Methodological considerations for childhood surveillance systems: the case of obesity

An international consensus on the methodology of a public health surveillance system will be essential in order to have a correct understanding of the progress of the growing challenge posed by the epidemic of obesity, to make inter-country comparisons possible, and overall to evaluate the effectiveness of preventive programmes and interventions. Recently, the European Charter on Counteracting Obesity, adopted at the WHO European Ministerial Conference on Counteracting Obesity in November 2006, called as well for the development of internationally comparable core indicators for inclusion in national health surveillance systems to be used for advocacy, policy making and monitoring purposes. At present, however, there is not yet a universal agreement on the appropriate methodology to carry out an epidemiological study or surveillance system to assess the prevalence and incidence of both overweight and obesity and monitor their trends over time in children and adolescents. The current disagreement involves the diagnosis method for overweight and obesity, the reference values and cut-off points to be applied and the age of the subjects. At the moment body mass index (BMI) is the most accepted anthropometric measure to assess overweight and obesity in epidemiological studies. The new WHO child growth standards from 0 to 5 years and the International Obesity Task Force internationally based criteria for overweight and obesity among children and adolescents aged 2 to 18 years are useful tools for international comparisons.

Syndromic surveillance for influenzalike illness in ambulatory care network

Conventional disease surveillance mechanisms that rely on passive reporting may be too slow and insensitive to rapidly detect a large-scale infectious disease outbreak; the reporting time from a patient's initial symptoms to specific disease diagnosis takes days to weeks. To meet this need, new surveillance methods are being developed. Referred to as nontraditional or syndromic surveillance, these new systems typically rely on prediagnostic data to rapidly detect infectious disease outbreaks, such as those caused by bioterrorism. Using data from a large health maintenance organization, we discuss the development, implementation, and evaluation of a time-series syndromic surveillance detection algorithm for influenzalike illness in Minnesota.     

甲状腺轴在儿童肥胖中的调节作用

近年来,越来越多的研究人员开始对甲状腺的功能与肥胖儿童的体重之间的关系感兴趣。观察到的甲状腺激素和促甲状腺激素水平的变化是否导致了肥胖儿童体重的增加,仍有待澄清。血清瘦素同TSH水平相关,甲状腺功能与肥胖相关的机制是下丘脑神经元的TRH和TSH分泌异常,从而瘦素水平升高。而体重与瘦素水平升高呈正相关。但TRH和TSH的这些分泌上的变化是否导致肥胖,依据甲状腺轴的变化是否应该对肥胖进行甲状腺素治疗,仍存在争议。因此,大多数学者认为,重要的是应该把生活方式的改变和减轻体重作为肥胖症的治疗方法而不是进行甲状腺素替代治疗。本文的目的是就当前对儿童肥胖与甲状腺轴相关关系做一探讨。     

Monitoring ambulatory care: impact of a surveillance program on clinical practice patterns in New York City.

Administrative records of the Title XIX (Medicaid) Program of New York City were reviewed to determine the impact of a surveillance system introduced to monitor physician billing. Billing patterns of the physicians subject to program sanctions, as well as the larger universe of all participating New York City physicians, showed changes coincident with the introduction of the surveillance program: utilization of x-rays, lab tests, injections, and first visit billing decreased.     

Incidence of obesity during childhood and adolescence in a large contemporary cohort

Background and Aims

Timing of obesity development during childhood and adolescence is unclear, hindering preventive strategies. The primary aim of the present study was to quantify the incidence of overweight and obesity throughout childhood and adolescence in a large contemporary cohort of English children (the Avon Longitudinal Study of Parents and Children, ALSPAC; children born 1991-1992). A secondary aim was to examine the persistence of overweight and obesity.

Methods

Longitudinal data on weight and height were collected annually from age 7-15 years in the entire ALSPAC cohort (n = 4283), and from 3 to 15 years in a randomly selected subsample of the cohort (n = 549; ‘Children in Focus’ CiF). Incidence of overweight and obesity (BMI (Body mass index) at or above the 85th and 95th centiles relative to UK reference data) was calculated. Risk ratios (RR) for overweight and obesity at 15 years based on weight status at 3, 7, and 11 years were also calculated.

Results

In the entire cohort, four-year incidence of obesity was higher between ages 7 and 11 years than between 11 and 15 years (5.0% vs 1.4% respectively). In the CiF sub-sample, four-year incidence of obesity was also highest during mid-childhood (age 7-11 years, 6.7%), slightly lower during early childhood (3-7 years, 5.1%) and lowest during adolescence (11-15 years 1.6%). Overweight and obesity at all ages had a strong tendency to persist to age 15 years as indicated by risk ratios (95% CI (Confidence interval)) for overweight and obesity at 15 years from overweight and obesity (relative to healthy weight status) at 3 years (2.4, 1.8-3.1), 7 years (4.6, 3.6-5.8), and 11 years (9.3, 6.5-13.2).

Conclusion

Mid-late childhood (around age 7-11 years) may merit greater attention in future obesity prevention interventions.     

Comparison of effectiveness and required time of two surveillance methods in intensive care patients

The intensive care unit (ICU) standardized protocol of the NNIS (National Nosocomial Infections Surveillance) system is a surveillance method of hospital acquired infections (HAI), which provides device-associated infection rates. The aim of this study was to assess the effectiveness and the required time for data collection and analysis of a selective surveillance method (SSM) derived from the NNIS ICU surveillance protocol, and to compare its data with that of a reference surveillance method (RSM). The sensitivity, specificity and the positive predictive value (PPV) of the RSM were 87.5, 100 and 100%, respectively. The sensitivity, specificity and the PPV of the SSM were 59.4 97.6 and 79.2%, respectively. Considering device-related infections only (ventilator-related pneumonia, catheter-related urinary tract infections, central line-related sepsis), the sensitivities of the RSM and the SSM were 80.9 and 90.5%, respectively. The SSM required only one third of the time of the RSM (1.1 h and 3.4 h per 10 beds per week with the SSM and the RSM, respectively). We conclude that the SSM has a very high sensitivity for detecting device associated infections, but is not sensitive enough for surveying all types of HAI.     

Wisconsin's environmental public health tracking network: information systems design for childhood cancer surveillance

In this article we describe the development of an information system for environmental childhood cancer surveillance. The Wisconsin Cancer Registry annually receives more than 25,000 incident case reports. Approximately 269 cases per year involve children. Over time, there has been considerable community interest in understanding the role the environment plays as a cause of these cancer cases. Wisconsin's Public Health Information Network (WI-PHIN) is a robust web portal integrating both Health Alert Network and National Electronic Disease Surveillance System components. WI-PHIN is the information technology platform for all public health surveillance programs. Functions include the secure, automated exchange of cancer case data between public health-based and hospital-based cancer registrars; web-based supplemental data entry for environmental exposure confirmation and hypothesis testing; automated data analysis, visualization, and exposure-outcome record linkage; directories of public health and clinical personnel for role-based access control of sensitive surveillance information; public health information dissemination and alerting; and information technology security and critical infrastructure protection. For hypothesis generation, cancer case data are sent electronically to WI-PHIN and populate the integrated data repository. Environmental data are linked and the exposure-disease relationships are explored using statistical tools for ecologic exposure risk assessment. For hypothesis testing, case-control interviews collect exposure histories, including parental employment and residential histories. This information technology approach can thus serve as the basis for building a comprehensive system to assess environmental cancer etiology.     

Public reaction to the UK government strategy on childhood obesity in England: A qualitative and quantitative summary of online reaction to media reports

This work aimed to summarise public real-time reaction to the publication of the UK government childhood obesity strategy by applying a novel research design method. We used a netnographic technique to carry out thematic analysis of user-generated comments to online newspaper articles related to the strategy. We examined likes/dislikes associated with comments as a proxy of agreement of the wider community with identified themes. To examine media influence on the comments we carried out thematic analysis of online media headlines published about the strategy, and compared these themes with themes identified from comments.Three newspaper articles and 1704 associated comments were included. Three parent themes were identified: paternalism/libertarianism, lobbyist influence and, anecdotal solutions. The comments were largely negative (94%). Commenters were split as to individual responsibilities and the role of the government, some felt that lobbyist influence had won out over the nation’s health and others offered non-evidence based solutions. The ten most liked and disliked comments reflected themes identified in our main analysis. There was parity between themes that emerged from comments and from headlines. This summary of public reaction to the obesity strategy publication may aid translation of public views and receptiveness into practice and inform subsequent government action and policy. Furthermore, the process applied herein may provide a means of informal public engagement.     

我国布鲁氏菌病监测研究与实践进展

近几年布鲁氏菌病（布病）报告发病水平持续上升、流行范围不断蔓延,已成为我国重要的公共卫生问题。持续改进布病的监测系统对于有效开展布病防控意义重大。本文系统综述了我国布病监测系统的建设与发展,对当前布病监测系统的主要特点进行了分析,对监测系统的评价进行了综述,并为进一步改进监测系统,以适应其新的监测防控需求提出建议。     

969名集体儿童的肥胖情况调查

目的了解本社区2～6岁集体儿童的肥胖情况，分析肥胖原因。方法对本社区管辖的9家幼托机构集体儿童进行健康监测。结果969名儿童有39名肥胖，肥胖率为4．02％，主要发生在5～6岁组，占肥胖人数的61．54％。结论从儿童时期预防肥胖有利于降低人群原发性高血压及心血管疾病的患病率。     

儿童期腹型肥胖对成年期腹型肥胖的影响

目的 探讨儿童期腹型肥胖对成年期腹型肥胖的影响。方法 基于"中国居民健康与营养调查"1993-2011年的研究数据，该调查要求研究对象在儿童期（7~17岁）和成年期（≥ 18岁）至少各随访一次。本研究选取儿童期第1次和成年期最后1次随访数据，最终纳入1 366名（男性占61.4%）研究对象。采用偏相关分析探讨儿童期腰围与成年期腰围的相关性。采用Cox回归模型分析儿童期腹型肥胖对成年期腹型肥胖的影响。结果 研究队列的中位随访时间为10.4年。36.4%（28/77）的儿童期腹型肥胖会持续至成年期。儿童期腰围与成年期的腰围存在中度关联（r=0.32，P<0.001）。与腰围正常儿童相比，腹型肥胖儿童在成年期发生腹型肥胖的风险增加（HR=7.54，95%CI：4.91~11.58）。结论 儿童期腹型肥胖显著增加成年期腹型肥胖的发生风险。     

孕前BMI、妊娠期糖尿病与儿童4岁时肥胖相关指标关联的出生队列研究

目的 探讨孕前BMI、妊娠期糖尿病（GDM）与儿童4岁时肥胖相关指标的关联。方法 基于已经建立的“马鞍山市优生优育队列”,对2013年10月至2015年4月出生的单胎活产儿,随访至4岁。在孕期首次填写问卷调查孕前身高、体重,在24～28周接受75 g口服糖耐量试验进行GDM诊断。在儿童4岁时测量身高、体重、腰围和体成分。组间比较采用χ²检验、方差分析或t检验,采用logistic回归模型与广义线性模型分析孕前超重/肥胖、孕前患有GDM与儿童肥胖相关特征的关系。结果 儿童4岁时超重、肥胖率分别为13.08%、6.03%。控制孕期和儿童人口统计学变量后,孕前母亲超重/肥胖者儿童在4岁时发生肥胖、腰围超标、腰围身高比超标的风险要高,其OR值（95% CI）分别为3.27（2.15～4.98）、2.32（1.72～3.14）和2.29（1.73～3.02）;且与体成分指标（骨骼肌、体脂肪、体脂百分比）相关（P<0.05）。孕期母亲患有GDM者,儿童4岁时肥胖发生风险要比母亲未患有GDM者高1.78倍（OR=1.78,95% CI：1.14～2.79）;但是孕期母亲患有GDM对4岁儿童腰围超标、腰围身高比超标发生风险并无影响,与体成分指标（骨骼肌、体脂肪、体脂百分比）无统计学关联。结论 孕前母亲超重/肥胖、孕期患有GDM是4岁儿童肥胖的独立危险因素,且孕前BMI与儿童体成分的各项指标相关。     

国外儿童肥胖研究热点的共词分析

目的检索国外儿童肥胖研究的相关文献,分析当前该主题的研究热点。方法对PubMed数据库中发表的有关儿童肥胖国外文献进行分析,下载这些文献的主题词并统计主题词出现的频次,截取频次〉66次的主题词作为高频主题词。两两统计高频主题词在同一篇文献中出现的频率,形成主题词共现矩阵,利用SPSS统计软件对矩阵做聚类分析,通过分析各类的文献内容,得到该主题的研究热点。结果共检出有关儿童肥胖的论文8324篇,出现频次超过66次的主题词为64个,其中出现频次最高的主题词为肥胖／流行病学,出现频次为1735次。通过对这64个高频主题词聚类得到8个研究热点。结论目前国外对儿童肥胖的研究热点主要集中在卫生政策、儿童肥胖病因及治疗方法、心理因素、诊断指标以及与儿童肥胖相关的疾病等方面。     

School based interventions versus family based interventions in the treatment of childhood obesity- a systematic review

Background

The prevalence of childhood obesity, which has seen a rapid increase over the last decade, is now considered a major public health problem. Current treatment options are based on the two important frameworks of school- and family-based interventions; however, most research has yet to compare the two frameworks in the treatment of childhood obesity.The objective of this review is to compare the effectiveness of school-based intervention with family-based intervention in the treatment of childhood obesity.

Methods

Databases such as Medline, Pub med, CINAHL, and Science Direct were used to execute the search for primary research papers according to inclusion criteria. The review included a randomised controlled trial and quasi-randomised controlled trials based on family- and school-based intervention frameworks on the treatment of childhood obesity.

Results

The review identified 1231 articles of which 13 met the criteria. Out of the thirteen studies, eight were family-based interventions (n = 8) and five were school-based interventions (n = 5) with total participants (n = 2067). The participants were aged between 6 and 17 with the study duration ranging between one month and three years. Family-based interventions demonstrated effectiveness for children under the age of twelve and school-based intervention was most effective for those aged between 12 and 17 with differences for both long-term and short-term results.

Conclusions

The evidence shows that family- and school-based interventions have a considerable effect on treating childhood obesity. However, the effectiveness of the interventional frameworks depends on factors such as age, short- or long-term outcome, and methodological quality of the trials. Further research studies are required to determine the effectiveness of family- and school-based interventions using primary outcomes such as weight, BMI, percentage overweight and waist circumference in addition to the aforementioned factors.     

A five year longitudinal study investigating the prevalence of childhood obesity: comparison of BMI and waist circumference

Objective

The purpose of this study was to examine the prevalence of obesity over time in the same individuals comparing body mass index (BMI), waist circumference (WC) and waist to height ratio (WHtR).

Study design

Five year longitudinal repeated measures study (2005–2010). Children were aged 11–12 (Y7) years at baseline and measurements were repeated at age 13–14 (Y9) years and 15–16 (Y11) years.

Methods

WC and BMI measurements were carried out by the same person over the five years and raw values were expressed as standard deviation scores (sBMI and sWC) against the growth reference used for British children.

Results

Mean sWC measurements were higher than mean sBMI measurements for both sexes and at all assessment occasions and sWC measurements were consistently high in girls compared to boys. Y7 sWC = 0.792 [95% confidence interval (CI) 0.675–0.908], Y9 sWC = 0.818 (95%CI 0.709–0.928), Y11 sWC = 0.943 (95%CI 0.827–1.06) for boys; Y7 sWC = 0.843 (0.697–0.989), Y9 sWC = 1.52 (95%CI 1.38–0.67), Y11 sWC = 1.89 (95%CI 1.79–2.04) for girls. Y7 sBMI = 0.445 (95%CI 0.315–0.575), Y9 sBMI = 0.314 (95%CI 0.189–0.438), Y11 sBMI = 0.196 (95%CI 0.054–0.337) for boys; Y7 sBMI = 0.353 (0.227–0.479), Y9 sBMI = 0.343 (95%CI 0.208–0.478), Y11 sBMI = 0.256 (95%CI 0.102–0.409) for girls. The estimated prevalence of obesity defined by BMI decreased in boys (18%, 12% and 10% in Y 7, 9 and 11 respectively) and girls (14%, 15% and 11% in Y 7, 9 and 11). In contrast, the prevalence estimated by WC increased sharply (boys; 13%, 19% and 23%; girls, 20%, 46% and 60%).

Conclusion

Central adiposity, measured by WC is increasing alongside a stabilization in BMI. Children appear to be getting fatter and the additional adiposity is being stored centrally which is not detected by BMI. These substantial increases in WC are a serious concern, especially in girls.     

2010年度卫生部全国细菌耐药监测报告:0～14岁儿童细菌耐药监测分析

目的了解我国2010年度0～14岁细菌感染患儿病原菌构成及耐药性。方法收集2010年1-12月129所成员单位医院的儿科及成都市妇女儿童中心医院、山东大学齐鲁儿童医院0～14岁住院患儿细菌感染的临床分离菌株,依据2010年CLSI标准的常规鉴定和纸片扩散法(K-B),测定菌株对抗菌药物的敏感性,采用WHO-NET软件对收集到的细菌监测资料进行统计分析。结果共收集细菌25 110株,其中革兰阴性菌14 910株占59.4%,革兰阳性菌10 200株占40.6%;分离细菌在前5位的依次为大肠埃希菌占15.1%、凝固酶阴性葡萄球菌占14.4%、金黄色葡萄球菌占11.9%、肺炎克雷伯菌占11.3%、铜绿假单胞菌占7.6%;耐甲氧西林金黄色葡萄球菌(MRSA)、耐甲氧西林凝固酶阴性葡萄球菌(MRSCN)检出率分别为21.9%、83.1%,未发现对万古霉素、利奈唑胺耐药和中介的金黄色葡萄球菌及凝固酶阴性葡萄球菌;链球菌属未发现对利奈唑胺、万古霉素、替考拉宁中介和耐药株;产ESBLs大肠埃希菌占27.6%、肺炎克雷伯菌占36.0%、阴沟肠杆菌占33.4%;肠杆菌科均出现耐碳青霉烯类抗菌药物,奇异变形菌对亚胺培南的耐药率达25.3%。结论 4年儿童细菌耐药监测结果提示了细菌耐药趋势,对儿童细菌感染性疾病合理使用抗菌药物有重要指导意义。     

学龄前儿童肥胖群体综合干预的研究

目的:通过研究寻找预防和控制儿童肥胖的有效方法。方法:以4所幼儿园2006年9月新入园的3岁(小班)儿童为研究对象,对实验组幼儿园儿童实施为期3学年的干预措施,包括健康教育、饮食管理和运动锻炼。干预前后对儿童进行体格测量及家长问卷调查。结果:干预后实验组肥胖发病率从9.8%下降到5.7%,而对照组肥胖发生率从10.1%上升到14.9%,差异有统计学意义(P<0.01)。结论:依托幼儿园,加强家园联系,从健康教育入手,采用饮食管理及坚持运动锻炼的群体综合干预措施是预防和控制儿童肥胖的有效方法。     

中国0~5岁儿童超重肥胖分布特征

目的 研究中国0~5岁儿童的超重肥胖现况及其分布特点。方法 数据来自"2010-2013年中国居民营养与健康状况监测"数据,2013年儿童调查采用多阶段分层整群抽样的方法,研究对象为全国30个省（自治区、直辖市）55个调查县（区）中0~5岁儿童32 862名。超重肥胖的判定：5岁以下儿童采用WHO 2006年生长发育标准;5岁儿童采用WHO 2007年生长发育参考值。结果采用2010年国家统计局的人口数据进行复杂加权计算。结果 2013年中国0~5岁儿童超重率为8.4%,男童和女童超重率分别为9.4%和7.2%;城、乡儿童超重率均为8.4%。0~、6~、12~、24~、36~、48~和60~71月龄组超重率分别为13.0%、11.1%、8.3%、6.0%、4.8%、3.9%和15.9%;家庭低、中和高收入水平儿童超重率分别为8.0%、8.8%和8.9%。0~5岁儿童肥胖率为3.1%,男童和女童肥胖率分别为3.6%和2.5%;城市和农村儿童肥胖率分别为3.3%和2.9%。0~、6~、12~、24~、36~、48~和60~71月龄组儿童的肥胖率分别为5.8%、3.8%、2.5%、1.6%、1.2%、1.3%和7.8%;低、中和高收入水平儿童肥胖率分别为2.8%、3.3%和3.5%。结论 中国0~5岁儿童的超重和肥胖率正在增高攀升,及时监测0~5岁儿童的超重肥胖状况和实施合理干预十分必要。     

Understanding the relationship between food environments,deprivation and childhood overweight and obesity: Evidence from a cross sectional England-wide study

Using a large cross sectional English sample, we quantified the association between weight status in children aged 4–5 and 10–11 year, characteristics of the food environment, and area deprivation. We observed a positive association between the density of unhealthy food outlets in a neighbourhood and the prevalence of overweight and obesity in children. An association in the opposite direction was observed for other types of food outlets, although after adjustment this was only statistically significant for older children. The prevalence of fast food and other unhealthy food outlets explained only a small proportion of the observed associations between weight status and socioeconomic deprivation. Children׳s weight status may be influenced by their local environment, particularly older children, but associations between obesity and deprivation do not appear strongly due to local food environment characteristics.     

The development of surveillance and screening for childhood obesity in the UK

This paper draws upon a review of empirical and policy literature to provide an analysis of the development of surveillance and screening for childhood obesity in the UK. It is argued that policy in this area has lacked coordination and that the intended application of surveillance and screening for childhood obesity in the UK has neither been clearly articulated nor adequately explored. At present, universal measurement of school children's height and weight is conducted as part of the National Child Measurement Programme. Results are not fed back to parents since this amounts to screening and there is insufficient evidence to satisfy National Screening Programme Committee criteria. Results will be fed back to parents beginning from the 2008/9 school year, but whilst expert committees globally have been divided on the effectiveness of screening, its benefits and harms remain uncertain. Experience internationally suggests that to date, inadequate attention has been given to psychological implications of intervention. Similarly, the benefits and harms of surveillance remain uncertain and evidence indicates that the stated purposes of the UK programme are unrealistic. In consideration of the rates, trends and potential consequences of childhood obesity, it is clear that the intended application of screening and surveillance for childhood obesity merits clear definition and rigorous examination.