Asthma severity in childhood,untangling clinical phenotypes*

Lang A, Mowinckel P, Sachs‐Olsen C, Riiser A, Lunde J, Carlsen K‐H, Lødrup Carlsen KC. Asthma severity in childhood, untangling clinical phenotypes.
Pediatr Allergy Immunol 2010: 21: 945–953.
© 2010 John Wiley & Sons A/S Assessment of childhood asthma severity and asthma control encompasses heterogeneous clinical presentations. The relationship between patterns of asthma symptoms and objective measurements is poorly defined in paediatric asthma. This study includes 115 asthmatic schoolchildren, of which 31 were at inclusion defined as Problematic severe asthma because of inadequate asthma control in the presence of high‐dose inhaled corticosteroid (HD‐ICS) treatment and at least one other asthma controller drug. Two partially overlapping clinical outcomes were defined irrespective of severity classification (Exacerbations and Chronic persistent asthma) in patients with uncontrolled asthma. The same symptom criteria were used as for Problematic severe asthma, but disregarding current medication. Lung function, exhaled nitric oxide (FE_NO), bronchial hyperresponsiveness, allergic sensitization and Quality of life (QoL) in the symptom subgroups were compared to children with well‐controlled asthma. Multifactor analysis was performed to assess the relative explanatory power of clinical asthma presentations and of HD‐ICS treatment on objective measurements. Whereas children included in the Exacerbations subgroup had objective features similar to patients with well‐controlled asthma, the Chronic persistent asthma subgroup demonstrated significantly reduced lung function, increased immunoglobin E, allergic poly‐sensitization and impaired QoL, similar to that in patients pre‐defined as Problematic severe asthma. The presence of chronic asthma symptoms was a significant explanatory factor for reduced lung function, QoL and increased FE_NO in multifactor analysis. Differences in objective measurements suggest that children with Chronic persistent asthma and those who are symptomatic predominantly during exacerbations may represent distinct phenotypes of childhood asthma with different clinical prognoses.     

Dietary patterns in infancy and their associations with maternal socio‐economic and lifestyle factors among 758 Japanese mother–child pairs: the Osaka Maternal and Child Health Study

Dietary habits established in early childhood contribute to lifelong dietary pattern and the development of early risk factors for disease in adulthood. Although a large body of epidemiologic data from Western countries show that the dietary pattern of children is influenced by maternal socio‐economic and lifestyle characteristics, information on this topic in non‐Western countries is absolutely lacking. The present study identified dietary patterns among infants aged 16–24 months, and then examined the influence of maternal socio‐economic and lifestyle characteristics on identified dietary patterns. Subjects were 758 Japanese mother–child pairs. Dietary data of infants were collected from the mothers using a questionnaire. Dietary patterns were extracted from the consumption of 15 foods (times week^?1) by cluster analysis. The following two dietary patterns were identified: ‘fruits, vegetables and high‐protein foods’ (n = 483) and ‘confectionaries and sweetened beverages’ (n = 275) patterns. After adjustment for all other predictors, maternal educational level, number of infants' siblings and maternal dietary patterns were independently associated with dietary patterns of infants. Infants whose mothers had a higher educational level and the ‘rice, fish and vegetables’ dietary pattern were less likely to belong to the ‘confectionaries and sweetened beverages’ pattern, whereas infants whose mothers had a higher number of children and the ‘wheat product’ dietary pattern were more likely to belong to the ‘confectionaries and sweetened beverages’ than the ‘fruits, vegetables and high‐protein foods’ pattern. In conclusion, the mother's socio‐economic position and dietary patterns were associated with the dietary patterns of infants in the Japanese pairs as observed in the Western populations.     

Portrait of socio-economic inequality in childhood morbidity and mortality over time, Québec, 1990-2005

Aim: To determine the age and cause groups contributing to absolute and relative socio‐economic inequalities in paediatric mortality, hospitalisation and tumour incidence over time. Methods: Deaths (n= 9559), hospitalisations (n= 834 932) and incident tumours (n= 4555) were obtained for five age groupings (<1, 1–4, 5–9, 10–14, 15–19 years) and four periods (1990–1993, 1994–1997, 1998–2001, 2002–2005) for Québec, Canada. Age‐ and cause‐specific morbidity and mortality rates for males and females were calculated across socio‐economic status decile based on a composite deprivation score for 89 urban communities. Absolute and relative measures of inequality were computed for each age and cause. Results: Mortality and morbidity rates tended to decrease over time, as did absolute and relative socio‐economic inequalities for most (but not all) causes and age groups, although precision was low. Socio‐economic inequalities persisted in the last period and were greater on the absolute scale for mortality and hospitalisation in early childhood, and on the relative scale for mortality in adolescents. Four causes (respiratory, digestive, infectious, genito‐urinary diseases) contributed to the majority of absolute inequality in hospitalisation (males 85%, females 98%). Inequalities were not pronounced for cause‐specific mortality and not apparent for tumour incidence. Conclusions: Socio‐economic inequalities in Québec tended to narrow for most but not all outcomes. Absolute socio‐economic inequalities persisted for children <10 years, and several causes were responsible for the majority of inequality in hospitalisation. Public health policies and prevention programs aiming to reduce socio‐economic inequalities in paediatric health should account for trends that differ across age and cause of disease.     

Socio‐economic and ethnic differences in the prevalence of overweight and obesity among school children

Aims: To trial the collection of measurements to provide population‐based prevalence of overweight and obesity in school children in western Sydney and examine the association between healthy weight and ethnicity and socio‐economic status (SES) in a socio‐economically and culturally diverse population. Methods: A cross‐sectional population‐based survey of 2341 children in Years 4 and 7 (mean ages 9 and 12 years, respectively) in 2007. Results: Nineteen per cent of children were overweight and a further 6% were obese. The prevalence of combined overweight and obesity was similar for boys and girls (26% vs. 24%, P= 0.35). SES was significantly associated with the prevalence of unhealthy weight: the odds of being overweight or obese were 1.79 times (95% confidence interval (CI) 1.35 to 2.36) higher for children from the lowest quartile than for children from the highest quartile. Compared to children from an English speaking background, children from a non‐English speaking background were significantly more likely to be overweight or obese (21% vs. 31%, P < 0.001). The prevalence of combined overweight and obesity was significantly higher for children from a Pacific Island (odds ratio (OR) 2.66, 95% CI 1.63 to 4.33), Middle Eastern (OR 1.63, 95% CI 1.22 to 2.17) or European (OR 1.67, 95% CI 1.12 to 2.49) background than for English speaking background children. Conclusion: Large jumps in the prevalence of overweight and obesity in children observed from the 1980s appear to be diminishing, with comparable prevalence reports in 2004 and 2007. Ethnicity and SES are each independently associated with the prevalence of unhealthy weight in children.     

The clinical benefit of evaluating health-related quality-of-life in children with problematic severe asthma

Aim: To evaluate health‐related quality‐of‐life (HR‐QoL) and the asthma control test (ACT) in children with problematic severe asthma and those with controlled asthma and to identify whether clinical characteristics show correlations with these measurements. Methods: This multicentre cross‐sectional study included 93 children in total, 54 with problematic severe asthma and 39 age‐matched with controlled asthma. Subjects completed the Paediatric Asthma Quality‐of‐Life Questionnaire as well as a standardized health questionnaire and the ACT. Objective measurements of exhaled nitric oxide, specific sensitization, pulmonary function and bronchial hyper‐responsiveness to methacholine were also taken. Results: HR‐QoL was reduced in children with problematic severe asthma (5.4 vs. 6.7, p < 0.001), particularly for girls (5.1 vs. 5.6 for boys, p = 0.02), and their ACT scores were also lower (17 vs. 23, p < 0.001) compared with those of subjects with controlled asthma. A HR‐QoL score <6.2 discriminated problematic severe asthma from controlled asthma with 85% sensitivity and 97% specificity, as did the ACT score <20 (79% sensitivity and 94% specificity). Objective measures and other clinical characteristics were weakly associated with HR‐QoL or ACT score. Conclusion: Subjective measurements of HR‐QoL and asthma control are both equally useful in differentiating children with problematic severe asthma from those with controlled asthma.     

Reduced quality of life in children with Gastro‐oesophageal reflux disease

Aim: To assess self‐reported Quality of life (QoL) in children with Gastro‐oesophageal reflux disease (GORD) aged 5–18 and compare this with both disease and healthy control children in a prospective consecutive sample. Methods: All children attending a tertiary paediatric gastroenterology clinic from February 2009 to May 2009 with GORD, chronic constipation and inflammatory bowel disease (IBD) were asked to complete the validated PedsQL generic QoL assessment (self‐report) at their clinic appointment. The PedsQL considers physical, emotional, social and school domains and is scored from 0 to 100. Healthy children were also recruited from the same site. Groups were compared using the independent samples Student’s t‐test. Results: A total of 184 children completed the assessment [103 (56%) male, mean age 10.7 years ± 3.3] including 40 children with GORD, 44 with chronic constipation, 59 with IBD and 41 healthy children. QoL was significantly lower in the GORD group compared with both children with IBD (74 vs. 82) and healthy children (74 vs. 84), and was comparable to that of children with chronic constipation (74 vs. 74). Conclusions: Self‐reported QoL in children with GORD attending a tertiary paediatric gastroenterology clinic is significantly reduced compared with both healthy children and children with IBD.     

‘I know it's wrong,but . . .’: a qualitative investigation of low‐income parents' feelings of guilt about their child‐feeding practices

In the developed world, child overweight and obesity rates are highest among the disadvantaged. This has resulted in calls for more research with low socio‐economic families to better understand their experiences with disadvantage and how they might lead to poorer weight outcomes. The present study, conducted in Australia, adopted a qualitative approach to investigate the factors affecting low socio‐economic parents' child‐feeding practices. Methods used to collect data were introspections, interviews and focus groups. In total, 37 parents of overweight or obese children aged between 5 and 9 years took part in the 6‐month study. Guilt emerged as an emotion that parents regularly experienced when allowing their children to consume too much food or foods high in fat, salt and/or sugar. Parents attributed their guilt‐inducing child‐feeding practices to both external and internal factors. Time scarcity and cost were factors that were primarily characterized by an external locus of control. The factors characterized by an internal locus of control were fear of their children experiencing hunger, the perceived need to secure their children's affection through the provision of treat foods, perceptions of their ability to balance their children's diets across eating situations and perceived laziness. Recommendations are provided for addressing guilt‐inducing child‐feeding practices.     

Actual asthma control in a paediatric outpatient clinic population: Do patients perceive their actual level of control?

Several epidemiological studies described poor asthma control in children. However, the diagnosis of childhood asthma in these studies is uncertain, and asthma control in children of an outpatient clinic population during treatment by a paediatrician is unknown. (1) to investigate the hypothesis that asthma control in a paediatric outpatient clinic population is better than epidemiological surveys suggest; (2) to find possible explanations for suboptimal asthma control. Asthmatic children aged 6–16 years, known for at least 6 months by a paediatrician at the outpatient clinic, were selected. During a normal visit, both the responsible physicians and parent/children completed a standardised questionnaire about asthma symptoms, limitation of daily activities, treatment, asthma attacks and emergency visits. Overall, excellent asthma control of 8.0% in this study was not significantly better than of 5.8% in the European AIR study (Chi‐square, p = 0.24). Separate GINA goals like minimal chronic symptoms and no limitation of activities were better met in our study. Good to excellent controlled asthma was perceived by most children/parents (83%), but was less frequently indicated by the paediatrician (73%), or by objective criteria of control (45%) (chi‐square, p = 0.0001). The agreement between patient‐perceived and doctor assessed control was low, but improved in poorly controlled children. Patients were not able to perceive the difference between ‘excellent asthma control’ and ‘good control’ (p = 0.881).Too little children with uncontrolled disease got step‐up of their asthma treatment. Although separate GINA goals like ‘minimal chronic symptoms’ and ‘no limitation of activities’ were significantly better in our study, overall, asthma control in this outpatient clinic population, treated by a paediatrician, was not significantly better than in the European AIR study. Poorly controlled disease was related to several aspects of asthma management, which are potentially accessible for improvements.     

Ambulatory physical activity levels of white and South Asian children in Central England

Aims: To assess ambulatory physical activity in white and south Asian children from Central England and to examine variation in activity between weekdays and weekends. Methods: 536 primary school children [255 boys and 281 girls, mean age (SD) = 9.6 (1.0) years] wore a sealed pedometer for 4 days (2 weekend and 2 weekdays). Repeated measures analysis of covariance was used to examine weekend versus weekday, gender, ethnic and socio‐economic status differences in steps/day controlling for age, hours of daylight and body mass index (BMI). Results: Children attained significantly higher mean steps/day during weekdays than weekends (p = 0.001) with age being more strongly associated with weekend than weekday steps/day (p = 0.014). The decline in steps/day from weekdays to weekends was greater in high compared to low socio‐economic status children (p = 0.002). White children attained higher mean steps/day than south Asian children (p = 0.015). BMI was negatively associated with steps/day (p = 0.004). 39.2 and 29.9% of white and south Asian children met the BMI‐referenced cut‐offs for health. Conclusion: Physical activity was greater during weekdays compared to weekends, was associated with BMI, age and socio‐economic status and white children were more active than south Asian children.     

Bottle milk feeding and its association with food group consumption,growth and socio‐demographic characteristics in Chinese young children

It is recommended that infants from the age of 12 months should be weaned from bottles. However, an overwhelming proportion of young children were still using bottle after the recommended age of bottle‐weaning. This cross‐sectional study examined the association between utensils for milk drinking and food group consumption, growth and socio‐demographic characteristics among young children. Data from the Survey of Infant and Young Child Feeding in Hong Kong were analyzed for 649 children aged 18–48 months old. Dietary outcomes were obtained via 3‐day dietary records, while utensils for milk drinking and socio‐demographic characteristics were collected from a self‐developed questionnaire. Length/height and weight of the children were measured by the nurses. Results showed that daily consumption of formula milk was significantly greater among bottle users or bottle plus cup users than non‐bottle users (p < 0.05). Exclusive bottle users had significantly lower intakes of meat and meat alternatives than bottle plus cup users for the 18 to 24‐month group (p = 0.001) and lower intakes of fruits than non‐bottle users in the 48‐month group (p = 0.015). BMI z‐score was significantly higher for exclusive bottle users than non‐bottle users, even after adjusting for socio‐economic factors and child's age (p = 0.006). The results showed that the milk drinking utensil was associated with the amount of formula milk and food group consumption as well as BMI z‐score. There is a need to actively discourage prolonged bottle use in order to help young children develop good dietary habits. © 2016 John Wiley & Sons Ltd     

以健康测量量表评价癫及哮喘患儿生活质量的对照研究

摘要 目的 以健康测量量表（SF 36）评估癫痫及哮喘患儿的生活质量。方法 采用SF-36量表对2007年6至12月在复旦大学附属儿科医院神经专科、呼吸专科及儿童保健门诊就诊的癫痫患儿、哮喘患儿和健康儿童进行生活质量评定。结果 研究期间85例癫痫患儿（癫痫组）、81例哮喘患儿（哮喘组）和87名健康儿童（正常对照组）进入分析。3组儿童的年龄、性别和受教育程度相匹配。①疾病及治疗情况：癫痫组和哮喘组服用1种药物者分别为70/85例和59/81例,癫痫组63/85例和哮喘组56/81例患病后规则服药,两组在服药种类和依从性上差异无统计学意义（P均＞0.05）;癫痫组36/85例至本次调查前至少有1年癫痫未发作;哮喘组29/81例最大呼气峰流速监测持续保持个人最佳值的80％以上。②生活质量评价：癫痫组的生活质量总分和8个分项的终得分与正常对照组差异均有统计学意义（P<0.01）;哮喘组的生活质量总分及生理功能、身体疼痛、总体健康和活力4个分项的终得分与正常对照组差异均有统计学意义（P<0.01）;无论疾病控制与否,癫痫组生活质量均较哮喘组差;癫痫组情感功能及精神健康状况明显差于哮喘组,其心理障碍不随疾病控制而明显改善。结论 ①癫痫和哮喘患儿生活质量较健康儿童明显下降;②癫痫患儿较哮喘患儿生活质量损害更为明显;③SF-36量表可作为评价疾病控制程度的手段,辅助评价疾病治疗的疗效;④癫痫 患儿的心理障碍应引起临床高度关注。     

Pneumonia in the first 2 years of life,and asthma in preschool‐age children

Background: The relationship between viral bronchiolitis in early infancy and subsequent wheezing and asthma has been well established. The aim of the present cross‐sectional study was to test the hypothesis that pneumonia severe enough to require hospitalization during the first 2 years of life could also be associated with asthma or asthma‐like symptoms in pre‐school children. Methods: Structured interviews were conducted with parents of children who were classified as exposed (n= 36) or non‐exposed (n= 84), based on whether they were hospitalized with radiologically confirmed pneumonia during the first 2 years of life. The main outcomes were ever physician‐diagnosed asthma, asthma‐like symptoms and use of anti‐asthmatic medications during the last 2 months and during the last 12 months. Results: The prevalence of ever physician‐diagnosed asthma was higher in the exposed group compared with the non‐exposed group (41.6% vs 22.6%, P= 0.01), with an adjusted prevalence ratio of 2.03 (95% confidence interval: 1.10–3.62). The exposed group had a trend toward a higher prevalence of asthma‐like symptoms and use of anti‐asthmatic medications during the last 2 months and during the last 12 months. Conclusions: Radiologically confirmed pneumonia in the first 2 years of life may be associated with asthma or asthma‐like symptoms in pre‐school children.     

Rhinitis, rhinosinusitis and quality of life in children

Quality of life (QoL) or, rather, health-related QoL, is currently regarded as a crucial aspect of the general well-being of patients and, in consequence, of the effects of a disease and its treatment. This is particularly true for respiratory allergy (asthma and rhinitis), which are chronic diseases and also for sinusitis (rhinosinusitis). A number of questionnaires (instruments), either generic or specific, have been developed and validated to assess the QoL in adults and children, for asthma and rhinitis, whereas there are few specific instruments for chronic rhinosinusitis. The literature provides strong evidence of the effects of allergic rhinitis, asthma and their treatments on QoL in paediatric patients, as well as in adults, whereas the number of experimental data on rhinosinusitis is limited, especially in children. Clinical trials evidenced some controversial points, mainly the weak correlation existing between QoL and traditional objective parameters. It has become clear that the QoL questionnaires measure the aspects of the disease that partially differ from the routinely evaluated parameters and that QoL should integrate, not replace, the objective measurements.     

Eosinophils and eosinophil cationic protein in children with and without sensitization to inhalant allergens

Eosinophil inflammation is a common feature of allergic disorders and particularly in allergic asthma interest has been paid to related markers. In a communitybased survey of 10-year-old children, the association of eosinophil count (EC) and serum eosinophil cationic protein (ECP) with allergic sensitization, clinical history and exposure to mite allergen was studied. Relying on the results of skin prick tests, the children were divided to three groups: (1) children showing no sensitization to one of the seven inhalant allergens (n=16); (2) children with sensitization to at least one of five non-mite allergens (n=16); and (3) children with sensitization to mite allergens (n-75). Clinical history of asthma and hay fever was ascertained using standardized questionnaires. EC in peripheral blood and serum ECP were measured on one single occasion. Prior to blood sampling, mite allergen exposure at home had been assessed by taking dust samples and measuring the mite antigen concentration by means of an enzyme immunoassay. Compared to group 1, higher ECs were obvious in group 2 (P=0.037) and in group 3 (P=0.0013). Regarding serum ECP, higher levels occurred in group 2 (P=0.0033) as well as in group 3 (P=0.0001) when comparing them to the reference group. Sensitized children with neither asthma, nor asthma-like symptoms, nor hay fever (n=28) did not have significantly lower ECs and serum ECP levels than those with hay fever (n=15;P=0.09,P=0.17) and those with asthma (n=22;P=0.69,P=0.64). Since mild asthmatics were in general included, our findings were limited with regard to clinical severity. Using multiple linear regression, EC occurs in positive association with mite allergen exposure at home (P=0.033) and with a history of asthma-like symptoms (P=0.02).Conclusion Our findings indicate that EC and serum ECP are confounded by the status of allergic sensitization. Therefore, value and limits of both parameters need further investigation before use in the management of allergic children can be recommended.     

Children's Nomenclatural Adventurism and Medical Evaluation study

Aim: The aim of this study was to determine whether there is an association between a child's first name and the likelihood of inpatient admission following presentation to a paediatric emergency department (ED). Methods: This was a retrospective review of electronic records held in the ED of an urban tertiary paediatric hospital. Data were obtained for all presentations up to the age of 16 years for a single month (n= 4260), each being allocated to 1 of the 10 predetermined first name categories. Results: A statistically significant increased risk for hospital admission was found for the following first name categories: popular culture (relative risk (RR) = 1.91, P= 0.000, 95% confidence interval (CI) = 1.60–2.28), apparently unique (RR = 1.52, P= 0.000, 95% CI = 1.23–1.87), Old Testament (RR = 1.39, P= 0.001, 95% CI = 1.14–1.69) and surname as first name (RR = 1.36, P= 0.015, 95% CI = 1.07–1.72). Conclusions: Our data confirm the impression that children with certain categories of first names have an increased likelihood of admission to hospital after presenting to the ED. We speculate that our findings, which are in concordance with those from educational and psychological literature, may reflect socio‐economic status and/or a ‘self‐fulfilling prophecy’. Further research may make it possible to assign names an RR rating (e.g. for hospital admission in the first 16 years of life), thus providing parents with another factor to consider when choosing names for their children. More studies are of course needed.     

Quality of life and academic functioning 6 years after paediatric referral for chronic pain

Aim: To assess health‐related quality of life (HR‐QoL) and academic functioning in adolescents and young adults 6 years after paediatric referral for chronic pain. Methods: In 99 children and adolescents with chronic pain (aged 8–17) referred to a paediatric outpatient clinic, pain and psychiatric disorders were assessed between 2000 and 2002. Participants were reassessed after minimal 5 years (aged 13–24). HR‐QoL [Medical Outcomes Study 36‐item Short‐Form (SF‐36)] was compared with Dutch population norms. Academic functioning (structured questionnaire) was compared with baseline. Results: Participant’s ratings in most HR‐QoL dimensions did not differ from population norms. Outcome was significantly decreased in Bodily Pain (p = 0.001 males, p < 0.000 females) and female General Health (p = 0.001). Poor general health perceptions (p = 0.002), poor global general health (p = 0.003) and a high somatic symptom level (p = 0.004) at baseline predicted poor HR‐QoL outcome. School/work attendance was significantly better than at baseline (p = 0.002). Conclusion: Six years after paediatric referral for chronic pain, HR‐QoL was mostly comparable to that of peers, and academic functioning improved. Self‐evaluated global health at referral may be an important predictor of HR‐QoL outcome of children with chronic pain, rather than psychiatric comorbidity.     

Association of maternal characteristics and behaviours with 4‐year‐old children's dietary patterns

This study examined the association of family and maternal characteristics with preschool children's dietary patterns. Trained interviewers evaluated subsample 3422 mothers and children enrolled in the population‐based birth cohort Generation XXI (Porto, Portugal, 2005–2006). Maternal characteristics and behaviours (exercise, smoking habits, diet and child‐feeding practices) and family characteristics were evaluated. Maternal diet was classified by a dietary score, and children's dietary patterns were identified by latent class analysis. Odds ratios (OR) and confidence intervals (95% CI) were estimated by multinomial regression models. The analysis was based on a framework with four conceptual levels: maternal socio‐economic position (SEP) at 12 years, maternal socio‐economic and demographic characteristics at child's delivery, family characteristics and maternal behaviours at child's 4 years. Three dietary patterns were identified in children: high in energy‐dense foods (EDF); low in foods typically consumed at main meals and intermediate in snacks (Snacking); higher in healthy foods; and lower in unhealthy ones (Healthier, reference). Lower maternal SEP had an overall effect on children's diet (low vs. high SEP; EDF, OR = 1.76, 95% CI: 1.42–2.18; Snacking, OR = 1.73, 95% CI: 1.27–2.35), while maternal education was directly associated with it (≤9 vs. >12 schooling years, EDF, OR = 2.19, 95% CI: 1.70–2.81; Snacking, OR = 2.22, 95% CI: 1.82–3.55). Children whose mothers had worse dietary score were significantly more likely to follow unhealthier patterns (first vs. fourth quartile; EDF, OR = 9.94, 95% CI: 7.35–13.44, P‐trend < 0.001; Snacking, OR = 4.21, 95% CI: 2.94–6.05, P‐trend < 0.001). Maternal diet was the key factor associated with children's diet, above and beyond socio‐economic and demographic characteristics, accounting for one‐third of the determination coefficient of the fully adjusted model. At preschool age, interventions should give a particular focus on maternal diet and low SEP groups.     

呼出气一氧化氮检测在幼儿支气管哮喘中的应用分析

目的分析各期支气管哮喘(AS)幼儿的呼出气一氧化氮(FeNO)浓度变化,探讨FeNO浓度与AS分期的相关性。方法选取2014年4~6月初次诊断为AS且处于急性发作期的1~3岁患儿58例为研究对象,依据治疗后病情转归情况分为慢性持续期(n=34)及临床缓解期(n=24),以同龄健康儿童30例为对照,对所有儿童行FeNO浓度、肺功能等检测。分析FeNO浓度与AS分期的相关性。利用受试者工作特征(ROC)曲线分析FeNO诊断AS的最佳诊断截点。结果各期AS患儿FeNO浓度均高于对照组儿童(P0.05)。急性发作期患儿Fe NO浓度高于慢性持续期和临床缓解期,且慢性持续期患儿FeNO浓度高于临床缓解期(均P0.05)。AS患儿FeNO浓度水平与AS分期相关(r=-0.382,P0.05)。ROC曲线分析显示FeNO诊断AS的最佳诊断截点为22.75 ppb,敏感度达0.933,但特异度仅为0.388。结论 AS幼儿FeNO浓度水平与AS分期相关;Fe NO浓度22.75 ppb可作诊断幼儿AS的界值。     

Association of sleep duration with socio‐economic status and behavioural problems among schoolchildren

Aim: In this population‐based study, we aimed to determine the total sleep duration (TSD), its association with socio‐economic status (SES) and behavioural symptoms among schoolchildren. Methods: A cross‐sectional study was performed among schoolchildren in Istanbul. A structured questionnaire evaluating the sleep schedule variables was filled out by their parents. SES was determined according to the Turkish SES scale. Results:  The mean age of 2669 children was 8.2 ± 2.4 years, and 51% of the students were girls. The mean TSD was 10.20 ± 1.04, and the mean bedtime was 21.57 ± 0.56 (both in hours, minutes ± SD). Boys tended to go bed later (p = 0.004) and slept less than girls (p = 0.02). The duration of sleep disruptions increased (p < 0.001), whereas TSD decreased with age (p < 0.001). Multiple linear regression revealed that waking time and TSD decreased significantly (p < 0.05) with higher SES among both girls and boys. Sleep fragmentation was associated with habitual snoring, parasomnias, daytime sleepiness and conduct symptoms. Conclusion: Decreased total sleep duration is more prominent in boys, older children and children among higher socio‐economic status. Insufficient sleep attributed to shortened total sleep duration by age and higher socio‐economic status might have a negative effect on both sleep hygiene and psychological well‐being in schoolchildren.     

Adaptation of the Manchester-Minneapolis Quality of Life instrument for use in the UK population.

INTRODUCTION: The availability of health-related quality of life (HRQL) measures that are reliable, valid, brief and comprehensible and appropriate for use with UK children is limited. We report the validation of a HRQL measure suitable for UK use in healthy children, children with chronic disease conditions and socially disadvantaged children. PATIENTS: A total of 1238 children took part in the study, including healthy children as controls (n = 824) and five exemplar groups: children diagnosed with asthma (n = 87), diabetes (n = 103) or inflammatory bowel disease (IBD; n = 69), children in remission from cancer (n = 68) and children in public care (n = 87). METHODS: In phase I, the Manchester-Minneapolis Quality of Life instrument (MMQL) Child Form was translated into UK English. In phases II and III, the questionnaire was shortened and validated. RESULTS: MMQL was anglicised and shortened to five components comprising 29 items. Good internal reliability was found with alpha reaching at least 0.69 for all subscales. Construct validity was established through moderate correlations with comparable PedsQL subscales (Pearson's r ranged from 0.38 to 0.58, p<0.01). Discriminant validity was also demonstrated in children with asthma and IBD, children in remission from cancer and children in public care, all of whom reported significantly lower HRQL than healthy children. Children with diabetes showed similar HRQL to their healthy peers. Good reproducibility and moderate responsiveness were demonstrated for the new measure. CONCLUSIONS: The anglicised and shortened MMQL was shown to be valid and reliable and could be a valuable new tool for the assessment of HRQL in children.