Children's mouthing and food-handling behavior in an agricultural community on the US/Mexico border

Children's mouthing and food-handling activities were measured during a study of nondietary ingestion of pesticides in a south Texas community. Mouthing data on 52 children, ranging in age from 7 to 53 months, were collected using questionnaires and videotaping. Data on children's play and hand-washing habits were also collected. Children were grouped into four age categories: infants (7-12 months), 1-year-olds (13-24 months), 2-year-olds (25-36 months) and preschoolers (37-53 months). The frequency and type of events prompting hand washing did not vary by age category except for hand washing after using the bathroom; this increased with increasing age category. Reported contact with grass and dirt also increased with increasing age category. The median hourly hand-to-mouth frequency for the four age groups ranged from 9.9 to 19.4, with 2-year-olds having the lowest frequency and preschoolers having the highest. The median hourly object to mouth frequency ranged from 5.5 to 18.1 across the four age categories; the frequency decreased as age increased (adjusted R(2)=0.179; P=0.003). The median hourly hand-to-food frequency for the four age groups ranged from 10.0 to 16.1, with the highest frequency being observed in the 1-year-olds. Hand-to-mouth frequency was associated with food contact frequency, particularly for children over 12 months of age (adjusted R(2)=0.291; P=0.002). The frequency and duration of hand-to-mouth, object-to-mouth and food-handling behaviors were all greater indoors than outdoors. Infants were more likely to remain indoors than children in other age groups. The time children spent playing on the floor decreased with increasing age (adjusted R(2)=0.096; P=0.031). Parental assessment was correlated with hand-to-mouth activity but not with object-to-mouth activity. The highest combined (hand and object) mouthing rates were observed among infants, suggesting that this age group has the greatest potential for exposure to environmental toxins.     

Contributions of children's activities to pesticide hand loadings following residential pesticide application

The role of children's activities in leading to pesticide exposure was evaluated by comparing pesticide loadings on the hands of children with the activities of the same children observed over a 4-h period. In all, 10 children ranging in age from 24 to 55 months were videotaped on the second day following a routine professional crack and crevice chlorpyrifos application in their homes. Before and following the video session, the children's hands were rinsed in isopropyl alcohol. Thus, only the chlorpyrifos that accumulated on and remained on the child's hands during the videotaping were removed for analysis after the videotaping session. The rinsate was analyzed for chlorpyrifos. The children's behaviors were quantified using virtual tracking device and the frequency and duration of behaviors, the hourly rate of behaviors, and the locations in which behaviors occurred were compared to hand loadings of pesticides. Pesticide hand loadings obtained following the videotaping sessions were associated with pesticide levels on surfaces and toys, but not with air levels. Pesticide loadings obtained following the videotaping sessions were also associated with frequencies, durations, and hourly rates of contact with bottles, and object-to-mouth behaviors, as well as contact duration with upholstered/textured surfaces. The hand loadings were also associated with the number of locations where the children exhibited object-to-mouth behavior and with children's use of house space during the videotaping sessions.     

Frequency of mouthing behavior in young children

Young children may be more likely than adults to be exposed to pesticides following a residential application as a result of hand- and object-to-mouth contacts in contaminated areas. However, relatively few studies have specifically evaluated mouthing behavior in children less than 5 years of age. Previously unpublished data collected by the Fred Hutchinson Cancer Research Center (FHCRC) were analyzed to assess the mouthing behavior of 72 children (37 males/35 females). Total mouthing behavior data included the daily frequency of both mouth and tongue contacts with hands, other body parts, surfaces, natural objects, and toys. Eating events were excluded. Children ranged in age from 11 to 60 months. Observations for more than 1 day were available for 78% of the children. The total data set was disaggregated by gender into five age groups (10-20, 20-30, 30-40, 40-50, 50-60 months). Statistical analyses of the data were then undertaken to determine if significant differences existed among the age/gender subgroups in the sample. A mixed effects linear model was used to test the associations among age, gender, and mouthing frequencies. Subjects were treated as random and independent, and intrasubject variability was accounted for with an autocorrelation function. Results indicated that there was no association between mouthing frequency and gender. However, a clear relationship was observed between mouthing frequency and age. Using a tree analysis, two distinct groups could be identified: children < or = 24 and children >24 months of age. Children < or = 24 months exhibited the highest frequency of mouthing behavior with 81+/-7 events/h (mean+/-SE) (n=28 subjects, 69 observations). Children >24 months exhibited the lowest frequency of mouthing behavior with 42+/-4 events/h (n=44 subjects, 117 observations). These results suggest that children are less likely to place objects into their mouths as they age. These changes in mouthing behavior as a child ages should be accounted for when assessing aggregate exposure to pesticides in the residential environment.     

Young children's hand contact activities: an observational study via videotaping in primarily outdoor residential settings

Microlevel activity time series (MLATS) data were gathered on hand contact activities of 38 children (1-6 years old) by videotaping in primarily outdoor residential environments. The videotape recordings were then translated into text files using a specialized software called VirtualTimingDevicetrade mark. Contact frequency (contacts/h), duration per contact (s/contact), and hourly contact duration (min/h) were summarized for outdoor hand contacts with 15 distinct object/surface categories ("Animal", "Body", "Clothes/Towels", "Fabric", "Floor", "Food", "Footwear", "Metal", "Non-dietary Water", "Paper/Wrapper", "Plastic", "Rock/Brick", "Toys", "Vegetation/Grass", and "Wood") and two aggregate object/surface categories ("Non-dietary objects/surfaces" and "Total objects/surfaces"). For outdoor both hand contacts with "Total objects/surfaces", contact frequencies ranged from 229.9 to 1517.7 contacts/h, median durations/contact ranged from < 1 to 5 s, and hourly contact durations ranged from 42.6 to 102.2 m/h. The data were analyzed for significant differences in hand contact activities as a function of (1) age, (2) location, (3) gender, and (4) hand. Significant differences (P < or = 0.05) were found for all four factors analyzed. Hourly contact durations with "Non-dietary objects/surfaces" and "Total objects/surfaces" increased with age (P = 0.01, rs = 0.42 and P = 0.005, rs = 0.46, respectively), while contact frequencies and hourly contact durations with "Wood" decreased with age (P = 0.02, rs = -0.38 and P = 0.05, rs = -0.32, respectively). Location was found to affect contact frequencies and hourly contact durations with certain objects/surfaces. For example, contact frequencies and hourly contact durations with "Fabric" were higher indoors (P = 0.02 for both), while contact frequencies and hourly contact durations with "Vegetation/Grass" were higher outdoors (P = 0.02 and P = 0.04, respectively). Girls had longer hourly contact durations with "Footwear" (P = 0.02), "Non-dietary objects/surfaces" (P = 0.03), and "Total objects/surfaces" (P = 0.01) than boys. The right hand had longer hourly contact durations with objects that are often manipulated with the hand (e.g., "Toys" (P = 0.0002)), while the left hand had longer hourly contact durations with passively touched objects/surfaces (e.g., "Clothes/Towels" (P = 0.003) and "Floor" (P = 0.04)).     

Design strategy for assessing multi-pathway exposure for children: the Minnesota Children's Pesticide Exposure Study (MNCPES)

Although children are exposed to a variety of environmental hazards, including pesticides, there is a scarcity of information available to estimate exposures realistically. This article reports on one of the first attempts to measure multi-pathway pesticide exposures in a population-based sample of urban and non-urban children. A design strategy was developed to assess multi-pathway pesticide exposures in children using personal exposure measurements in combination with complimentary measurements of biological markers of exposure, concentrations in relevant environmental media, and time spent in important microenvironments and participating in exposure-related activities. Sample collection and analysis emphasized measurement of three insecticides (i.e., chlorpyrifos, diazinon, and malathion) and one herbicide (i.e., atrazine). These compounds were selected because of their frequent use, presence in multiple environmental media, expected population exposures, and related hazard/toxicity. The study was conducted during the summer of 1997 in Minnesota and involved a stratified sample of households with children ages 3-12 years. Participants resided in either (a) the cities of Minneapolis and St. Paul (urban households), or (b) Rice and Goodhue Counties just south of the metropolitan area (non-urban households). Results from a residential inventory documenting storage and use of products containing the target pesticides were used to preferentially select households where children were likely to have higher exposures. The study successfully obtained pesticide exposure data for 102 children, including measurements of personal exposures (air, hand rinse, duplicate diet), environmental concentrations (residential indoor/outdoor air, drinking water, residential surfaces, soil), activity patterns (obtained by questionnaire, diary, videotaping), and internal dose (metabolites in urine).     

Quantified outdoor micro-activity data for children aged 7-12-years old

Estimation of aggregate exposure and risk requires detailed information regarding dermal contact and mouthing activity. We analyzed micro-level activity time series (MLATS) of children aged 7-12 years to quantify these contact behaviors and evaluate differences by age and gender. In all, 18 children, aged 7-12 years, were videotaped while playing outdoors. Video footage was transcribed via Virtual Timing Device (VTD) software. We calculated the hand and mouth contact frequency, hourly duration and median duration of contact with 16 object categories. Median mouthing frequencies were 12.6 events/h and 2.6 events/h for hands and non-dietary objects, respectively. Median hourly mouthing duration was 0.4 min/h and 0.1 min/h with hands and objects. Median mouthing contact duration was 1 s and 1.5 s with hands and objects, respectively. The median object contact frequency for both the hands combined was 537.3 events/h with an hourly contact duration of 81.8 min/h and a median contact duration of 3 s. There were no significant differences in the mouthing activity between genders or age groups. Female children had longer and more frequent hand contacts with several surface types. Age was negatively correlated with hand contacts of floor and wood surfaces. Contact frequencies in this study are higher than current regulatory recommendations for this age group.     

儿童术后应用PCA的观察与护理

目的：通过对40例不同年龄（5～14岁）患儿的腹部和会阴部手术后应用PCA泵的护理，观察镇痛的临床效果与不良反应。方法：用镇痛液配方为0．075％布比卡因100ml＋芬太尼0．2mg，对年龄5～9岁的患儿，泵速用3ml／h，并由患儿或家长施行自控镇痛：对年龄10～14岁的患儿，泵速用4ml/h，由患儿自己施行自控镇痛。观察患儿术后镇痛效果及恶心、呕吐、皮肤瘙痒、尿潴留、头痛等不良反应。结果：镇痛效果好，患儿生命体征平稳，SpO2在95％以上，未发生呼吸抑制、头痛。有2例发生恶心呕吐，1例发生皮肤瘙痒。结论：PCA用于5～14岁患儿腹部及会阴部手术后镇痛安全有效。     

Shigellosis in Amsterdam, 1991-1998: incidence and results of contact tracing

OBJECTIVE: To determine the incidence of reported shigellosis in Amsterdam (1991-1998) and the factors related to the secondary attack rate of shigellosis. DESIGN: Retrospective. METHODS: From an automated data bank data were collected on all registered shigellosis patients in Amsterdam in the period 1991-1998, and their contacts found by contact tracing. RESULTS: 567 Patients with shigellosis had been reported and a Shigella infection has been diagnosed in 96 of the 983 contacts. The annual incidence decreased statistically significantly from 13 to 8/100.000. 329 males and 334 females were infected. The highest number of cases was found in children from 0-4 years and among adults from 20-34 years. Of the 663 patients 106 (16%) required hospitalization; for children under 7 this proportion was 30% (32/108). Among the contacts (excluding the 14 contacts with the same foreign source and the same first sickness day as the index patient) the secondary attack rate was 8%. Young age, of both the patient and the contact was independently related to a higher secondary attack rate. CONCLUSION: With contact tracing for shigellosis a large number of secondary infections were found. Given the high infection rate and large number of hospitalisations among children, contact tracing should focus at this young age group.     

Assessment of the nutritional status of children with special needs in Alexandria: I. Nutrient intake and food consumption

The present study was undertaken to evaluate the nutritional status of children with special needs in Alexandria city, on the basis of nutrient intake and food consumption. Socio-demographic characteristics and dietary data were determined in a sample of 231 disabled children chosen randomly from five specialized day care centers. Results showed that the age of the sample ranged from less than 7 to 24 years with a mean age of 12.6 +/- 4.7 years. Mental retardation represents the highest proportion of subjects followed by Down's syndrome and then Autism Male subjects were found to consume higher nutrients than females at all ages except age under seven years. The intake of both gender was less than the recommended for energy, calcium, vitamin A, niacin and zinc. While the intake of protein and vitamin C was more than the RDA Iron intake was below the recommended for females at all ages and within the acceptable level for male. The results also showed that there is a relationship between nutrient intake and disability type. Down syndrome children were found to consume more nutrients than mentally retarded and autistic subjects.     

Pathways of human exposure to arsenic in a community surrounding a copper smelter

Several studies have found elevated levels of urinary arsenic among residents living near a copper smelter in Tacoma, Washington. To assess pathways of exposure to arsenic from the smelter, biological and environmental samples were collected longitudinally from 121 households up to 8 miles from the smelter. The concentration of inorganic and methylated arsenic compounds in spot urine samples was used as the primary measure of exposure to environmental arsenic. Urinary concentration of arsenic dropped off to a constant background level within one-half mile of the smelter in contrast to environmental concentrations, which decreased more steadily with increasing distance. Among all age-sex-specific groups in all areas, only children ages 0-6 living within one-half mile of the smelter had elevated levels of arsenic in urine. A separate analysis of data for these children suggests that hand-to-mouth activity was the primary source of exposure. Inhalation of ambient air and resuspension of contaminated soil were not important sources of exposure for children or adults.     

Polybrominated diphenyl ethers in relation to autism and developmental delay: a case-control study

Background  

Polybrominated diphenyl ethers (PBDEs) are flame retardants used widely and in increasing amounts in the U.S. over the last few decades. PBDEs and their metabolites cross the placenta and studies in rodents demonstrate neurodevelopmental toxicity from prenatal exposures. PBDE exposures occur both via breastfeeding and hand-to-mouth activities in small children.     

儿童婴幼儿期视屏接触时间与孤独症样行为的关联

探讨婴幼儿期视屏接触时间与孤独症样行为的关联,为探索孤独症水平行为的影响机制提供线索.方法 采用回顾性研究,调查深圳市龙华区22 586名幼儿园儿童的主要养育者,用自编问卷收集一般人口学变量、视屏接触时间,采用儿童孤独症行为量表(Autism Behavior Checklist,ABC)评估孤独症样行为,分析婴幼儿过早接触视屏对孤独症样行为的影响.结果 婴幼儿期电视和新一代电子产品的视屏接触时间均随年龄增长而增长.<1,1~<2,2~3岁电视视屏0 h/d的比例分别为60.1%,35.0%,20.2%,新一代电子产品视屏0 h/d的比例分别为74.0%,52.6%,26.8%.儿童ABC量表阳性率为5.3%,男性(6.0%)比女性(4.4%)高[OR值(95% CI)为1.37(1.23~1.54)].各年龄段电视和新一代电子产品的视屏接触时间均与孤独症样行为有相关性(P<0.05).1岁内中高视屏组,2~3岁保持中高视屏接触时间、逐渐增加视屏接触时间与2~3岁无视屏组相比,孤独症样行为的风险更高且视屏接触时间越长风险越大(电视视屏组OR值分别为2.14,2.77;亲子一代电子产品视屏组OR值分别为2.48,2.81,P值均<0.05).0~3岁每日观看视屏≥1,<1 h/d组与无视屏组相比,电视视屏的OR值分别为2.45,2.01,新一代电子产品视屏的OR值分别为2.33,2.01(P值均<0.05).0~3岁单次视屏接触时间越长孤独症样行为的风险越大,≥1h/次、0.5~<1 h/次、15~30min/次与<15 min/次相比,OR值分别为2.50,1.79,1.47(P值均<0.05).结论 婴幼儿期过早接触视屏、每日观看视屏总时间过多、单次视屏接触时间过长均可能增加孤独症样行为.2岁内的婴幼儿不宜每天视屏,2~3岁应控制视屏总时间<0.5 h/d且单次视屏<15 min.     

U.S. children with emotional and behavioral difficulties: data from the 2001, 2002, and 2003 National Health Interview Surveys

OBJECTIVE: This report presents selected prevalence estimates for children ages 4-17 years with difficulties in emotions, concentration, behavior, or being able to get along with others using data from the 2001, 2002, and 2003 National Health Interview Surveys (NHIS). METHODS: Data for the U.S. civilian noninstitutionalized population were collected using computer-assisted personal interviews (CAPI). In 2001, a total of 10,367 interviews were completed about sample children ages 4-17 years by the member of the household most knowledgeable about the child's health. The number of completed interviews about sample children ages 4-17 years was 9,512 in 2002 and 9,399 in 2003. Questions on children's emotional and behavioral difficulties from the Strengths and Difficulties Questionnaire (SDQ) were first asked in the NHIS in 2001. SUDAAN software was used to tabulate statistics shown in this report. RESULTS: In 2001, 2002, and 2003, approximately 5% of U.S. children ages 4-17 years had emotional or behavioral difficulties, and for approximately 80% of these children, there was an impact on their functioning. Children with difficulties in emotions, concentration, behavior, or being able to get along with others varied by sex, age, race, family structure, poverty status, and health insurance status. About 50% of these children were upset or distressed by their emotional or behavioral difficulties, and about 80% had difficulties that impacted their family life, friendships, learning, or leisure activities.     

儿童情感交叉擦腿综合征的相关因素及行为问题研究

目的 了解儿童情感交叉擦腿综合征(childhood masturbation,CM)发生的相关因素、临床表现及家长可接受的就医模式;借助Achenbach儿童行为量表,评估6岁及6岁以上CM患儿同时伴发的行为问题。方法 选取CM的儿童89例,通过电话交谈及完成一个CM相关因素的自编调查问卷;采用Achenbach儿童行为量表(CBCL家长用)对21例6~11岁女性患儿的行为问题进行评估;对资料进行统计分析。结果 1)70.79%患儿在睡前躺着发生CM,并且有不同程度类似性高潮的表现,67.21%的3岁以上的患儿表示有舒服的快感。2)CM发生的相关影响因素众多,其中65.17%存在父母少陪,缺少亲密的身体接触和语言呵护等情感关怀缺失情况;46.07%的患儿开始此行为是对泌尿生殖系统疾病本能的反应,而后发展成习惯性动作。3)73.03%的家长则表示不同意将儿童此行为摄像备诊断所用。4)Achenhach儿童行为量表测试结果6岁以上CM组的行为问题得分(24.38±14.32)高于对照组(20.76±15.3),但差异无统计学意义(P>0.05)。 结论 CM是一种与成人手淫相类似的行为,可达到拟似性高潮的程度,影响因素中以缺少父母的情感关怀为突出;在国内摄像用于诊断的依从性差,诊断CM无法主要依赖于摄像资料;6岁以上CM女性儿童的行为问题并不很突出。     

宁夏五县农村7岁及以下儿童腹泻两周患病情况及影响因素分析

目的 了解宁夏回族自治区五县农村7岁及以下儿童腹泻的患病现状及其影响因素,为采取相应的干预措施和优化卫生资源配置提供科学依据。方法 数据来源于宁夏卫生厅与哈佛/牛津大学研究团队合作开展的“创新支付制度,提高卫生效益”试点项目对宁夏五县(海原、盐池、同心、彭阳、西吉)“农村居民家庭卫生健康询问调查”2009、2011、2012年和2015年调查的10 318名儿童的资料,应用SPSS 23.0软件通过单因素分析和非条件二分类 Logistic回归对儿童腹泻影响因素进行筛选。结果 宁夏五县农村7岁及以下儿童腹泻两周患病率为5.4%(558/10 318),单因素分析结果显示不同年龄、民族以及是否计划免疫儿童的腹泻患病率不同,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示回族儿童(OR=1.351,95%CI:1.090~1.671),儿童年龄小(0~＜2岁,OR=10.515,95%CI:7.308~15.129; 2~＜4岁,OR=3.319,95%CI:2.285~4.821)和家庭年收入水平低(OR=1.555,95%CI:1.229~1.966)可能是该地区儿童腹泻的危险因素。结论 宁夏五县农村地区7岁及以下儿童两周腹泻患病率较高,民族、年龄、家庭年收入水平是宁夏农村地区儿童腹泻的主要影响因素。     

Is treatment adherence associated with better quality of life in children with sickle cell disease?

The association of treatment adherence with quality of life (QOL) and the role of sickle cell disease complications were explored in children with sickle cell disease. Primary caregivers of 43 children, ages 5 years and older, and 21 children, ages 8 years and older, completed a standardized measure of QOL during an admission for pain or fever to the hematology acute care unit. Adherence was measured through medical staff ratings, caregiver-report of sickle cell disease-related care activities, and matching of medical staff standard recommendations for treatment of pain and fever with sickle cell disease-related care activities. Sickle cell disease complications were assessed via medical file review. Pearson correlation coefficients indicated that better adherence was associated with poorer overall QOL. In follow-up analyses, although sickle cell disease complications were associated with adherence, it did not explain the negative correlation of adherence with QOL. Higher treatment adherence may interfere with activities that contribute to QOL for some children. Further research to investigate the role of sickle cell disease complications, as well as psychosocial factors, in determining both treatment adherence and QOL is suggested.     

Person-to-person transmission of hepatitis A virus in an urban area of intermediate endemicity: implications for vaccination strategies

Developing countries with an increasing hepatitis A disease burden may target vaccination to specific groups, such as young children, as an initial control strategy. To better understand transmission of hepatitis A virus in such countries, the authors prospectively studied household and day-care/school contacts of cases in Almaty, Kazakhstan. Overall, by the time of identification of symptomatic index cases, half of transmission had already occurred, having been detected retrospectively. The odds of household contacts' becoming infected were 35.4 times those for day-care/school contacts (95% confidence interval (CI): 17.5, 71.7). Within households, younger age of either index cases or susceptible contacts elevated the odds of secondary infection among susceptible contacts: The presence of a case under 6 years of age raised the odds 4.7 times (95% CI: 1.2, 18.7); and compared with contacts aged 14 years or older, the odds of infection were increased to 7.7 (95% CI: 1.5, 40.3) and 7.0 (95% CI: 1.4, 34.3) among contacts aged 0-6 years and 7-13 years, respectively. Young children are appropriate targets for sustainable hepatitis A vaccination programs in areas undergoing hepatitis A epidemiologic transition. If vaccine is determined to be highly effective postexposure and if it is feasible, vaccinating household contacts could be a useful additional control strategy.     

Television watching and some eating habits of 6-14-year-old children in Amsterdam, the Netherlands; a cross-sectional study

OBJECTIVE: To describe the time spent by children between the ages of 6-14 years watching television during a weekday and to examine associated factors. DESIGN: Cross-sectional questionnaire study. METHOD: Data were collected during a vaccination campaign against meningococci C in Amsterdam in September 2002. From a sample of 2910 parents of 6-14-year-old children 1775 agreed to participate in the study. Socio-demographic characteristics and data on television viewing the previous day, the presence of a television in the child's bedroom and on eating habits were collected by short interviews. RESULTS: In total 1587 children were included in the analyses, 805 boys and 782 girls. In total 40.1% of the boys and 36.5% of the girls had watched television for > or = 2 h during the previous day. Among the children < or = 10 years 28.7% had a television in their bedroom, among children > 10 years this was 45.7%. Age (> 10 years), ethnicity (notably Surinam origin) and having a television in the bedroom was related to spending more time watching television. Having parents with a high socioeconomic status (SES) was associated with less television viewing than having parents with a lower SES. Children who had not eaten fresh fruit or who had visited a snackbar the previous day had been watching television for > or = 2 h more often than children who had eaten fresh fruit (p < 0.001) or who had not visited a snackbar (p < 0.05). CONCLUSION: Children spent a lot of time watching television. In view of the relation between television viewing and overweight this is an alarming development. Possibilities for the prevention of overweight by reducing television viewing must be investigated.