Housing characteristics and children's respiratory health in the Russian Federation

OBJECTIVES: We studied housing characteristics, parental factors, and respiratory health conditions in Russian children. METHODS: We studied a population of 5951 children from 9 Russian cities, whose parents answered a questionnaire on their children's respiratory health, home environment, and housing characteristics. The health outcomes were asthma conditions, current wheeze, dry cough, bronchitis, and respiratory allergy. RESULTS: Respiratory allergy and dry cough increased in association with the home being adjacent to traffic. Consistent positive associations were observed between some health conditions and maternal smoking during pregnancy, many health conditions and lifetime exposure to environmental tobacco smoke (ETS), and nearly all health conditions and water damage and molds in the home. CONCLUSIONS: Vicinity to traffic, dampness, mold, and ETS are important determinants of children's respiratory health in Russia.     

The SELMA Study: A Birth Cohort Study in Sweden Following More Than 2000 Mother-Child Pairs

Background: This paper describes the background, aim and study design for the Swedish SELMA study that aimed to investigate the importance of early life exposure during pregnancy and infancy to environmental factors with a major focus on endocrine disrupting chemicals for multiple chronic diseases/disorders in offspring. Methods: The cohort was established by recruiting women in the 10th week of pregnancy. Blood and urine from the pregnant women and the child and air and dust from home environment from pregnancy and infancy period have been collected. Questionnaires were used to collect information on life styles, socio-economic status, living conditions, diet and medical history. Results: Of the 8394 reported pregnant women, 6658 were invited to participate in the study. Among the invited women, 2582 (39%) agreed to participate. Of the 4076 (61%) non-participants, 2091 women were invited to a non-respondent questionnaire in order to examine possible selection bias. We found a self-selection bias in the established cohort when compared with the non-participant group, e.g. participating families did smoke less (14% vs. 19%), had more frequent asthma and allergy symptoms in the family (58% vs. 38%), as well as higher education among the mothers (51% vs. 36%) and more often lived in single-family houses (67% vs. 60%). Conclusions: These findings indicate that the participating families do not fully represent the study population and thus, the exposure in this population. However, there is no obvious reason that this selection bias will have an impact on identification of environmental risk factors.     

Mite and pet allergen levels in homes of children born to allergic and nonallergic parents: the PIAMA study

The Prevention and Incidence of Asthma and Mite Allergy (PIAMA) study is a birth cohort study that investigates the influence of allergen exposure on the development of allergy and asthma in the first several years of life. The objectives of this study were to investigate the relationship between a family history of allergy and/or asthma and exposure of newborn children to mite and pet allergen and to study the influence of different home and occupant characteristics on mite allergen exposure. Dust was sampled from the child's mattress and the parental mattress at 3 months after birth of the index child and analyzed for mite and pet allergens. Subjects were divided in groups according to history of asthma and allergy in their parents, and allergen exposure was studied in the different groups. Cat allergen exposure was significantly lower on parental mattresses in families with allergic mothers, but dog allergen exposure was not different. Mite allergen exposure was lower on parental mattresses in families with allergic mothers. Use of mite allergen-impermeable mattress covers reduced mite allergen exposure. Some other characteristics such as age of home and mattress were also found to influence mite allergen exposure. Parental mattresses in homes of allergic mothers had lower cat and mite (but not dog) allergen loadings than mattresses in homes of nonallergic parents. Paternal (as opposed to maternal) allergy seemed to have little influence.     

Factors associated with rotavirus diarrhoea in children living in a socially diverse urban centre in Brazil

A case-control study, aimed at identifying factors associated with rotavirus diarrhoea cases presenting to health facilities, was conducted in children from low-income and middle-low-income families in Brazil. Cases were 390 children with diarrhoea and rotavirus in stools; controls were 1674 children without diarrhoea presenting to the same facilities. Data were collected by questionnaire and observations during home visits. Explanatory variables were grouped according to a conceptual model of causation. The ORs by non-conditional logistic regression and population-attributable fractions were calculated. Socioeconomic factors contributed a third of cases, followed by contact with diarrhoea cases and by not being breast fed. In cases aged <1 year, not being breast fed was the main determinant, followed by socioeconomic factors, and crowding and contact outside the home; in older children, socioeconomic factors followed by contact inside and outside the home were the main determinants. Environmental and sanitation variables were not associated with diarrhoea in the final model, and socioeconomic factors were only partly mediated by proximal variables. Transmission of rotavirus appears to be mostly by person-to-person contact, and shows marked social differentials not explained by the biological factors studied. The rotavirus vaccine is unlikely to protect against the full range of circulating genotypes of rotavirus, and understanding rotavirus epidemiology remains essential to the development of control policies.     

Pets, allergy and respiratory symptoms in children.

The relationship between pet ownership and respiratory allergy and symptoms was investigated in a population of 3344 Dutch children of 6-12 years old. Pet ownership was defined by the presence of cats, dogs, birds and/or rodents in the home. The reported prevalence of respiratory allergy and symptoms was lower among children of current pet owners than among children of parents who owned no pets. When past pet ownership was taken into account, however, a different picture emerged. The lowest prevalence of respiratory allergy and symptoms was found in children of current pet owners who had no pets in the past. The next lowest prevalence was found in children of current pet owners who had had pets in the past also. The next highest prevalence was found in children who never had pets in their life. The highest prevalence of reported pet allergy, chronic cough, wheeze, attacks of shortness of breath with wheezing, and doctor-diagnosed asthma was found in children who had pets in the past but not anymore. Past cat ownership especially was associated with a high prevalence of pet allergy and doctor-diagnosed asthma. Almost 2% of the population reported to never have owned pets for health reasons, and more than 12% reported removing pets from the home for health reasons in the past. These results show that selective avoidance and removal of pets leads to distortions of cross-sectional associations between pet ownership and respiratory allergy and disease among children.     

The Relationship between Asthma Severity,Family Functioning and the Health-Related Quality of Life of Children with Asthma

This study compared the health-related quality of life (HRQL) of 236 children with mild or moderate/severe asthma with that of a large representative sample of children in the general community. The study also examined the relationship between the HRQL of children with asthma and their demographic characteristics, asthma severity and family functioning. Children with asthma had a significantly poorer HRQL than other children in the community. Amongst the children with asthma, parents reported that children living in single-parent families had poorer physical health, mental health and social functioning than children in two-parent families. There was a significant relationship between the mental health of children with asthma and family functioning but no significant relationship between their physical health and family functioning. These findings suggest that the domains comprising the HRQL of children with asthma are related to both disease and non-disease factors. A better understanding of these relationships will facilitate the development of new interventions to help children with asthma. This revised version was published online in June 2006 with corrections to the Cover Date.     

Relationships between welfare status,health insurance status,and health and medical care among children with asthma

OBJECTIVES: This study evaluated the relationships between health insurance and welfare status and the health and medical care of children with asthma. METHODS: Parents of children with asthma aged 2 to 12 years were interviewed at 6 urban clinical sites and 2 welfare offices. RESULTS: Children whose families had applied for but were denied welfare had more asthma symptoms than did children whose families had had no contact with the welfare system. Poorer mental health in parents was associated with more asthma symptoms and higher rates of health care use in their children. Parents of uninsured and transiently insured children identified more barriers to health care than did parents whose children were insured. CONCLUSIONS: Children whose families have applied for welfare and children who are uninsured are at high risk medically and may require additional services to improve health outcomes.     

Home accidents in Al-Khobar City,eastern province,Saudi Arabia: A case-control socioeconomic study

A one-month prospective case-control study was conducted in two sectors of Al-Khobar City (Saudi population of 65,070) with the objective of identifying the socioeconomic factors that are related to home accidents among Saudis. All accidents reported to 20 health facilities during the period were recorded and for the home accidents a questionnaire was completed at the Emergency Rooms (ERs) and the subjects were subsequently interviewed at their homes. Of the 1,104 Saudis who reported to the ERs of these health facilities 209 (18.9 percent) had home accidents. 206 were interviewed at home together with 448 families (controls) randomly drawn from the family folders at the primary health care centers in the two sectors. In the event 25 more home accidents were identified and the number of control families was accordingly reduced to 423 while the accidents increased to 231. The overall incidence rate was 355/100,000 Saudis per month, being lower (327.6/100,000) for the first sector (Al-Thougba) with a population of a relatively lower socioeconomic status than the second (Al-Khobar) sector (399.5/100,000). The number of home accidents was related to family size and was also larger in families living in villas and flats compared to single story and portable buildings. Families with home accidents had significantly more members than the controls.It is recommended that extensive community-oriented research be conducted to identify, evaluate, and subsequently control the environmental and human factors that contribute to the incidence and outcome of home accidents in Saudi Arabia.Lt. Col. Hadi S. Al-Nahari is a primary health care physician at King Abdul-Aziz Air Base Hospital, Dhahran 31932, Saudi Arabia; Seifeddin G. Ballal is associate professor of occupational health in the department of family and community medicine, College of Medicine and Medical Sciences, King Faisal University, Dammam, Saudi Arabia.The authors acknowledge with gratitude the support and cooperation of the staff of the hospitals and the Primary Health Care Centers that participated in this study.     

宜昌市儿童哮喘的危险因素分析

目的 分析影响宜昌市儿童哮喘发病的危险因素, 为预防儿童哮喘的发生和急性发作提供指导。方法 采用分层随机整群抽样的方法, 在宜昌市抽取10 456名儿童进行初筛问卷调查, 筛选出疑似哮喘儿童, 对其再次发放哮喘儿童调查问卷进一步调查确诊, 同时选取与哮喘儿童数量相近, 性别、年龄相匹配的非哮喘儿童进行病例对照研究。结果 个人药物过敏史、过敏性鼻炎、湿疹史以及一级亲属哮喘或过敏史;家居环境中墙面涂有油漆、用煤炭取暖、做饭、霉斑现象、装修史、家属吸烟以及用毛毯做被褥;3个月以内添加辅食、1岁以内使用抗生素均是影响宜昌市儿童哮喘发病的危险因素。结论 对于有个人或家属过敏性疾病史的儿童, 家长应尽量避免家庭环境中过敏原的暴露, 积极避免危险因素可防止哮喘的发生或减少其急性发作的次数。     

Parental employment and work-family stress: associations with family food environments

Parental employment provides many benefits to children's health. However, an increasing number of studies have observed associations between mothers' full-time employment and less healthful family food environments. Few studies have examined other ways in which parental employment may be associated with the family food environment, including the role of fathers' employment and parents' stress balancing work and home obligations. This study utilized data from Project F-EAT, a population-based study of a socio-demographically diverse sample of 3709 parents of adolescents living in a metropolitan area in the Midwestern United States, to examine cross-sectional associations between mothers' and fathers' employment status and parents' work-life stress with multiple aspects of the family food environment. Among parents participating in Project F-EAT, 64% of fathers and 46% of mothers were full-time employed, while 25% of fathers and 37% of mothers were not employed. Results showed that full-time employed mothers reported fewer family meals, less frequent encouragement of their adolescents' healthful eating, lower fruit and vegetable intake, and less time spent on food preparation, compared to part-time and not-employed mothers, after adjusting for socio-demographics. Full-time employed fathers reported significantly fewer hours of food preparation; no other associations were seen between fathers' employment status and characteristics of the family food environment. In contrast, higher work-life stress among both parents was associated with less healthful family food environment characteristics including less frequent family meals and more frequent sugar-sweetened beverage and fast food consumption by parents. Among dual-parent families, taking into account the employment characteristics of the other parent did not substantially alter the relationships between work-life stress and family food environment characteristics. While parental employment is beneficial for many families, identifying policy and programmatic strategies to reduce parents' work-life stress may have positive implications for the family food environment and for the eating patterns and related health outcomes of children and parents.     

成人哮喘影响因素的病例对照研究

目的探讨成人哮喘的影响因素。方法使用成组的病例对照研究方法，采用问卷调查方式，对调查数据进行单因素和多因素非条件Logistic回归分析。结果单因素Logistic回归分析结果显示，有12个因素与成人哮喘有关联；多因素Logistic回归分析显示，8个因素被选入方程，其中粉尘过敏史（OR为9．38）、家中使用羽绒被（OR为7．66）、食物过敏史（OR为4．03）、过敏性鼻炎史（OR为3．76）、经常感到压抑和沮丧（OR为3．33）、接触过粉尘或气体（OR为2．47）、父亲吸烟（OR为1．49）是成人哮喘的危险因素；婴儿期母乳喂养（OR为0．29）是保护因素。结论成人哮喘可能是生活方式、环境和遗传共同作用而导致的一种疾病。     

Cognitive predictors of self-management behavior of asthmatic children and their families in Alexandria

The aim of this work was to study self-management behavior (SMB) of asthmatic children and their parents, its cognitive predictors as well as its effect on the child stress and health care utilization. Data was collected by interviewing 500 asthmatic children aged 9-18 years and 500 of their parents. The study revealed that very low percentage of the respondents had good asthma management behavior. The most frequent behaviors were taking medication, going to doctor and avoiding asthma triggers. The least practiced behaviors were breathing exercises and bronchial hygiene practices. The main predictor for children's SMB which constituted 36.3% of its variance was parental management behavior. Most of the studied cognitive factors were proved as predictors for children's SMB including knowledge, self-efficacy, health locus of control, perceived seriousness and barriers. Socioeconomic status was the main predictor of parental SMB, together with knowledge, powerful others health locus of control, health value, perceived barriers and father's education shared by 46.4% in explanation of its variance. Child knowledge, parental SMB, and socioeconomic status were significantly predicting health care utilization and level of child stress. A need was highlighted for initiation an asthma management educational program to families of asthmatic children.     

Socioeconomic risk factors in the prevalence of asthma and other atopic diseases in children 6 to 7 years old in Valencia, Spain

A cross-sectional survey of a cohort study was carried out between June and December 1994 in Valencia, Spain (population in 1994: 764,293 inhabitants). Two hundred sixty public and private schools randomly selected from the total of schools in Valencia were invited to participate; 3948 children aged 6–7 years cooperated in our study after informed consent was obtained from parents and school director. The survey in Valencia is part of the International Study of Asthma and Allergy in Childhood (ISAAC). Prevalences for asthma, rhinitis and atopic dermatitis were determined and contrasted with socioeconomic status (SES) among children. No statistically significant associations were established between the prevalences of asthma, rhinitis and atopic dermatitis, and SES. However, atopic dermatitis was found to be common among upper class children (21.5 per 100 children). Likewise, significant associations were observed between the severity of atopy (2 or 3 atopic manifestations) and SES (p=0.000), being greater for lower strata (4.5 per 100 children); for the three SES level significant differences were established (p = 0.008) regarding passive exposure to tobacco smoke in the home.     

Household exposure factors,asthma, and school absenteeism in a predominantly Hispanic community

The Passaic Asthma Reduction Effort (PARE) used an asthma symptom and household exposure factor questionnaire to screen 4634 elementary school children over a 4-year period in Passaic, New Jersey. During the first year, an additional 240 preschool children were also screened. Overall, 16% of the school children were reported by their parents to have been diagnosed with asthma. In all, 30% of responding families claimed to have at least one family member diagnosed with asthma and this was five times more likely if the target child had asthma. Exposures consistently associated with childhood asthma diagnosis included environmental tobacco smoke (ETS), presence of dampness/mold, roaches, and furry pets in the home. Diagnosis of asthma was primarily associated with all six symptoms used in the PARE questionnaire, and secondarily with environmental factors. Puerto Rican and black children had the highest asthma prevalence (26% and 33%), while Mexican children had the lowest (7%). Use of medications and school absenteeism among asthmatic children were associated with wheeze and night cough, but not with any specific environmental exposure. Increased school absenteeism by children undiagnosed with asthma was associated with ETS and dampness/mold in the home. Differences in asthma diagnosis and absenteeism in response to environmental factors were found across ethnic subgroups. Getting asthmatic children on medical management protocols and providing families with education about environmental risk reduction should aid in reducing morbidity in this ethnically complex population. Such coordinated efforts offer the promise of reducing school absenteeism.     

北京市郊区儿童哮喘病影响因素病例对照研究

目的了解北京市郊区儿童哮喘病相关影响因素,为采取相应干预措施提供依据。方法采用自行设计调查问卷抽取北京市郊区小学27 445名1~5年级小学生父母进行横断面调查,对按标准筛查出的370例哮喘病例组学生和868名对照组学生父母进行病因调查。结果病例组低出生体重、非足月出生、母乳喂养6个月、有哮喘家族史、有过敏家族史、有过敏症、被动吸烟和家中燃煤做饭且不排风的比例分别为8.4%,10.0%,69.7%,21.4%,26.2%,34.3%,77.0%和26.8%;对照组分别为4.2%,6.0%,75.7%,8.3%,17.7%,11.7%,70.6%和19.8%,差异均有统计学意义(P0.05);多因素Logistic回归分析结果表明,低出生体重、有哮喘家族史、有过敏家族史、有过敏症和家中燃煤做饭且不排风是北京市郊区儿童患哮喘的危险因素;母乳喂养6个月是北京市郊区儿童患哮喘的保护因素。结论应针对儿童易患哮喘病的危险因素制定相应的预防措施,提倡母乳喂养,以降低患哮喘的相对危险性。     

Utilization of Child Health Services by Children in Single-Parent and Two-Parent Families

With the increase in single-parent families questions have been raised concerning the adequacy of the access to care for children residing in these families A year of visits to primary health care sources are compared for a random sample of elementary school children residing with one or two-parent families Contrary to expectations concerning the medical disenfranchisement of sigleparent children when socioeconomic status, ethnicity, and children and youth project enrollment are controlled, no differences are found in use/ nonuse of facilities or range of visits Further studies should take into account parental employment as a separate and possibly more important factor than number of parents in the home when studying use of pediatric services.     

Birth order and sibship size: evaluation of the role of selection bias in a case-control study of non-Hodgkin's lymphoma

Substantial heterogeneity has been observed among case-control studies investigating associations between non-Hodgkin's lymphoma and familial characteristics, such as birth order and sibship size. The potential role of selection bias in explaining such heterogeneity is considered within this study. Selection bias according to familial characteristics and socioeconomic status is investigated within a United Kingdom-based case-control study of non-Hodgkin's lymphoma diagnosed during 1998-2001. Reported distributions of birth order and maternal age are each compared with expected reference distributions derived using national birth statistics from the United Kingdom. A method is detailed in which yearly data are used to derive expected distributions, taking account of variability in birth statistics over time. Census data are used to reweight both the case and control study populations such that they are comparable with the general population with regard to socioeconomic status. The authors found little support for an association between non-Hodgkin's lymphoma and birth order or family size and little evidence for an influence of selection bias. However, the findings suggest that between-study heterogeneity could be explained by selection biases that influence the demographic characteristics of participants.     

The Association between Parental Perception of Neighborhood Safety and Asthma Diagnosis in Ethnic Minority Urban Children

Low-income populations, minorities, and children living in inner cities have high rates of asthma. Recent studies have emphasized the role of psychosocial stress in development of asthma. Residence in unsafe neighborhoods is one potential source of increased stress. The study objective was to examine the association between parental perception of neighborhood safety and asthma diagnosis among inner city, minority children. Cross-sectional data from a community-based study of 6–8-year-old New York City children were used. Asthma was defined as parental report of physician-diagnosed asthma and at least one asthma-related symptom. Parental perceptions of neighborhood safety were assessed with a questionnaire. Associations between perceived neighborhood safety and asthma were examined using chi-squared tests. Multivariate logistic regression analyses were then performed. Five hundred four children were included with 79% female, 26.5% non-Hispanic Black, and 73.5% Hispanic. Asthma was present in 23.8% of children. There was an inverse association between feeling safe walking in the neighborhood and asthma with 45.7% of parents of asthmatic children reporting they felt safe compared to 60.9% of parents of non-asthmatic children (p = 0.006). Fewer parents of asthmatic children than of non-asthmatic children reported that their neighborhood was safe from crime (21.7% versus 33.9%, p = 0.018). In multivariate analyses adjusting for race/ethnicity, age, gender, socioeconomic status, number of smokers in the home and breastfeeding history, parents reporting feeling unsafe walking in the neighborhood were more likely to have a child diagnosed with asthma (OR = 1.89, 95%CI 1.13–3.14). Psychosocial stressors such as living in unsafe neighborhoods may be associated with asthma diagnosis in urban ethnic minority children. Addressing the increased asthma burden in certain communities may require interventions to decrease urban stressors.     

The impact of childhood chronic neurological diseases on Greek families

BACKGROUND: Although the impact of childhood chronic neurological diseases (CND) on patients' psychological well-being has been increasingly addressed, little attention has been given to the influence of these conditions on family members and family functioning. The purpose of the present study was to investigate the family characteristics of Greek children suffering from CND. METHODS: A total of 52 parents of children with CND were studied by using the Family Environmental Scale (FES), the Family Burden Scale, the General Health Questionnaire (GHQ-28) and a questionnaire on the knowledge of their children's illness, their coping strategies and their satisfaction with our services. During the same period, 30 parents of hospitalized children for common paediatric illnesses completed the FES. In both groups social and demographic features were registered. Appropriate statistical processes were applied to compare the above-mentioned family groups and to study the differences between the families of children with epilepsy (n=37) and the families of children with other CND (n=15). RESULTS: Parents of children with CND discuss their problems less freely, talk less openly around home, score highly on FES subscale of Conflict and, pay more attention to ethical and religious issues and values. Furthermore, the families of children with other CND were more burdened regarding the financial state and the health status of other family members in comparison with families of children with epilepsy. In addition, families of children with epilepsy were more involved in social and recreational activities, appeared to be more knowledgeable on the availability of help in critical conditions and were more satisfied with rendered medical services, in comparison with families of children with other CND. CONCLUSION: These preliminary findings provide important information concerning the special characteristics of Greek families of children suffering from CND, which may prove especially helpful in organizing specific support services.