James+Gern+et+al.+(2009)

=Annotation=

James Gern et al (2009) "The Urban Environment and Childhood Asthma (URECA) Birth Cohort Study: Design, Methods, and Study Population," //BMC Pulmonary Medicine// 9:17.


 * CostelloeKuehnBrandon:

(in progress, at note-taking stage)

Annotation Template for Scientific Articles and Interviews: 1. Who is writing/speaking and what is their expertise? Where does the author/speaker work and what is their organizational position? What prepared the author/speaker to occupy this position? There are 14 authors listed and they are spread out geographically all over the U.S.: Madison, Chapel Hill, Bethesda, Baltimore, St. Louis, Boston, NYC. Most are at Schools of Medicine. One at "Rho Federal Systems Division, and one from the National Institute of Allergy and Infectious Diseases. James E Gern is the only "corresponding author," what does this mean?

2. What topics and questions does the article/interview address? Does the author/speaker refer to related studies? "The incidence and morbidity of wheezing illnesses and childhood asthma is especially high in poor urban areas" (This is a Substantive Logic of the study). "This paper describes the study design, methods, and population of the Urban Environment and Childhood Asthma (URECA) study, which was established to investigate the immunologic causes of asthma among inner-city children (The parts of the paper that focus on study design and methods outline the Design Logics for this study).

3. What methods and tools are used for the analysis? The study enrolled "pregnant women in central urban areas of Baltimore, Boston, NYC, and St. Louis and is following their offspring from birth through age 7 years. The birth cohort consists of 560 inner-city children who have at least one parent with an allergic disease or asthma, and all families live in areas in which at least 20% of the population has incomes below the poverty line... 49 inner-city children with no parental history of allergies or asthma were enrolled... To track immune development, cytokine responses of blood mononuclear cells stimulated //ex vivo// are measured at birth and then annually. Environmental assessments include allergen and endotoxin levels in house dust, pre- and postnatal maternal stress, and indoor air nicotine and nitrogen dioxide. Nasal mucous samples are collected from the children during respiratory illnesses and analyzed for respiratory viruses. The complex interactions between environmental exposures and immune development will be assessed with respect to recurrent wheeze at age 3 years and asthma at age 7 years."

4. What data is produced and used?

5. What are the primary findings? "The primary hypothesis is that specific urban exposures in early life promote a unique pattern of immune development (impaired antiviral and increased Th2 responses) that increases the risk of recurrent wheezing and allergic sensitization in early childhood, and of asthma by age 7 years.

6. What quotes usefully articulate the author/speaker’s key points and contributions? "the overall goal of the URECA study is to develop a better understanding of how specific urban exposures affect immune development to promote wheezing illnesses and asthma"

7. What are the implications of the findings?

8. What economic, political, cultural, or scientific trends or factors seem to have shaped the author/speaker’s orientation?

9. What about the article/interview illustrates the expertise and bias the author/speaker brings to their work?

10. How can the article/interview contribute to our research group’s shared questions? **

The article //The Urban Environment and Childhood Asthma (URECA) birth cohort study: design, methods, and study population//, was written by several authors in a fairly objective format. The paper is for the most part scientific and does a good job of excluding anything that is purely an opinion. The combined authors bring a wealth of knowledge to the article, the article it is difficult to comprehend at times, simply because the article is written in such a scientific matter. The article does a good job of detailing the processes that were followed for their research. The article certainly addresses factors that can lead to an increased risk of having allergies or atopic diseases. The researchers use both case study techniques as well as a large scale experiment to collect data that will support their hypothesis. They do a good job of eliminating potential participants that do not or will not meet all of the criteria specified by the experiment. This quote provided in the background paragraph clearly illustrates why asthma is such a big problem and gives a reason why this experiment is being conducted: With 22 million current asthmatics in the U.S., including 6.5 million children, asthma is a significant public health problem [1]. The problem is even more significant among children and adults living in the inner city, where asthma prevalence, morbidity, and mortality rates are much higher than overall U.S. rates [2-4]. Many inner-city populations are characterized by low socioeconomic status (SES), and indicators of low SES, such as low family income, low education level, and residence in a high poverty area, are associated with an increased asthma prevalence URECA’s conclusion is that a number of environmental and other factors are increased in the inner city and these factors are known to be injurious to lung health in early childhood. URECA’s hypothesis is that unique environmental exposures in the inner city interact with genetic factors during the prenatal and postnatal periods to adversely influence the development of the innate and adaptive immune systems, increasing the risk for allergic sensitization and atopic diseases. The problem with this hypothesis is that the group really goes out of its way to find women who will have the highest chance of bearing children with allergies and atopic diseases. They enroll mostly minority women who are unmarried, extremely poor, live in urban areas, and smoke. Their control group is less than one tenth the size of the test group. For these reasons the researchers are doing themselves a great disservice and allowing biased data to skew their results. Obviously if you enroll only the highest risk people you will find that their children will contract illness. While the group is making a step in the right direction it seems that they would do better to focus their efforts in other areas to make a more significant impact on allergies and atopic diseases.
 * CroninAndrew:**

1. People Who Wrote: Researchers, Doctors, People associated with University Research, all MDs, all housed in medical schools (University of Wisconsin), American board of allergy and immunology (pharmaceutical approach), What kind of degree?, What do they know how to do/focus on?
 * CullumMichelle:

2. Did not know of any other outside studies that worked on what they did. Gave number of birth cohort studies in Europe but not in U.S. Put along side other birth cohort studies with a specialty of low income, urban people and urban conditions affect immune systems. 90% had allergy or asthma in their parents. Small groups (not control) that didn't have asthmatic parents. Compared to national norms. What is considered national norms? Are there things that you can do to reduce asthma triggers? Gas heating--high knox levels--also from cigarette smoke. Shared exposures or genetic link?

3. How did they do it? Track children over 7 years.

4. What kind of data is used? Above.

5. What will it find? Venting cooking stoves. Need study for politics to get something done, far more likely to treat the wealthy if they were the ones sick. Establish the fact that lower income situations and problems are detrimental to children and lung health. Expose a greater problem and show greater disparities. How to do you move out to a broader public? Mode of communication, accessibility does not rule out mode of complexity.Appeal to specific groups of people who are key players in treating/caring for asthma and alter each communication and content appropriately. Put stress is biomedical apparatus--take into account how lifestyles affect health. Clinton administration-children as key players in public health. Environmental policy-30 year old or 6 year old who all tolerate toxins in different ways? Bias built in-thinking these big cohort studies with give you something to work with to help change the picture of asthma.

6. One of our shared questions, what kind of research is done is NY State. Big epi studies done in NY--many more epi studies per person than nearly any other state. Running list of all the studies out there for NY.

DasDoug:

FortunKim:

KennerAli:

MarkowitzKathryn:

RichmanAlexander:**

The Researchers were from New Your Sate medical universities. What makes this interesting is that all of the researchers held a medical degree. This article is focused on a study of babies from birth to seven years of age. The Article addresses the issue of babies that are brought up in an urban environment and the challenges that the environment and underlining problems that a parent pose on the baby. At least one of the parents in the study was allergic to something. This study is focused on tracking these kids and how their immune system was responding. Since this article is focused in an urban environment there are so many causes that can affect a kid’s immune system that it is almost impossible to tell what the major under lying cause is. Sure the article states that social economical status is one of the main causes but it could also be the manufacturing firm that is making billions of dollars and releasing something into the year that the study is unaware of The method that was used was the scientific process. There were two hypothesis “First, unique environmental exposures in the inner city interact with genetic factors during the prenatal and postnatal periods to adversely influence the development of the innate and adaptive immune systems, increasing the risk for allergic sensitization and atopic diseases. Second, immune dysregulation in infancy increases the risk of developing lower respiratory infections caused by viruses and perhaps atypical bacteria.” (2)

An Interesting quote is that “Children in the URECA cohorts are at increased risk of developing asthma from a number of perspectives. Both minority and low socioeconomic status are associated with an increased risk of asthma, which likely is a consequence of harmful environmental exposures. The risk of asthma is further increased for the allergic families cohort by having at least one parent with allergic disease” (13)

This article is written by a set of researchers holding degrees in Medicine studying at New York universities of medicine. Therefore, this article takes a focus on medicinal and biological causes of asthma in the body as opposed to types of ecological factors like weather patterns, etc... The study focused on low-income urban communities. Subjects of the study were focused on from pregnancy through youth. Certain subjects were removed from the pool of study as they were seen not pertinent to the study. This study referred to as URECA aims to identify the factors that affect recurrent wheezing and asthma in inner-city children. In addition, the study aims to identify environmental factors that impact the "developmental pattern of cytokine responses" and to identify environmental factors that develop "total IgE, allergic sensitization, and atopic dermatitis." The study also tries to identify a possible genetic link that may exist between parents and child. This study is primarily carried out through the methods of blood testing along with extensive surveying of subjects. It was noted that it was very hard to keep track of all subjects because, being low-income, residence is very unstable, and some subjects moved and were lost to poverty. The study produced data that shows the harmful effect of many known chemical factors on the people studies as well as some other interesting social factors. It appears that they have discovered that stress is a large factor in asthma. Stress is very common in low socio-economic neighborhoods, where families don't know if they will have a job tomorrow or be be able to put food on the table the next week. Overprotective parents have seem to also induce asthma. Another common cause of stress and consequently asthma is street violence, which can cause a significant amount of stress. They also concluded that stress induces more smoking, which is a major factor in asthma. Overall, the conclusion of URECA seems to indicate that the inner-city neighborhoods tend to have increased exposure to all of the known factors causing asthma.
 * SchmittWilliam:**

//The Urban Environment and Childhood Asthma birth cohort study// was put together by a team that supervised various parts of the project in various parts of the country. This validates the data found as the information is coming from a variety of reputable sources. This study focused on low-income families living in urban areas. This is important to note since the data found is not proportional to the national percentages of asthma risk factors. The percentages can only be applied to low-income, urban situations. However, the authors did include some assumptions about asthma that could not be proven by this study. “Children in the URECA cohorts are at increased risk of developing asthma from a number of perspectives. Both minority and low socioeconomic status are associated with an increased risk of asthma, which likely is a consequence of harmful environmental exposures” (13). This is likely to be true since those participating in the tests are of the minority which, traditionally (not tested in this process), produces more asthmatics and the low-income factor generally relates to less continuous and/or reliable health care. I do not believe, however, that the authors can fully state that asthma was caused by harmful environmental exposures. Sure it was shown that there was a large presence of asthma inducers in these homes, but there was no comparison to homes of higher-income families or families that lived in different neighborhoods. The tests that were carried out in this experiment were detailed very carefully to validate the accuracy of the data. Overall, the article was successful in this regard. There were only a few problems I see with the tests performed. One was with the testing of airborne chemicals. The tests only obtained information on known asthma inducing chemicals. While there is not necessarily a problem with this, it does not test for all possible compounds in the air that could induce asthma. The other problem was the non-testing of the fathers. I understand that they were not tested to eliminate another variable; however, some of the infants were chosen based on the fact that the father had asthma, hay fever, or eczema. In those cases I do not feel that it makes sense to only test the mother and child. If the father was the one with the history of asthma, I feel that at least some participation on his part should have been required. When it came to talking about the results of the test, it was said that the participants only received some of the medical results. If the participants do not have access to the information on their home environment compared to others, how is it possible to make changes to lessen the chances of problems occurring?
 * SpartzJennifer:**


 * SullivanPatrick:

WattersKevin**:

1. Who is writing/speaking and what is their expertise? Where does the author/speaker work and what is their organizational position? What prepared the author/speaker to occupy this position?

There are 14 authors listed and they are spread out geographically all over the U.S.: Madison, Chapel Hill, Bethesda, Baltimore, St. Louis, Boston, NYC. Most are at Schools of Medicine. One at "Rho Federal Systems Division, and one from the National Institute of Allergy and Infectious Diseases. James E Gern is the only "corresponding author," what does this mean?

2. What topics and questions does the article/interview address? Does the author/speaker refer to related studies?

They address the topics of asthma as it relates to people of lower income living in urban settings. They raised questions, through analysis of the study performed, that dealt with 3 variables: the mother, the fetus, and the environment around them. The questions raised had to do with the relationships between these 3 variables at different stages of life. Did the mother have asthma? -if the child has asthma does that mean there could be a genetic link? These questions would then be compared to women who lived with the same environmental conditions but did not have a predisposition to asthma themselves. -if the child does have asthma, that may correlate the cause to more environmental reasons than genetic (in this instance).

The only instance when the author mentions another study is when the absence of other studies, thus far, was mentioned.

3. What methods and tools are used for the analysis?

The methods and tools used for analysis rely heavily on blood cultures and survey questions, both administered at predestined times.

4. What data is produced and used?

The data produced and used depends on the adherence of the patient to the criteria set fourth by the scientists performing the study. As seen, this study required a large pool of applicants to account for the illegible patients due to an assortment of reasons listed in the study.

5. What are the primary findings?

The findings seemed typical to what I would have thought the range and severity would be for low income residents of an urban environment. I did however find it interesting that for the study in many cases the newborns were accepted based on just the maternal medical history. Why not the father too? I also wondered if in a study where they are looking at the possibility of genetic linkage, why do they not go into detail of the relationship between mother and father. For instance, if a Black Mother and a Hispanic Father make a child, you are left with a Black Hispanic Son or Daughter, could the mixing of race somehow be a cure, if it was genetically linked.

6. What quotes usefully articulate the author/speaker’s key points and contributions?

"The URECA study is uniquely poised to add new information about how environmental exposures and lifestyles that are specific to children in low-income areas of the inner city affect immunological development and the risk of developing recurrent wheezing and ultimately asthma".

This quote sums up the study and the views I believe the scientists to have.

7. What are the implications of the findings?

The implications of the findings show that many children from low income inner cities are susceptible to asthma. I think there should be research done to upper class children who live in the city to contrast with another economic group for the urban environment, but I also think they should study the asthma rates of low income rural residents and upper class rural residents. I believe this additional data juxtaposed against each other would allow for a much clearer picture about asthma, I believe their study is too small to full understand asthma. I believe this data is one puzzle piece, but that's it.

8. What economic, political, cultural, or scientific trends or factors seem to have shaped the author/speaker’s orientation?


 * Her personal reasons for doing a study like this?**

9. What about the article/interview illustrates the expertise and bias the author/speaker brings to their work?

I believe exclusion of some data or questions is what makes the study biased. There should have been more questions asked (these questions may have been answered by other inclusions into the study itself).

10. How can the article/interview contribute to our research group’s shared questions?

I believe this article can help contribute to the groups shared questions because of the different worlds we all most likely grew up in. Most of us being from middle-upper class families lived much different than those of the study.