Asthma in adolescents and young adults: relationship with early childhood respiratory morbidity.

AIM. This study was undertaken to examine the relationship between respiratory illness in early childhood and asthma in adolescence and young adulthood (age group 10-23 years). METHOD. The study population comprised 277 boys and 274 girls, born between 1967 and 1978 and registered from their birth to the year of study (1989) on the practice lists of the four general practices taking part in the continuous morbidity registration project (CMR) at the University of Nijmegen in the Netherlands. Details of all episodes of respiratory morbidity presented in the first five years of life and registered in the project were collected together with data on current respiratory status determined by means of a questionnaire on respiratory symptoms, spirometry and a histamine-challenge test. RESULTS. Sixteen per cent of the study group were diagnosed as having asthma. Only asthma and acute bronchitis in early childhood were significantly associated with asthma at age 10-23 years. CONCLUSION. Asthma in adolescence and young adulthood is related to asthma and acute bronchitis in early childhood. This study supports the view that this could be a causal relationship although an alternative explanation could be misclassification. The results provide no indication that upper respiratory tract infections are associated with the development of asthma in adolescence or young adulthood.     

Development of respiratory illness in childhood — a longitudinal study in general practice

The prognosis of early childhood respiratory illness has been studied by analysis of historic cohorts using data recorded since 1967 in the continuous morbidity registration project of the University of Nijmegen. The characteristics of this project are discussed, including the stability of the practice (study) population, a factor which allows longitudinal analysis to be performed.

The development of respiratory morbidity during the first eight years of life has been analysed and a group of 710 patients characterized on the basis of their respiratory morbidity in the first two years of life. In general the highest levels of respiratory morbidity are seen in the first years of life, with a gradual decline over the years studied. Upper respiratory tract infections are largely responsible for this morbidity. An elevated level of episodes of respiratory illness in patients aged two to seven years was observed when the following characteristics of early life respiratory morbidity were present: more than three episodes of respiratory illness, lower respiratory tract infections or catarrhal conditions. However, by the age of seven years the level of morbidity of the children with these characteristics was very similar to that of children without these characteristics. Respiratory morbidity in childhood is predominantly benign and self-limiting. Only children with atopic conditions in early childhood showed a higher prevalance of asthma and chronic bronchitis at the end of the study period.

     

Segmental patterns of rib-vertebra angles in chest radiographs of children: Changes related to rib level,age, sex,side and significance for scoliosis

Rib-vertebra angles (RVAs) were measured (T1–12) on the chest radiographs of 412 children aged 0–17 years attending the hospital with minimal disorders or diseases (boys 193, girls 219). A new method for measuring RVAs is used and the asymmetry of rib-vertebra angles is calculated as rib-vertebra angle differences (RVADs). The data are analysed in three age groups—infancy, childhood, and puberty, after the classification of Karlberg (1989). The findings show the following:(1) RVAs decrease from T1–12, especially so between (T8 and T12.2) Between infancy and childhood, RVAs of the upper ribs incrase, more so in boys than girls. (3) Between childhood and adolescence there is a further elevation of ribs, involving more ribs in boy than girls (boy T1–10, girls T1–8). (4) Between infancy and childhood, the lower ribs droop more in girls than boys (boys T9–10/12, girls T7/8–12). There is no change in the RVAs of the lower ribs between childhood and puberty in either boys or girls. (5) The hypothesis is suggested that RVAs are influenced by the central nervous system through its influence on trunk muscle activity. (6) Ribvertebra angle asymmetries (or differences, RVADs) are related to age and sex; their pattern reflects the common age, sex, and laterality patterns of idiopathic scoliosis. Extremes of such asymmetries may be an etiological factor for both infantile and adolescent idiopathic scoliosis. © 1992 Wiley-Liss, Inc.     

Sex differences in the association between sleep duration, diet and body mass index: a birth cohort study

Sex differences in the effects of sleep duration on dietary intake and eating behaviours were examined prospectively in relation to overweight/obesity at ages 6 and 7. Using data from a representative sample (QLSCD 1998-2010) of children born in the province of Québec (Canada), 1106 children were followed to age 6 and 1015 to 7years. Average nocturnal sleep duration was surveyed annually from 2.5-6years, food-frequency and eating behaviour questionnaires were administered at age 6, and body weight and height were measured at 6 and 7years. Associations were examined longitudinally and mediation examined with adjustments for potential confounders. In boys and girls, shorter sleep duration patterns were associated significantly with less favourable dietary intakes at 6years: boys consumed vegetables and fruits less frequently and meats/alternatives more frequently than boys with longer sleep patterns; and girls consumed vegetables, fruits and milk products less frequently and soft-drinks more frequently than girls with longer sleep patterns. However, boys with shorter sleep patterns were also more likely to eat at irregular hours or to eat too much/fast at 6years. These behaviours, and not dietary intake, mediated an inverse association between sleep duration and overweight/obesity in boys. Sleep duration did not associate with any problem eating behaviours or overweight/obesity in girls. Shorter sleep in early childhood appears to associate with problematic eating behaviours in boys and diet quality in both sexes, regardless of an association with overweight/obesity. This is important for public health and should be considered in relation to other diet-related diseases.     

TW3 bone age: RUS/CB and gender differences of percentiles for score and score increments

BACKGROUND: Longitudinal data on bone age progression is scarce. AIM: The study aimed to present reference values for Tanner-Whitehouse 3 (TW3) bone age score and score increments, and to provide means and standard deviations of appearance time for all TW3 stages. Gender differences and differences between radio ulna and short bones (RUS) and carpal bone (CB) scores were studied. SUBJECTS AND METHODS: Bone age data collected for ages 3 months to 20 years in 232 subjects during the First Zurich Longitudinal Study (1954-1976) were used. Smoothed empirical percentiles of TW3 RUS and CB scores for age, of score increments for age and of score increments for attained score are presented. Means and standard deviations of the appearance times are calculated by parametric censored regression. RESULTS: There are clear differences between the RUS and CB scores and between the genders. Boys are delayed with respect to girls, with different delays for RUS and CB. For RUS, differences in maturation reflect the known differences of physical growth, with a later and more intense peak in boys. For CB, there is little difference in timing and intensity. However, girls reach the final score about 2 years earlier than boys. The consistently earlier mean appearance times in girls indicate that skeletal maturation is, already in childhood, more rapid in girls than in boys. There are significant gender differences in the sequence of appearance. CONCLUSION: Reference values for TW3 score and score increments and mean appearance times for stages add to existing knowledge and indicate important RUS/CB and gender differences, whose sources are largely unknown.     

Height and height velocity in early, average and late maturers followed to the age of 25: a prospective longitudinal study of Swedish urban children from birth to adulthood

A sample of 103 Swedish boys and 80 Swedish girls followed longitudinally were grouped into early, average and late maturers on the basis of age at peak height velocity. In girls there were significant differences in height between the maturity groups from 5 to 14 years of age, but the final height did not differ between the groups. In boys there were significant differences in height between the maturity groups from 12 to 16 years, no significant difference at the age of 17 years, and from 18 years of age and on, late-maturing boys were significantly taller than the early maturity boys. From 21 years and onwards they were also taller than the average-maturing boys. Thus final height differed significantly between the late-maturing boys and the other two maturity groups of boys, averaging 6.5 cm and 4.2 cm, respectively.     

Childhood cough variant asthma and its relationship to classic asthma.

BACKGROUND: In pediatrics, some patients with chronic cough who have no evidence of a causative disease are diagnosed as having cough variant asthma (CVA). The precise prognosis of infants and children with CVA, however, is still unclear. OBJECTIVE: To evaluate the relationship between CVA and classic asthma in childhood. METHODS: To diagnose CVA, we performed a methacholine inhalation challenge with use of a transcutaneous oxygen pressure (tcPO2) monitoring system in 100 children with chronic cough, and 75 children (45 boys and 30 girls; mean age, 5.7 years) were diagnosed as having CVA. These patients underwent follow-up monitoring for more than 3 years to ascertain whether classic asthma developed. For comparison, 53 age-matched children with classic asthma (30 boys and 23 girls; mean age, 5.6 years) and 30 age-matched control subjects (12 boys and 18 girls; mean age, 5.5 years) also participated in this study. Consecutive doses of methacholine were doubled until a 10% decrease in tcPO2 from the baseline was reached. The cumulative dose of methacholine at the inflection point of tcPO2 (Dmin-PO2) was considered to represent the sensitivity of tcPO2 to inhaled methacholine. RESULTS: After 3 years or more of follow-up assessments, 52 of the 75 patients answered our questionnaire. Of the responding patients, 28 had been diagnosed as having classic asthma. A significant difference was noted in the age at onset of CVA between the children in whom classic asthma developed (the asthma-developed group) and those in whom classic asthma did not develop (the asthma-free group). No statistically significant differences in Dmin-PO2 between the asthma-developed group and the asthma-free group or between the girls and the boys, however, were foun CONCLUSIONS: This study showed that 75% of children with chronic cough had CVA, that classic asthma developed in 54% of the children with CVA, and that it is not the severity of bronchial hyperresponsiveness in CVA but the age at onset of CVA that is a risk factor for the development of classic asthma in childhood CVA.     

The role of early aggressive behavior in the frequency, seriousness, and types of later crime

This study reports on the relation between aggressive behavior at early school age and later delinquent activities of 1,027 subjects (517 boys and 510 girls) prospectively followed from late childhood to adulthood. The research group was a fairly unbiased age sample of children, covering most of the range of social and psychological upbringing conditions for 10-year-old children in a Swedish community. Aggressiveness was measured by teacher ratings at ages 10 and 13 years. Delinquency, defined as registered lawbreaking, was covered through age 26. There was a strong connection between both the aggressiveness ratings at ages 10 and 13 and adult delinquency for boys, with the majority of delinquents and recidivists being recruited from the early-aggressive boys. High ratings of aggressiveness were characteristic of boys who later committed violent crimes and damage to public property and generally of subjects with a diversified offense pattern. Aggressiveness was not predictive of later crime for girls until they reached the age of 13. For both sexes the relation between aggressiveness and crime was to a large extent independent of intelligence and family education. The possibility of making individual prognoses and the role of aggressiveness for the sexes are discussed.     

Development of Psychiatric Comorbidity With Substance Abuse in Adolescents: Effects of Timing and Sex

Examined the impact of childhood psychiatric disorders on the prevalence and timing of substance use and abuse and tested for sex differences. A representative population sample of 1,420 children, ages 9, 11, and 13 at intake, were interviewed annually. American Indians and youth with behavioral problems were oversampled; data were weighted back to population levels for analysis. By age 16, more than half the sample reported substance use, and 6% had abuse or dependence. Alcohol use began by age 9, and smoking in the 13th year. Mean onset of dependence was 14.8 years, and mean onset of abuse was 15.1 years. Substance use began earlier in boys, but not girls, who later developed abuse or dependence. Disruptive behavior disorders and depression were associated with a higher rate and earlier onset of substance use and abuse in both sexes, but anxiety predicted later onset of smoking. Family drug problems were the strongest correlate of early onset. Despite differences in prevalence of psychopathology, boys and girls showed more similarities than differences in the course of early substance use and abuse, and its associations with psychopathology.     

Maturation of Prestimulation-Induced Startle Modulation in Girls

This study of the maturation of prestimulation-induced modulation of startle in 4- to 8-year-old girls and young women demonstrated significant effects of age on both startle amplitude and onset latency modulation. Prestimulation with nonstartling tones resulted in strong inhibition of both amplitude and latency of the startle blink reflex in adults when 25-ms tones preceded the startling stimuli by 120 ms or 250 ms. Following sustained prestimulation for 2000 ms, the adults showed weak nonsignificant response facilitation. Eight-year-old girls showed mature inhibitory startle amplitude modulation, but significantly less inhibition of onset latency compared to adults. Preschool girls showed significantly less amplitude and latency inhibition and more facilitation than 8-year-olds and adult women. These findings in female subjects were very similar to those obtained by Ornitz, Guthrie, Kaplan, Lane, and Norman (1986) in male subjects. Gender differences were limited to the 8-year-old age group. The 8-year-old girls showed significantly less startle amplitude inhibition than 8-year-old boys following the 120-ms and 250-ms prestimulation intervals and less latency facilitation following 2000 ms of sustained prestimulation. In general, these findings suggest that brainstem mechanisms that mediate startle response modulation undergo development during early childhood and do not mature until about 8 years of age in both male and female subjects. The results are discussed in relation to studies of gender effects on development of other neurophysiological variables and to maturation of the nervous system.     

Skeletal maturity of the hand and wrist in Japanese children by the TW2 method.

The skeletal maturity of Japanese children aged 0--18 years in Tokyo was compared with that of British children by the TW2 method. The skeletal age was the same as or less than the chronological age until 8 years. Thereafter, it was in advance of chronological age until 18 years in boys and 15 years in girls. The hand and wrist bones completed maturation about the same time in both Japanese and British children, at the age of 18 years in boys and 16 years in girls.     

Internal working models of attachment during late childhood and early adolescence: an exploration of stability and change

This article addresses the question of how the transition from late childhood to early adolescence influences the organization of attachment. The applicability of a measure for attachment representations in early adolescence, the Attachment Interview for Childhood and Adolescence (AICA), was explored. The AICA is based on the Adult Attachment Interview, which was adapted in minor ways to the early adolescent age-group. It was hypothesized that attachment shows considerable stability from late childhood to early adolescence, although some changes might become manifest especially because distancing mechanisms toward the parents may be activated in this period. Also, stability may be different for the various secure and insecure attachment classifications. Lastly, because gender differences become larger during the transition from childhood to adolescence, attachment differences between boys and girls were explored. The same 31 Italian participants (14 girls, 17 boys) completed the AICA at 10 years and at 14 years of age. The AICA attachment classification distributions did not differ from Adult Attachment Interview (AAI) distributions in comparable but older adolescent or young adult samples. The stability of attachment security was considerable: 74% (k = .48). The stability of the dismissing and secure categories was somewhat higher than the stability of the (small) preoccupied and unresolved categories. The participants tended to show more dismissing strategies across the four years, and to report more rejection from their parents. It was suggested that the activation of dismissing defense mechanisms might be necessary to keep parental figures at some distance in order to achieve a more definite personal identity. Finally, no significant gender differences in attachment emerged during the transition from late childhood to early adolescence.     

Skeletal maturity of the hand and wrist in Japanese children by the TW2 method

The skeletal maturity of Japanese children aged 0–18 years in Tokyo was compared with that of British children by the TW2 method. The skeletal age was the same as or less than the chronological age until 8 years. Thereafter, it was in advance of chronological age until 18 years in boys and 15 years in girls. The hand and wrist bones completed maturation about the same time in both Japanese and British children, at the age of 18 years in boys and 16 years in girls.     

Birth seasons and heights among girls and boys below 12 years of age: lasting effects and catch-up growth among native Amazonians in Bolivia

Background: Seasons affect many social, economic, and biological outcomes, particularly in low-resource settings, and some studies suggest that birth season affects child growth.

Aim: To study a predictor of stunting that has received limited attention: birth season.

Subjects and methods: This study uses cross-sectional data collected during 2008 in a low-resource society of horticulturists-foragers in the Bolivian Amazon, Tsimane’. It estimates the associations between birth months and height-for-age Z-scores (HAZ) for 562 girls and 546 boys separately, from birth until age 11?years or pre-puberty, which in this society occurs ～13–14?years.

Results: Children born during the rainy season (February–May) were shorter, while children born during the end of the dry season and the start of the rainy season (August–November) were taller, both compared with their age–sex peers born during the rest of the year. The correlations of birth season with HAZ were stronger for boys than for girls. Controlling for birth season, there is some evidence of eventual partial catch-up growth, with the HAZ of girls or boys worsening until?～?age 4–5?years, but improving thereafter. By age 6?years, many girls and boys had ceased to be stunted, irrespective of birth season.

Conclusion: The results suggest that redressing stunting will require attention to conditions in utero, infancy and late childhood.     

Epinephrine dispensing patterns for an out-of-hospital population: a novel approach to studying the epidemiology of anaphylaxis

BACKGROUND: The underlying rate of occurrence of anaphylaxis from all potential triggers in the general population is unknown. OBJECTIVE: We sought to obtain a perspective on the epidemiology of anaphylaxis in a defined general population by studying epinephrine dispensing patterns in an out-of-hospital setting. METHODS: Using an administrative claims pharmaceutical database, we analyzed dispensing data for all epinephrine formulations prescribed for out-of-hospital treatment over 5 consecutive fiscal years in a population of 1.15 million persons in the province of Manitoba, Canada. We identified the number and percentage of individuals in the general population for whom epinephrine was dispensed on one or more occasions, their age and sex, and the type of formulation dispensed. In addition to performing these analyses for the entire population of children, adults, and elderly individuals, we also performed analyses by 5-year age groupings; furthermore, for individuals younger than 5 years of age, we performed a detailed analysis by 6-month age groupings. RESULTS: During the 5-year period, 0.95% of this defined general population had injectable epinephrine dispensed for out-of-hospital treatment. There were substantial variations in epinephrine dispensing rates across subsets of the population, ranging from 1.44% for individuals younger than 17 years of age, to 0.9% for individuals 17 to 64 years of age (inclusive), to 0.32% for those age 65 years or older. In infancy, childhood, and early adolescence boys were more likely to have epinephrine dispensed than girls. Beginning at age 15 years and continuing into adulthood, girls and women were more likely to have epinephrine dispensed than boys and men. In the elderly there were no differences in dispensing patterns between the sexes. The highest epinephrine dispensing rate (5.3%) was found for boys age 12 to 17 months. CONCLUSIONS: Epinephrine dispensing data provide a novel and practical approach for studying and monitoring the epidemiology of anaphylaxis in a community. Using this approach, we provide evidence that anaphylaxis from all triggers peaks in early childhood and then gradually declines into old age.     

TW3 bone age: RUS/CB and gender differences of percentiles for score and score increments

Background: Longitudinal data on bone age progression is scarce.

Aim: The study aimed to present reference values for Tanner–Whitehouse 3 (TW3) bone age score and score increments, and to provide means and standard deviations of appearance time for all TW3 stages. Gender differences and differences between radio ulna and short bones (RUS) and carpal bone (CB) scores were studied.

Subjects and methods: Bone age data collected for ages 3 months to 20 years in 232 subjects during the First Zurich Longitudinal Study (1954–1976) were used. Smoothed empirical percentiles of TW3 RUS and CB scores for age, of score increments for age and of score increments for attained score are presented. Means and standard deviations of the appearance times are calculated by parametric censored regression.

Results: There are clear differences between the RUS and CB scores and between the genders. Boys are delayed with respect to girls, with different delays for RUS and CB. For RUS, differences in maturation reflect the known differences of physical growth, with a later and more intense peak in boys. For CB, there is little difference in timing and intensity. However, girls reach the final score about 2 years earlier than boys. The consistently earlier mean appearance times in girls indicate that skeletal maturation is, already in childhood, more rapid in girls than in boys. There are significant gender differences in the sequence of appearance.

Conclusion: Reference values for TW3 score and score increments and mean appearance times for stages add to existing knowledge and indicate important RUS/CB and gender differences, whose sources are largely unknown.     

Differences in the physical growth of US-born black and white children and adolescents ages 2-19, born 1942-2002

AIM: The present study estimates differences in the trend and in the age-by-height profiles of US-born non-Hispanic black and white children and adolescents born 1942-2002. SUBJECTS AND METHODS: The combined NHES and NHANES data sets stratified by ethnicity and gender were used. The differences in height-for-age z-scores (HAZ) were decomposed into an age effect and a secular trend effect using a non-linear regression model. RESULTS: The tempo of growth among blacks is faster than among whites. Black girls are more than 0.3sigma taller than white girls between the ages of 3 and 11. At age 9 this amounts to some 2.7 cm. White boys catch up to black boys at age 14 and white girls catch up at age 15 and are taller thereafter. At age 19 whites are only slightly taller: By 0.12sigma (0.8 cm) for boys and 0.03sigma (0.2 cm) among girls. The cumulative effect of the differences in the secular trend is considerable. Between the birth cohorts of the mid-1950s and the beginning of the new century blacks gained some 0.17sigma (girls) and 0.23sigma (boys) relative to white HAZ values. CONCLUSION: Blacks have a faster tempo of linear growth in childhood partly on account of their nutritional habits, as girls in particular tend to have higher BMI values, and partly probably because of genetic differences.     

Genetics of pre-pubertal growth: A longitudinal study of Japanese twins

Background: Genetic factors explain a major part of the variation of adult stature, but little is still known on the genetics of growth, especially in non-Caucasian populations.

Aim: To analyse the quantitative genetics of pre-pubertal growth in Japanese children.

Subjects and methods: Data from birth until 11 years of age were collected on 349 complete twin pairs based on previously recorded height measures. The data were analysed using two different multivariate models by the Mx statistical package.

Results: No major sex differences were found and thus boys and girls were analysed together. Since 1 year of age, genetic factors explained from 42–71% and environmental factors shared by co-twins from 14–33% of the variation of height. Genetic continuity of height was high and 75% of the genetic variance was shared since 1 year of age. Environmental factors affecting height showed weaker correlations between early and late childhood than genetic factors.

Conclusion: Growth from early to late childhood is largely regulated by the same set of genes. However, also environmental factors shared by co-twins are important for growth. Identifying specific environmental factors affecting growth has potentially important public health implications, even in an affluent society such as Japan.     

Childhood predictors of violent behavior

In this study, prospective childhood data from birth to 7 years of age were used to determine predictors of subsequent violent behavior. The childhood predictors found for the girls accounted for more variance in the reported later violent offenses: 24.9% compared to 3.8% for the boys. This large difference may be due partly to the fact that violent behavior is more unusual among girls; thus, those girls who are violent are more readily differentiated from the others. The only two early childhood variables that were found to predict for both genders were: (a) less normal behavior and (b) presence of deviant or stereotyped behavior. Thus, abnormal behavior in childhood can be considered to be a fairly reliable predictor to greater likelihood of later violent behavior.     

Anthropometric assessment of nutritional status among highland Kashmiri children: Reevaluating the assumption of female nutritional disadvantage

As part of a larger project investigating the health of rural villagers in Kashmir, India anthropometric data were collected from 132 residents of the highland village of Basmina. Here data for 70 children (53% of the total sample) less than 10 years old are examined and compared to United States reference data and presented as a percentage of the median and Z-scores to describe nutritional status differences by age and sex. Overall, these children maintain indices of weight/age, stature/age, and arm circumference (AC)/age at almost ?2.0 Z-scores or more below reference medians. Weight/height and triceps skinfold/age approximate ?1.4 and ?1.3 Z-scores below the median, respectively. These data along with clinical observations suggest that the Basmina sample is low normal to mildly malnourished. However, preschool children show evidence of moderate and severe malnutrition. The entire child sample shows a higher prevalence of malnutrition when compared to other populations living under similar conditions. The results are contrary to the belief that Indian girls are at a nutritional disadvantage when compared to boys. In fact, preschool girls maintain higher, though not significant, percentages of weight/age, weight/height, and AC/age. Girls between 5 and 10 years old also maintain a higher triceps/age index. On the other hand, boys between 5 and 10 years old maintain a higher stature/age index, but the difference is not statistically significant.