Childhood disablement and family incomes.

Data on the incomes of families with a severely disabled child were obtained by replicating the Family Expenditure Survey. These data were compared with income data from a control group of families with children, drawn from the FES for the same period. The participation rates, hours, and earnings of the women with a disabled child were all found to be substantially lower than those of women in the control group, differences between the samples increasing with the age of the youngest child. The earnings of men with a disabled child were also lower than those of men in the control group, though differences were more pronounced among non-manual workers. Loss of parental earnings was not made good by social security benefits paid on account of disablement. In general the incomes of the families with a disabled child were lower than those of the control families, the magnitude of the differences increasing with family income and the age of the youngest child. Nevertheless, one group of families with a disabled child--manual workers whose youngest child was under 5--had slightly higher incomes than similar families in the control group.     

Childhood morbidity and adulthood ill health.

STUDY OBJECTIVE--The aim of the study was to investigate the relationship between the state of health in childhood and ill health in early adult life. DESIGN--The study used data collected as part of the National Child Development Study and related health at 7 years of age to that at 23. A wide range of information on child health in the cohort was available, which was used to construct a broader measure of health status than selected diagnostic categories. SETTING--The survey population was nationwide. PARTICIPANTS--The study population included all children born in the week 3-9 March 1958. They were followed up at 7, 11, 16, and 23 years. Of the target population of 17,733 births, 12,537 (76%) were retraced and interviewed at 23. MEASUREMENTS AND MAIN RESULTS--Children at age 7 were allocated to 13 morbidity groups; 20% of children had reported no ill-health apart from the common infectious diseases, but 10% were included in four or more of the morbidity groups. Children with no reported morbidity retained their health advantage into early adulthood: ratios of observed to expected ill health for four of the five indices examined at age 23 were all significantly below one (self rated health 0.81, asthma and/or wheezy bronchitis 0.63, allergies 0.79, emotional health 0.75). Children with more morbidity at age 7 had higher ratios of ill health in adulthood. A chronic condition in childhood was associated not only with excess morbidity in the short term but also with a poor health rating in early adult life (ratio = 1.38). Morbidity was significantly increased for most of the adulthood indices among children with asthma and/or wheezy bronchitis. However most ill health in young adulthood occurred in study members with a relatively healthy childhood. CONCLUSIONS--Although the state of health in childhood has long term implications, it does not form a substantial contribution to ill health in early adult life.     

Childhood lead exposure in Trail revisited.

We sought to identify modifiable determinants of elevated blood lead levels in preschool children; to compare the current situation with past information; to determine historical trends in environmental lead contamination in Trail; and to find a basis for identifying appropriate precautions and protection against future lead exposure. In Phase 1, blood samples were drawn from all children aged 2 to 5. In Phase 2, children in the highest and lowest quartile of blood leads were surveyed by questionnaire. Environmental samples of drinking water, paint, housedust, soil and vegetables were taken from their residences, and soil samples were collected from nearby parks. The average blood lead level was 13.8 micrograms/dl, range 4 to 30 micrograms/dl. This is approximately 40% lower than in 1975, when a previous survey was done, but is high compared to other places in Canada. The study of environmental determinants of lead revealed that soil lead levels and, secondarily, housedust lead levels are the principal determinants of high blood lead. Children with high blood leads also tended to concentrate in neighbourhoods near the lead-zinc smelter.     

Childhood cancer: A growing problem.

Childhood cancer is the leading cause of disease-related death among children in the United States,and rates are increasing by approximately 1% each year. Unfortunately,the science of epidemiology has not provided definitive answers to the question of why cancer strikes children.     

儿童孤独症测验的应用研究

目的 研究儿童孤独症测验(Childhood Autism Spectrum Test,CAST)作为孤独症筛查量表在我国应用的可靠性及有效性。方法 对CAST进行多轮翻译、回译和校对形成中文版,以杭州市38名孤独症儿童为病例组,12名精神发育迟滞儿童和59名正常儿童为对照组,对儿童家长进行问卷调查。结果 CAST中文版具有良好的内部一致性信度和效标关联效度。31个计分题目中有25个具有良好的区分度,当临界分为16分时,量表具有最佳敏感度、特异性和阳性预测值。不同年龄组儿童的CAST总分无差异。结论 儿童孤独症测验(CAST)中文版有良好的信效度,适用于2.5岁以上儿童孤独症的筛查,但个别题目仍待完善。     

Childhood lead poisoning and managed care.

Childhood lead poisoning is a problem that disproportionately affects impoverished children. Many aspects of affected children's lives may be involved in the prevention and treatment of this disease. Changes in child health services are occurring in the context of fundamental changes of virtually all human services. Managed care changes may alter the sites where children get primary care services, the content of that care, and linkages of medical services to public health, nutrition support, housing, mental health, education, and social services. This article discusses the opportunities and the dangers that managed care changes may pose to the prevention and treatment of childhood lead poisoning.     

Childhood immunization coverage by provider type.

OBJECTIVE: To determine how child characteristics and immunization coverage levels differ among children using public and private providers. METHODS: Immunization coverage rates between 1996 and 2004 were compared among children aged 19-35 months, using data from the National Immunization Survey. Coverage was based on the 4:3:1:3:3 vaccine series: four or more doses of diphtheria, tetanus toxoids, acellular pertussis vaccine; three or more doses of poliovirus vaccine; one or more doses of measles-mumps-rubella vaccine; three or more doses of Haemophilus influenzae type b vaccine; and three or more doses of hepatitis B vaccine. Coverage differences were examined by provider types (child vaccinated by private, public, or a mix of providers), and stratified by child's race/ethnicity, area of residence, and household income level. RESULTS: Between 1996 and 2004, the proportion of children seeing exclusively private providers increased (58%-61%; P < .05); the proportion seeing only public providers decreased (19%-15%; P < .01). Coverage levels increased among children seeing all provider types. Coverage levels were higher for children using private providers than those using public providers in 2004 (83% vs 79%; P <.05). Except for White race (coverage was higher among those using private providers vs public providers), coverage levels by demographic variables did not significantly differ between children using only public or only private providers in 2004. CONCLUSIONS: Equal emphasis should be placed on the efforts of public providers and private providers to increase coverage among children of all race/ethnicity, income, and residential groups.     

Parental Exposure to Pesticides and Childhood Brain Cancer: U.S. Atlantic Coast Childhood Brain Cancer Study

Background

The etiology of childhood brain cancer remains largely unknown. However, previous studies have yielded suggestive associations with parental pesticide use.

Objectives

We aimed to evaluate parental exposure to pesticides at home and on the job in relation to the occurrence of brain cancer in children.

Methods

We included 526 one-to-one–matched case–control pairs. Brain cancer cases were diagnosed at < 10 years of age, and were identified from statewide cancer registries of four U.S. Atlantic Coast states. We selected controls by random digit dialing. We conducted computer-assisted telephone interviews with mothers. Using information on residential pesticide use and jobs held by fathers during the 2-year period before the child’s birth, we assessed potential exposure to insecticides, herbicides, and fungicides. For each job, two raters independently classified the probability and intensity of exposure; 421 pairs were available for final analysis. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) using conditional logistic regression, after adjustment for maternal education.

Results

A significant risk of astrocytoma was associated with exposures to herbicides from residential use (OR = 1.9; 95% CI, 1.2–3.0). Combining parental exposures to herbicides from both residential and occupational sources, the elevated risk remained significant (OR = 1.8; 95% CI, 1.1–3.1). We observed little association with primitive neuroectodermal tumors (PNET) for any of the pesticide classes or exposure sources considered.

Conclusions

Our observation is consistent with a previous literature reporting suggestive associations between parental exposure to pesticides and risk of astrocytoma in offspring but not PNET. However, these findings should be viewed in light of limitations in exposure assessment and effective sample size.     

Childhood cancers: space-time distribution in Britain.

STUDY OBJECTIVES--To examine a national data set of all childhood cancers for evidence of space-time interactions within three distinct sets of dates and places (at birth, at diagnosis, and at death), to show whether the patterns found for these events represent separate phenomena or statistically interdependent processes, and to see whether the childhood leukaemias and the childhood solid cancers have separate distinctive patterns in these respects. DESIGN--This was a space-time cluster analysis. The large number of cases enabled division of the data into two sets, one for hypothesis generation and the other for hypothesis testing. SETTING--England, Scotland, and Wales. SUBJECTS--A national collection of 22,360 children aged 0-15 years with fatal cancers and leukaemias in the period 1953 to 1980. MAIN RESULTS--There was significant clustering among the leukaemias and lymphomas on date and place of birth (particularly among cases born within 1 km and up to 5 months apart), and on date and place of diagnosis (particularly among cases diagnosed from 3 to 5 km apart and up to 9 months apart). There was no clustering among the solid cancers. These findings were confirmed in two separate analyses of two separate sets of data. CONCLUSIONS--The birth clustering was significant among pairs diagnosed at differing ages, and diagnosis clustering was significant among pairs born at different times, and it was concluded that the two types of clustering must be regarded as separate and statistically independent phenomena. Both the birth and the diagnosis clusters comprised many independent pairs of cases, with no large multiple case clusters. This suggests the involvement of multiple time-space localised exposures to hazards with short and constant latent intervals; probably an infectious agent or an environmental toxin. Given the separate nature of the two types of clustering, exposure to more than one hazard may be involved.     

Childhood leukaemia: a model of pre-obesity.

The prevalence of obesity in children, as in adults, is increasing dramatically. The extent to which this is due to reduced energy expenditure, increased energy intake, or both, is unclear at present. This in part reflects the limitations of existing models of the pre-obese state. In childhood acute lymphoblastic leukaemia (ALL), patients typically gain weight excessively during and after 2 years of therapy, and are at high risk of becoming obese. Previous studies have failed to identify the cause of obesity in these patients. We have tested the hypothesis that excess weight gain in ALL is due to reduced total energy expenditure (TEE), measured using the doubly-labelled water method, and have identified risk factors for excess weight gain in ALL. Pre-obese children with ALL in the dynamic phase of weight gain are less physically active than their peers, with a reduced TEE of approximately 1.2 (95% CI 0.2, 2.2) MJ/d. While other factors might contribute to excess weight gain, lifestyle (i.e. reduced habitual physical activity) plays a central role in ALL. Several considerations suggest that ALL might be a useful model of the pre-obese state: lifestyle is critical to development of obesity in ALL; ALL is relatively common; approximately 70% of patients survive; patients are readily accessible during the 2 years of therapy and beyond.     

Childhood cancer and parental occupation in Finland.

A case-control study was conducted of the occupations of parents of children under 15 with diagnosed malignancies. The total series contained all childhood cancers cases reported to the Finnish Cancer Registry during the period 1959-75. The parental occupations, recorded at the time of pregnancy, were collected from maternity welfare centres. The cases were analysed as a singly group or as subgroups according to the diagnoses-brain tumours, leukaemia, and all other malignancies. The maternal occupations found more frequently among cases than controls included farmers' wives (1959-68 only), pharmacists, saleswomen, bakers, and factory work of an vehicle driving, machine repair, painting, and the work of men who gave an academic degree as their occupation. Some of these occupations involve possible exposure to harmful chemicals, although chance correlations cannot be excluded.