Impact of type A influenza on children: a retrospective study.

Excess morbidity was studied during influenza A epidemics (1968-69, 1972-73) among children in a large prepaid group practice program. Excess rates of hospitalization for influenza-related conditions, primarily pneumonia and bronchitis, ranged from 5 per 10,000 (95 per cent confidence limits (CL): 1 to 9) for non-high-risk children to 29 per 10,000 (95 per cent CL: 5 to 53) for children with high-risk conditions. The relative increases in hospitalization rates were greatest for 5-14 year old boys: 278 per cent and 104 per cent increases for high-risk and non-high-risk boys, respectively. The absolute increase was greatest for 0-4 year olds. The excess rate of ambulatory medical care contacts, 2.6 per 100 (95 per cent CL: -1.6 to 6.8 per 100) was not statistically significant. Excess hospitalization rates among 0-14 year olds during epidemics were three to five times larger than those for persons between 15 and 64 years of age but only one-fifth the rate of persons over age 65.     

DTP immunization status and tetanus antitoxin titers of Mexican American children ages six months through eleven years.

Data from the Mexican American portion of the Hispanic Health and Nutrition Examination Survey (HHANES), conducted in 1982-83, were analyzed for the number of diphtheria, tetanus, and pertussis (DTP) immunizations reported for Mexican American children 6 months-11 years of age and for levels of tetanus antitoxin titers in Mexican American children 4-11 years of age. In Mexican American children 6 months-11 years, 98.2 per cent had one or more DTP immunizations reported (95 per cent CI: 97.5, 98.9%); 85.1 per cent had three or more DTP immunizations reported (95 per cent CI: 83.2, 87.0%). The reported immunization coverage in Mexican American children was corroborated by the tetanus antitoxin titers which were above the minimum protective level (greater than or equal to 0.01 IU/ml) in 99.6 per cent of the 4-11 year olds. Using the American Academy of Pediatrics' (AAP) recommendations for the number of DTP immunizations, 61.1 per cent of the children 6 months-11 years of age had the age-appropriate number of immunizations (95 per cent CI: 58.5, 63.7%). AAP immunization completion rates were higher for children who: had a source of care reported (62.1 vs 44.3%; 95% CI of the difference: 7.1, 28.5); had insurance coverage (63.5 vs 56.1%; 95% CI of the difference: 2, 12.8); lived in a standard metropolitan statistical area (SMSA)-not central city as compared to SMSA-central city or not SMSA (66.6 vs 57.1%; 95% CI of the difference: 4.3, 14.7); and had 12 or more completed years of education for the head of the household (65.4 vs 58.3%; 95% CI of the difference: 1.8, 12.4).(ABSTRACT TRUNCATED AT 250 WORDS)     

Changes in caries prevalence in 7-12-year-old children from Araraquara, S?o Paulo, Brazil: 1989-1995]

The aim of this study was to compare the prevalence of caries in 7-12-year-old children from Araraquara, S?o Paulo, Brazil, in 1989 and 1995. Systematic random samples were drawn from the population of children enrolled in public schools. The surveys were carried out by trained examiners using the DMFT index and WHO diagnostic criteria. There was an increase in the percentage of children free of caries in the permanent dentition in all age groups (from 29 per cent in 1989 to 51 per cent in 1995). Amongst 12 year olds, the DMFT index was 3.8 in 1989 and 2.6 in 1995. Decreases were observed in the percentages of children classified in the 1-3 DMFT index category (from 40 per cent in 1989 to 31 per cent in 1995) and in the 4-6 DMFT index category (26.6 per cent in 1989 to 16.5 per cent in 1995). There was also a reduction in the percentage of children with a DMFT of 7 or more (4.4 per cent in 1989 to 1.5 in 1995). The WHO/FDI goal for the year 2000 of a mean DMFT index no more than 3 at the age of 12 years was achieved in this population, and on-going efforts should be made to reduce the percentage of children with caries in order to achieve the WHO/FDI goals for the year 2010.     

Preventive care: do we practice what we preach?

We used insurance claims from enrollees in the Rand Health Insurance Experiment to determine the amount of selected components of preventive care received by a representative sample of the non-aged population in the United States and to determine whether insurance coverage was an important determinant of that amount. Only 45 percent of infants received timely immunization for DPT and polio; 93 per cent received some well child care by 18 months of age. In the three-year experimental period, only 4 per cent of adults had a tetanus shot, 66 per cent of women aged 17-44 and 57 per cent aged 45-65 received a Pap smear, and 2 per cent of women aged 45-65 had a mammogram. Cost sharing was associated with even less preventive care: 60 per cent of children on the free plan and 49 per cent on cost sharing plans received preventive care of any type. For adults, women on the free plan received more preventive care of several kinds, and those aged 45-65 received more Pap smears than those on cost-sharing plans. Even with free care, most enrollees did not receive adequate preventive care. Thus, free care alone, while significant, is not a sufficient incentive to providing recommended levels of preventive care. The average per person insurance charge for increasing the amount of preventive care to a level consistent with that recommended would be $22 for a complete set of immunizations by age 18 months, $9 for a Pap smear every three years, and $97 for a Pap test and mammogram every three years.     

An assessment of the California Child Passenger Restraint Requirement.

To evaluate the California Child Passenger Restraint Law requiring children under four years of age to be transported in car seats, we examined monthly injury and fatality levels from January 1978 to December 1983 for children 0-3 and 4-7 years of age using Box-Jenkins time series models. A significant 8.36 per cent reduction in injuries was found for the 0-3 year old age group, but no significant reduction in injuries was found for 4-7 year olds. No significant reduction in fatalities was found for either age group. A similar analysis of injuries and fatalities in Texas, a state without a car seat law, showed no significant reductions in either injuries or fatalities. There was no change in the number of California 0-3 year olds in the years after the law was enacted.     

Diet and nutritional status of 4–18-year-olds: public health implications

The National Diet and Nutrition Survey: young people aged 4–18 years, published in June 2000, is the most detailed survey yet to be undertaken in this age group in Britain. It has revealed that Britain's young people are largely inactive and, although the majority appears to have adequate intakes of most vitamins, intakes tended to be lowest in families on benefit. This was particularly the case for folate and vitamin C, reflecting lower intakes of fruit and vegetables. Thirteen per cent of 11–18‐year‐olds had low vitamin D status, the vitamin usually provided via exposure to sunlight and essential for the development of healthy bones. A sizeable proportion of children may have inadequate intakes of a number of minerals, including zinc, calcium, potassium, magnesium and iron. For example, 25% of 11–14‐year‐old girls and 19% of those aged 15–18 years had intakes of calcium that were likely to be inadequate (i.e. lower than the LRNI); in all age and gender groups there was evidence of low zinc intakes; and 14% of girls and 13% of boys had low ferritin levels, suggesting low iron stores and an increased risk of anaemia. On the positive side, fat intakes were close to the population goal of 35% of dietary energy, but intakes of saturated fatty acids exceeded the recommended population level for adults of 11% of energy, and intakes of sugars and salt were also high in many children. This article discusses some of the public health implications of this major survey.     

Time from infection with HIV to onset of AIDS in patients with haemophilia in the UK

The two-stage parametric regression model of Brookmeyer and Goedert has been adapted and fitted to data on the development of AIDS in haemophiliacs in the UK who are seropositive for HIV. The risk of developing AIDS by a given time following seroconversion increases with increasing age at seroconversion. It is likely that the risk increases smoothly with age, although the data have been analysed in three age categories, and it is estimated that by seven years after seroconversion 6 per cent of patients aged under 25 at seroconversion, 20 per cent of those aged 25-44 and 34 per cent of those aged 45 or more have developed AIDS. For a given age at seroconversion the annual risk of developing AIDS increases with increasing time after seroconversion, and at seven years the annual risks of developing AIDS during the next year in the three age groups are estimated to be 2 per cent for those aged less than 25 at seroconversion, and 10 and 11 per cent respectively for those aged 25-44 and 45 or more.     

Breastfeeding improves survival, but not nutritional status, of 12-35 months old children in rural Bangladesh

The association between breastfeeding, nutritional status and survival was investigated in a cohort of 1087 children aged 12-35 months from rural Bangladesh followed monthly during 2 years. Mean weight-for-age (%NCHS) of breastfed children was 69.6 per cent (s.d.: 9.3 per cent) compared to 70.6 per cent (s.d.: 10.7 per cent) (P less than 0.001) for non-breast fed children. This confirms that after 1 year of age, breastfed children tend to be more malnourished than non-breastfed children. Despite this difference in nutritional status, risk of dying, after adjusting for age, was six times higher in non-breastfed malnourished children than in similarly malnourished breastfed children. This suggests that breastfeeding beyond 1 year should be encouraged in communities with a high prevalence of malnutrition, despite the frequently observed association between prolonged breastfeeding and malnutrition.     

Community Mothers Programme--seven year follow-up of a randomized controlled trial of non-professional intervention in parenting

BACKGROUND: The Community Mothers Programme aims at using experienced volunteer mothers in disadvantaged areas to give support to first-time parents in rearing their children up to 1 year of age. The programme was evaluated by randomized controlled trial in 1990. METHODS: Seven years later, trial participants were interviewed about child health, nutrition, cognitive stimulation, parenting skills, and maternal self-esteem. The aim of this study was to see whether the demonstrated benefits at 1 year of age of this programme could be sustained at age 8. RESULTS: One-third of the original group (38 intervention, 38 control), were contacted and interviewed. The risk for having an accident requiring a hospital visit was lower in the intervention group: relative risk (RR) 0.59, 95 per cent confidence interval (CI) 0.31-1.11. Intervention children were more likely to visit the library weekly: RR 1.58, 95 per cent CI 1.10-2.26. Intervention mothers were more likely to check homework every night: RR 1.23, 95 per cent CI 1.05-1.43 (p=0.006); and to disagree with the statement 'children should be smacked for persistently bad behaviour': RR 2.11, 95 per cent CI 1.10-4.06. They were more likely to disagree with the statement 'I do not have much to be proud of': RR 1.24, 95 per cent CI 1.04-1.40; and to make a positive statement about motherhood than controls: RR 1.53, 95 per cent CI 1.06-2.20. Subsequent children of intervention mothers were more likely to have completed Haemophilus influenzae b: RR 1.26, 95 per cent CI 1.06-1.51; and polio immunization: RR 1.19, 95 per cent CI 1.02-1.40. CONCLUSIONS: The Community Mothers programme had sustained beneficial effects on parenting skills and maternal self-esteem 7 years later with benefit extending to subsequent children.     

Driver licensing age and lifestyles of 16 year olds.

The relationship of driver licensure rate differences to 16 year old lifestyles was assessed by surveying 15 and 16 year olds in New York, Michigan, and New Jersey. Michigan 16 year olds reported the highest rates of licensure (56 per cent), whereas New York (14 per cent licensed) and New Jersey (2 per cent licensed) had much lower rates. Teenagers in Michigan reported greater decreases in use of bicycles and reliance on parents and relatives for transportation but, for the most part, the differences in 16 year old licensure and mobility were not reflected in lifestyle differences.     

Schmerzen bei Kindern und Jugendlichen in Deutschland: Prävalenz und Inanspruchnahme medizinischer Leistungen

As part of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), representative data were collected on pain in 14,959 children and adolescents aged 3 to 17 years in Germany. The results are reported separately for 11-17-year olds, who were asked themselves, and 3-10 year olds, whose parents reported on their pain. Among the 3-10 year olds, the prevalence of pain over three months was 64.5% and among the 11-17 year olds it was 77.6% (71.1% altogether for the 3-17 year old children). Pain prevalence increased significantly with age; in all age groups girls reported pain significantly more often than boys of the same age. In the 3-10 year olds the most common pain localisation was stomach pains, followed by pain in the head and throat. Children and adolescents aged 11 to 17 most often reported headaches, followed by pains in the stomach and back. Pain occurring at least once a week in the last three months was reported by 24.3% of the 11-17 year old children and adolescents and by 9.9% of the 3-10 year old children suffering from pain. More than half (54.1%) of the 3-10 year olds and more than one third of the 11-17 year olds (35.9%) who reported recurrent principal pain consulted a doctor for this reason; 36.7% and 46.7% respectively took medicine. These results show that pain is a relevant problem in children and adolescents in Germany.     

Promotion of mouthguards among amateur football players in Victoria

Abstract: Wearing mouthguards while playing contact sports reduces the prevalence and severity of orofacial injuries. We report on a 1991–92 promotion of mouthguard use among amateur football players in Melbourne. Four questionnaires were completed by players (1991 season: middle: n =638, 49 per cent response; late: n =770, 51 per cent; 1992: early: n =505, 26 per cent; late: n =698, 54 per cent), in four age groups (16–19, 20–23, 24–29, 30–44 years), about perceived mouthguard value and usage, injury experience, and awareness of a promotional message. Over the two seasons, mouthguard ownership and consistent wear increased and dental injuries decreased. Ownership of mouthguards increased among: 20–23 year olds and 30–44 year olds (13 and 16 per cent); managers, tradespersons, salespersons, labourers and the unemployed (14–19 per cent); residents of northern and western regions (12 and 13 per cent); those with 6 to 10 years of education (29 per cent); players in old boys' networks (13 per cent); and those with English as a first language (8 per cent). Consistent wear was high at matches (89 per cent) but low at training (13 per cent), owing to perceived lack of physical contact. Of dental injuries reported by 25–31 per cent, fractures predominated over luxations and avulsions. Fractures and avulsions were more common at matches than training; luxations predominated at training. When a mouthguard was not worn, the likelihood of a fractured or avulsed tooth was at least twice that when a mouthguard was worn. Some injuries occurred despite the wearing of mouthguards. The promotional message appeared effective in increasing mouthguard use; newspapers and football journals provided effective message locations for players, and ground signs and the electronic scoreboard for spectators.     

Informed consent by children and participation in an influenza vaccine trial.

Two hundred thirteen school children, ages six to nine, were presented the opportunity to participate in an experimental trial of swine influenza vaccine. In non-directive question and answer sessions, all groups of children except one composed only of six year olds elicited all relevant information on the details of the trial and the associated risks and benefits. Forty-six per cent of the subjects declined to participate. Letters requiring informed consent of the parents were sent to the homes of the others. Almost 15 per cent of these parents agreed to their children's participation. In this setting, children initiate their own visits to the school nurse practitioner. A significant association was found between volunteering for the study and higher use of services (but not for medical reasons). Younger children and boys, regardless of their patterns of use, were less inclined to volunteer for the experiment.     

208例麻疹患者的临床流行病学分析及几点经验教训

目的 从临床工作者的视点探讨深圳１９９８年的麻疹较大流行的特点和临床特点。方法 利用本院收治的２０８例麻疹的资料,分析比较４个年龄段中外来人口和本地人口患者的占有比、≤８月龄患儿的麻疹疫苗接种史和母亲麻疹史、〉８月龄患者中外来人口和本地人口的麻疹疫苗接种史等。结论 （１）〉８月龄的外来人口１０７例中,未种麻疹疫苗者占７９．４％;〉８月龄的本地人口７２例中,未种麻疹疫苗者占４１．７％;（２）发病年龄     

我国部分脊髓灰质炎高发省急性弛缓性麻痹病例发病情况调查

１９９４年６月中旬卫生部疾病控制司专业考察小组,在我国一个脊髓灰质炎（脊灰）高发省份随机抽取２０个地区,对其４５所地（市）级和１３所县级医院进行了ＡＦＰ病例的主动搜索,共查出１９９１～１９９４年５月发病的ＡＦＰ病例６８１例,分布于１０１个县市。结果表明：０～１４岁儿童ＡＦＰ、脊灰、非脊灰ＡＦＰ及ＧＢＳ年平均发病率分别为１．０４／１０万、０．４８／１０万、０．５７／１０万及０．３１／１０万,其中脊灰发病率明显较１９９１年下降,其构成比由１９９１年的第一位逐年降低;此外,约９５％的脊灰患者分布于０～４岁组,表明０～４岁儿童应为今后监测和保护的重点;非脊灰ＡＦＰ发病率具有明显的地区性差异,认为采用“０～４岁非脊灰ＡＦＰ发病率＞１／１０万”作为监测系统敏感性指标似更合乎国情。     

Tetanus immunization of adult members of an HMO.

Thirty-nine per cent of 1,900 randomly selected adult Health Plan members received one or more tetanus injections during a 10-year period of continuous eligibility. Age-specific immunization rates decreased from 47 per cent for 20-39 year olds to 28 per cent for those over age 70. Nearly half of the elderly, age 60+, received a booster of tetanus toxoid rather than tetanus-diphtheria toxoids as recommended by the Immunization Practices Advisory Committee of the Centers for Disease Control. Access to care does not appear to be a sufficient condition for achieving recommended levels of immunization, especially among the elderly.     

Fertility profile of a rural community of Kashmir in longitudinal association with maternal age

The study was conducted among 264 rural women past menopause who had never used contraception and who attended Hajin Health Block attached to the Community Medicine Department of the SKIMS Srinigar, Kashmir Valley, India. Retrospective reports of pregnancy histories and outcomes were collected. 1405 live births occurred: 654 (46.55%) were male and 751 (53.45%) were female. The sex ratio at birth was 1148 females per 1000 males. 39.29% of births occurred to women 20-25 years old. By the age of 35 years and higher, only 5.90% of births occurred. 1217 children survived: 578 male and 639 female. The survival ratio was 1105 females to 1000 males. Child survival was 92.20% among women under 20 years old and only 57.83% among women 35 years and older. Child survival decreased with increasing age; maternal age and child survival were found to be highly significantly correlated for male children and for both sexes. Average number of children during the entire reproductive period was 5.32 children: 2.48 male and 2.84 females. 84.77% of children were born by the maternal age of 30 years. An average of 4.62 children survived per woman: 2.19 male and 2.43 female. 87.23% of infants born to mothers under 30 years old survived. 1.41 children were born to women by the age of 20 years; 1.30 children survived, which represented 26.50% of the average family size. The gross reproduction rate in this study was 2.84, and the net reproduction rate was 2.43. An increase in marriage age to 20 years would reduce fertility by 26.50%. The most cost effective approach to family planning would concentrate on women 20-25 years old, the most fertile years of the reproductive period. Permanent methods could be introduced among women 25-30 years old, because 85% of family size would have already been achieved.     

Infant feeding practices in a poor district of Santo Domingo

During August-December 1989, in the Dominican Republic, local health promoters interviewed 103 primary caretakers and took anthropometric measurements from 103 children aged 3 years and under during home visits in three poor neighborhoods of Los Alcarrizos (Alto de Chavon, Barrio Landia, and Pueblo Nuevo) to examine infant feeding practices. 95% of the mothers had started breast feeding. The median duration of breast feeding was 7.5 months. Almost 33% had quit breast feeding by 3 months. Perception of insufficient milk was the leading reason for early discontinuation of exclusive breast feeding. The local pharmacies in all three communities offered powdered milk. About 25% of mothers began using breast milk substitutes within the first week. A non-infant formula milk powder was the most commonly used breast milk substitute. 30% of mothers stored prepared milk for later feeds, as long as half a day. Only 13% of households had a refrigerator. The most frequently used first weaning foods were orange juice, lime juice, and beans. 76% of mothers had used or were currently using baby bottles. 95% of them reported washing the bottle in boiling water. The median age of introducing the baby bottle was 3 days. Only 44% of mother covered prepared food during storage. The most commonly eaten foods among children aged at least 1 year were milk, beans, rice, and citrus fruits. Yet the children did not eat all these foods daily. 18% of 1-2 year olds and 13% of 2-3 year olds did not eat meats and alternatives regularly. 7% of 1-2 year olds and 10% of 2-3 year olds did not eat fruits and vegetables regularly. 4% of 1-2 year olds and 3% of 2-3 year olds did not eat breads and cereals regularly. About 14% of all children were not consuming any milk at the time of the survey. These findings will be used to refine nutrition education programs in the district to make them more effective.     

Driver education and fatal crash involvement of teenaged drivers.

Fatal crash involvement of teenagers per licensed driver and per population in 27 states was related to the proportions of teenagers who received high school driver education. Among 16--17 year olds, driver education was associated with a great increase in the number of licensed drivers, without a decrease in the fatal crash involvement per 10,000 licensed drivers- About 80 per cent of the 16--17 year olds who took high school driver education obtained licenses that they would not otherwise have obtained until age 18 or thereafter. The net effect is much higher death involvement rates per 10,000 population, on average, in states with greater proportions of 16-17 year olds receiving high school driver education. The data suggest that most teenagers would obtain licenses when they are 18--19 years old, irrespective of high school driver education, and indicate that differences among the states in fatal crash involvement rates per 10,000 licensed 18--19 year old drivers were not significantly related to either high school driver education or delayed licensure.     

Sexual behaviour of young people and the risk of HIV infection.

A survey of 16-21 year old people in Somerset was undertaken to find out about their sexual behaviour prior to mounting a local education campaign on AIDS. A representative sample of 400 people, using quota sampling in 40 randomly selected electoral wards, completed a schedule structured part self administered questionnaire. Of these, 371 (92%) considered themselves heterosexual. Nearly half (47%) of the 16 year olds had engaged in sexual intercourse, rising to 89% by the age of 21. Mean frequency of sexual intercourse among the sexually active is 62 per year. The frequency of partner change decreases with increasing age for non-virgins from 2.1 for 16 year olds to 1.5 partner changes per year for 21 year olds (mean frequency 1.7 per year, ie, a new partner every 7 months). This level of sexual activity could eventually give rise to HIV prevalence rates similar to those found in Africa, i.e., 15-100 HIV antibody positive per 1000.