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1.
Cincotta DR Crawford NW Lim A Cranswick NE Skull S South M Powell CV 《Archives of disease in childhood》2006,91(2):153-158
Aims
To compare prevalence, reasons, motivations, initiation, perceived helpfulness, and communication of complementary and alternative medicine (CAM) use between two tertiary children''s hospitals.Methodology
A study, using a face‐to‐face questionnaire, of 500 children attending the University Hospital of Wales, Cardiff, UK was compared to an identical study of 503 children attending the Royal Children''s Hospital, Melbourne, Australia.Results
One year CAM use in Cardiff was lower than Melbourne (41% v 51%; OR = 0.67, 95% CI 0.52–0.85), reflected in non‐medicinal use (OR = 0.41, 95% CI 0.29–0.58) and general paediatric outpatients (OR = 0.38, 95% CI 0.21–0.67). Compared to Melbourne, factors associated with lower CAM use in Cardiff included families born locally (father: OR = 0.58, 95% CI 0.44–0.77) or non‐tertiary educated parents (mother: OR = 0.54, 95% CI 0.38–0.77). Cardiff participants used less vitamin C (OR = 0.31, 95% CI 0.18–0.51) and herbs (OR = 0.49, 95% CI 0.34–0.71), attended less chiropractors (OR = 0.25, 95% CI 0.06–0.37) and naturopaths (OR = 0.08, 95% CI 0.02–0.33), but saw more reflexologists (OR = 3.33, 95% CI 1.08–10.29). In Cardiff, CAM was more popular for relaxation (OR = 1.92, 95% CI 1.03–3.57) but less for colds/coughs (OR = 0.4, 95% CI 0.27–0.73). Most CAM was self‐initiated (by parent) in Cardiff and Melbourne (74% v 70%), but Cardiff CAM users perceived it less helpful (OR = 0.46, 95% CI 0.31–0.68). Non‐disclosure of CAM use was high in Cardiff and Melbourne (66% v 63%); likewise few doctors/nurses documented recent medicinal CAM use in inpatient notes (0/21 v 2/22).Conclusions
The differences in CAM use may reflect variation in sociocultural factors influencing reasons, motivations, attitudes, and availability. The regional variation in use and poor communication highlights the importance of local policy development. 相似文献2.
Birth anthropometric measures, body mass index and allergic diseases in a birth cohort study (BAMSE)
Objective
We aimed to assess increased birth weight or birth length in relation to allergic diseases at 4 years of age, taking body mass index (BMI) at age 4 as a covariate in the adjustment.Methods
The parents of a large prospective birth cohort answered questionnaires on environmental factors and allergic symptoms when their children were 2 months and 1, 2 and 4 years old. Perinatal data on weight and length at birth were received from the child care health centres. The children were clinically examined at 4 years of age and height and weight recorded. Blood was drawn for analysis of specific IgE antibodies to common inhalant allergens. Risk associations between birth anthropometric measures and wheeze, allergic diseases or sensitisation were estimated in multivariate logistic regression analyses (n = 2869).Results
There were no clear overall associations between birth weight and allergic diseases at 4 years of age. Birth length ⩾90th percentile was inversely associated with any wheeze at age 4 (adjusted OR 0.64, 95% CI 0.44 to 0.92) but was significantly associated only with late‐onset wheeze (adjusted OR 0.40, 95% CI 0.21 to 0.77). No such associations were seen for persistent or transient wheeze, eczema, rhinitis or allergic sensitisation. Transient wheeze during the first 2 years of age tended to be associated with increased BMI at age 4.Conclusion
Increased birth weight was not associated with wheeze or allergic disease. Increased birth length may play a protective role in late‐onset wheeze in early childhood. 相似文献3.
McGarvey C McDonnell M Hamilton K O'Regan M Matthews T 《Archives of disease in childhood》2006,91(4):318-323
Background
It is unclear if it is safe for babies to bed share with adults. In Ireland 49% of sudden infant death syndrome (SIDS) cases occur when the infant is bed‐sharing with an adult.Objective
To evaluate the effect of bed‐sharing during the last sleep period on risk factors for SIDS in Irish infants.Design
An 8 year (1994–2001) population based case control study of 287 SIDS cases and 831 controls matched for date, place of birth, and sleep period. Odds ratios and 95% confidence intervals were calculated by conditional logistic regression.Results
The risk associated with bed‐sharing was three times greater for infants with low birth weight for gestation (UOR 16.28 v 4.90) and increased fourfold if the combined tog value of clothing and bedding was ⩾10 (UOR 9.68 v 2.34). The unadjusted odds ratio for bed‐sharing was 13.87 (95% CI 9.58 to 20.09) for infants whose mothers smoked and 2.09 (95% CI 0.98 to 4.39) for non‐smokers. Age of death for bed‐sharing and sofa‐sharing infants (12.8 and 8.3 weeks, respectively) was less than for infants not sharing a sleep surface (21.0 weeks, p<0.001) and fewer bed‐sharing cases were found prone (5% v 32%; p = 0.001).Conclusion
Risk factors for SIDS vary according to the infant''s sleeping environment. The increased risk associated with maternal smoking, high tog value of clothing and bedding, and low z scores of weight for gestation at birth is augmented further by bed‐sharing. These factors should be taken into account when considering sleeping arrangements for young infants. 相似文献4.
Aim
To quantitatively examine the influence of study methodology and population characteristics on prevalence estimates of autism spectrum disorders.Methods
Electronic databases and bibliographies were searched and identified papers evaluated against inclusion criteria. Two groups of studies estimated the prevalence of typical autism and all autism spectrum disorders (ASD). The extent of variation among studies and overall prevalence were estimated using meta‐analysis. The influence of methodological factors and population characteristics on estimated prevalence was investigated using meta‐regression and summarised as odds ratios (OR).Results
Forty studies met inclusion criteria, of which 37 estimated the prevalence of typical autism, and 23 the prevalence of all ASD. A high degree of heterogeneity among studies was observed. The overall random effects estimate of prevalence across studies of typical autism was 7.1 per 10 000 (95% CI 1.6 to 30.6) and of all ASD was 20.0 per 10 000 (95% CI 4.9 to 82.1). Diagnostic criteria used (ICD‐10 or DSM‐IV versus other; OR = 3.36, 95% CI 2.07 to 5.46), age of the children screened (OR = 0.91 per year, 95% CI 0.83 to 0.99), and study location (e.g. Japan versus North America; OR = 3.60, 95% CI 1.73 to 7.46) were all significantly associated with prevalence of typical autism. Diagnostic criteria, age of the sample, and urban or rural location were associated with estimated prevalence of all ASD.Conclusions
Sixty one per cent of the variation in prevalence estimates of typical autism was explained by these models. Diagnostic criteria used, age of children screened, and study location may be acting as proxies for other study characteristics and require further investigation. 相似文献5.
F Vázquez-Nava J A Quezada-Castillo S Oviedo-Trevi?o A H Saldivar-González H R Sánchez-Nuncio F J Beltrán-Guzmán E M Vázquez-Rodríguez C F Vázquez Rodríguez 《Archives of disease in childhood》2006,91(10):836-840
AIM: To determine the association between allergic rhinitis, bottle feeding, non-nutritive sucking habits, and malocclusion in the primary dentition. METHODS: Data were collected on 1160 children aged 4-5 years, who had been longitudinally followed since the age of 4 months, when they were admitted to nurseries in a suburban area of Tampico-Madero, Mexico. Periodically, physical examinations were conducted and a questionnaire was given to their parents or tutors. RESULTS: Malocclusion was detected in 640 of the children (51.03% had anterior open bite and 7.5% had posterior cross-bite). Allergic rhinitis alone (adjusted odds ratio = 2.87; 95% CI 1.57 to 5.25) or together with non-nutritive sucking habits (adjusted odds ratio = 3.31; 95% CI 1.55 to 7.09) had an effect on anterior open bite. Bottle feeding alone (adjusted odds ratio = 1.95; 95% CI 1.07 to 3.54) or together with allergic rhinitis (adjusted odds ratio = 3.96; 95% CI 1.80 to 8.74) had an effect on posterior cross-bite. Posterior cross-bite was more frequent in children with allergic rhinitis and non-nutritive sucking habits (10.4%). CONCLUSIONS: Allergic rhinitis alone or together with non-nutritive sucking habits is related to anterior open bite. Non-nutritive sucking habits together with allergic rhinitis seem to be the most important factor for development of posterior open bite in children under the age of 5 years. 相似文献
6.
Aims
To assess co‐morbidity and risk factors for otitis media, tonsillopharyngitis, and lower respiratory infections in school children.Methods
Logistic regression analysis of co‐morbidity and risk factors for airway infections in a population based sample of 10 year old children living in Oslo, Norway. Main outcome measures: otitis media, tonsillopharyngitis, and lower respiratory infections in past 12 months.Results
Airway infections in 10 year old children were common, and significant co‐morbidity was found between the various airway infections. Home dampness was a risk factor for all infections, adjusted odds ratios ranging from 1.2 (95% CI 1.0 to 1.5) to 1.4 (95% CI 1.1 to 1.6) for otitis media and tonsillopharyngitis respectively. Atopic disease was a constitutional risk factor, particularly strong for lower airway infections (adjusted odds ratio 2.4, 95% CI 1.8 to 3.1). African or Asian ethnicities were associated with the airway infections, adjusted odds ratios ranging from 1.2 (95% CI 0.9 to 1.7) to 1.7 (95% CI 1.2 to 2.3).Conclusions
Respiratory tract infections were common in 10 year old children. There was substantial co‐morbidity between upper and lower airway infections. Environmental and constitutional factors were identified and positively associated with the infections. Results support the hypothesis of 1957 that the whole respiratory tract is one unit. 相似文献7.
Joseph DV Jackson JA Westaway J Taub NA Petersen SA Wailoo MP 《Archives of disease in childhood. Fetal and neonatal edition》2007,92(6):F484-F488
Background
Smoking is a major risk factor for cot death. Many infants smoke passively as a result of parental smoking. This paper reports on infants exposed to a smoking environment and how they accumulate metabolites of cigarette smoke, such as cotinine, which may be physiologically harmful.Aim
To assess cotinine levels in infants of smoking parents.Method
Cotinine excretion in urine was assessed in 104 infants, of whom 71 had smoking parents and 33 had non‐smoking parents. All cotinine levels were measured at approximately 12 weeks of age. The subjects were selected from a database of infants in developmental physiological studies which assessed the impact of various factors on early postnatal development.Results
On average babies with at least one parent who was a current cigarette smoker excreted 5.58 (95% CI 3.4 to 9.5) times as much cotinine in the urine as did the babies of non‐smoking parents. Maternal smoking was the largest contributing factor. Co‐sleeping (p = 0.037) and the minimum room temperature (p = 0.028) were significant contributory factors.Conclusion
Infants from smoking households accumulate cotinine, a metabolite of nicotine, which may have a detrimental effect on the cardiorespiratory system. 相似文献8.
Aims
To investigate the diagnoses made for children referred to a “fits, faints, and funny turns” clinic.Methods
Prospective study of 380 children referred to a dedicated secondary care clinic over an eight year period.Results
Twenty three per cent of children were given a final diagnosis of one of the childhood epilepsies, with 48% of these having a specific epilepsy syndrome. Syncope was the commonest cause of a non‐epileptic event (syncope and reflex anoxic seizures comprised 100/238, 42%) but there were a wide variety of other causes. Fifty three events (14%) were unclassified and managed without a diagnostic label or treatment.Conclusions
In children with funny turns referred to secondary care, the diagnostic possibilities are numerous; among non‐epileptic events, syncopes predominate. The majority do not have epilepsy. Unclassifiable events with no clear epileptic or non‐epileptic cause are common and can be safely managed expectantly. 相似文献9.
Gittins NS Hunter-Blair YL Matthews JN Coulthard MG 《Archives of disease in childhood》2007,92(6):499-501
Objectives
To determine whether the tissue plasminogen activator, alteplase, is more effective than heparin in preventing blood clots developing in children''s haemodialysis central lines between dialysis sessions.Design
A prospective double‐blind, within‐patient multiperiod cross‐over controlled trial of instilling a “lock” of either heparin 5000 U/ml or alteplase 1 mg/ml into the central lines of two children haemodialysed twice weekly, and seven dialysed thrice weekly, over 10 weeks.Setting
A UK paediatric nephrology unit.Main outcome measures
Weight of blood clot aspirated from the line at the start of the next dialysis session.Results
The odds of a clot forming was 2.4 times greater with heparin than alteplase (95% CI 1.4 to 4.0; p = 0.001), and when present they were 1.9 times heavier (31 vs 15 mg; 95% CI 1.5 to 2.4; p<0.0005). There was no effect of inter‐dialytic interval. One child required an alteplase infusion to clear a blocked line following a heparin lock. We subsequently changed our routine locks from heparin to alteplase. Comparing the year before and after that change, the incidence of blocked lines requiring an alteplase or urokinase infusion fell from 2.7 to 1.2 per child (p<0.03), and the need for surgical replacements from 0.7 to nil (p<0.02).Conclusion
Alteplase is significantly more effective than heparin in preventing clot formation in central haemodialysis lines. This reduces morbidity and improves preservation of central venous access. It is more expensive, though relatively economic if packaged into syringes and stored frozen until needed, but reduces the costs of unblocking or replacing clotted lines. 相似文献10.
Background
The timing of parturition in most mammals is thought to be linked to a late gestational rise in corticosteroid production by the fetal adrenal gland. We hypothesised that gestational age would be prolonged in our patients with impaired cortisol production secondary to congenital adrenal hyperplasia (CAH) due to 21‐hydroxylase deficiency.Methods
We compared the gestational age of patients affected by salt‐wasting CAH due to 21‐hydroxylase deficiency (born 1978–2004; n = 31) with that of children with congenital hypothyroidism (born 1981–2003; n = 30) and a control group of short normal children (born 1980–2002; n = 120). Each group was compared with national (England 2002–3) and regional (2003–4) data on gestational age from hospital episode statistics. Post‐term delivery was defined as birth beyond 41 completed weeks.Results
National statistics reveal a frequency of 4.4% for singleton deliveries beyond 41 weeks. In our region the frequency was 4.6%. In the group of children with CAH, the frequency of post‐term delivery was 19.3% (p<0.001). In patients with congenital hypothyroidism, the frequency was 13.3% (p = 0.02). The proportion of short children who did not have a recognised endocrinopathy born post term was comparable to national and regional data at 6.7%.Conclusions
A prolonged gestation is more likely in pregnancies where the fetus has the salt‐wasting form of CAH. This may be due to impaired cortisol production, although other changes in steroidogenesis may also be contributory. 相似文献11.
Objectives
Hypospadias, a common birth defect, has shown widespread variation in reported rates and temporal trends across countries over the last 30 years. The aim of this study was to determine the prevalence and trends of hypospadias in an Australian population.Design
Population‐based study of all male infants born in Western Australia (WA) between 1980 and 2000 diagnosed with hypospadias and notified to the WA Birth Defects Registry.Main outcome measures
Prevalence of hypospadias, birth outcome and association with other congenital anomalies, stratified by degree‐of‐severity.Results
1788 cases of hypospadias were registered in WA in 1980–2000 with an overall prevalence of 34.8 (95% confidence interval (CI): 33.2 to 36.4) cases per 10 000 births. The prevalence increased by 2.0% per annum (95% CI: 1.2% to 2.8%) from 27.9 in 1980 to 43.2 per 10 000 births in 2000 (p<0.001). Hypospadias was mild in 84% of cases, moderate‐severe in 11% and unspecified in 5%, with the number of moderate‐severe hypospadias almost doubling over time (p<0.01). There were 1465 (82%) cases of isolated hypospadias and 323 (18%) had co‐existing anomalies. Infants with co‐existing genital (relative risk (RR) 4.5; 95% CI: 3.3 to 6.1) or non‐genital (RR 1.5; 95% CI: 1.0 to 2.2) anomalies were more likely to have moderate‐severe hypospadias compared with isolated cases.Conclusion
Hypospadias affects one in 231 births and has been reported to have increased significantly over the last 20 years. Future investigation of the aetiology of hypospadias is important to identify potentially modifiable risk factors and ensure optimal male reproductive health in the future. 相似文献12.
Miron D Daas A Sakran W Lumelsky D Koren A Horovitz Y 《Archives of disease in childhood》2007,92(6):502-504
Background
Guidelines recommend obtaining a renal ultrasonogram (RUS) for young children after a first urinary tract infection (UTI).Objective
The aim of the current study was to assess the concordance of prenatal and post‐UTI RUS findings in children with a first simple UTI.Methods
This was a prospective study and included all children aged 5 years or younger who were hospitalised with a first simple UTI (determined as clinical response and normalisation of temperature within 48 h on initiation of antibacterial therapy with no complications). Data were collected from each child regarding the results of prenatal and post‐UTI RUS.Results
Overall, 250 children were included in the study and the results of late‐pregnancy and post‐UTI RUS were available for 84% (n = 209). Complete concordance between the two RUS was demonstrated in 96% (n = 201). The predictive value of normal antenatal to normal post‐UTI RUS was 96% (95% CI: 93% to 99%). These results include four children with mild transient pelvic dilatation. In eight children in whom renal anomalies were demonstrated only in post‐UTI RUS, the influence of these anomalies on the children''s management was negligible.Conclusions
Prenatal‐RUS have been performed in most children <5 years old hospitalised with a first simple UTI. Concordance with post‐infection tests is very high. Findings which appear only in post‐infectious RUS usually have negligible effects on children''s management. Thus, in such children with normal antenatal RUS omitting post‐UTI RUS could be considered. 相似文献13.
Uldall P Alving J Hansen LK Kibaek M Buchholt J 《Archives of disease in childhood》2006,91(3):219-221
Aims
To determine the proportion of children admitted with difficult to treat paroxysmal events to a tertiary epilepsy centre who did not have epilepsy.Methods
In an observational retrospective study, all case notes of 223 children admitted in 1997 were examined. The referral was made from the local paediatric department in 51% of cases, other departments in 27%, and from general or specialist practitioners in 22%. Doubt regarding the diagnosis of epilepsy was expressed in the referral note in 17%. On admission, 86% were on antiepileptic drug treatment. During admission all children were subjected to a comprehensive intensive observation and 62% had EEG monitoring.Results
In total, 39% (87/223) were found not to have epilepsy. In 30% of children (55/184) referred without any doubts about the epilepsy diagnosis, the diagnosis was disproved. Of the 159 children admitted for the first time, 75 (47%) were discharged with a diagnosis of non‐epileptic seizures. Of 125 children admitted for the first time with no doubts about the diagnosis of epilepsy, 44 (35%) did not have epilepsy. Staring episodes were the most frequently encountered non‐epileptic paroxysmal event. Psychogenic non‐epileptic seizures were found in 12 children. A total of 34 (15%) had their medication tapered off; a further 22 (10%) had tapered off medication before admission.Conclusion
The present study supports the view that misdiagnosis of epilepsy is common. The treating physician should be cautious in diagnosis, especially of staring episodes. A diagnostic re‐evaluation should be undertaken in difficult cases with continuing paroxysmal events in order to avoid unnecessary drug treatment and restrictions on the child''s lifestyle. 相似文献14.
Micronutrients (including zinc) reduce diarrhoea in children: the Pakistan Sprinkles Diarrhoea Study
Sharieff W Bhutta Z Schauer C Tomlinson G Zlotkin S 《Archives of disease in childhood》2006,91(7):573-579
Aims
To examine the effect of the daily use of micronutrients (including zinc) or the same micronutrients plus heat inactivated lactic acid bacteria (LAB), on diarrhoea in children compared to placebo.Methods
A triple blind randomised clinical trial in an urban slum of Karachi, Pakistan. Micronutrients (including zinc), micronutrients (including zinc and LAB), or placebo, were provided daily for two months to 75 young children (aged 6–12 months) identified at high risk for diarrhoea related mortality on the basis of history of at least one episode of diarrhoea in the preceding two weeks. The longitudinal prevalence of diarrhoea was defined as the percentage of days a child had diarrhoea out of the days the child was observed.Results
Mean longitudinal prevalence of diarrhoea in the micronutrient–zinc group was 15% (SD = 10%) child‐days compared to 26% (SD = 20%) child‐days in the placebo group and 26% (SD = 19%) child‐days in the micronutrient–zinc–LAB group. The difference between the micronutrient–zinc–LAB and placebo groups was not significant.Conclusion
The daily provision of micronutrients (including zinc) reduces the longitudinal prevalence of diarrhoea and thus may also reduce diarrhoea related mortality in young children; heat inactivated LAB has negative effects in these children. 相似文献15.
Objective
To determine the uptake of current antenatal HIV testing, the prevalence of risk factors for HIV in pregnant women and the acceptability of the rapid point‐of‐care HIV test (RPOCT) among pregnant women and their midwives.Design
A retrospective review of 717 notes to determine current HIV screening practices and a cross‐sectional survey using a self‐completed questionnaire for pregnant women and midwives.Setting
The antenatal clinic (ANC) and postnatal wards (PNW) at a university teaching hospital in the West Midlands.Participants
486 women attending the ANC or admitted to the PNW during a fortnight in May–June 2006. 72 midwives on the delivery ward completed a second questionnaire.Results
The questionnaire showed that 90.4% of those offered the standard HIV test accepted it, with 7.2% having at least one risk factor for HIV. Over half of the decliners perceived themselves as not at risk. 85.2% would accept the rapid test, including 35.6% of the decliners. 92.8% of midwives agreed/strongly agreed the RPOCT has a role on the delivery ward and 97.2% would be happy to offer the test with appropriate training and guidance.Conclusions
Midwives deem the RPOCT to be appropriate for a variety of perinatal settings. It is also acceptable to a clinically significant proportion of those who decline the standard test (21 of 59) and therefore has the potential to increase screening and detection rates. Hence, by allowing early diagnosis and the initiation of antenatal interventions, it could reduce the rate of mother‐to‐child transmission (MTCT) in the UK. 相似文献16.
Objective
To determine current use of vitamin K (VK) prophylaxis in newborns and review the efficacy and effectiveness of regimens used.Design
Efficacy and effectiveness calculated using current practice details, data from Southern Ireland and two previous surveys, together with contemporaneous studies of vitamin K deficiency bleeding (VKDB).Setting
Current survey: United Kingdom (Great Britain and Northern Ireland). Efficacy and effectiveness tables: United Kingdom and Southern Ireland.Main outcome measures
Current VK prophylaxis following uncomplicated term deliveries. Relative risk of VKDB calculated for the VK actually received and for “intention to treat”.Results
Questionnaire response rate 95% (n = 243), all recommending VK prophylaxis. No association between unit size and route of administration. For uncomplicated term deliveries, 60% recommended intramuscular (IM) prophylaxis, 24% oral and 16% offered both routes without bias. All units offering IM gave a single dose, mostly 1 mg Konakion Neonatal. Oral regimens showed more variation: two thirds gave 2 mg (range 0.5–2 mg), the number of doses ranged from 1 to 11 and many used preparations off‐licence or the unlicensed Orakay. IM prophylaxis, if given, provided the best protection (most efficacious) against VKDB. However, on an intention‐to‐treat basis (effectiveness), there is no statistically significant difference between the risks of VKDB after intended IM VK and after oral prophylaxis intended to continue beyond a week.Conclusions
Although the principles of VK prophylaxis is now accepted by all, there is no uniformity in practice. Omission of prophylaxis appears to be a greater problem for IM than for multi‐dose oral prophylaxis, affecting overall effectiveness. 相似文献17.
Aims
To review the effect of total splenectomy on lung function and nutrition in children with cystic fibrosis related liver disease (CFLD) and associated portal hypertension. The stated indications for surgery and the short and long term risks of the procedure were also documented.Method
Over a 25 year period from January 1980 to June 2005, approximately 650 patients with cystic fibrosis (CF) were treated at the Royal Children''s Hospital, Melbourne, Australia. Nine patients with CFLD who underwent a splenectomy during that time were identified and their medical records were reviewed.Results
FEV1% predicted dropped by −16±11% in the two years pre‐splenectomy. This contrasts with the increase in FEV1% predicted of 2±16% in the two years post‐splenectomy (p = 0.05). The cumulative gain in WAZ score (ΔWAZ pre) over the two years prior to splenectomy of 0.045±0.69 was not significantly different from the cumulative gain in WAZ score (ΔWAZ post) for the two years after splenectomy of 0.15±0.36 (p = 0.65). The average age at splenectomy was 14.8 years (SD = 3 years). The average weight of an excised spleen was 983 g (SD = 414 g). There were no deaths associated with splenectomy. The median length of follow up post‐splenectomy was 6.0 years (range 0.7–15.8). There were no episodes of bacterial peritonitis or overwhelming sepsis.Conclusions
Splenectomy may have a beneficial effect on lung function although this may not manifest itself until the second year post‐splenectomy. Splenectomy in patients with CFLD appears to be a safe procedure. 相似文献18.
Anthracopoulos MB Liolios E Panagiotakos DB Triantou K Priftis KN 《Archives of disease in childhood》2007,92(3):209-212
Background
The prevalence of asthma and wheezing has risen during the past four decades. Recent reports suggest that the “asthma epidemic” has reached a plateau.Objective
To examine further trends in the prevalence of childhood diagnosed asthma and wheezing in an urban environment in Greece.Methods
A population‐based cross‐sectional parental questionnaire survey was repeated among third‐grade and fourth‐grade school children (8–10 years) of public primary schools in 2003 in the city of Patras, Greece, by using methods identical to that of surveys conducted in 1978 (completed questionnaires, n = 3003), 1991 (n = 2417) and 1998 (n = 3076).Results
2725 questionnaires were completed in the 2003 survey. The prevalence rates of current asthma and/or wheezing in 1978, 1991, 1998 and 2003 were 1.5%, 4.6%, 6% and 6.9%, respectively (p for trend <0.001). The lifetime prevalence of asthma and/or wheezing in the three more recent surveys was 8%, 9.6% and 12.4%, respectively (p for trend <0.001). The male:female ratios of current asthma and/or wheezing in the four surveys were 1.14:1, 1.15:1, 1.16:1 and 1.22:1, respectively. The proportion of those with wheezing diagnosed with asthma has increased during the study period, more so among non‐current children with asthma.Conclusions
Our findings show a continuous increase in the prevalence of asthma and wheezing among preadolescent children in Patras, Greece, over 25 years, albeit at a decelerating rate. There seems to be a true increase in wheezing, despite some diagnostic transfer, particularly among younger children. The male predominance of the disease has persisted in the population of this study.Several studies have reported a rise in the prevalence of childhood asthma in Western countries over the past 3–4 decades. This increase can be, at least partially, explained by changes in diagnostic criteria and increased public awareness of the disease.1 Those few serial studies that have used identical methods support the impression of a true increase in the prevalence of childhood asthma.2,3,4,5,6,7 However, recently reported trends show no further increase in the prevalence of asthma, suggesting that the asthma epidemic may have reached a plateau.8,9,10,11Using a standard parental questionnaire, the increasing prevalence of asthma was shown among 8–10‐year‐old school children in Patras, Greece, in 1978, 1991 and 1998.6 In this study, we hypothesised that a plateau in the prevalence of asthma has been reached in the city of Patras as well. To test this hypothesis, we performed another survey in 2003 using the same method as in the previous years and reanalysed the data, including sex analysis of the prevalence of asthma over the whole 25‐year surveillance period. 相似文献19.
Objective
Zinc deficiency is prevalent in children in developing countries. Supplemental zinc provides therapeutic benefits in diarrhoea. Our aim was to evaluate the effect of daily zinc supplementation for 14 days on diarrhoea duration, severity, and morbidity in children.Methods
In a randomised, open label non‐placebo controlled trial, we assessed the efficacy of providing zinc sulfate to 6–60 month old children with acute diarrhoea for 2 weeks followed by 3 months of morbidity surveillance. Children were randomly assigned to zinc (n = 150) and control (n = 130) groups and received 15–30 mg elemental zinc daily.Results
Supplemented children had significantly improved plasma zinc levels by day 14 of therapy. Zinc deficiency was observed in 2.6% of the treatment and 3.3% of the control group. The mean duration of diarrhoea after starting supplementation was 3.02±2 days in the zinc group and 3.67±3.2 days in the control group. There was no significant difference in diarrhoea duration by treatment group (p>0.05). The number of stools after starting supplementation was 5.8±3.7 and 5.1±3.9 on day 1, 2.9±1.6 and 3.0±2.2 on day 2, and 1.8±1.1 and 1.6±0.9 on day 3 in the zinc and control groups, respectively. There was no significant difference in diarrhoea severity by treatment group (p>0.05). No significant effect was found on the incidence and prevalence of diarrhoea in the zinc compared with the control group.Conclusion
Our data indicate that supplementing children with acute diarrhoea in Turkey with 3 RDA of elemental zinc for 14 days improved neither diarrhoea duration nor severity despite significant increments in plasma zinc. 相似文献20.
Harnden A Perera R Brueggemann AB Mayon-White R Crook DW Thomson A Mant D 《Archives of disease in childhood》2007,92(7):594-597