全国儿童营养专题讨论会会议纪要

为总结我国儿童营养研究成果,推动我国儿科营养学发展,《中华儿科杂志》编辑委员会、中华医学会儿科学分会儿童保健学组共同主办的“全国儿童营养专题讨论会”于2006年4月18至21日在湖北省宜昌市召开。本次会议共收到学术论文103篇,来自全国各地从事儿童营养研究的代表50余人参加了会议。大会邀请了儿保、消化、新生儿等专业8位专家进行专题报告,15人大会发言。代表们就儿童营养有关问题进行了深入讨论,现将会议的主要内容介绍如下。     

Injury control in childhood.

The behavior and environment of individuals are key determinants of both unintentional and intentional injuries in childhood and adolescence. These two determinants often interact so that certain behaviors lead to different injury outcomes depending on the environmental context of the injury. For example, depression is more likely to lead to suicide in the presence of alcohol intoxication. Alcohol intoxication is much more likely to lead to the choice of a firearm in a suicide attempt. Children with poor pedestrian crossing skills are far more likely to be hit in a busy urban intersection than in a safer location. The science of injury control has attempted to learn more about both the behavioral, environmental, and agent characteristics that lead to injury. Each of these dimensions offers opportunities for injury prevention or amelioration of the outcome. Despite increasing knowledge about how certain behaviors are associated with specific types of injuries, there has been only limited success achieved by attempts to modify behavior, particularly by persuasion or education. More success has been derived by legislative mandates. The most success, particularly in the prevention of unintentional injury, has been achieved by modification of the environments and the agents that are most often associated with injury. Because intentional injuries involve extremely complex and aberrant behavior, there is a persistent concern that attempts to modify the environment (e.g., handgun control) will be overridden by those with a high level of intent, i.e., they will seek another method. Although this may be true for carefully premeditated acts, suicide attempts and assaults by youth are usually precipitated by an acute stressor that depends on the availability of a weapon at that immediate time. While we develop more sophisticated psychosocial epidemiologic models that accurately predict violent behavior, we must continue to analyze aspects of intentional injuries that offer an opportunity to reduce the injury severity after the injury has occurred. Pediatricians and other health providers of children have played three important historical roles in the field of injury control. As clinicians, we have a unique opportunity to discuss these concerns with our patients and use our influence to attempt to modify individual behavior and inform about risks. As investigators, pediatricians have been important advocates of research initiatives to use the same epidemiologic methods used to study infectious diseases and cancer and apply them to the study of injury. Finally, pediatricians have played a critical public policy role in the evolution of injury control. Pediatricians have been at the helm behind most legislative initiatives to reduce injury among all people.(ABSTRACT TRUNCATED AT 400 WORDS)     

小儿免疫临床与研究进展专题研讨会会议纪要

由《中华儿科杂志》编辑委员会、中华医学会儿科学分会免疫学组共同主办的“小儿免疫临床与研究进展专题研讨会”于2005年9月9日至11日在湖北宜昌召开.来自全国20个省、直辖市的103名代表参加了本次研讨会.与会代表就目前国内儿童免疫缺陷病、过敏性疾病、风湿病和感染免疫疾病的研究现状进行了深入而广泛的讨论.     

第四届小儿消化系统疾病专题研讨会会议纪要

全国第四届小儿消化系统疾病学术会议于 2 0 0 2年 6月5～ 8日在广州举行。来自全国各地的 86名代表出席了会议 ,广州市各医院 3 0余位儿科医师也应邀列席本次学术会议。大会共收到论文 110篇 ,文章选题广泛 ,内容涉及小儿消化内镜、儿童幽门螺杆菌感染、胃炎及消化性溃疡、胃肠动力障碍性疾病、小儿肝病及腹泻病等。会议邀请了国内及日本的 8名专家作了专题讲座 ,内容为 :消化道出血的诊断程序和治疗进展、小儿先天性消化疾病外科治疗新进展、胃肠动力学进展、再发性腹痛与小儿心理因素、细菌性痢疾研究进展、肠道粘膜免疫系统与肠道疾病、…     

Plasma enteroglucagon in the control of childhood celiac disease

To study whether or not plasma enteroglucagon reflects changes of the small intestinal mucosa during different phases of celiac disease, we studied fasting and postprandial concentrations of plasma enteroglucagon, as well as small intestinal mucosa morphology, in children with celiac disease and in a reference group of children without gastrointestinal disorders. The children with celiac disease were studied before dietary treatment, during gluten-free diet, and during gluten challenge. In untreated celiac children we found high mean basal and postprandial plasma enteroglucagon concentrations compared with the reference group (p less than 0.001). After a gluten-free diet period of 0.2-4.5 years (mean, 1.0 year), when the small intestinal histology was normal or only mildly abnormal, there was a decrease of both mean basal plasma enteroglucagon concentration (from 81 to 17 pmol/L; p less than 0.001) and mean postprandial plasma enteroglucagon concentration (from 129 to 39 pmol/L; p less than 0.001). During a subsequent gluten challenge, which resulted in a mucosal relapse, there was a rise in mean postprandial plasma enteroglucagon concentration (from 39 to 74 pmol/L; p less than 0.005), although there was a substantial overlap in values from treated and challenged patients. These findings suggest that plasma enteroglucagon levels, particularly after a mixed meal, are correlated with the small intestinal mucosal morphology in childhood celiac disease. Determination of plasma enteroglucagon may facilitate the control of the dietary adherence during gluten-free diet and may in some children indicate mucosal relapse during gluten challenge. Thus, the number of control biopsies may be reduced.     

Main trends in the control of hereditary diseases in childhood

The results of the activity of the Department for Congenital and Hereditary Diseases of the Moscow Research Institute of Pediatrics and Childhood Surgery of the Ministry of Public Health of the RSFSR point to the efficacy of the work of the Centre for Hereditary Pathology of that Institute in the field of the diagnosis, treatment and prevention of hereditary diseases of children. The prospects of further studies are outlined.     

New specimens and laboratory diagnostics for childhood pulmonary TB: progress and prospects

Childhood pulmonary TB (PTB) is under diagnosed, in part due to difficulties in obtaining microbiological confirmation. However, given the poor specificity of clinical diagnosis, microbiological confirmation and drug susceptibility testing is important in guiding appropriate therapy especially in the context of drug resistant TB. Confirmation is often possible, even in infants and young children, if adequate specimens are collected. Culture yield varies with the severity of illness, specimen type and culture method. Induced sputum is recognised as a safe procedure with a high diagnostic yield. Advances include optimised protocols for smear microscopy and modified culture techniques, such as the Microscopic Observation Drug Susceptibility Assay. Detection of Mycobacterium tuberculosis nucleic acid in respiratory specimens has high specificity but relatively poor sensitivity, particularly for smear negative disease. The recent development of an integrated specimen processing and real-time PCR testing platform for M. tuberculosis and rifampicin resistance is an important advance that requires evaluation in childhood TB.     

Motivational interviewing to improve blood-glucose control in childhood diabetes

Motivational interviewing (MI) is a relatively new approach to counselling which has been developed largely in the addiction field. The method is patient-centred and helps resolve ambivalence about behaviour change whilst avoiding conflict and advice-giving by the clinician. This approach has qualities which seem particularly appropriate when dealing with teenagers. Recent evidence from clinical trials shows that motivational interviewing may be effective in facilitating healthier approaches to diet and exercise in young people and improved glycaemic control and quality of life in teenagers with diabetes. These findings suggest that MI has a role to play in the management of childhood chronic disease such as diabetes, but the future challenge is how to incorporate these principles into routine clinical practice given the general shortage of skilled, trained psychologists.     

Vagus nerve stimulation for control of intractable seizures in childhood

Vagus nerve stimulation (VNS) is gaining increasing popularity and credibility as a treatment option for children with intractable epilepsy. VNS offers several advantages over extant treatments. Its efficacy is maintained during prolonged stimulation, and seizure control actually improves with time. There is no associated cognitive impairment and no adverse drug interactions. Unlike cerebral surgery, VNS is a potentially reversible form of therapy. The computer-controlled characteristic of the device permits complete and involuntary treatment compliance. VNS is safe and well-tolerated. Its side effects are generally transient and mild, and no physiologic perturbations have been reported despite extensive monitoring. Serious adverse events are rare, and no deaths have been attributed to VNS therapy itself or to the technique of surgical insertion. In this article, we discuss the theoretical background behind VNS and review the clinical studies that substantiate its long-term safety, feasibility, tolerability and potential efficacy in children with refractory epilepsy.     

A key to effective control of childhood injuries

Abstract Injuries account for 50% of deaths in Australian children aged 1-14 years, and are a major cause of hospital admission and disability. Injury surveillance systems involving the establishment of ongoing, systematic collection and analysis of data relevant to injury prevention and trauma management have a critical role in the effective control of the injury pandemic. Contemporary Australian initiatives including the establishment of the National Injury Surveillance and Prevention Project, new national public health programmes and research initiatives have the potential to establish a new wave of injury control programmes on a firm scientific base.     

Treating childhood acute lymphoblastic leukaemia (ALL): Summary of ten years' experience in Italy

Between 1976 and 1986, 2,093 children with ALL were enrolled in three consecutive generations of trials conducted by the Associazione Italiana Ematologia Oncologia Pediatrica (AIEOP). A 50% event-free survival at 5 years was achieved overall in this population, approximately accounting for more than 50% of the entire childhood ALL population in Italy. Participation in the group protocols increased from the original seven founding centers to the current 37 institutions. Results in the standard population (non-T immunophenotype, non-FAB L3, and < 50,000 white blood cells [WBC]/ml) were considerably better with more recent, more aggressive protocols. The two major results in this population (N = 540) were a relatively low incidence (8% at 5 years) of central nervous system (CNS) relapse in the “good”-risk population (< 10,000 WBC, ages 3–6 years, and FAB L1), without the use of cranial irradiation, and a projected 4-year disease-free interval for bone-marrow relapse of 80% in the “average”-risk group, where a three-drug reinduction program was adopted after consolidation. Overall, the event-free survival of the most recent generation (protocol 82, median follow-up time of 38 months) is 66% at 4 years (95% confidence limits [CL] 61–71). Based on these 10 years of experience, the general strategy of the group for the 90s is outlined and discussed.     

Expectation of parental control and the maintenance of bottle-feeding in childhood

ObjectiveTo investigate association between parental locus of control (belief of individuals about what or who has control of the events of their lives) and bottle feeding habits among children from 3 to 5 years of age.MethodologyParental locus of control validated in Brazil, and semi-structured questionnaire to obtain sociodemographic, health, and oral habit behaviors was applied to mothers of 992 preschool children. Outcome variable “use of feeding bottle” was studied according to the time of its use (≤36 months and >36 months). Simple logistic regression models were adjusted and raw odds ratios were estimated for variables of distal blocks, which contemplated parental locus of control, socioeconomic characteristics of family, and maternal habits. In the intermediate block, the variables for conditions of the child's birth and place of health care attendance during the prenatal period and early childhood were included. In the proximal block, the time of breastfeeding and pacifier use were reported. Variables were analyzed from the distal to the proximal block, and the individual analyses that presented p ≤ 0.20 remained in each model; included in the subsequent block were the variables with p ≤ 0.10, because this was a study of prevention.ResultsLonger time of feeding bottle use was associated with the internal parental locus of control, mothers older than 31 years of age, white race, premature children, who used pacifiers and are treated in the private health system.ConclusionsChildren who maintained the habit of feeding bottle use for a longer time were those whose mother presented an internal locus of control.     

维生素D缺乏性佝偻病防治建议专家讨论会纪要

维生素D(VitD)缺乏性佝偻病是我国儿科重点防治的四病之一,全国佝偻病防治科研协作组在卫生部领导下,1986年制定了我国"婴幼儿佝偻病防治方案",规范了我国佝偻病防治工作,经过多年努力,我国儿童佝偻病的发病率已明显降低.