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Children who live in neighborhoods plagued by violence may have a higher risk of asthma than those who grow up in more peaceful surroundings, a new study hints.

Researchers found that among more than 2,000 Chicago children age 9 or younger, those from neighborhoods with moderate to serious problems with violence were about 60 percent more likely to develop asthma in the next few years than children from less violent neighborhoods.

The association was not explained by factors like race, family income, or other neighborhood characteristics, like the overall levels of poverty and unemployment.

This suggests that something about exposure to violence, itself, may influence children’s asthma risk, according to the researchers, led by Dr. Michelle J. Sternthal of the Harvard School of Public Health in Boston.

The findings, published online in the European Respiratory Journal, are based on interviews with parents of 2,071 Chicago children, conducted three times over six years. More than 80 percent were African American or Hispanic.

At the second interview, parents were asked about neighborhood violence — specifically, how many times their child had ever seen someone physically assaulted or attacked with a weapon, or heard a gun shot. At the third interview, parents were asked whether their child had ever been diagnosed with asthma.

Overall, Sternthal’s team found, two-thirds of children in the study had been exposed to at least moderate levels of neighborhood violence, while 19 percent had been diagnosed with asthma.

Asthmatic children were more likely than those without asthma to live in highly violent neighborhoods.

Of children with asthma, 43 percent were from neighborhoods with a high level of violence, according to the researchers. That compared with 32 percent of kids without asthma. And while 36 percent of non-asthmatic kids lived in neighborhoods with little violence, that was true of only 22 percent of children with asthma.

When the researchers considered a range of factors that might explain the connection, neighborhood violence itself remained linked to a higher asthma risk.

It is plausible, according to Sternthal’s team, that exposure to community violence could affect kids’ asthma development. Chronic stress, for example, may affect the nervous and immune systems in a way that increases the risk of inflammatory diseases like asthma.

Neighborhood violence may also affect asthma risk indirectly — if, for example, it harms mothers’ mental well-being and, along with that, their ability to care for their children.

In addition, kids in violent neighborhoods may be unable to go outdoors and get exercise — which could, the researchers say, promote obesity, a risk factor for asthma.

It has long been known that asthma rates are higher-than-average in U.S. inner cities, with factors such as air pollution and indoor allergens believed to play a role. If neighborhood violence is in fact an asthma risk factor, Sternthal and her colleagues write, it could help explain the elevated rates of the disease in urban areas.

It would also mean that experts need to look beyond traditional health-related measures to combat asthma in inner cities, the researchers point out. Efforts to reduce neighborhood violence, they say, could have additional benefits for children’s health.

SOURCE: http://erj.ersjournals.com/cgi/content/abstract/09031936.0000301 0v1

The more obese a woman is when she becomes pregnant, the greater the likelihood that she will give birth to an infant with a congenital heart defect, according to a study conducted by researchers at the National Institutes of Health and the New York state Department of Health.

The researchers found that, on average, obesity increases a woman’s chance of having a baby with a heart defect by around 15 percent. The risk increases with rising obesity. Moderately obese women are 11 percent more likely to have a child with a heart defect, and morbidly obese women are 33 percent more likely.

“The current findings strongly suggest that by losing weight before they become pregnant, obese women may reduce the chances that their infants will be born with heart defects,” said Alan E. Guttmacher, M.D., acting director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the NIH Institute that conducted the study.

Congenital heart defects are the most common type of birth defect, affecting 8 in every 1,000 newborns (http://www.nhlbi.nih.gov/health/dci/Diseases/chd/chd_what.html). These defects consist of a number of problems in the structure of the heart and range from minor to life threatening.

Previous studies have shown that maternal obesity during pregnancy is associated with complications for mothers and infants (http://www.cdc.gov/reproductivehealth/maternalinfanthealth/PregComplications.htm#obesity). Obesity increases the risk for pregnancy-induced hypertension, preeclampsia (a serious form of hypertension during pregnancy), gestational diabetes, and cesarean delivery. Infants born to women who were obese during pregnancy are themselves at increased risk for overweight and type II diabetes later in life. Previous research by NICHD scientists and others has also shown an association between maternal obesity and birth defects, such as neural tube defects — serious malformations of the spinal column. In the United States, 1 in 5 women are obese at the beginning of pregnancy.

The findings were published online in the American Journal of Clinical Nutrition. The study’s first author was James L. Mills, M.D., M.S., at the NICHD’s Division of Epidemiology, Statistics and Prevention Research. Other authors of the study were James Troendle, Mary R. Conley and Tonia Carter, also of the Division of Epidemiology, Statistics and Prevention Research, and Charlotte M. Druschel, of the New York State Congenital Malformations Registry.

“The trend is unmistakable: the more obese a woman is, the more likely she is to have had a child with a heart defect,” Dr. Mills said.

Overall, previous studies on maternal obesity and congenital heart defects were inconclusive, with some suggesting a link and others finding no association.

To conduct the current study, the researchers analyzed data in the New York State Congenital Malformations Registry, a repository of case reports on children born with birth defects in New York state, excluding New York City. Using 1.53 million births that took place in the state over the course of 11 years, the researchers compared the records of mothers of 7,392 of children born with major heart defects to those of more than 56,000 mothers of infants born without birth defects.

The researchers calculated the mothers’ body mass index (BMI), a measure of an individual’s proportion of body fat to her height. A normal BMI is 18.5 to 24.9; overweight is 25 to 29.9 and obese is 30 and above.

The obese mothers were 15 percent more likely than mothers with normal BMI to have children with heart defects. Women classified as morbidly obese — with a BMI of 40 or higher — were 33 percent more likely than women with normal BMI to have children with heart defects.

The risk of heart defects increased sharply at a BMI of 30 and was progressively higher with each increase in BMI.

On average, women who were overweight but not obese had no increased risk. However, the researchers saw the chances of having a child with a congenital heart defect increase for obese women, and increase sharply for morbidly obese women.

The study examined records of infants after they had been born and for this reason it cannot conclusively prove that obese women who lose weight before they conceive will reduce their infants’ risks of heart defects. For conclusive proof, a study would need to enroll obese women who were not yet pregnant, follow those who succeed in losing weight before conceiving, and then determining the frequency of heart defects among the children subsequently born to them. However, until such a study can be conducted, the researchers believe it is reasonable to assume that attaining a healthy weight before conception will reduce the risk for heart defects.

“If a woman is obese, it makes sense for her to try to lose weight before becoming pregnant,” Dr. Mills said. “Not only will weight loss improve her own health and that of her infant, it is likely to have the added benefit of reducing the infant’s risk for heart defects.”

The NICHD sponsors research on development, before and after birth; maternal, child, and family health; reproductive biology and population issues; and medical rehabilitation. For more information, visit the Institute’s Web site at http://www.nichd.nih.gov/.

Adding a second chemotherapy drug to the treatment regimen of people with biliary tract cancer improves their survival odds considerably, according to new research.

This type of cancer — which occurs in the bile duct and gall bladder — is notoriously difficult to treat and often fatal.

“These are uncommon cancers, and the lack of any definitive data to support a regimen has meant that patients have had rather a raw deal, treated with an assortment of regimens and not given the option of clinical trials, as is the case for other, more common cancers,” said Dr. John Bridgewater, senior author of a paper appearing in the April 8 issue of the New England Journal of Medicine.

The treatment verified in the study is already “what many would consider a standard treatment, and we know from informal communications with many colleagues that many across the world, not just in the U.S. or U.K., are already using this as a standard regimen,” added Bridgewater, who is a senior lecturer in medical oncology at the Cancer Institute at the University College London.

Medical professionals have not been sure whether biliary tract cancers responded to chemotherapy at all.

“This establishes that chemotherapy works in this disease and that the combination of two drugs, which are standard, is actually superior to the one drug and, more likely than not, superior to doing nothing,” said Dr. Tanios Bekaii-Saab, medical director of the gastrointestinal oncology division at the Ohio State University Comprehensive Cancer Center.

Although still relatively rare, the incidence of this type of cancer is on the rise, perhaps due to increases in gallstone disease and hepatitis C, the study and an accompanying editorial stated. According to information in the report on the study, about 9,000 new cases of biliary tract cancer are diagnosed in the United States each year.

Because it’s so rare, Bekaii-Saab said, “there really are not a lot of options.” For advanced cancer, it’s different chemotherapy drugs and combinations. Early stage cancer can be removed surgically, he said.

The study involved 410 men and women with locally advanced or metastatic biliary tract cancer — either gallbladder cancer, ampullary cancer (in a part of the intestine into which the pancreatic and bile ducts flow) or cholangiocarcinoma (in the bile ducts).

It took researchers at 37 institutions six years to amass that number of patients, the researchers said.

“Frankly, there’s never been a study like this, meaning a phase 3 study of 400-plus patients looked at in a randomized way,” Bekaii-Saab said.

Participants were randomized to receive either the chemotherapy agent cisplatin followed by gemcitabine or just gemcitabine. All were treated as outpatients.

Up till now, gemcitabine alone has been the mainstay of treatment, according to the editorial.

People in the combination therapy group lived an average of 11.7 months, compared with 8.1 months for those in the gemcitabine-alone group, a difference of 3.6 months.

Recurrences were delayed in the combination group compared with the single-therapy group, and tumor control was also better.

Side effects were about the same in both groups.

“Although, it may seem modest, 3.6 months is a significant benefit,” Bridgewater said. “Many standard regimens have been established with improvements in survival of less than this, and the critical point is that this was achieved without increased toxicity.”

Bekaii-Saab added that, without treatment, people with this type cancer face an average survival of three to four months. “This is tripling the chances of patients surviving this cancer in a stage 4 setting,” he said. “Your life span goes from an average of a short four months to about a year. Also, when the tumor shrinks, you’re feeling better.”

Also, he said, about half will survive a year, and 20 percent up to two years.

“Without any treatment, zero percent will ever survive the two years,” Bekaii-Saab said. “This is a significant improvement.”

For children at higher-than-average risk of asthma, having a dog around the house may increase the chances of developing the lung disease, a new study suggests.

The study, which followed 380 children at increased risk of asthma due to family history, found that those exposed to relatively high levels of dog allergen at the age of 7 were more likely to have asthma.

In contrast, there was no relationship between cat-allergen exposure and a child’s risk of asthma, according to findings published in the journal Pediatric Allergy and Immunology.

Exactly why dogs were related to a higher risk of asthma, while cats were not, is not entirely clear. But one factor may be endotoxin, a substance produced by bacteria that is known to trigger inflammation in the airways, explained lead researcher Dr. Chris Carlsten, of Vancouver General Hospital in British Columbia, Canada.

Carlsten and his colleagues found that children exposed to dog allergen at home were not at increased risk of developing an immune-system sensitization to dog allergen itself. Therefore, greater exposure to endotoxin may at least partly explain the association between having a dog in the home and a child’s risk of asthma.

“Dogs tend to have a lot of endotoxin on them, because they’re dogs,” Carlsten told Reuters Health. In contrast, cats have much less, he said.

So should families with a history of asthma or allergies opt for a kitten over a puppy, or no fluffy pets at all?

“This study doesn’t answer it,” Carlsten said. “And in general, there is not enough evidence to recommend for or against pets.”

He said that for now, his advice to parents is to base the decision on their family’s desire to have a pet, rather than the potential effects on asthma risk.

The findings are based on 380 children who were at increased asthma risk because at least one first-degree relative (meaning a parent, sibling or child) had the lung disease or two or more first-degree relatives had other allergies, such as eczema or hay fever.

The children’s mothers were recruited for the study during pregnancy, and researchers measured the levels of three allergens — cat, dog and dust mite — in the families’ homes, periodically over the child’s first year of life and again when they were 7 years old.

At the outset, roughly half of the families were randomly assigned to an intervention aimed at lowering the child’s risk of developing allergies and asthma. That included encouraging mothers to breastfeed for at least four months, and having parents limit their children’s exposure to dust mites, pets and tobacco smoke.

Carlsten’s team found that exposure to higher levels of dog allergen — at least 2 micrograms per gram of house dust — at age 7 was associated with a nearly three-fold increase in the risk of asthma compared with lesser dog-allergen exposures. But that was only among children in the intervention group; 17 of 97 children exposed to higher levels of dog allergen at home had asthma at age 7.

Neither cat nor dust-mite exposure in infancy or at age 7 was related to the risk of asthma. Children with high dust-mite exposure were, however, more likely to show sensitization — an immune system reaction during skin testing — to dust-mite allergen.

According to Carlsten, the findings underscore the complexity of the relationship between indoor-allergen exposures and children’s asthma risk. More research, he said, is still needed to understand those intricacies.

Because the current study included only children at elevated risk of asthma, it is not clear whether the findings might also apply to children at average risk.

SOURCE: Pediatric Allergy and Immunology.