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RESPIRATORY HEALTH IN NORTHERN EUROPE The RHINE study group is a network created by the scientists from Iceland, Norway, Sweden, Denmark and Estonia who are involved in the European Community Respiratory Health Survey (ECRHS). The ECRHS I study was conducted in 1990 to 1994 in order to estimate the variation in the prevalence of asthma and allergy in young adults in Europe and other parts of the world (1). Secondary aims were to estimate variations in exposure to risk factors for asthma: to measure their association with asthma and to estimate the variation in treatment practice for asthma in the International community. The prevalence of asthma in young adults (20-44 years) in different parts of the world:
Analyses of risk factors have highlighted the importance of occupational exposure and allergy against indoor allergens (mite and cat). Analysis of treatment practices has confirmed that the treatment of asthma varies widely between countries and that asthma is often undertreated.
The Respiratory Health in Northern Europe (RHINE) is a follow-up study of participants from seven Northern European centres who participated in European Community Respiratory Health Survey (ECRHS) stage I. The target population for the RHINE study were all subjects (n=21,802) from Reykjavik in Iceland, Bergen in Norway, Umeå, Uppsala and Göteborg in Sweden, Aarhus in Denmark and Tartu in Estonia that participated in stage 1 of the ECRHS (response rate 83.7%). The eligible subjects were sent a postal questionnaire in 1999-2001. In total 16,191 (74.3%) subjects answered the questionnaire.This questionnaire includes questions on respiratory symptoms, asthma, rhinitis, bronchitis, smoking, indoor environment, occupation, early life exposure and sleep disorders. The aims of the RHINE study are: 1. To assess the incidence and remission rate of asthma and allergic rhinitis and to determine risk factors in a representative Nordic population sample. 2. To assess the influence of occupational and home related environmental exposure on the development of asthma and allergic rhinitis in Northern Europe. 3. To investigate the association between the menstrual cycle and asthmatic symptoms in women. 4. To assess the incidence and
remission of sleep disturbances and determine risk factors including atopy
and asthma. ECRHS II The ECRHS II is a follow-up survey of subjects from 14 countries who participated in the clinical phase of ECRHS I (3,4). The study is funded by the European Commission, as well as other sources of funding, as part of their Quality of Life Programme.The participants answered a detailed structured interview about symptoms, exposure to known or suspected risk factors for asthma, occupation and health service utilisation. Blood was taken for measurement of specific IgE to house dust mite, grass, cat and Cladosporium and DNA extraction (not all centres). Spirometry and methacholine challenge was performed. Health related quality of life was assessed by self completed questionnaires: SF-36 and AQLQ. In a sub-sample home visits were made to measure exposure to house dust mites and cat allergens. Throughout the study outdoor exposure to PM2.5, PM10 and NO2 was measured in the centres participating in the study. The aims of the ECRHS II study are: 1. To determine the incidence and prognosis of asthma and allergy in adults.
In the centres in the Northern European countries (Iceland, Norway, Sweden and Estonia) participating in the ECRHS II participants are also asked to fill in a sleep questionnaire, a questionnaire on symptoms of anxiety and depression (HAD) and a questionnaire on symptoms related to the sick building syndrome.
The RHINE III is a questionnaire based survey of participants from RHINE II. The protocol is again almost the same as in RHINE II but with some additions:
References 1. Burney PG, Luczynska C, Chinn S, Jarvis D. The European Community Respiratory Health Survey. Eur Respir J 1994: 7: 954-960. 2. Janson C , Anto J, Burney P, Chinn S, de Marco R, Heinrich J, Jarvis D, Kuenzli N,Leynaert B, Luczynska C, Neukirch F, Svanes C, Sunyer J, Wjst M The European Community Respiratory Health Survey (ECRHS) so far: what are the main results? Eur Respir J 2001; 18: 598-611. 3. The European Community Respiratory Health Survey Steering Committee. The European Community Respiratory Health Survey II. Eur Respir J 2002; 20: 1071–1079. 4. ECRHS, European Community Respiratory Health Survey.http://www.ecrhs.org 5. Johannessen A, Verlato G, Benediktsdottir B, Forsberg B, Franklin K, Gislason T, Holm M, Janson C, Jögi R, Lindberg E, Macsali F, Omenaas E, Gomez Real F, Waatevik Saure E, Schlünssen V, Sigsgaard T, Duelien Skorge T, Svanes C, Torén K, Waatevik M, Miodini Nilsen R, de Marco R. Longterm follow-up in European respiratory health studies – patterns and implications. BMC Pulm Med 2014;14:63. 6. Timm S, Svanes C, Janson C, Sigsgaard T, Johannessen A, Gislason T, Jogi R, Omenaas ER, Forsberg B, Toren K, Holm M, Bråbäck L, Schlünssen V. Place of upbringing in early childhood as related to inflammatory bowel diseases in adulthood - a population-based cohort study in Northern Europe. Eur J Epidemiol 2014; 29:429-437.
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