Airway reactivity in parents of infants and young children with recurrent wheeze: a case-control study

The aim of this study was to look at the current lifestyle of young adult survivors of childhood cancer between the ages of 16 and 30 years to document their achievements and expose any psychosocial problems. Sixty six young adult survivors were contacted and asked if they and their siblings (16-30 years) would take part in a lifestyle study; 48 patients and 38 sibling controls were interviewed. This took the form of a structured lifestyle questionnaire, a self esteem questionnaire (Oxford Psychologists Press), and an unstructured interview. Fifty five per cent of patients achieved five or more A-C grades at 'O' level/GCSE compared with 62% of siblings and a national average of 30%. Despite that these patients were significantly less likely to go on to higher education than their siblings. The two groups were equally employable and earning similar salaries. There were three cases of known employer prejudice. A slightly higher percentage of patients than siblings had their driving licence. Seventeen patients felt their appearance had changed and eight felt that they had a residual physical mobility problem. Both groups were socially active and equally likely to partake in competitive sports. There was no overall difference in the self esteem of the two groups. In general the survivors of childhood cancer were coping well in their young adult life and achieving the same lifestyle goals as their siblings. However, significant problems have been identified.     

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喘息是婴幼儿最常见的呼吸道症状之一。有关婴幼儿喘息的诊断、鉴别诊断及治疗也是儿科最常遇到的难题。本文着重讨论婴幼儿病毒相关性喘息的治疗。婴幼儿第一次喘息发作,多数是毛细支气管炎所致,其病原主要是呼吸道合胞病毒(RSV),还有腺病毒、流感病毒、副流感病毒等[1]。婴幼儿病毒相关性喘息的治疗包括以下几方面。1一般治疗1.1环境及体位要求环境安静整洁,室内经常通风换气,使空气比较凉爽,保持一定温度(20℃左右)及湿度(相对湿度55%～60%)。注意隔离,防止继发细菌或其它病毒感染。护理耐心,保证患儿休息,对喘憋重者首先应抬高头部与…     

Bronchodilation in infants with malacia or recurrent wheeze.

BACKGROUND: Controversy remains regarding the effectiveness of bronchodilators in wheezy infants. AIMS: To assess the effect of inhaled beta(2) agonists on lung function in infants with malacia or recurrent wheeze, and to determine whether a negative effect of beta(2) agonists on forced expiratory flow (V'(maxFRC)) is more pronounced in infants with airway malacia, compared to infants with wheeze. METHODS: We retrospectively analysed lung function data of 27 infants: eight with malacia, 19 with recurrent wheeze. Mean (SD) age was 51 (18) weeks. Mean V'(maxFRC) (in Z score) was assessed before and after inhalation of beta(2) agonists. RESULTS: Baseline V'(maxFRC) was below reference values for both groups. Following inhalation of beta(2) agonists the mean (95% CI) change in mean V'(maxFRC) in Z scores was -0.10 (-0.26 to 0.05) and -0.33 (-0.55 to -0.11) for the malacia and wheeze group, respectively. CONCLUSIONS: In infants with wheeze, inhaled beta(2) agonists caused a significant reduction in mean V'(maxFRC). Infants with malacia were not more likely to worsen after beta(2) agonists than were infants with recurrent wheeze.     

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喘鸣是婴幼儿时期呼吸道疾病中最常见的症状,病因很多,并非所有的喘鸣均由哮喘引起。气管、支气管炎及气管、支气管软骨软弱、异物、血管畸形,胸内肿瘤以及支气管淋巴结核等,均可引起喘鸣。分析天津市儿童医院收治的以喘鸣为主要症状的3岁以下婴幼儿196例,其主要病因见表1。表1天津市儿童医院收治的196例以喘鸣为主要症状的婴幼儿喘鸣病因病因例数大气道阻塞气管、支气管异物21气管、支气管淋巴结核51先天性气管、支气管、肺发育畸形12支气管软骨软化3纵隔囊肿和(或)肿瘤19血管畸形1中叶综合征5小气道阻塞毛细支气管炎30以喘息为表型的婴幼…     

Bronchodilation in infants with malacia or recurrent wheeze

Background: Controversy remains regarding the effectiveness of bronchodilators in wheezy infants. Aims: To assess the effect of inhaled ß₂ agonists on lung function in infants with malacia or recurrent wheeze, and to determine whether a negative effect of ß₂ agonists on forced expiratory flow (V''_maxFRC) is more pronounced in infants with airway malacia, compared to infants with wheeze. Methods: We retrospectively analysed lung function data of 27 infants: eight with malacia, 19 with recurrent wheeze. Mean (SD) age was 51 (18) weeks. Mean V''_maxFRC (in Z score) was assessed before and after inhalation of ß₂ agonists. Results: Baseline V''_maxFRC was below reference values for both groups. Following inhalation of ß₂ agonists the mean (95% CI) change in mean V''_maxFRC in Z scores was -0.10 (-0.26 to 0.05) and -0.33 (-0.55 to -0.11) for the malacia and wheeze group, respectively. Conclusions: In infants with wheeze, inhaled ß₂ agonists caused a significant reduction in mean V''_maxFRC. Infants with malacia were not more likely to worsen after ß₂ agonists than were infants with recurrent wheeze.     

儿童反复肺炎危险因素的病例对照研究

目的：探讨无明确基础疾病儿童反复患肺炎的相关危险因素。方法：选择无明确基础疾病的106例反复肺炎患儿及106例单次肺炎患儿进行成组病例对照研究,采用单因素χ2检验及多因素logistic回归模型调查反复肺炎的危险因素。结果：单因素χ2检验分析结果显示,病例组患儿有喘息病史、食物或药物过敏史、湿疹病史及一过性粒细胞减少症的比例高于对照组,差异有统计学意义。多因素logistic回归分析结果显示,喘息病史（OR=13.387,95% CI: 5.541～32.343）、食物或药物过敏史（OR=4.267,95% CI: 2.081～8.751）及一过性粒细胞减少症（OR=3.606,95% CI: 1.806～7.202）是儿童反复肺炎的独立危险因素。结论：喘息病史、食物或药物过敏史及一过性粒细胞减少症病史增加了无明确基础疾病儿童反复患肺炎的风险。     

Phenotype-directed treatment of pre-school-aged children with recurrent wheeze

Wheeze in childhood may comprise different underlying diseases. Disease-specific treatment could potentially improve treatment efficacy. Various attempts have been made to differentiate between pre-school wheeze phenotypes. In this review, the results of clinical trials evaluating treatment of pre-school wheeze are discussed, with specific emphasis on the characteristics and phenotype of the study populations. Evidence suggests that systemic corticosteroids are not beneficial for the treatment of mild-to-moderate exacerbations of pre-school wheeze, irrespective of phenotype. The use of high-dose intermittent inhaled corticosteroid treatment cannot be recommended because of unacceptable side effects. Treatment with regular inhaled corticosteroids and leukotriene antagonists offer modest benefit, but neither treatment reduces hospitalisation rates. There is currently some evidence for a phenotype-specific effect of treatment. Phenotype-directed treatment of pre-school wheeze is currently limited by our ability to accurately differentiate between clinically useful phenotypes.     

Factors associated with refusal of childhood vaccines among parents of school-aged children: a case-control study

BACKGROUND: The rate of nonmedical exemptions to school immunization requirements has been increasing, and children with exemptions have contributed to outbreaks of vaccine-preventable diseases. OBJECTIVES: To determine why parents claim nonmedical exemptions and to explore differences in perceptions of vaccines and vaccine information sources between parents of exempt and fully vaccinated children. DESIGN: Case-control study. SETTING: Colorado, Massachusetts, Missouri, and Washington. PARTICIPANTS: Surveys were mailed to the parents of 815 exempt children (cases) and 1630 fully vaccinated children (controls randomly selected from the same grade and school) recruited from 112 private and public elementary schools. Surveys were completed by 2435 parents (56.1%). MAIN OUTCOME MEASURES: Parental reports. RESULTS: Most children (209 [75.5%] of 277) with nonmedical exemptions received at least some vaccines. The most common vaccine not received was varicella (147 [53.1%] of 277 exempt children). The most common reason stated for requesting exemptions (190 [69%] of 277) was concern that the vaccines might cause harm. Parents of exempt children were significantly more likely than parents of vaccinated children to report low perceived vaccine safety and efficacy, a low level of trust in the government, and low perceived susceptibility to and severity of vaccine-preventable diseases. Parents of exempt children were significantly less likely to report confidence in medical, public health, and government sources for vaccine information and were more likely to report confidence in alternative medicine professionals than parents of vaccinated children. CONCLUSION: Continued efforts must be made to educate parents about the utility and safety of vaccines, especially parents requesting nonmedical exemptions to school immunization requirements.     

潮气呼吸肺功能在反复喘息婴幼儿中的应用及临床意义

目的探讨不同类型反复喘息婴幼儿潮气呼吸肺功能的变化及临床意义。方法选取2013年10月至2014年2月收治的3岁以下反复喘息患儿80例,根据哮喘预测指数分为阳性组和阴性组,分别在入院时(急性期)、出院时(缓解期)和出院后1周(恢复期)测定其潮气呼吸肺功能,比较两组喘息患儿的达峰时间比(TPTEF/TE)和达峰容积比(VPEF/VE);并与20例健康儿童对照比较。结果从急性期、缓解期至恢复期,阳性组和阴性组的TPTEF/TE和VPEF/VE均呈上升趋势,不同时期之间的差异均有统计学意义(P均=0.000)。急性期时,TPTEF/TE和VPEF/VE在阳性组和阴性组间的差异无统计学意义(P0.05),但均低于对照组,差异有统计学意义(P0.05);到缓解期时,阴性组的TPTEF/TE和VPEF/VE均已高于阳性组,但低于对照组,差异有统计学意义(P0.05);恢复期时,阴性组和对照组间TPTEF/TE、VPEF/VE的差异无统计学意义(P0.05),且均高于阳性组,差异有统计学意义(P0.05)。结论哮喘预测指数阳性婴幼儿的肺功能损害比哮喘预测指数阴性患儿持续时间长;运用潮气呼吸肺功能为反复喘息婴幼儿预测哮喘提供客观的临床指标。     

Pediatricians' role in supporting parents as they care for infants and young children

Primary care pediatric health care clinicians can integrate basic principles and strategies of the field of infant mental health within the time constraints of their current practice, while advocating for additional resources to support the expansion of the preventive potential afforded by new scientific advances in this field. Infant mental health is a relatively young field with the potential to reduce human suffering and health care costs associated with early-onset developmental, emotional, and behavioral disorders. This will depend not only on primary care pediatric diagnostic acumen, but also on related investments in health care preventive screenings and interventions, training and infrastructure, as well as community supports. The health and development of infants, young children, and families emerge from the interactions of a wide range of factors-including health, education, and economic policy, as well as attributes of local communities and the larger physical environment-and impact economics and security at national and global levels.     

Risk factors for development of dehydration in young children with acute watery diarrhoea: a case-control study

In a case-control study to understand the risk factors for development of life-threatening dehydration, a total of 379 children comprising 243 cases (moderate or severe dehydration) and 136 controls (non or mild dehydration) up to 2 years of age suffering from acute watery diarrhoea were studied. By univariate analysis, the presence of vibrios in stool, withdrawal of breast feeding during diarrhoea, not giving fluids, including oral rehydration solution (ORS), during diarrhoea, frequent purging (> 8/ day), vomiting (> 2/day) and undernutrition were identified as risk factors. However, by multivariate analysis after controlling for confounders, withdrawal of breast feeding during diarrhoea (odds ratio (OR) = 6.8, p < 0.00001) and not giving ORS during diarrhoea (OR = 2.1, p < 0.006) were identified as significant risk factors. The confounding variables which also contributed significantly to increasing the risk were age (≤ 12 months; OR = 2.7, p = 0.001), frequent purging (> 8/day; OR = 4.1, p < 0.00001), vomiting (> 2/day; OR = 2.4, p = 0.001) and severe undernutrition (%median <60 weight-for-age of Indian Academy of Paediatrics classification; OR = 3.1, p = 0.001). We feel that these findings will be useful for Global and National Diarrhoeal Diseases Control Programmes for formulating intervention strategies for preventing death due to diarrhoeal dehydration.     

儿童反复呼吸道感染部分相关影响因素分析

目的：探讨反复呼吸道感染与其部分相关影响因素的关系。方法用病例对照的研究方法，调查分析反复呼吸道感染与其部分影响因素的关系。结果儿童反复呼吸道感染和母乳喂养、微量元素缺乏(锌缺乏)、营养不良、环境因素(室内装修、被动吸烟、饲养宠物)、使用糖皮质激素存在相关性，但与母乳喂养这种相关性只在5岁以下的儿童中发现。还发现了不管出生前或出生后，二手烟与反复呼吸道感染的相关只是在男孩中发现，而在女孩中却不相关。家居装修、微量元素缺乏(锌缺乏)、营养不良、母乳喂养与反复呼吸道感染相关只是在女孩中发现，而在男孩中却不相关，提示各个影响因素对男孩和女孩的影响是不一样。结论反复呼吸道感染是受多因素影响的，而不同的影响因素对性别的影响也不同。     

Stress over time: parents with young handicapped children

Data from three research studies provided information about stress encountered by parents of young handicapped children as they sought services and information regarding diagnosis, treatment, and prognosis. In depth interviews were conducted with 115 families of children between the ages of 1 6/12 and 5 9/12 years, with mild to moderate handicaps. Three specific periods were considered: the initial diagnosis of handicapping condition, the first efforts at seeking help or intervention, and the transition from infant to preschool programs. Various child characteristics and community factors which seemed related to stress during these periods were considered. Problems encountered with professionals are identified, and implications for training and practice are offered.     

Daily physical activity in young children and their parents: A descriptive study

BACKGROUND:

Little is known about physical activity (PA) in young children and about the relationship between their PA and that of their parents.

OBJECTIVE:

The main purpose of the present study (Y-Be-Active) was to examine the daily PA levels of young children and their parents, and to explore the relationship between children’s and parents’ PA.

METHOD:

Fifty-four children (mean age 4.3 years) and their parents (54 mothers, mean age 35.8 years; 50 fathers, mean age 38.2 years) wore accelerometers for three weekdays and two weekend days. Parents also completed questionnaires on family sociodemographics and PA habits.

RESULTS:

Children spent most of their time in light PA. Almost all children attained 30 min of daily moderate-to-vigorous PA (MVPA), and most boys and girls attained 60 min of daily MVPA on weekdays. Only 60% of fathers and approximately one-half of mothers attained 30 min of daily MVPA on weekdays and weekend days. Children’s and fathers’ PA were correlated on weekends. Few parents (20% to 30%) participated regularly in organised PA with their child. Fathers’ involvement in PA with their children was associated with higher MVPA in children.

CONCLUSIONS:

Many young children and parents did not meet current Canadian recommendations for daily PA. Parental involvement in PA with their young children, particularly the involvement of fathers, appeared to promote higher levels of MVPA in young children.     

Indoor environmental risk factors in young asthmatics: a case-control study.

One hundred and ninety three children with asthma and 318 controls aged 1-4 years were evaluated for atopic heredity and exposure to possible indoor risk factors for asthma-for example exposure to furred pets, tobacco smoke, and home dampness. A subgroup of cases were classified as cat and/or dog allergic on the basis of skin prick tests. Heredity for asthma was a significant risk factor (odds ratio (OR) 3.0, confidence interval (CI) 2.1 to 4.6). Environmental tobacco smoke was associated with an excess risk for asthma (OR 1.7, CI 1.1 to 2.3) and signs of home dampness tended to increase this risk (OR 1.3, CI 0.9 to 2.0). High dose exposure to cat and/or dog resulted in an increased risk only in asthma cases sensitised to cat and/or dog (OR 2.7, CI 1.0 to 7.3). A combination of high dose exposure to cat and/or dog, environmental tobacco smoke and damp housing was associated with an OR of 8.0 (CI 1.9 to 34.1). Raised indoor humidity has been shown to reflect low air exchange, which may also lead to increased doses of inhaled aeroallergens and tobacco smoke, and contribute to the interaction between the three risk factors.     

Hiatal hernia in infants and young children: a 2- to 3-year follow-up study.

Nine children were evaluated two to three years after institution of either medical or surgical management of their hiatal herniae. Four children treated medically ranged from 6 to 16 months of age. There were clinically cured of symptoms and one clinically improved, indicating the efficacy of medical management in some young children. The fifth medically treated child, age 10 years, was also clinically improved. Four children initially had surgical hiatal hernia repair: one (16 days old) because of pulmonary aspiration with associated cardiorespiratory arrest, two (ages 3 and 6 years) because medical management failed, and one (age 7 years) who presented with an esophageal stricture. Surgery for hiatal herniae in children should be reserved for patients in whom medical management has failed or for patients with serious complications.     

Effects of nebulized corticosteroids therapy on hypothalamic–pituitary–adrenal axis in young children with recurrent or persistent wheeze

Inhaled corticosteroids (ICS) are preferred drugs for the long-term treatment of all severities of asthma in children. However, data about the safety of ICS in infants is lacking. So, it is essential to do further clinical studies to examine the safety and efficacy of ICS in this population. In this study, the effects of nebulized budesonide and nebulized fluticasone propionate suspensions on hypothalamic–pituitary–adrenal axis is examined in infants with recurrent or persistent wheeze. Thirty-one children aged 6–24 months admitted to our hospital between January and December 2005 with symptoms of recurrent or persistent wheeze were included in the study. The patients were randomly allocated to receive 0.25 mg BUD or 0.25 mg fluticasone propionate twice daily for 6 wk and half dose for another 6 wk with a jet nebulizer at home. Blood samples for basal cortisol concentration, adrenocarticotropic hormone, glucose, HbA1c and electrolytes were obtained at the beginning and at the end of the study. Adrenal function assessment was based on changes in cosyntropin-stimulated plasma cortisol levels. The study was completed with 31 patients, 16 of whom received BUD and 15 FP. All patients except one had plasma cortisol concentrations above 500 nmol/l (18 μg/dl) or had an incremental rise in cortisol of >200 nmol/l after stimulation. Although nebulized steroids seem to be safe in infancy, we recommend that adrenal functions should be tested periodically during long-term treatment with nebulized steroids.