Evaluation of the Sheffield system for identifying children at risk from unexpected death in infancy. Results from Birmingham and Newcastle upon Tyne.

The "at birth" system which is used in Sheffield to identify children likely to die unexpectedly in infancy, was tested retrospectively in Birmingham (83 cases) and in Newcastle upon Tyne (56 cases). The discrimination between cases and age-matched controls was poor in both cities. Analysis of the 8 factors used in the system showed that only 2 maintained significant case/control differences in Birmingham and Newcastle. Further investigation showed that other factors from maternity records showed significant case/control differences in these cities. Although the system used in Sheffield would not be of use in a prospective prevention programme in either Newcastle or Birmingham, the possibility of evolving an "at risk" system which might apply more widely is discussed.     

Epidemiologic study of infant botulism in Pennsylvania: Report of the Infant Botulism Study group

The majority of the almost 400 confirmed cases of infant botulism in the United States have occurred in California, Pennsylvania, and Utah. In Pennsylvania, 44 of 53 (83%) cases occurred within a geographic area of Southeastern Pennsylvania which represents one tenth of the Commonwealth's area and one third of the population at risk for infant botulism. In Southeastern Pennsylvania, a map of the residences of cases circumscribes a discrete ring around Philadelphia. A case-control study performed to seek host-related risk factors, identifies the significant associations of botulism with infants who are white, breast-fed, and born at term into two-parent families with hospitalization insurance. County control studies were performed to identify differences in host-related factors between areas of high and low prevalence of botulism. Although some "protection" could be afforded Philadelphia infants by their feeding and family characteristics, the differences in case rates between Philadelphia and the botulism "ring counties" cannot be explained entirely by host-related factors. Further, the absence of botulism in counties just outside of the botulism "ring," where infants were found to have identical potential risk factors, suggests that an uneven distribution of botulinal spores in the environment is the most significant determinant of case rate.     

Returning to Primary School After Treatment for Cancer

Questionnaires were sent to the teachers of 14 children returning to school after treatment for childhood cancer and their 11 siblings. Forty-four control children from the same classes were also selected. Behavioral rating scores (Deasy-Spinetta) showed no differences between cases and siblings or control children in tern of learning disabilities, socialization, and emotional behavior. Teachers reported few problem on the case children's return to school, although many had been anticipated. Most children adapted well, and there were no major changes in behavior or performance. Siblings, too, coped well with the experience. The Royal Victoria Infirmary at Newcastle, where the children were treated, has two community liaison nurses and three social workers. The value of the support that they provide to both families and schools is clearly reflected in the ease with which children reintegrate into their school environment after what can be, for some, a prolonged absence.     

Evaluation of attempted prevention of unexpected infant death in very high-risk infants by planned health care

Three hundred and ninety-six babies born in Sheffield between 1982 and 1990 identified as being at "very high risk" of unexpected infant death by means of a scoring system, received an intensive programme of health care including a case discussion between a paediatrician, the GP and the health visitor held in the family doctor's surgery, weekly visits from the health visitor and informal hospital admission. Significantly fewer sudden unexpected infant deaths occurred in this group than were expected by logistic regression anlysis or occurred in the best available control group with comparable scores ( p = 0.024). Problems in evaluation include identification of an adequate control population, ethical difficulties in introducing a controlled study when the programme is already perceived as effective, and the calculation of "expected death rates". The results of this study indicate that very energetic programmes of intervention may prevent some deaths in vulnerable infants.     

2008~2019年湖南省手足口病流行特征及空间流行病学分析

目的 分析2008~2019年湖南省手足口病疫情及空间自相关特征与时空聚集性,为湖南省手足口病的防控提供参考依据。 方法 采用空间自相关及时空聚集性分析方法对湖南省2008~2019年手足口病的监测数据进行分析。 结果 2008~2019年湖南省手足口病疫情呈明显季节性分布,每年1~3月为低发期,高发季节为4~7月。主要的高发人群集中在0~5岁儿童,年平均发病率为2 197.784/10万,占总发病人数的95.89%（1 460 391/1 522 910）;以散居儿童最多,占发病病例数的82.59%（1 257 739/1 522 910）。全局自相关分析显示湖南省手足口病发病呈显著的聚集性分布,局部自相关分析显示手足口病高-高聚集区主要集中在长沙市、株洲市、岳阳市等地区的区县。通过时空扫描统计可得聚集时间多为4~7月,2008~2010年聚集在湖南省的东北部,2011~2019年主要集中在湘中部地区。 结论 湖南省手足口病疫情高发季节为4~7月,高发人群为0~5岁的儿童,且疫情存在时空聚集性,主要集中在湖南省东北部及中部地区。建议以此为指导,确定湖南省手足口病的重点防控区域,优化卫生资源配置。 引用格式:     

CTLA-4基因多态性与过敏性紫癜的相关性研究

目的探讨CTLA-4基因多态性与儿童过敏性紫癜(HSP)的相关性。方法选取60例HSP患儿为病例组,其中男33例,女27例;另选取30例健康儿童为对照组。按有无肾脏损害将HSP患儿分为紫癜性肾炎(HSPN)组(n=30)和Non-HSPN组(n=30)。采用PCR-RFLP法,对CTLA-4基因+49及-1722位点各基因型及等位基因频率进行分析。结果 +49位点AA、AG、GG基因型及等位基因频率在病例组和对照组之间、HSPN组与Non-HSPN组之间、不同性别HSP患儿间比较差异均无统计学意义(P0.05)。-1722位点TT、TC、CC基因型及等位基因频率在病例组和对照组之间、不同性别HSP患儿间比较差异均无统计学意义(P0.05);CC基因型及T、C等位基因频率在HSPN组与Non-HSPN组间比较差异有统计学意义(P0.05)。将+49位点与-1722位点组合:各组合基因型频率在病例组和对照组之间、不同性别HSP患儿间比较差异无统计学意义(P0.05);GG+CC基因型组合在HSPN组与Non-HSPN组间比较差异有统计学意义(P0.05)。结论 CTLA-4基因+49位点A/G基因多态性与HSP发病无关;-1722位点CC基因型及C等位基因,以及+49位点GG与-1722位点CC组合基因型可能为HSPN发病的危险因素。     

Infant Mortality in Belfast

Data on all livebirths and infant deaths occurring to residents in Belfast 1963-5 and in Birmingham 1964 were analysed in order to examine possible reasons why the infant mortality rate in Belfast (29·4 per 1000 livebirths) was higher than in Birmingham (21·4).The hypothesis that the excess infant mortality in Belfast was mainly due to a higher proportion of infants born to high parity Belfast mothers was tested and found to be untenable. Though significant differences between the distributions of livebirths by parity in the two cities were demonstrated, they could have accounted for only about 12% of the excess. Differences between the two livebirth distributions by birthweight were more important and accounted for 40% of the excess infant mortality in Belfast. A high mortality rate attributed to postnatal asphyxia and atelectasis (I.C.D. No. 762) was noted in this city.     

A 7-year study of bloodstream infections in an English children’s hospital

Knowledge of the pattern of bloodstream infection (BSI) can help determine antibiotic prescribing policy and infection control procedures. Data on 2364 consecutive episodes of BSI at Birmingham Childrens Hospital over 7 years were collected prospectively. A total of 1224 (51.8%) episodes were community-acquired, but only 281 (11.9%) were in previously healthy children. Intravascular devices (IVDs) were the most common source of infection, accounting for 48.9% of episodes. Gram-positive, gram-negative and anaerobic bacteria accounted for 66.2%, 31.3% and 0.4% of isolates, and 2.2% were yeasts. Coagulase-negative staphylococci, Staphylococcus aureus and enterococci accounted for over 50% of all isolates. Of these, only enterococci were predominantly hospital-acquired. Neisseria meningitidis was the most common cause of community-acquired BSI in previously healthy children. Of cases of meningococcaemia, 55.6% were diagnosed by PCR alone. Antibiotic resistance, especially in Enterobacteriaceae, S. aureus and enterococci, was more common than in earlier studies of BSI in children, and varied between specialties. The overall mortality rate directly attributable to infection was 2.4%, but was higher in neonates (6.2%) and in previously healthy children with community-acquired infections (5.3%). Conclusion:intravascular devices have emerged as the commonest source of bloodstream infection in children, leading to marked similarities in the species distribution of blood culture isolates across specialties other than General Paediatrics, and explaining the low overall mortality rate. Antibiotic resistance was found frequently in most commonly isolated pathogens, but differences between specialties suggest the existence of local risk factors, some of which might be amenable to infection control interventions.Abbreviations BSI bloodstream infection - IVD intravascular device     

Diaper Type as a Risk Factor in Urinary Tract Infection of Children

Objective

Urinary tract is one of the most common sources of infection in children under the age of two years. Many known and unknown risk factors predispose to this important disease in children. This study was conducted to determine whether using a specific type of diaper plays a role in urinary tract infection (UTI) in girls under the age of 2 years.

Methods

This case control study was performed in hospitalized children; girls with their first urinary tract infection were selected as cases, and those admitted for other reasons comprised the control group. Two groups were matched for age (±1 month), and other known risk factors for UTI. Type of diapers (superabsorbent, standard disposable and washable cotton), used for these children during six months, from October 2007 to March 2008, were compared in both groups.

Findings

59 matched pair infant girls less than 2 years were selected. It was revealed that in cases with UTI superabsorbent diapers were used more frequently than in controls (Odds ratio=3.29, P-value=0.005) There were no significant differences in other factors like number of diapers used per day, the time between defecation and diaper change, mothers’ educational level, level of family income and mother''s occupation.

Conclusion

The use of superabsorbent diapers could be a risk factor for urinary tract infection in infant girls.     

Utilization analysis of an observation unit for children with asthma

BACKGROUND: Short-stay observation unit (OU) care for children with asthma has the potential to reduce hospitalization rates for this common pediatric condition. In the effort to increase the efficiency of such a unit, knowledge of predictive factors for successful discharge is important. OBJECTIVES: 1) To define clinical predictive factors determined at the time of initial presentation in the emergency department (ED) that would identify which children with asthma are most likely to be successfully discharged from an OU. 2) To compare the management provided in the initial 3 hours upon arrival at the ED between the children who are eventually successfully discharged from an OU to those who require an inpatient admission. 3) To compare the length of stay in the OU between the patients who eventually go home to those who require an inpatient admission. DESIGN: Case control study. SETTING: Urban, tertiary-care pediatric ED. PARTICIPANTS: From a collected database of all patients with asthma 1 to 18 years of age, presenting to the ED from July 1, 1993 to June 30, 1994 (n = 2248), a random sample of 350 patients was identified. All children meeting the definition of "case" or "control" from this sample were included. Cases were defined as children with asthma who were successfully discharged after a stay in the OU. Controls were defined as children with asthma who were not successfully discharged; that is, children who required subsequent inpatient admission. RESULTS: Of the 350 children with asthma in the randomly selected subset sample, 47 cases and 21 controls were identified. In both cases and controls, patients had similar characteristics regarding mean age, sex, mean weight, previous history of asthma, and mean length of illness. The use of medications in the 24 hours prior to presentation to the ED was similar between both groups. No differences were found in the mean respiratory rate upon presentation between the cases and the controls (40/min vs. 44/min; P = 0.2), mean oxygen saturation (95 vs. 94%; P = 0.4). However, there was a significant difference in the requirement of supplemental oxygen between cases and controls (15 vs. 43%; P = 0.01; OR = 0.23:0.07 to 0.76). No further differences were found in the first 3 hours of ED management. The number of albuterol and ipratropium nebulizations was similar. The use, dosage, and timing of systemic steroids were also similar between the groups. The cases remained in the OU for a shorter period of time (8.7 hours vs 9.2 hours; 95% C.I.: -2.8 to 1.8) than the controls. CONCLUSION: No clinical predictive factors determined at the time of arrival to the ED were identified for children with asthma who were successfully discharged from the OU except for a lesser need of oxygen supplementation. The patients observed in the OU had similar management in the initial 3 hours of arrival and similar length of stay in the OU, regardless of their disposition outcome. Maximal OU efficiency remains limited by the lack of clear predictive factors for successful discharge. Further study in this area is indicated.     

Determinants for asthma control,quality of life and use of complementary and alternative medicine in asthmatic pediatric patients in four cities

Background

Asthma is a significant chronic health problem worldwide. Management aims at disease control by reducing functional impairment and exacerbations and improving quality of life (QoL). We report a multi-center study to survey asthma control and QoL in four cities in the Pearl River Delta.

Methods

The conjoint survey involved ten Hong Kong pediatric hospitals/units, two Shenzhen hospitals, two Macau hospitals, and two Guangzhou hospitals on asthma control (using Asthma Control Test) and QoL (Pediatric Allergic Disease Quality of Life Questionnaire, PADQLQ). Acceptability of a treatment is graded as very good/good/fair/poor.

Results

Good asthma control was only reported in 80% subjects in Hong Kong, but higher in sister cities (85–94%, P <?0.001). Allergic rhinitis, “incense burning”, and “smoker in family” were prevalent among the four cities. Logistic regression showed better control of asthma was associated with better PADQLQ (B?=???0.029, P < 0.001), better acceptability of bronchodilator (B?=???1.488, P = 0.025), negatively with “smoker in family” (B?=???0.83, P = 0.015) and various PADQLQ domains. Conversely, worse PADQLQ was associated with allergic rhinitis severity (B?=?4.77, P <?0.001), poor control of asthma (B?=?7.56, P <?0.001), increased frequency of traditional Chinese medicine use (B?=?1.7, P < 0.05), increased frequency of bronchodilator usage (B?=?1.05, P < 0.05), “smoker in family” (B?=?4.05, P < 0.05), and incense burning at home (B?=?3.9, P < 0.05).

Conclusions

There are some clinical and cultural differences among the four southern Chinese cities within the Guangdong province. This study identifies potentially modifiable environmental and treatment factors associated with poor asthma control and QoL for health-care interventions. Having a smoker in the family is independently associated with poor asthma control and QoL.

     

Substantiation and adverse appeal outcomes: content analysis and testing of Drake's harm/evidence model

Little is known about the influence of evidentiary and case characteristics on adverse appeal outcomes for substantiated cases of maltreatment. This article, therefore, reports on a sample of adverse appeal outcomes during a 2-year period. Using Drake's Harm/Evidence model to examine the adverse outcomes, the study describes differences between substantiated cases that were "modified" versus "overturned" during appeal, as well as differences in their evidentiary characteristics across different types of maltreatment. Content analysis and logistic regression analysis of administrative data were used to predict overturned versus modified outcome. Overall, child neglect, substantiated cases that did not meet basic evidentiary standards, and cases that were deemed as not credible were more likely to be overturned in comparison to being modified. A substantiation assessment framework (SAF) is developed and implications of Drake's Harm/Evidence model for investigating maltreatment as well as for understanding judicial decision making in appealed cases of maltreatment is highlighted.     

Effects of Maryland''s law banning Saturday night special handguns on crime guns

OBJECTIVES: To determine the effects of a 1988 Maryland law that banned "Saturday night special" handguns on the types of guns used in crime. To determine if controls on the lawful market for handguns affect the illegal market as well. SETTING: Baltimore, Maryland, and 15 other US cities participating in a crime gun tracing project. METHODS: Cross sectional comparison of the proportion of crime guns that are banned by the Maryland law, comparing Baltimore, MD with 15 other cities outside of Maryland. Multivariate linear regression analysis to determine if observed differences between Baltimore and 15 other cities are explained by demographic or regional differences among the cities rather than Maryland's law. RESULTS: Among crime guns, a gun banned by Maryland's law is more than twice as likely (relative risk (RR) 2.3, 95% confidence interval (CI) 2.0 to 2.5) to be the subject of a crime gun trace request in 15 other cities combined, than in Baltimore. Among homicide guns, a crime especially relevant for public safety, a comparable difference (RR 2.1, 95% CI 1.1 to 4.2) was observed. The proportion of Baltimore's crime guns that are banned is 12 percentage points lower than would be expected based on its demographic and regional characteristics alone. Among crime guns purchased after 1990, a much smaller proportion in Baltimore are banned models than in 15 other cities. CONCLUSIONS: Maryland's law has reduced the use of banned Saturday night specials by criminals in Baltimore. Contrary to the claims of some opponents of gun control laws, regulation of the lawful market for firearms can also affect criminals.     

Trichotillomania in childhood: case series and review

Trichotillomania is a relatively common cause of childhood alopecia. We report our observations of 10 children with trichotillomania seen over a 2-year period at Texas Children's Hospital. Patient ages ranged from 9 to 14 years (mean: 11.3 years) with an equal gender ratio. The duration of hair-pulling ranged from 1 month to 10 years (median: 4.6 months). The scalp alone was affected in 8 cases, the scalp and eyelashes in 1 case, and the eyelashes alone in 1 case. The frontal scalp and vertex were the most common sites affected. Associated findings included nail-biting in 2 cases, "picking" of the skin in 1 case, and headaches in another case. Noted precipitating factors in 3 patients included "stress" at home and school. Associated psychopathology included major depression in 1 case, attention-deficit/hyperactivity disorder in 1 case, and an "anxious and nervous personality" in 1 case. The most important differential diagnosis to exclude from trichotillomania is alopecia areata, which was seen concomitantly in 1 patient and preceded the onset of hair-pulling by 11 months. Eight patients were referred to a child psychologist for additional management, of which 2 were subsequently treated with antidepressant medication. Trichotillomania is a disorder of multifaceted pathology, and an interdisciplinary approach to management is often helpful. The common prepubertal age of onset provides an important opportunity for the pediatrician to lend support to affected patients and their families.     

极低出生体重儿脑损伤临床及高危因素分析

目的 调查极低出生体重儿(very low birth weight infant,VLBWI)脑损伤发病情况并分析其高危因素,以探讨改善神经发育预后的方法.方法 回顾性分析2007年10月至2014年9月我院NICU收治的326例VLBWI脑损伤发生情况,分析脑损伤组(132例)与无脑损伤组(194例)在一般情况、高危围生因素、早产儿合并症和呼吸支持治疗方面的差异,并对相关危险因素进行Logistic回归分析.结果 326例VLBWI中,发生早产儿脑损伤132例,发生率40.49％;其中出血性脑损伤80例(24.54％,80/326),包括脑室周围-脑室内出血66例(20.25％,66/326)(Ⅰ～Ⅱ级41例、Ⅲ～Ⅳ级25例),非出血性脑损伤52例(15.95％,52/326),包括脑室周围白质软化46例(14.11％,46/326).脑损伤组及无脑损伤组的一般资料显示,除性别外,胎龄、胎数、出生体重等方面差异有无统计学意义(P＞0.05).进一步比较两组间高危围生因素、早产儿合并症及呼吸支持治疗共28个因素的分布,结果提示在窒息、绒毛膜羊膜炎、产前激素使用、新生儿呼吸窘迫综合征、低氧血症、呼吸暂停、肺出血、动脉导管未闭、低血压、酸中毒、低碳酸血症、贫血、高血糖、血小板减少、高频通气、宫外发育迟缓16个方面差异有统计学意义(P＜0.05),进一步二分类Logistic回归分析显示产前激素使用与脑损伤发生呈负相关,绒毛膜羊膜炎、酸中毒和动脉导管未闭与脑损伤发生呈正相关,早产儿脑损伤的危险分别增加了0.108、7.222、3.045和4.565倍.结论 VLBWI的实际病死率及脑损伤发生率仍较高.绒毛膜羊膜炎、动脉导管未闭和酸中毒与早产儿脑损伤的发生密切相关.产前激素可预防早产儿脑损伤的发生.在VLBWI的围生期管理中应高度重视这些影响因素,以降低早产儿脑损伤发生率.     

Ultrasound in intussusception: A false cystic lead point

Lead point lesions are very rarely suspected during ultrasound (US) investigation of intussusception. We report a case of idiopathic intussusception where US suggested a cysticlead point. At operation there was no structural abnormality but fluid was noted to be trapped within intussuscepted mesentery.The incidence of non-idiopathic or secondary intussusception is 5–6% with Meckles diverticulum being numerically the most important single entity. The lead point is only rarely identified on ultrasound.A large Chinese series of 377 cases of diagnosis and reduction of paediatric intussusception under US control [1] makes no mention of ultrasonic identification of a secondary cause in any of their cases. A European series of 145 cases [2] noted a causative lesion in 8 (5,6%), of which 2 (lymphoma, intestinal duplication) were identified during the ultrasound study. Adamsbaum [3] recently published a case of an enterogenous cyst as a lead point identified on ultrasound. We present a case with very similar ultrasonic features but which at operation was found to represent fluid trapped within the intussuscepted mesentery rather than a true cystic lead point.     

Loss of heterozygosity at 11p13 and 11p15 in Wilms tumor: a study of 22 cases from India

Purpose

11p13 and 11p15 loss of heterozygosity (LOH) in Wilms tumor (WT), the commonest molecular pathogenetic event in WT, shows variation in different parts of the world. The present study looked for the presence of 11p13 and 11p15 LOH as well as nephrogenic rests in WT occurring in India.

Method

Twenty-two cases of WT were subjected to thorough pathological examination for presence of nephrogenic rests. Fresh frozen tissue was evaluated for LOH at 11p13 and 11p15, using PCR for microsatellite markers.

Results

Among twenty-two consecutive cases of WT, 20 were unilateral and 2 were bilateral. 6/22 showed LOH at 11p13 (27.7 %) and 1/22 showed LOH at 11p15 (4.54 %). 2/22 cases showed presence of nephrogenic rests. One of the cases with LOH at 11p13 had intralobar nephrogenic rest in the adjacent kidney. One specimen had perilobar nephrogenic rest in the adjacent kidney but did not show LOH for either 11p13 or 11p15 in the tumor.

Conclusion

LOH at 11p13 is seen in 27.27 % of WT in India, which is similar to reports in the English language literature. LOH at 11p15 was seen in 4.54 % of WT, which is lower than that reported from Western subjects.     

Pancreatitis in children. A study in the North of England.

Cases of pancreatitis in children in the Newcastle Regional Board area were studied over approximately 6 years. There were 9 cases aged between 6 weeks and 15 years. In 5 children (all under 7 years of age) likely aetiological factors were found (2 cases of mumps and 1 case wach due to trauma, measles, and hereditary pancreatitis). In 4 children all over 13 years of age no likely aetiological factor was found. It is speculated that they may represent one end of the age spectrum of idiopathic pancreatitis as it occurs in adults. Hereditary pancreatis was definitely found in only one child and possibly in one other. Therefore, it probably does not represent the major cause of pancreatitis in children as has been previously thought. One child died, but all the other children have thrived since their illness.     

Birth weight at term and lung function in adolescence: no evidence for a programmed effect.

It has been suggested that factors which influence low birth weight at term may be associated with reduced lung function in later life. This hypothesis was investigated in a comparative (retrospective) cohort study of 164 matched pairs of subjects where the observers responsible for tracing and studying the subjects were unaware of their case or control status. The subjects, born in Cardiff between 1975 and 1977, were of mean age 15.7 years. Cases (low birth weight (< 2500 g) at term) were matched with controls (normal birth weight (3000-3800 g) at term) for sex, parity, place of birth, date of birth, and gestation. Lung function was measured using a portable spirometer. The corrected mean differences (95% confidence interval) in forced vital capacity (FVC) and flow when 50% or 25% of the FVC remains in the lungs between the cases and controls were respectively -41 ml (-140 to 58), -82 ml/sec (-286 to 122), and -83 ml/sec (-250 to 83). None of these differences were statistically significant. These results are inconsistent with the hypothesis that low birth weight at term is associated with reduced lung function in adolescence.