厦门市同安区儿童哮喘患病情况调查分析

目的 调查2012-2013年厦门市同安区0~14 岁儿童哮喘患病情况及哮喘发病的危险因素, 为今后儿童哮喘的防治工作提供科学依据。方法 通过多阶段分层随机整群抽样方法, 采用2010年第三次全国儿童哮喘流行病学调查问卷, 调查厦门市同安区10 168名0~14岁儿童哮喘患病情况;其次采用1∶1病例对照研究方法和Logistic 回归分析法对哮喘患儿的发病危险因素进行研究。结果 在调查的10 168人中, 哮喘患儿428人, 总患病率为4.21%。男性患病率(5.88%)高于女性(2.28%)(P＜0.001)。哮喘患儿中, 首次发病以3岁内居多占74.76%;发作诱因最常见的为呼吸道感染占85.61%;发作先兆最常见的为打喷嚏占95.20%;经常发作强度以轻度最常见占68.25%;发作类型以突然发作最多占78.50%;好发季节为换季占50.60%;好发时间为夜间和清晨占71.45%。通过对428例哮喘患儿及428例非哮喘儿童的病例对照研究并且经Logistic 回归分析显示, 哮喘发病的独立危险因素包括:个人过敏史、过敏性鼻炎、家族过敏史、家族哮喘史(P＜0.001)。结论 厦门市同安区0~14岁儿童哮喘患病率高于10年前厦门市区哮喘发病率。男性哮喘患病率高于女性。个人过敏史、过敏性鼻炎、家族哮喘史及家族过敏史是该地区儿童哮喘发病的独立危险因素。     

Child Asthma and Change in Elevated Depressive Symptoms Among Mothers of Children of a Birth Cohort from Quebec

The authors examined the association between maternal reports of child asthma attacks since birth and occurrence of elevated maternal depressive symptoms at seventeen months postpartum in the present study. The modifying role of poverty in this association was also examined. Data from n = 1,696 mother–child dyads from the Quebec Longitudinal Study of Child Development, a birth cohort of children born in 1998, were used. Maternal depressive symptoms were measured with an abridged and validated twelve-item version of the Center for Epidemiologic Studies Depression Scale. Maternal reports of child asthma attacks since birth in relation to the occurrence of maternal depressive symptoms at 17 months postpartum and the potential modifying role of poverty were tested using multiple logistic regression models. When mothers reported child asthma attacks, those without elevated depressive symptoms at 5 months postpartum had lower odds of elevated depressive symptoms one year later (OR = 0.2, 95% CI: 0.1–0.7). Poverty was associated with increased odds of elevated maternal depressive symptoms (OR = 2.4, 95% CI: 1.5–3.9), without interacting with child asthma. Through this study, the authors suggest that in mothers without elevated symptoms at 5 months, reported child asthma attacks since birth did not contribute one year later to new occurrence of depressive symptoms.     

Child asthma and change in elevated depressive symptoms among mothers of children of a birth cohort from Quebec

The authors examined the association between maternal reports of child asthma attacks since birth and occurrence of elevated maternal depressive symptoms at seventeen months postpartum in the present study. The modifying role of poverty in this association was also examined. Data from n = 1,696 mother-child dyads from the Quebec Longitudinal Study of Child Development, a birth cohort of children born in 1998, were used. Maternal depressive symptoms were measured with an abridged and validated twelve-item version of the Center for Epidemiologic Studies Depression Scale. Maternal reports of child asthma attacks since birth in relation to the occurrence of maternal depressive symptoms at 17 months postpartum and the potential modifying role of poverty were tested using multiple logistic regression models. When mothers reported child asthma attacks, those without elevated depressive symptoms at 5 months postpartum had lower odds of elevated depressive symptoms one year later (OR = 0.2, 95% CI: 0.1-0.7). Poverty was associated with increased odds of elevated maternal depressive symptoms (OR = 2.4, 95% CI: 1.5-3.9), without interacting with child asthma. Through this study, the authors suggest that in mothers without elevated symptoms at 5 months, reported child asthma attacks since birth did not contribute one year later to new occurrence of depressive symptoms.     

Home-taught pediatric asthma program improves outcomes, cuts hospital, physician visits

Providers, payers breathe easier, reduce per patient costs by at least $11,500 with home-taught pediatric asthma management program. Olsten Kimberly QualityCare reports terrific success in slashing hospital and physician costs by aggressive at-home training for children with asthma. See how registered nurse educators are teaching asthmatic children and their families to reduce the severity of attacks and need for hospital or physician visits.     

贵阳地区400例哮喘患儿病情控制状况及影响因素分析

目的 了解贵阳地区哮喘患儿病情控制现状及影响哮喘控制的因素,为进一步加强儿童哮喘防治工作提供依据。方法 选取在贵州医科大学附属医院儿科哮喘门诊就诊的病程超过12个月的1~14岁哮喘患儿400例,采用回顾性调查的方法对其家长就哮喘控制状况及疾病认知情况进行问卷调查,以患儿近12个月有无哮喘发作为标准将其分为控制组和未控制组,对可能影响哮喘控制的相关因素进行多因素分析。结果 在过去12个月内,72.5%的患儿有过哮喘发作,35.5%的患儿有过因哮喘发作的急诊治疗,17.8%的患儿有过因哮喘发作导致的住院治疗。家庭经济收入、家长学历、家长认知水平、坚持规范用药、坚持定期复诊是哮喘患儿控制的保护因素;个人过敏史、哮喘家族史、被动吸烟史是哮喘患儿控制的危险因素。结论 贵阳地区哮喘患儿病情整体控制状况并不理想,与全国城市平均水平相比还存在一定的差距。家长对疾病的认知水平、治疗依从性及不良环境的接触等因素是影响哮喘控制的主要危险因素,认识并改善影响因素,有助于提高哮喘控制水平。     

Factors conditioning effectiveness of a reminder/recall system to improve influenza vaccination in asthmatic children

In order to verify whether a telephone recall system directly managed by pediatricians who usually follow up children for their asthma is more effective than an anonymous recall system, we randomly assigned 285 asthmatic children (177 males; mean age 10.3 ± 3.4 years) to one of three groups: those whose mothers were to be called by a pediatrician not previously involved in caring for their asthmatic children and who received the vaccine in our immunisation clinic (group 1); those whose mothers were to be called by a pediatrician from our asthma clinic and who received the vaccine in the immunisation clinic (group 2); and those whose mothers were to be called by a pediatrician from our asthma clinic and who received the vaccine in the same clinic (group 3). Our findings highlight that the use of a reminder/recall system increases vaccination rates in asthmatic children, and show that the best results are obtained when the mothers are contacted and the vaccine administered by the pediatricians who usually follow up the child for asthma.     

Asthmatic children's risk factors for emergency room visits, Brazil

OBJECTIVES: To study a sample of asthmatic children to get to know how the disease is managed by caretakers and to identify predictive factors associated with attendance in emergency room for asthma. METHODS: A cross-sectional study nested in a cohort was undertaken in the urban area of Pelotas, Southern Brazil. 981 children aged 4-5 years, who belong to the cohort of 1993, participated in this study. RESULTS: The asthma prevalence in the children sample was 25.4%. Morbidity for asthma was quite high: 31% of the children were seen in emergency rooms in the last year, 57% attended medical clinics and 26% were hospitalized in the first 4 years of life. The crude analysis identified the following predictive factors for emergency room visits: low educational level (RO=4.1), low family income (RO=6. 5), 3 or more children sleeping in the same room (RO=2.2), severity of asthma attacks (RO=2.7), use of asthma medicines in the last year (RO=1.9) and hospitalizations due to asthma (RO=3.0). Multivariate analyses using logistic regression were used to adjust each variable for the effect of the remainder. CONCLUSIONS: The asthma prevalence among preschool children in Pelotas is high, resulting therefore in high morbidity. The predictor factors for emergency room visits due to asthma found, after multivariate analysis, were mother's low educational level, severity of the asthma attacks and hospitalization.     

云南省两城区儿童哮喘患病情况及其危险因素分析

目的 了解云南省城区儿童哮喘的流行现状、危险因素及其治疗情况,为进一步规范儿童哮喘的诊治及预防提供依据。方法 采用随机整群抽样的方法,通过自填式问卷调查与集中调查相结合的方式进行调查。对于初筛问卷中的可疑哮喘患儿按哮喘诊断标准进行诊断,对确诊的哮喘患儿填写哮喘儿童调查表。建立问卷数据库,并对数据进行整理、分析。结果 云南省两城区0~14岁儿童哮喘患病率为1.24%。哮喘患儿中既往诊断为哮喘及咳嗽变异性哮喘的为66.37%。哮喘患儿中使用抗生素治疗的有69.64%,使用支气管舒张剂治疗的有54.76%,吸入激素治疗有60.71%。家族过敏史、早产、房屋装修、烟草烟雾暴露等因素为哮喘发病的独立危险因素。结论 云南省城区0~14岁儿童哮喘患病率较10年前有明显增加。仍需进一步规范哮喘患儿诊治方法。预防早产、减少室内外污染、及时治疗变应性疾病及预防呼吸道感染是减少哮喘患病和预防哮喘发作的有效方法。     

儿童支气管哮喘心理行为问题研究进展

支气管哮喘(哮喘)是儿童呼吸系统疾病中一种常见的慢性非感染性疾病。由于疾病影响和长期治疗,哮喘儿童较健康的同龄儿童易产生更多的心理行为问题,同时这些心理行为因素又可诱发并加重哮喘的发作,影响哮喘患儿的治疗与康复,现就二者之间的相互关系及发生机制予以概述。     

GP care for moderate to severe asthma in children: what do infrequently attending mothers disagree with and why?

OBJECTIVES: Our aim was to identify and account for areas of disagreement with GP care for moderate to severe child asthma among mothers who infrequently use this care. Identifying and understanding these areas of disagreement has the potential to improve child access to GP care. METHODS: This qualitative study in Auckland, New Zealand, used a general inductive approach to analyse 23 semi-structured, personal interviews during March-October 2001 with samples of 11 mothers of children with moderate to severe asthma, and 12 medical providers (10 in general practice and two in hospital emergency departments). Disagreement was defined by mothers' non-acceptance or disapproval of aspects of GP care they reported getting for child asthma. RESULTS: Mothers and providers described four areas in which some mothers disagree with aspects of GP care for child asthma. Contributing to infrequent attendance, the areas are the validity of the diagnosis, the level of service provision, the effectiveness of care and the level of respect from practice staff. These areas revealed three groups of mothers. GP factors contributing to disagreements among mothers were reported to be inconsistent care; information deficits on asthma and individual children; a lack of commitment to identifying the cause(s) and self-management of asthma in children; and an unmet need for asthma management plans that incorporate families' knowledge, goals and preferences. CONCLUSIONS: Disagreement, among mothers, with areas of GP care for child asthma contributes to non-attendance for this care. This paper identifies opportunities for GPs to keep disagreements to a minimum and facilitate access.     

A national study of asthma in childhood.

A history of asthma was obtained in 3.5% of a representative national sample of children aged 11 years. A further 8.8% had a history of wheezy bronchitis. In the 12 months before the interview, 2% had experienced attacks of asthma and a further 2.9% attacks of wheezy bronchitis. Both conditions were significantly more common among boys than girls, and a history of asthma was reported more frequently among children from non-manual than from manual social classes. Children with frequent attacks of wheezing had lower mean relative weights. A history of eczema and hay fever was more frequently discovered in children with reported asthma than in those with wheezy bronchitis, whereas migraine or recurrent headaches, recurrent abdominal pain, and recurrent throat or ear infections were more commonly associated with wheezy bronchitis than with asthma. The modified Rutter home behaviour scale, which reflects the parental view of the child's behaviour, was significantly raised among children with a history of wheezing, but their school behaviour as judged by the Bristol social adjustment guide showed no such difference. In spite of increased absence from school because of illness, no differences were found in educational attainment between children with a history of asthma or wheezy bronchitis and those with neither condition.     

Illness experience and related knowledge amongst children with asthma

Summary Forty-nine children with asthma (aged 7–16 years) completed a questionnaire concerned with (1) general knowledge about the body and how it works, and (2) specific knowledge about the cause and prognosis of asthma, knowledge of allergens and self-care behaviours. Compared with a matched group of healthy children, they were less well-informed about general knowledge of the body. Knowledge of asthma was also poor. Few children made any specific attempts to avoid situations known to precipitate attacks. There was no significant increase with age in knowledge of allergens or awareness of how to control attacks. The results indicate a need to make asthmatic children more aware of their illness, particularly with regard to self-care.     

Risk factors for asthma and cough among Hispanic children in the southwestern United States of America, 2003-2004.

OBJECTIVES: To investigate the impact of environmental tobacco smoke (ETS) exposure and mother's place of birth (Mexico vs. United States of America) on the prevalence of asthma and dry nighttime cough among children 2-12 years old residing in the southwestern United States. METHODS: Data were collected from November 2003 through March 2004 as part of a health survey of Hispanic mothers with young children who sought emergency, nutrition, or other clinical services. Information about respiratory health was obtained for one randomly selected child per United States-born (no. = 144) or Mexico-born (no. = 125) mother. Information on maternal and household sociodemographic variables, smoking, parental asthma, and child's exposure to room or automobile ETS during the previous seven days was also collected. Adjusted prevalence ratios were estimated with modified Poisson regression models. RESULTS: Most sociodemographic and ETS exposure variables differed significantly by mother's country of birth. Modeled asthma prevalence was 1.95 [95% confidence interval (CI) = 1.03-3.68] times greater in children of United States-born mothers than children of Mexico-born mothers. This difference persisted after known asthma risk factors were controlled for, including parental asthma, socioeconomic and demographic variables, and child ETS exposure. Children's recent automobile ETS exposure was associated with dry nighttime cough [adjusted prevalence ratio (PR) = 1.94, 95% CI = 1.19-3.15] and asthma (PR = 2.09; 95% CI = 0.99-4.39). CONCLUSIONS: Exposure to ETS in automobiles is an important risk factor for asthma and dry nighttime cough among Hispanic children in the southwest United States, regardless of mother's country of birth. Further research is needed to identify causes of the higher prevalence of asthma in Hispanic children of United States-born mothers.     

Self-Competence and Coping in Urban Children With Asthma

This study examines associations among self-competence, asthma coping strategies, and asthma-related functioning in school-aged children with asthma. Thirty 8- to 10-year-old children and their mothers from inner-city neighborhoods were interviewed. Hierarchical multiple regression analyses revealed that higher levels of children's self-competence were significantly related to more accurate asthma knowledge. Higher levels of active and avoidance asthma coping strategies were significantly related to higher levels of participation in activities and recommended asthma management behaviors. Implications for future research and culturally sensitive clinical supports for urban families are discussed.     

Effect of indoor environmental factors on development of atopic symptoms in children followed up to 4 years of age

The increased prevalence of atopic diseases reported in many Western countries is thought to be caused by changes in living conditions. For a long time attention was focused on indoor environmental factors and early feeding patterns, but during recent years other factors have received more attention. An unselected, Swedish, population-based cohort of 904 children were followed from the age of 3 months to 4 years. Questionnaires were sent to the mothers of the children when they were 3 months, 18 months and 4 years of age. A blood sample was taken from a subgroup of the children when they were 4 years old which was analysed for IgE specific antibodies to food and inhalant allergens. The prevalences of asthma, allergic eye-nose reactions, eczema, and food reactions at 4 years of age and a positive blood test were analysed as outcome factors. Features of housing and early feeding patterns were found to have limited effect on the development of allergies in the children. Presence of older siblings resulted in a decreased tendency to produce IgE antibodies. Early exposure to furry animals seemed to prevent the development of asthma. Children who were frequently infected up to 18 months of age showed an increased prevalence of allergic symptoms at 4 years of age. Children of mothers with a higher prevalence of complaints about indoor factors, or who had increased general symptoms or skin or mucous membrane symptoms ran a greater risk of developing various allergic symptoms. However, these children did not have higher levels of IgE antibodies. The reported allergic symptoms in the children may be due to non-immunological reactions, although it is also possible that the mothers may have over-reported such symptoms.     

芜湖市学龄前儿童情绪和行为问题调查分析

目的 了解芜湖市学龄前儿童情绪和行为问题,并分析其影响因素。 方法 随机抽取芜湖市7所幼儿园,采用基本信息问卷、儿童长处和困难问卷家长版进行调查,并对影响儿童情绪和行为的因素进行单因素和多因素分析。 结果 芜湖市学龄前儿童困难总分异常发生率为8.72%,其中多动(17.04%)、同伴交往问题(20.81%)较为突出,除情绪症状外,男童发生情况均高于女童,差异有统计学意义(P<0.05),同伴交往问题3岁组较为突出,亲社会行为随年龄增加儿童亲社会能力越好,差异有统计学意义(P<0.05);单因素分析结果显示儿童性别、父母文化程度、父母健康状况、父亲吸烟喝酒、母亲吸二手烟、儿童吸二手烟、儿童哮喘与儿童情绪和行为问题相关,差异有统计学意义(P<0.05);多因素logistic回归分析结果显示,与儿童情绪和行为问题有关因素为男孩、妈妈文化程度低、爸爸吸烟、儿童吸二手烟、哮喘。 讨论 芜湖市学龄前儿童情绪和行为问题发生率处于国内中等水平,要根据性别、年龄、家庭环境等进行针对性的早期干预。     

Asthma in schoolchildren. Demographic associations and peak expiratory flow rates compared in children with bronchitis.

The frequency of asthma in 10 971 school-children between the ages of 5 and 14 years was reported by their parents to be 3-8%. Of these, 20-7% were said to have had bronchitis, 5-9% pneumonia, and 4-7% eczema. Asthma was reported more commonly in boys than girls and was greatest in children of social classes I and II. One-third of the children were reported to have their first attack before the age of 2 years. Few (18%) first attacks started after the age of 5 years. There was no evidence that bronchitis predisposed to the later development of asthma, or vice versa. Within each age-sex group children with a history of asthma had lower peak expiratory flow rates than children who gave no such history. These diffences in PEFR were greater than for children with a history of bronchitis.     

Psychological Adjustment of Mothers of Children Undergoing Bone Marrow Transplantation: The Role of Stress, Coping, and Family Factors

We investigated factors related to depression and ruminative worry in 24 mothers of children preparing to undergo bone marrow transplantation (BMT). Stress, family, and coping variables were tested for their associations with maternal depression and ruminative worry. Results indicated that major life stress, social stresses, and disengagement coping substantially predicted the adjustment of mothers of children preparing to undergo BMT. Surprisingly, few family environment characteristics and illness stresses were related to adjustment. Results suggest that intervention programs should help mothers to reduce avoidant coping and should monitor the presence of major social stresses in addition to the illness of the child.     

Caretaking as articulation work: the effects of taking up responsibility for a child with asthma on labor force participation

A well-established quantitative literature has documented the financial toll for women's caretaking. Still, we do not know much about the process by which women end up taking on an extensive caretaking role and what they do on a daily basis. Based on in-depth interviews with a convenience sample of fifty caretakers of school aged children with asthma and nine health professionals in the USA, this study examines how health professionals socialize mothers into an intensive caretaking role for their children with asthma, how mothers negotiated and perform that role, and the impact of care work on their labor force participation. Care providers assign broad caretaking tasks that require further articulation work to get the job done. Although mothers care for their children in varied ways, caring for a child with a chronic disease remains a time-consuming activity. Mothers pay a price for the indeterminate nature of articulation work by scaling back their involvement in the paid labor force.     

Maternal infections in pregnancy and the development of asthma among offspring.

BACKGROUND: Previous studies have suggested that asthma phenotype could probably be programmed before birth. The current study examined the impact of maternal vaginitis and febrile infections during pregnancy on the subsequent development of asthma among children. METHODS: The analyses were based on 8088 children from the northern Finland birth cohort, 1985-1986. RESULTS: The prevalence of asthma at age 7 was 3.5%. Children had a higher risk of asthma if their mothers experienced vaginitis and febrile infections during pregnancy, odds ratio (OR) = 1.41, (95% CI: 1.08-1.84) and 1.65 (95% CI: 1.25-2.18), respectively, after adjusting for other covariates. There was a clear time trend in risk of childhood asthma corresponding to the timing of maternal febrile infections in pregnancy. The adjusted OR for the first, second and third trimesters were 2.08 (95% CI: 1.13-3.82), 1.73 (95% CI: 1.09-2.75) and 1.44 (95% CI: 0.97-2.15), respectively. Maternal history of allergic diseases, birthweight <2500 g and male gender also seemed to be risk factors for childhood asthma. CONCLUSIONS: Our results suggest that further investigation of the relation of maternal infections during pregnancy to asthma among children seems warranted.