The environmental accident at 'Schweizerhalle' and respiratory diseases in children: a time series analysis

During an investigation concerned with the relationship between air pollution and respiratory diseases in children, the 'Schweizerhalle' accident occurred when unknown amounts of pollutants were discharged into the environment. In that investigation, two series of medical data were collected during one year: (a) The daily relative number of preschool children, exhibiting diseases of the respiratory tract, who either came to the outpatients' clinic of the Children's Hospital or were reported by paediatricians in Basle; (b) The daily number of respiratory symptoms per child, observed in a group of randomly selected preschool children. The purpose of the present time series analysis is the assessment of possible change in these series after the environmental accident. The nature of the change is studied by complementary approaches. First, a forecast arising from models identified in the preaccident period is compared with the actual data. Thereafter, intervention models which adequately and parsimoniously represent the change are identified. Finally, an identification of a change-point is performed.     

学龄前儿童活动父亲参与现况的调查

【目的】 调查学龄期儿童父亲参与的现况,寻找其影响因素。 【方法】 应用自编调查问卷,对1 246名16~72月龄的儿童进行调查,应用最适多元回归分析法分析父亲参与的时间及方式的影响因素。 【结果】 83%的父亲每天陪伴儿童时间在1 h以上,8.5%的父亲陪伴儿童每天不足半小时。在校正儿童年龄、性别的基础上,父亲参与时间与父母文化程度相关(P<0.05)。在文化程度高的家庭中,父亲较多参与玩游戏、讲故事,较少看电视。家庭结构、居住地也会影响父亲参与的方式。 【结论】 大部分父亲通过不同的方式参与儿童的直接养育过程,其时间和方式受多种因素的影响。     

乙型肝炎病毒在恶性血液系统疾病患儿中的分布

目的了解乙型肝炎病毒(HBV)感染在恶性血液系统疾病患儿的分布,以期能为临床诊治提供参考。方法回顾性分析2006年8月-2011年8月在医院首次住院治疗的恶性血液系统疾病患儿187例为血液病组,同期200例体检儿童为对照组,比对分析HBV感染情况,数据采用SPSS13.0进行分析。结果血液病组HBV感染率、HBsAg阳性率为33.69%、24.60%,高于对照组的5.50%、0.50%(P<0.05);乙型肝炎五项标志物检测结果显示,HBsAb阳性率最高,为43.85%,阳性率最低的为HBsAg+HBeAg+HBcAb、HBsAg+HBeAb+HBcAb模式,阳性率为1.60%,未发现乙型肝炎五项标志物全部阳性患儿;治疗前肝功能异常率为27.81%高于治疗后肝功能异常率为41.71%;治疗前、治疗后肝功能异常率HBV感染为42.86%、61.90%,无HBV感染患儿为20.16%、31.45%。结论 HBV感染在恶性血液系统疾病患儿中发生率较高,在化疗后患儿肝功能损害会有所加重,化疗期间需要加强保肝治疗及定期监测HBV再激活。     

Housing conditions and the quality of children at birth.

Low birth weight (less than 2,501 grams at birth) rates were computed for the 338 health areas of New York City for three time periods: 1969-1971, 1979-1981, and 1985-19. Frequency distributions of the 338 health areas were developed according to the percent of babies with birth weights less than 2,501 grams for each of the periods indicated above. Comparison of the 1970 and 1980 distributions indicates a decrease in low birth weight rates, but an increase in both tails of the 1980 distribution, resulting in greater variability in 1980 rates. This polarization reveals that some areas of New York City had achieved very low rates while other areas had increased to exceptionally high rates. The distribution for 1986 (1985-1987) indicates a continuation of rate shifts, particularly in the low rate tail where, in comparison with 1980, 19 additional health area populations had rates of low birth weight less than 0.05. With 1970 as a reference point, 71 additional health area populations had achieved rates less than 0.05 by 1986. In contrast, the high tail for 1986 does not shift and is very similar to that of 1980. As previously noted, the shift in rate values in the high tail from 1970 to 1980 is not in the expected direction and contributes to the polarization of health status in New York City populations by contributions of newborns. Low birth weight values for 1986 stabilize this shift in the "wrong" direction. The range of minimum and maximum values, which increased from 0.144 to 0.190 to 0.226 for 1970, 1980, and 1986 respectively, document the change in degree of polarization. Health areas in the high low birth weight tail experienced the greatest amount of housing destruction and community devastation between 1970 and 1980.     

Risk of cancer in children with the diagnosis immaturity at birth

Cancer risk in children born before term has been assessed in a large number of case-control studies but very rarely in cohort studies. We carried out a cohort study of 35 178 children with the diagnosis immaturity at birth in the Hospital Discharge Register during 1977-89. The children were followed for cancer in the Danish Cancer Registry until 1994 and comparisons were made with incidence rates for all children in Denmark. The 64 observed cases of childhood cancer in the cohort corresponded closely to the expected number {standardised incidence ratio (SIR) = 1.03; [95% confidence interval (CI) 0.80, 1.32]}. The only cancer site with an observed number that deviated significantly from the expected number was central nervous system (CNS) tumours (26 cases observed; SIR = 1.57; [95% CI 1.02, 2.30]) in particular medulloblastoma (9 cases observed; SIR = 3.1; [95% CI 1.4, 5.9]). In a nested case-control study of the CNS tumours, we found that more cases than controls had been exposed to diagnostic X-rays, but the result was not significant. Surprisingly, for those born before term, the risk of CNS tumours increased with increasing gestational age in the nested case-control data. Our results are in line with previous evidence that children born before term are not at increased risk for childhood cancer in general. An explanation behind the excess of CNS tumours could not be identified, but the effect of diagnostic X-rays in newborns may deserve further attention.     

Increased prevalence of malignant diseases in the close neighborhood of children with cancer

Clustering of cancer in families may be due to chance, inherited genetic mutations, common exposure to environmental agents, or a combination of these factors. The authors, to address a clinical impression that cancer occurs more often in the environment of a child with cancer, investigated whether the prevalence of cancer among children and adults in the neighborhood of children with cancer was higher than the prevalence in the neighborhood of healthy children. One hundred thirty-seven children diagnosed with a malignant disease between 1981 and 1992 at the Department of Pediatrics, University Hospital of Link?ping, Sweden, were investigated and compared with 232 healthy control children. The control children were traced from the official Swedish population registry. It was found that 13 percent of the children with cancer and six percent of the control children were close neighbors of other children diagnosed with cancer (p < .05). Cancer also was more common in the circles of acquaintances around the children with cancer than in circles of acquaintances around control children (p < .03). The frequency of cancer in the neighborhood or in the circle of acquaintances was significantly greater in older children than in younger children. These results support the hypothesis that environmental factors can initiate or precipitate cancer in children as well as in adults.     

Influence of death from circulatory diseases on life expectancy at birth in Japan

This study aims to evaluate the contribution of the change in circulatory diseases mortality to the life expectancy at birth observed during the years 1955-1995 in Japan. We used data on the population and the number of deaths by cause, age, and sex in 1955, 1965, 1975, 1985, and 1995. The contribution of different ages and causes of death to the change in life expectancy were examined with the method developed by Pollard. We found that the reduction in circulatory diseases mortality contributed to the improvements in life expectancy for both sexes during the decade 1975-1985. Much of this was due to the decrease in cerebrovascular disease. In the years 1985-1995, however, the contribution of cerebrovascular disease decreased in both sexes, while that of heart disease grew to become the largest of any single condition. By age, the contribution of all circulatory diseases increased among the elderly in recent years. The contribution of the change in circulatory diseases mortality to the life expectancy at birth has increased in recent years but seems to have reached a plateau. The weight against improvements in life expectancy in middle-aged people has shown little change, so that reducing the mortality rate in middle-aged people is now a major issue.     

School attainment of children who had a single umbilical artery at birth

Lilja M. School attainment of children who had a single umbilical artery at birth. Paediatric and Perinatal Epidemiology 2010; 24: 166–170. To the best of our knowledge, this is the first registry study of school achievements among children born with a single umbilical artery (SUA). A total of 1600 infants born with SUA during 1983–86 were studied. We linked the Swedish Medical Birth Registry with the Swedish School Registry, which contains the school grades of all children in Sweden when leaving compulsory school. Risks were estimated as odds ratios (OR) using the Mantel‐Haenzel procedure, after adjustment for four potential confounders: year of birth, maternal age, parity and maternal education. There was a 60% excess of children born with SUA who did not complete compulsory school after removal of infants born preterm, small‐for‐gestational age and low Apgar score (OR = 1.60 [95% confidence interval 1.28, 2.00]). When sports and the three core school subjects (mathematics, English and Swedish) were studied, there was an increased risk for ‘not passed’ in all subjects except sport and a slight decrease in the probability of achieving ‘passed with distinction or excellence’. In the three core subjects there was an association with gender, boys with SUA being more likely to have ‘not passed’ than girls. In conclusion the children born with SUA are more likely than children born with three vessels to show impaired school achievements.     

Perinatal origin of malignant diseases

In the present days the molecular genetical investigations are the mainstream of establishing the etiology of malignant diseases. Beside these surveys, prenatal, neonatal, environmental and developmental risk factors for malignancy have repeatedly been investigated during the last few years. Mounting evidences show the importance of the intrauterine and perinatal period in tumor genesis and health quality in later life. This review article summarizes the results of traditional epidemiologic studies which identified a number of risk factors for malignancy. These easily detectable anamnestic data, developmental, physical features can further support the prenatal origin of tumors and can give new directions for the modern molecular genetical investigations.     

Occupations of fathers of children dying from neoplasms.

It has been suggested in a number of recent reports that there is a possible relationship between parental occupation and malignant disease in children. A proportional mortality analysis relating deaths among children in England and Wales in 1959-63 and 1970-72 to occupation of father as stated on the child's death certificate has not shown any convincing evidence for such associations. Earlier papers published on the subject are reviewed. Although there is some slight evidence for associations between childhood tumours and certain parental occupations there is little consistency between the results reported by different authors. A previously reported association between higher social class and deaths from neoplasms was found also in this study. The explanation for this finding is unknown, and it remains possible that it is an artefact.     

Interventions for the control of diarrhoeal diseases among young children: prevention of low birth weight

The effect of low birth weight (LBW) on diarrhoea morbidity and mortality is analysed and interventions to increase birth weights are reviewed. Birth weight is a major determinant of infant mortality and, in developed countries at least, its effect on neonatal mortality is independent of socioeconomic status. We have located no satisfactory data on LBW as a determinant of diarrhoea mortality or morbidity. The strong association between LBW and mortality, however, makes it likely that there is an association between LBW and diarrhoea mortality in developing countries where diarrhoea is a major cause of infant death. Poor maternal nutrition, certain infections, pre-eclampsia, arduous work after mid-pregnancy, short birth intervals, and teenage pregnancy are likely to be causally associated with LBW in developing countries. Tobacco and alcohol consumption are additional risk factors.     

Anxiety and the presence of the father at childbirth

The authors give a report of a follow-up the anxiety of 363 couples whereby the husband decided to be present at the childbirth and took part in the childbirth preparation courses. The anxiety state and anxiety trait in men was found to be significantly lower than in women. The data of women were compared to a matched control group consisting of 135 pregnant women. In cases where the husband was present at childbirth the anxiety state and anxiety trait of the women was considerably lower than in the control group. The degree of anxiety was found independent of age, educational level, occupation but depended of parity. During the childbirth preparation the anxiety state of the husbands reduced considerably, whereas in the women the trend of increasing anxiety state could be prevented. In the group where the husband was present at childbirth the authors did not find any close relationship between the degree of anxiety and the examined obstetrical parameters (gestational age at labour, outcome and duration of labour, and the birth-weight.     

Body size at birth and blood pressure among children in developing countries

BACKGROUND: Studies in developed countries have shown that reduced fetal growth is related to raised blood pressure in childhood and adult life. Little is known about this association in developing countries, where fetal growth retardation is common. METHODS: In 1994-1995, we measured blood pressure in 1570 3-6-year-old children living in China, Guatemala, Chile, Nigeria and Sweden. We related their blood pressure to patterns of fetal growth, as measured by body proportions at birth. The children were all born after 37 weeks gestation and weighed more than 2.5 kg at birth. RESULTS: In each country, blood pressure was positively related to the child's current weight. After adjusting for this and gender, systolic pressure was inversely related to size at birth in all countries except Nigeria. In Chile, China and Guatemala, children who were proportionately small at birth had raised systolic pressure. For example, in Chile, systolic pressure adjusted for current weight increased by 4.9 mmHg (95% CI : 2.1, 7.7) for every kilogram decrease in birthweight, by 1 mmHg (95% CI : 0.4, 1.6) for every centimetre decrease in birth length, and by 1.3 mmHg (95% CI : 0.4, 2.2) for every centimetre decrease in head circumference at birth. In Sweden, systolic pressure was higher in children who were disproportionately small, that is thin, at birth. Systolic pressure increased by 0.3 mmHg (95% CI : 0.0, 0.6) for every unit (kg/m3) decrease in ponderal index at birth. These associations were independent of the duration of gestation. CONCLUSIONS: Raised blood pressure among children in three samples from China, Central and South America is related to proportionate reduction in body size at birth, which results from reduced growth throughout gestation. The relation between fetal growth and blood pressure may be different in African populations. Proportionately reduced fetal growth is the prevalent pattern of fetal growth retardation in developing countries, and is associated with chronic undernutrition among women. Improvement in the nutrition and health of girls and young women may be important in preventing cardiovascular disease in developing countries.     

Shortness at birth is associated with insulin resistance in pre-pubertal Jamaican children

AIM: To investigate the relationship between anthropometry at birth and glucose/insulin metabolism in childhood using the response to an oral glucose challenge. METHOD: Four hundred mother/child pairs on whom gestational and birth data were available were studied. After an overnight fast, anthropometric measurements were made on the children and an oral glucose tolerance test performed. The plasma concentrations of insulin, pro-insulin and 32-33 split pro-insulin were also measured. Skinfold thicknesses were used to calculate percentage body fat and fat mass was derived from the percentage fat and absolute weight. RESULTS: The mean age of the children was 8 y (range 7.5-10.5), and six exhibited impaired glucose tolerance based on WHO criteria. Insulin concentration 120 min after the oral glucose load (a measure of insulin resistance) was inversely related to length at birth (P<0.005). The children who were in the shortest quartile at birth and were heaviest at 8 y old had the highest insulin concentration. CONCLUSION: Shortness at birth is related to insulin resistance. Such insensitivity to the action of insulin is greater in heavier children.