as ascertained by health plan pediatricians, in over 1,200 infants enrolled at birth between 1980 and 1984 in Tucson, Arizona. The incidence of wheezing lower respiratory tract illnesses increased significantly (p = 0.005) with decreasing maternal age, whereas the incidence of nonwheezing lower respiratory tract illness was independent of maternal age. A logistic regression was used to control for the effects of several known confounding factors. When compared with infants of mothers aged more than 30 years, adjusted odds ratios were 2.4 (95% confidence interval 1.8-3.1) for infants whose mothers were less than age 21 years (p < 0.0001), 1.8 (95% confidence interval 1.4-2.3) for infants whose mothers were aged 21-25 (p < 0.0001); and 1.4 (95% confidence interval 1.1-1.6) for infants whose mothers were aged 26-30 (p < 0.001). These results suggest that young motherhood is an important risk factor for wheezing lower respiratory tract illnesses during the first year of life. Both biological and social factors related to maternal age may explain these findings.

Adult↗
PubMed1992

Risk factors for developing wheezing and asthma in childhood.

Wheezing lower respiratory tract illness in infancy and asthma share the clinical findings of wheezing and respiratory distress. Although the link between wheezing lower respiratory tract illness in infancy and the subsequent development of asthma is a limited one, both conditions do share some common risk factors, including exposure to environmental tobacco smoke, difficult living conditions (low socioeconomic class, crowding, allergen exposure), and increased risk in males. The impact of baseline lung function on wheezing lower respiratory tract illness risk is substantial and may be independent of airway reactivity. In contrast, the development of chronic airway inflammation mediated by allergic sensitization plays a central role in the development of persistent asthma. Although the endogenous risks for these two outcomes may be fixed, it is clear that caregivers may help to reduce or eliminate the exogenous risks listed earlier by parental education and improvement of the living conditions of young children.

Asthma↗