Odense Child Cohort (Odense Børnekohorte) a project on children s health
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1 Odense Child Cohort (Odense Børnekohorte) a project on children s health 1
2 List of contents Odense Child Cohort (Odense Børnekohorte) a project on children s health... 1 List of contents... 2 Project details... 3 Sum mary What will we do?... 4 Why should we do it?... 4 APPENDIX
3 Project details Applicant: Municipality of Odense, Child and Youth Department Odense University Hospital, Hans Christian Andersen Children's Hospital, Paediatric Research Unit On behalf of Odense Child Cohort study (Odense Børnekohorte): Professor Steffen Husby Dept. of Paediatrics, Odense University Hospital DK 5000 Odense C, Denmark Ph.: E mail: Steffen.Husby@ouh.regionsyddamark.dk (w) steffen.husby@dadlnet.dk (h) Purpose: To obtain new knowledge about child health, diseases and the prevention of certain diseases. Location: The project takes place in Odense Duration: Project start Preliminary finish date: Budget: : Total DKK The project has received a grant for purchase of equipment from K.A. Rohde and Wife's Foundation and Ronald McDonald Child Foundation. Further funds have been provided by the Municipality of Odense, Region of Southern Denmark, Odense Patient Data Exploratory Network (OPEN) and Odense University Hospital (OUH). 3
4 Summary Odense Child Cohort (Odense Børnekohorte) a project on children s health What will we do? The project entitled "Odense Child Cohort" will track 4000 children as a cohort from fetus to the age of 18 years. A cohort study implies tracking a certain group of people, in this case, children over a period of time. All women residing in the Municipality of Odense, who are pregnant within the period between 1 January 2010 and 30 July 2012, are invited to participate in the project. The project aims to provide new knowledge about child health and diseases, and to obtain information on which prevention of certain diseases in children can be based. Even though most children thrive, the childhood of some is characterised by disease and an unhealthy lifestyle. This project will provide new knowledge and, thus, benefit children in the future both in Denmark and abroad. The Odense Child Cohort study is the combined initiative of the Municipality of Odense, Odense University Hospital (OUH) and the Region of Southern Denmark. What is our purpose? The aim is to use two future birth cohorts to determine the social, environmental and hereditary factors which either promote health or otherwise cause failure to thrive, and somatic and mental disease, i.e.: 1. To acquire accurate, validated pointers for already known risk factors for lifestyle diseases that can be used specifically for intervention and prevention 2. To explore and determine factors in the physical, chemical, psychological and social environment resulting in subsequent failure to thrive and disease 3. To disseminate the knowledge gained, so it can be applied throughout society in general. Why should we do it? A child cohort study is necessary for the early detection of families at risk, so that preventive efforts and health measures can be initiated. With regard to children and adolescents with risk behavioural patterns, some degree of conformity has been observed between children with caries and children with obesity. The Odense Child Cohort study differs from other research projects in that it is the collaborative effort of the municipality, the university hospital and the region. This allows for easier application of research results into practical preventive measures at the municipal level. Linking social data with physical examinations/tests, can also elucidate less studied 4
5 health areas. In particular, the cohort survey will enhance the social data obtained by the health visitors during the child's first year of life. As one of the nation's largest hospitals, OUH can provide other benefits. For instance, OUH has launched a register (Odense Patient Data Exploratory Network (OPEN)) for the collection of data and biological materials from a variety of departments and research units. The coordination of the two databases (OPEN and Odense Child Cohort) will eventually have an invaluable synergic effect. In this way, the Odense Child Cohort study will be able to benefit research activities and provide guidance for the local council's work with children, adolescents and families, both now and in the future. The population of Odense includes about 10% of people with other ethnic backgrounds. This allows the project to identify predictors, such as obesity and language development, within ethnic groups and thus optimize preventive interventions among these. This is an area which has been inadequately studied previously due, among other things, to the difficulty in recruiting participants from other ethnic groups. How are we doing it? Data will be collected from two cohorts pregnancies and births in the Municipality of Odense, corresponding to approximately 4000 babies born to a similar number of families. The pregnancy cohort study will collect information on social status (education, age, ethnicity, housing conditions, number of siblings), maternal physical data and lifestyle (weight, height, pregnancy weight, IVF, medications, diabetes and other illness), paternal data and lifestyle (age, work, smoking, alcohol, drugs) and other factors, (e.g. sun exposure, pollutants), as well as blood and hair samples from both parents. During the birth of the child, we will collect biological material (umbilical cord blood and tissue) in order to elucidate hereditary factors, immunological factors and environmental pollutants and vitamin status (especially vitamin D) of both mother and child. Subsequently, the child will be followed for 18 years, during which information on length of breast feeding, growth, development, diseases, immunizations, mental wellbeing, dental status, diet, educational courses, sports and leisure activities, etc., will be gathered and compared with data from child health checks and blood tests. Expected results 1) Detection of children at risk in terms of exercise, diet, alcohol, smoking especially with a view to preventive measures 2) Causality between biological and chemical substances, diseases and lifestyle 3) Detection of specific health problems in children from various ethnic groups (at birth and during the first year of life) and determination of the causes (pregnancy related diabetes, social conditions, vitamin D) 4) Elucidation of the relationship between infections in childhood and the special circumstances related to pregnancy, childbirth, social and environmental conditions 5
6 APPENDIX 1 Overview of the sub projects It is expected that, during the 18 years of continuous tracking, further projects will be added for the cohort study but, for the present, eleven sub projects have been included. Additional projects will need to be approved by the Regional Ethical Committee. The protocols detailing the additional sub projects can be obtained from the cohort secretariat. The sub projects are listed below in random order. Project 1: Vitamin D Vitamin D status in pregnancy and the first year of life will be examined in order to establish the importance of Vitamin D for overall health, especially in a wide range of frequentlyoccurring diseases (incidence of preeclampsia, prematurity, decreased bone mineralization in preterm infants, viral and bacterial infections, asthmatic bronchitis and allergic diseases). Furthermore, the importance of vitamin D for autoimmune diseases, metabolic diseases and cancer will eventually be investigated. Responsible: Dr Henrik Thybo Christensen, Ph.D., Dept. of Paediatrics, Hans Christian Andersen Children s Hospital, Odense University Hospital. Project 2: Infections in infancy (0 3 years of age) Care in day care establishments and kindergartens is associated with a high risk of infection, increased consumption of medicine, and hospitalization in the first year of life. In a collaboratory effort between general practitioners and the hospital, the contributory factors to this high risk will be examined as well as the part played by family size, living conditions and habits. Furthermore, this project will examine the incidence of upper respiratory tract and intestinal infections that occur in the population without necessarily leading to hospitalization. Responsible: Niels Fisker, Ph.D., Senior Registrar, and Dr Arne Høst, Chief Consultant, Dept. of Paediatrics, Hans Christian Andersen Children's Hospital, Odense University Hospital. Project 3: Development of language among Danish children Development of language is one of the most apparent, most important and most exciting processes in childhood and is closely linked to children's general and particularly cognitive development. Investigations include monitoring the differences in language development among disadvantaged children and children with an immigrant background. A general 6
7 comparison of late language development and literacy and educational success will be made. Responsible: Associate Professor Dorthe Bleses, Ph.D., Head, Centre for Child Language, University of Southern Denmark. Project 4: Fetal factors in the development of polycystic ovary syndrome (PCOS) Polycystic ovary syndrome (PCOS) is the most common hormonal disorder among women of childbearing age, where it is seen in 5 8%. PCOS is a heterogeneous condition where the most common symptoms are increased male hair growth, irregular menstruation and infertility. Several studies have shown that women with PCOS have often been small from birth and have gone into early puberty. This project will investigate which factors occurring in pregnancy and early childhood may increase the risk of developing PCOS. Responsible: Dr Dorte Glintborg, Ph.D., and Dr Marianne Andersen, Ph.D., Department of Endocrinology M, Odense University Hospital Project 5: Early exposure to chemicals with endocrine disrupting potential and subsequent obesity and allergy development The importance of exposure to environmental toxins (heavy metals, phthalates, endocrine disruptors) during fetal and early life and subsequent vaccination response, obesity and allergy development will be highlighted. Data obtained from pregnancy, childbirth and the first years of life, including biological material (blood samples from parents, placenta, umbilical cord blood, blood samples from the child) will be explored. Responsible: Professor Philippe Grandjean, Ph.D., Tina Kold Jensen, Centre for Environmental Medicine, University of Southern Denmark, and Dr Arne Høst, Chief Consultant, Dept. of Paediatrics, Hans Christian Andersen Children s Hospital, Odense University Hospital. Project 6: The prevalence and causes of motor uncertainty in one year olds A motor test will be carried out on a selected group of children (1200 children) at one year of age. The test should detect the spread of motor uncertainty (Developmental Coordination Disorder, DCD) and help to elucidate the reasons. Responsible: Vibeke Grandt, M.Sc., Physiotherapist, Children and Youth Department, Municipality of Odense. Main supervisor: Karsten Froberg, Associate Professor, RICH, University of Southern Denmark. 7
8 Project 7: Ethnic differences in use of antenatal care/prenatal diagnosis Investigations into the use of antenatal care among men and women of other ethnic origin than Danish will be carried out by questioning pregnant women. The possible correlation between delayed antenatal care, including late gestational age at first visit to doctor, and a negative birth outcome, will be investigated. Responsible: Grete Skøtt Pedersen, M.Sc., Ph.D. student, Department of Public Health, University of Southern Denmark Main supervisor: Professor Anne Marie Nybo Andersen, Department of Public Health, University of Copenhagen Project 8: The significance of epigenetics for the link between conditions early in life and health late in life Restricted growth in the uterus and in the first years of life is linked with health late in life. The reason for this is unknown. The aim of this study is to investigate whether changes in genetic make up are the reason for the connection between circumstances early in life and illness and survival late in life. Responsible: Professor Kaare Christensen, Lene Christiansen, Lecturer, and Frans Bødker, Project Coordinator, IST, University of Southern Denmark Project 9: Genetic environmental social interaction in the development of Attention Deficit Hyperactivity Disorder (ADHD) The aim of this project is to identify the risk factors and protective factors involved in the development of ADHD and to characterise early behavioural difficulties and emotional problems that may be present Responsible: Professor Niels Bilenberg, The Child and Youth Psychiatric House, Region of Southern Denmark. Project 10: Breast feeding: The influence of social and biological factors on breast feeding and duration of breast feeding 8
9 The majority of Danish women breast feed their children but it is unsure for how long and to what extent breast milk formula is given. Precise data can be obtained by SMS tracking technology. The aim of the project is to find out to what degree Danish women breast feed, including for how long, and which factors influence its start and finish. Responsible: Dr Gitte Zachariassen, Ph.D., Professor Steffen Husby, Hans Christian Andersen Children s Hospital, Odense University Hospital Project 11: Tracing alcohol consumption during pregnancy and the long term effects of this on mother, child and family The amount of alcohol drunk by Danish women during pregnancy is unknown. The aim of the project is to gain greater knowledge of the consequences of parents alcohol consumption during pregnancy and, based on this information, to determine the minimum level of alcohol intake that will affect the fetus and child. Responsible: Lene Bjerregaard, M.Sc., Ph.D. student, Nurse, Hans Christian Andersen Children s Hospital, Odense University Hospital 9
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