Home nebulizers in childhood asthma. Parental perceptions and practices

Seventy five percent of 91 parents of asthmatic children (aged 6 months to 15.4 years) with home nebulizers, responded to a questionnaire that sought to document parental experience with this form of therapy. The most common indications for acquiring a nebulizer were inability to use metered dose inhalers and poor response or intolerance to oral medications. When the children were classified into those who used the nebulizer daily (27/69) and those who used it less than daily (42/69), we found that the daily users were more likely to be in the severest category of asthma, by parental assessment, prior to the home nebulization program (p = 0.0035). Retrospective, uncontrolled comparison before and after the acquisition of a home nebulizer showed significant decreases both in hospital admissions (1.7 vs 0.7; p less than 0.001) and total in-patient days (4.1 vs 1.7; p less than 0.0001). Home nebulizers are well tolerated by parents and children alike and may be associated with decreased morbidity.     

Parental smoking and asthma in childhood

The effect of parental smoking on childhood asthma was investigated in which, data from 302 asthmatic and 433 healthy children aged 1 to 12 years, were studied. All asthmatic patients received prick tests for common allergens. A significantly higher number of heavy parental smokers was found in asthmatic children under 6 years of age with negative prick tests (P=0.02). A stepwise logistic regression was performed in order to verify interactions between parental smoking and other variables. It is concluded that parental smoking is an important risk factor for prick test negative asthmatic children aged 6 years or less.     

Severe pneumonia in a remote hilly area: Integrated management of childhood illness

Objective: This study aims to profile children with severe pneumonia in the perspective of Integrated Management of Childhood Illness (IMCI) strategy in a resource-constrained environment.Methods: 115 consecutive children, aged 2 months to 10 yr, hospitalized with severe pneumonia were prospectively evaluated between May 1997 and June 1998 at a civil hospital in the northern hilly state of India.Results: All children had tachypnea and lower chest wall indrawing. Grunting was observed in 39.7%, inability to drink in 16.5%, and cyanosis in 1.7% cases. Radiological investigation was carried out only in 90 children that included abnormal chest radiographs (CXRs) in 76.6% cases. Feeding malpractices, vaccination inconsistencies, exposure hazards to smoking, micronutrient as well as macronutrient deficiencies, treatment from unqualified practitioners, inconsequential involvement of health care workers, predominant burden on mothers in the care of sick children, failure to recognize signs and symptoms of pneumonia by parents at home, lack of oxygen facilities, problems of accessibility and less faith on primary health care services were widely prevalent bottlenecks for effective implementation of 3 components of IMCI.Conclusion: Our study offers practical insights that can be useful in customizing IMCI to needs of children with pneumonia in a resource-constrained environment.     

Sex influences on lung function and medication in childhood asthma

AIM: To evaluate possible sex differences in prevalence, diagnosis and treatment of asthma, and influence on lung function associated with asthma severity in a population-based birth cohort (BAMSE) of 4089 children. METHODS: At 4-y follow-up, 92% responded to a questionnaire on symptoms of asthma, current medication and doctor's diagnosis of asthma. A total of 2965 children participated in clinical testing, including measurements of peak expiratory flow (PEF), and were assigned to groups of asthma or no asthma by reported airway symptoms. RESULTS: Children in asthma groups had lower PEF readings compared to healthy children. This effect was most pronounced for both sexes in the persistent group (boys p<0.05, girls p<0.001) and for girls in the transient group (p<0.01). A doctor's diagnosis of asthma did not significantly differ between boys and girls, but significantly more boys than girls had inhaled corticosteroids, even when stratifying by frequency of symptoms. CONCLUSION: These results suggest that when 4-y-old children are stratified according to common diagnostic criteria, girls have a larger effect on PEF of asthma symptoms and are less frequently treated compared to boys.     

Low-dose theophylline in childhood asthma: a placebo-controlled, double-blind study

Regular anti-inflammatory treatment is essential in treating persistent asthma. Most commonly, inhaled corticosteroids (ICS) are used. However, especially in children, there is concern about the long-term safety of ICS such that doses should be kept to a minimum. The use of theophylline has decreased because of frequent side-effects in therapeutic doses. In adults, there have been reports about an immunomodulatory effect of low-dose theophylline. To study the clinical and immunomodulatory effect in children, 36 patients (mean age 12.5 SD 2.4 years) with moderate, persistent asthma on regular ICS were recruited into a placebo-controlled, double-blind study. After a 6-week run-in period, patients received either theophylline 10 mg/kg bodyweight or placebo for 12 weeks. Diary cards, lung function, peripheral blood lymphocyte subpopulations and serum eosinophil cationic protein (sECP) were assessed. In the treatment group, mean serum theophylline was 7.1 mg/l. There was no change in symptoms or use of rescue medication. Mean (SD) peak expiratory flow (PEF) increased from 86% (24) to 95% (18) predicted. sECP decreased from 43.2 μg/l (32.5) to 26.5 μg/l (16.9) (p = 0.02). Lymphocyte subpopulations did not change. The study failed to show a beneficial clinical or an immunomodulatory effect of theophylline when used in low doses. These results do not support a more important role of theophylline in the long-term treatment of moderate childhood asthma.     

Economic and other barriers to adopting recommendations to prevent childhood obesity: results of a focus group study with parents

Background

The gold standard to assess hyperbilirubinemia in neonates remains the serum bilirubin measurement. Unfortunately, this is invasive, painful, and costly. Bilimed^®, a new transcutaneous bilirubinometer, suggests more accuracy compared to the existing non-invasive bilirubinometers because of its new technology. It furthermore takes into account different skin colours. No contact with the skin is needed during measurement, no additional material costs occur. Our aim was to assess the agreement between the Bilimed^® and serum bilirubin in preterm and term infants of different skin colours.

Methods

The transcutaneous bilirubin measurements were performed on the infant's sternum and serum bilirubin was determined simultaneously. The agreement between both methods was assessed by Pearson's correlation and by Bland-Altman analysis.

Results

A total of 117 measurement cycles were performed in 99 term infants (group1), further 47 measurements in 38 preterm infants born between 34 - 36 6/7 gestational weeks (group 2), and finally 21 measurements in 13 preterm infants born between 28 - 33 6/7 gestational weeks (group 3). The mean deviation and variability (+/- 2SD) of the transcutaneous from serum bilirubin were: -14 (+/- 144) μmol/l; -0.82 (+/- 8.4) mg/dl in group 1, +16 (+/- 91) μmol/l;+0.93(+/- 5.3) mg/dl in group 2 and -8 (+/- 76) μmol/l; -0.47 (+/- 4.4) mg/dl in group 3. These limits of agreement are too wide to be acceptable in a clinical setting. Moreover, there was to be a trend towards less good agreement with increasing bilirubin values.

Conclusion

Despite its new technology the Bilimed^® has no advantages, and more specifically no better agreement not only in term and near-term Caucasian infants, but also in non-Caucasian and more premature infants.     

Economic and other barriers to adopting recommendations to prevent childhood obesity: results of a focus group study with parents

Background  

Parents are integral to the implementation of obesity prevention and management recommendations for children. Exploration of barriers to and facilitators of parental decisions to adopt obesity prevention recommendations will inform future efforts to reduce childhood obesity.     

Education in childhood asthma: a preliminary study of need and efficacy

This study initially assessed in parents of children with asthma, their knowledge of the condition and its management. Using a knowledge questionnaire a mean score for 30 parents of 69.1% was found, with a range between 44% and 86%. The study went on to examine whether an educational intervention program for parents could both improve knowledge and lower morbidity. The results for 14 parents who completed the educational intervention program were compared to those for 14 parents who did not complete the program. Both groups showed an increase in knowledge at 1 and 3 months after their initial interview (P less than 0.005) but the active group had significantly better knowledge at 1 month (P less than 0.0001) and 3 months (P less than 0.001) compared to the control group. There was no change in morbidity in either group as assessed by hospital admissions, visits to a doctor, days off school and number of wheezing episodes. We have shown that knowledge can be improved by an educational program for parents of children with asthma but have not been able to demonstrate an effect on short-term morbidity.     

MMR: marginalised, misrepresented and rejected? Autism: a focus group study.

OBJECTIVE: To explore how the measles, mumps, and rubella (MMR) vaccine controversy impacted on the lives of parents caring for children with autism. DESIGN: Qualitative focus group study. SETTING: United Kingdom. PATIENTS: A purposively selected sample of 38 parents took part in 10 focus group discussions between March 2003 and May 2005. RESULTS: Many parents felt that the MMR vaccine could be too potent for children who are susceptible to developing autism. Of the parents whose children received the MMR vaccine, many felt guilty that they may have caused or contributed to their child's autism. Some parents felt frustrated by health professionals' lack of understanding of the negative impact the MMR controversy has had on them. Some parents were anxious about subsequent MMR decision-making for their children. CONCLUSIONS: The controversy has had a negative impact on some parents of children with autism. This has implications for health professionals, who need to be particularly aware of the issues these parents face in future MMR decision-making for their affected child and younger siblings. It is anticipated that these findings will raise awareness among health professionals of the difficulties faced by such parents. More generally, there is a need to promote a greater awareness of the important role health visitors can play in parental decision-making and for research examining whether health professionals feel they receive sufficient training in communication skills. It is also essential that the latest scientific research findings are disseminated quickly to these parents and to those health professionals advising parents on matters of vaccine safety.     

Self-concept, attitude toward illness and family functioning in adolescents with type 1 diabetes

OBJECTIVES:

The primary objective of the present study was to assess self-concept in adolescents with type 1 diabetes, and to determine whether this is associated with attitudes toward having chronic disease, family functioning or severity of diabetes. The secondary objective was to assess the impact of family income, sex, age and age at diagnosis on adolescent self-concept.

METHODS:

A cross-sectional, self-report survey of 48 adolescents with type 1 diabetes (22 boys and 26 girls; mean ± SD age at time of study 15.2±1.7 years [range 12.2 to 18.0 years]; mean age at diagnosis 9.2±3.3 years [range 1.3 to 14.9 years]) was performed using the Piers-Harris Children’s Self-Concept (PHCSC) scale, second edition; the Child Attitude Toward Illness Scale; and the Family Assessment Measure scale, version III. Demographic information including net family income and a symptom inventory form to assess disease severity was collected.

RESULTS:

Adolescents’ self-concept measured by the PHCSC scale was significantly positively correlated with a more positive attitude toward chronic illness as measured by the Child Attitude Toward Illness Scale. The PHCSC scale was found to have a significant negative correlation with the Family Assessment Measure scale score, indicating that a better self-concept was correlated with enhanced family functioning. Self-concept was not significantly correlated with disease severity, income of family, sex, age at diagnosis, age at time of study, episodes of diabetic ketoacidosis or episodes of hypoglycemia.

CONCLUSIONS:

Adolescents with better self-concept had more positive attitudes toward their chronic illness and enhanced family functioning. Although no correlation with diabetes disease severity was seen in the study population, interventions aimed at improving adolescent self-concept may have a positive impact on diabetes treatment by improving attitude toward living with type 1 diabetes.     

Maternal autoimmune diseases, asthma and allergies, and childhood autism spectrum disorders: a case-control study

OBJECTIVE: To investigate the association between physician-documented diagnoses of maternal autoimmune diseases, allergies, and asthma around the time of pregnancy and subsequent diagnoses of autism in children. DESIGN: A case-control study nested within a cohort of infants born between January 1995 and June 1999. SETTING: Northern California Kaiser Permanente Medical Care Program. PARTICIPANTS: Cases (n = 420) were children with at least 1 diagnosis of an autism spectrum disorder (ASD) recorded in Kaiser Permanente outpatient clinical databases. Controls (n = 2100) were children without an ASD diagnosis who were frequency matched to cases on sex, birth year, and hospital of birth. MAIN OUTCOME MEASURES: Frequencies of maternal immunologic disorders were compared between cases and controls with a chi2 statistic, and relative risks were estimated by crude and adjusted odds ratios and 95% confidence intervals using logistic regression. RESULTS: The final study population included 407 cases and 2095 controls. A similar proportion of case and control mothers had a diagnosis of any autoimmune disease in the 4-year period surrounding pregnancy (10.3% vs 8.2%, P = .15). After adjustment for maternal factors, only 1 autoimmune condition, psoriasis, was significantly associated with ASDs (adjusted odds ratio, 2.7; 95% confidence interval, 1.3-5.8). A greater than 2-fold elevated risk of ASD was observed for maternal asthma and allergy diagnoses recorded during the second trimester of pregnancy. CONCLUSIONS: These findings suggest that maternal autoimmune disorders present in women around the time of pregnancy are unlikely to contribute significantly to autism risk. Further etiologic investigations are needed to confirm these results and should include objective documentation of diagnoses and consider a larger set of maternal immune-related conditions, including asthma and allergies.     

槐杞黄颗粒辅助治疗儿童哮喘的随机对照多中心临床研究

目的：比较全球哮喘防治创议(The Global Initiative for Asthma,GINA)方案与 GINA 方案联合口服槐杞黄颗粒治疗哮喘患儿的临床疗效和安全性。方法采用随机、多中心平行对照临床试验方法。共收集1128例哮喘患儿,随机分为两组。观察组患儿采用 GINA 方案联合口服槐杞黄颗粒治疗,GINA 方案治疗组患儿按 GINA 方案治疗。分别于用药后的第1个月、3个月、6个月进行临床评价及 C-ACT 评分。临床评价指标为上呼吸道感染次数、支气管炎和肺炎发生次数、喘息发作次数、应用急救药次数、因喘息住院次数。比较两组的药物不良反应发生情况。结果用药后的第1个月、3个月、6个月,观察组较 GINA方案治疗组上呼吸道感染发生次数、支气管炎和肺炎发生次数及喘息发作次数均明显减少(P ＜0.05),C-ACT 评分均明显升高(P ＜0.05)。与药物相关的不良反应16例(轻度腹泻),其中观察组7例(1.15％), GINA 方案治疗组9例(1.73％),组间差异无统计学意义(P ＞0.05)。结论 GINA 方案联合口服槐杞黄颗粒治疗哮喘患儿,能明显减少其呼吸道感染及喘息发作的次数,可显著改善临床疗效,更好地达到哮喘控制的目标,且安全性好。