Clustering of acute respiratory infection hospitalizations in childcare facilities

Aim: To estimate how risk of acute respiratory infection (ARI) hospitalization in children attending childcare facilities with a recently (within 1 month) hospitalized child is affected by gender, age and other characteristics. Methods: Population‐based prospective cohort study of 436 434 Danish 0–5‐year‐old children attending childcare during 1989–2004. Information was collected from Danish registers. Main outcome measure was incidence rate ratios (IRRs) of in‐patient hospitalization for ARI. Results: During 1 777 999 person‐years of follow‐up 42 681 hospitalizations for ARI occurred, of which 362 (1%) occurred within 1 month after another child was hospitalized for ARI in the facility. Children attending a facility with a recent ARI hospitalization had an increased risk of 42% (95% CI 27%;60%) compared with other children. The increased risk was higher in 0–2‐year‐old children than in 3–5‐year‐old children (55% vs 17%, p = 0.02) and if the latest hospitalized child was 0–2 years rather than 3–5 years (52% vs 19%, p = 0.04). The increased risk was similar in boys and girls, but was higher if the latest hospitalized child was a boy rather than a girl (52% vs 13%, p = 0.02). Conclusion: Although occurring infrequently, clustering of ARI hospitalizations involve 0–2‐year‐olds and boys as first hospitalized child relatively more often than would be expected.     

苏州地区急性呼吸道感染住院患儿病毒病原学分析

目的：了解苏州地区急性呼吸道感染（ARI）住院患儿的病毒病原学情况。方法：采集1 668例7岁以下ARI住院患儿鼻咽分泌物,直接免疫荧光法检测呼吸道合胞病毒（RSV）,流感病毒A,B型（IV A,B）,副流感病毒1,2,3型（PIV 1,2,3）及腺病毒A(ADA)等7种常见呼吸道病毒,用RT-PCR法检测人类偏肺病毒（hMPV）N基因。结果：① 1 668例患儿中,病毒检测阳性597例（35.8%）。单项病毒感染561例（33.6%）,其中7种常见呼吸道病毒检出率为23.1%,以RSV为主（17.6%）,好发于冬春季,主要见于1岁以下婴幼儿;② hMPV阳性率为10.6%,3~5月份为检出高峰期。③ 36例混合感染中,22例为RSV合并hMPV感染,主要见于1岁以下婴幼儿。结论：RSV是该地区ARI的主要病毒病原,RSV感染好发于冬春季,多见于1岁以下婴幼儿,hMPV是3~5月份ARI患儿的主要病毒病原,混合感染多见于1岁以下婴幼儿。［中国当代儿科杂志,2009,11（7）：529-531］     

Respiratory syncytial virus and metapneumovirus in children over two seasons with a high incidence of respiratory infections in Brazil

Acute respiratory infections (ARI) are one of the most important causes of death in children. Human metapneumovirus (HMPV), a virus first described in 2001, has now been detected in almost all continents. HMPV causes bronchiolitis and pneumonia with a clinical spectrum similar to respiratory syncytial virus (RSV). We describe the incidence of HMPV and RSV during two consecutive seasons with a high incidence of ARI in Aracaju, Brazil. HMPV was responsible for 24% of cases of bronchiolitis in the 1st season (April-May 2002) but was not found in the 2nd year (April-May 2003). RSV was recovered from 61 (55%) children with ARI in 2002 and from 72 (68%) in 2003. Children with RSV bronchiolitis in 2002 had more hypoxia but less wheezing than in 2003. The incidence of HMPV and RSV genotypes causing bronchiolitis varied between the years. Long-term prospective studies are required to better describe the epidemiology of these viruses in children.     

Economic effects of childhood cancer on families

OBJECTIVE: To assess the financial impact of childhood cancer on families. METHODS: This was a cross-sectional survey of parents caring for children who were diagnosed with cancer during the period 1990-1993. Self-administered questionnaires were completed by the parents of 237 children from throughout New Zealand with different types of cancer. Dollar amounts were adjusted to the equivalent of December 2000. RESULTS: Eighty-six per cent of the 192 living children were well or in remission. A further 45 children had died. The average extra amount spent, because of the child's illness, by the family of a living child in the 30 days prior to participation in the study was NZ$220 (SD NZ$330). On average, this was 13% of the family income after tax. After reported entitlement to compensation from various sources was allowed for, families were left with a mean deficit of NZ$157 (SD NZ$278) for the 30 days. Twelve families had a shortfall of more than NZ$500, including three families that had a shortfall of more than NZ$1000. Expenditure was greater for those whose children spent more time in hospital (P = 0.003). There was no significant association between the total cost and the distance travelled to the treatment centre (P = 0.96). For 24 families, after-tax income in the month prior to participation in the study was at least NZ$500 lower than it had been in the month before the child's diagnosis. Thirty-seven per cent of families reported that they needed to borrow money because of the financial effects of the child's illness. Bereaved parents spent an average of NZ$3065 (SD NZ$2168) on funeral expenses. CONCLUSION: There is a large financial burden on families who have a child with cancer.     

Mortality among children in rural areas of the People's Democratic Republic of Yemen

A prospective study on health and mortality of children under 7 years of age was conducted in rural parts of PDR Yemen during 1982-84. Altogether, 2071 children and 976 mothers were followed for 1 year and visited twice. The infant mortality rate (IMR), child mortality rate and under-5 mortality rate were 86, 11 and 129 per 1000, respectively. Sixty per cent of all deaths occurred during infancy. Diarrhoea commonly preceded death during infancy, and symptoms of measles during the 2nd year of life. The mothers of the deceased children were younger than the average rural mother (P less than 0.05) and more often primiparae, whereas illiteracy rates and median income did not differ from families which had not experienced death of a child. The risk of dying within 1 year was three times greater for wasted children in general, but 24 times greater for 1-2-year-olds. No increased risk was found for stunted children at any age. The prevalence of bottle feeding up to 18 months of age was high, and exclusive breastfeeding below 6 months of age was rare in the villages with the highest IMR (P less than 0.05). Infections seemed to be the trigger factor for death, but wasting predisposed to death at least after infancy.     

Weight-for-age of children admitted to the Ethio-Swedish Children's Hospital, Addis Ababa, 1978

The weight-for-age of 1235 hospital-admitted children aged between one month and 14 years was assessed. Sixty per cent (764) of child admissions in all age groups had weights less than 80% of the Harvard reference weight-for-age value; 27% (339) had weights less than 60% of the Harvard reference weight-for-age value. Of children who were diagnosed to suffer from protein-energy malnutrition on admission, marasmus was diagnosed most frequently, followed by marasmic-kwashiorkor and kwashiorkor. Seventy-five per cent of child admissions who died in hospital had weights less than 80% of the reference; the lower the child's admission weight-for-age, the higher the likelihood of death. A significantly higher proportion (P less than 0.01) of female admissions weighed less than 60% of reference weight-for-age compared with male admissions. Girls diagnosed as suffering from marasmus had a higher death rate than boys with a similar diagnosis. Children from poor families or large families were more likely to have a low weight-for-age than children from wealthy or small families.     

Health care for children and youth in the United States: annual report on patterns of coverage, utilization, quality, and expenditures by income.

OBJECTIVES: To examine differences by income in insurance coverage, health care utilization, expenditures, and quality of care for children in the United States. METHODS: Two national health care databases serve as the sources of data for this report: the 2000-2002 Medical Expenditure Panel Survey (MEPS) and the 2001 Nationwide Inpatient Sample (NIS) from the Healthcare Cost and Utilization Project (HCUP). In the MEPS analyses, low income is defined as less than 200% of the federal poverty level and higher income is defined as 200% of the federal poverty level or more. For the HCUP analyses, median household income for the patient's zip code of residence is used to assign community-level income to individual hospitalizations. RESULTS: Coverage. Children from low-income families were more likely than children from middle-high-income families to be uninsured (13.0% vs 5.8%) or covered by public insurance (50.8% vs 7.3%), and less likely to be privately insured (36.2% vs 87.0%). Utilization. Children from low-income families were less likely to have had a medical office visit or a dental visit than children from middle-high-income families (63.7% vs 76.5% for office-based visits and 28.8% vs 51.4% for dental visits) and less likely to have medicines prescribed (45.1% vs 56.4%) or have utilized hospital outpatient services (5.2% vs 7.0%), but more likely to have made trips to the emergency department (14.6% vs 11.4%). Although low-income children comprise almost 40% of the child population, one quarter of total medical expenditures were for these children. Hospital Discharges. Significant differences by community-level income occurred in specific characteristics of hospitalizations, including admissions through the emergency department, expected payer, mean total charges per day, and reasons for hospital admission. Leading reasons for admission varied by income within and across age groups. Quality. Low-income children were more likely than middle-high-income children to have their parents report a big problem getting necessary care (2.4% vs 1.0%) and getting a referral to a specialist (11.5% vs 5.3%). Low-income children were at least twice as likely as middle-high-income children to have their parents report that health providers never/sometimes listened carefully to them (10.0% vs 5.1%), explained things clearly to the parents (9.6% vs 3.4%), and showed respect for what the parents had to say (9.2% vs 4.2%). Children from families with lower community-level incomes were more likely to experience ambulatory-sensitive hospitalizations. Racial/Ethnic Differences Between Income Groups. Use and expenditure patterns for most services were not significantly different between low- and middle-high-income black children and were lower than those for white children. CONCLUSIONS: While health insurance coverage is still an important factor in obtaining health care, the data suggest that efforts beyond coverage may be needed to improve access and quality for low-income children overall and for children who are racial and ethnic minorities, regardless of income.     

儿童急性特发性血小板减少性紫癜125例临床分析

目的探讨儿童特发性血小板减少性紫癜(ITP)的临床特征。方法回顾性分析125例ITP住院患儿的临床资料,并对其发病年龄、诱因、出血情况及3种不同治疗方案的治疗效果进行分析。结果 (1)婴幼儿发病多见,其中年龄1个月～1岁者37例(29.6%),～3岁者38例(30.4%),≤3岁占所有病例数的60%;(2)起病诱因不明者67例(53.6%),诱因明确58例(46.4%),12例(9.6%)发病前1个月内有预防接种史;(3)以肾上腺糖皮质激素治疗为主的综合治疗可使出血症状很快消失;治疗后3、7 d的血小板值与治疗前比较差异有显著性(P<0.01)。结论(1)儿童ITP发病年龄以婴幼儿期多见;(2)约半数患儿有前驱感染史,疫苗接种后ITP发生率高于以往报道;(3)泼尼松、泼尼松+静脉注射用人免疫球蛋白治疗以及地塞米松+静脉注射用人免疫球蛋白3种方法治疗儿童ITP均有较好疗效。     

Frequency and severity of infections in day care

This study was undertaken to compare prospectively the frequency, nature, and severity of infections experienced by children in three types of child care arrangements: home care, group care (two to six children), and day care (seven or more children). Children were enrolled at birth and observed for 12 to 18 months. At entry there were 159 children in home care, 40 in group care, and 45 in day care. The families were telephoned every 2 weeks to record on a standardized form the type and severity of illnesses experienced during the previous interval. Severe illnesses were defined by high fever, duration exceeding 10 days, or physician visit. Children remaining in their original child care group for at least 1 year were compared with regard to the frequency and severity of illness. Children in group care and day care were more likely than children in home care to experience at least six respiratory infections, more than 60 days of illness, and more than four severe illnesses (P less than 0.01). Similarly, life table analyses showed that children in home care had fewer episodes of infection than did children in day care (P less than 0.01). Although no children were hospitalized because of acute infections during the first year of study, hospitalization for myringotomy and tube placement occurred in 21% of children in day care and 3% of children in home care (P less than 0.01).     

Neonatal Screening: Life-Stress Scores in Families Given a False-Positive Result

ABSTRACT. In a previous study the psychological reactions to a false-positive result of a neonatal screening test were studied in 102 families. The present study deals with life-stress factors in the same families at the time of screening. The number of factors are used to denote a life-stress score and the families have been divided into two groups: those with high and those with low scores. The children's physical health during the first year and the changes in the families during the five years after the screening have also been investigated. There were no large differences between the two groups of families; however, the mothers in families with high scores more often breastfed their children for less than two months, more frequently required medical care during the infants'first year of life and were more often separated during the first five years.     

Neonatal screening: life-stress scores in families given a false-positive result

In a previous study the psychological reactions to a false-positive result of a neonatal screening test were studied in 102 families. The present study deals with life-stress factors in the same families at the time of screening. The number of factors are used to denote a life-stress score and the families have been divided into two groups: those with high and those with low scores. The children's physical health during the first year and the changes in the families during the five years after the screening have also been investigated. There were no large differences between the two groups of families; however, the mothers in families with high scores more often breastfed their children for less than two months, more frequently required medical care during the infants' first year of life and were more often separated during the first five years.     

Impact of mass supplementation of Vitamin A

Objective To study the impact of mass supplementation of Vitamin A solution on morbidity due to diarrhea, Acute respiratory infection (ARI) and xerophthalmia. Methods The two rounds of age specific mass distribution of Vitamin A solution were undertaken during January 2000 and December 2000 respectively covering 27642 (98.7%) and 31762 (88.0%) children respectively out of total beneficiaries in two round of PPI in Chandigarh. A random sample of 276 children from intervention area and 252 children from control area in the age group of 1–5 yr were followed up on monthly basis for morbidity pattern for a period of nine mth. The morbidity pattern for intervention and control area children was compared to see the impact of mass supplementation of Vitamin A solution. Results The average annual episodes of diarrhea in intervention children were lower (3.9 per yr) as compared to control children (5.2 per yr) although difference was not statistically significant (P>0.05) except in initial month. The average annual episodes of ARI in intervention children were lower (5.1 per yr) as compared to Control children (6.0 per yr) although difference was not significant (P>0.05) except in initial first mth. There was significant decline in vitamin A deficiency (VAD) as no case of Bitot’s spot was found in intervention children as compared to control children where the prevalence of Bitot’s spot ranged from 4.3–5.08% during different visits. The mortality rate was found to be higher in control children with a death rate of 8 per 1000 children during the study period as compared to intervention children where no death was recorded. Conclusion It is concluded that mass supplementation of vitamin A led to significant reduction in xerophthalmia and decline in mortality in the intervention area as compared to control area.     

Epidemiology of pneumonia in rural underfives

Rural underfives (5335) were followed for a period of one year from January to December 1987 for acute respiratory infections (ARI). Those affected with pneumonias were studied in detail to know the epidemiology. The children reported an attack rate of 0.29/child/year. Severe cases constitute 0. 5%. Infants had higher attack rate (0.59/child/year), 47.7% of episodes occurred in infants and 87.7% occurred in children below 3 years. Males had a higher attack rate (0.32 Vs 0.27). Mean duration of attack was 5.45 ± 1.95 days. The attack rate was higher in winter. The case fatality rate was 1.26%. It was highest in neonates (10.7%) Females had higher case fatality rate than males (1.5% Vs 1.1%). Mortality was very high in severe cases. Case fatalities were high in seasons when the climatic change occurred, the highest being in autumn.     

Are orphans at increased risk of malnutrition in Malawi?

The objective of this study was to compare the nutritional status and health problems of village orphans, non-orphans and orphanage children, and to identify factors associated with undernutrition. A cross-sectional study was conducted in three orphanages and two villages near Blantyre, Malawi. Seventy-six orphanage children, 137 village orphans and 80 village non-orphans were recruited. Anthropometric measurement was done and guardians were interviewed. In the group of children aged < 5 years, the prevalence of undernutrition in orphanage children was 54.8% compared with 33.3% and 30% of village orphans and non-orphans, respectively. Sixty-four per cent of young orphanage children were stunted compared with 50% of village orphans and 46.4% of non-orphans. The mean (SD) Z-score of height/age was significantly lower in the orphanage group, -2.75 (1.29) compared with -2.20 (1.51) and -1.61 (1.57) in the village orphan and non-orphan groups (p < 0.05). Conversely, older orphanage children (> or = 5 years) were less stunted and wasted than orphans and non-orphans in villages. Illness of children in the last month was reported to be higher in the non-orphan group, especially diarrhoeal disease, which occurred in 30% compared with 10.8% of village orphans and 6.6% of orphanage children. More than three children in a family being cared for by guardians was significantly associated with undernutrition. Orphanage girls were more likely to be malnourished than orphanage boys. Children who had been admitted to an orphanage for more than a year were less malnourished. In village orphans, there was no association between undernutrition and duration of stay in extended families. Age and education of guardians were not associated with the nutritional status of children. We conclude that young orphanage children are more likely to be undernourished and more stunted than village children. Older orphanage children seem to have better nutrition than village orphans. There was no significant difference in nutritional status between village orphans and non-orphans.     

Riboflavin and hemoglobin status of urban school boys: Relationship with income diet and anthropometry

Riboflavin and hemoglobin status of urban school boys from low income families were examined in relation to their diet, per capita income and anthropometric status. Majority of the children had severe biochemical riboflavin deficiency as judged by the erythrocyte glutathione reductase activation test. There was significant but weak correlation between ribo flavin status and income as well as diet, suggesting that factors besides income and diet also influence riboflavin status. Despite deficiency of calories and other nutrients, 76% of the children had normal anthropometric status by Waterlow's classification. Riboflavin deficiency was more severe and clinical signs more frequently seen in children with weight for height less than 80% of the N.C-H.S. standards. There was perceptible improvement in riboflavin status when the per capita income exceeded Rs. 300. More than 70% children suffered from mild and moderate anemia. Hemoglobin status did not show any correlation with income, diet or anthropometry.     

Occurrence and management of acute respiratory illnesses in early childhood

AIM: Acute respiratory illnesses (ARI) impose massive economic burden on health services. The growing costs, limited benefits of pharmacotherapeutic agents, and alarming rise in antibiotic resistance poses a major health challenge. Analysis of the nature and burden of ARI through well-designed epidemiologic studies will help in the development of a uniform public health approach to identify methods to reduce disease transmission and maximise prevention strategies. The aim of this study was to analyse the nature and magnitude of the burden of ARI encountered by a cohort of children in the first 5 years of life. METHODS: This community-based prospective study of ARI followed a cohort of children from birth until 5 years of age. Information on all episodes of ARI encountered, and their management, was collected through daily symptom diary and fortnightly telephone calls. RESULTS: Four episodes of ARI/year were reported in the first 2 years and 2-3 episodes/year between 2 and 5 years. The majority were upper respiratory infections. 53% had at least one lower respiratory infection in the first year. For the majority, symptoms lasted 1-2 weeks. 53% were treated with antitussives or cough mixtures, 44% with paracetamol and 23% with antibiotics. A total of 46% of the episodes presented to a family physician, with younger children and those with lower respiratory infection more likely to seek attention. CONCLUSION: ARI are common in childhood and although symptoms may last for 4 weeks, the majority resolve spontaneously. Use of medication does not appear to significantly alter the course or duration of symptoms of ARI.     

Use of healthcare resources,family function,and socioeconomic support during the first four years after preterm birth

OBJECTIVES: To assess the use of healthcare resources for preterm infants and to evaluate family function and socioeconomic support in a defined population from birth to 4 years of age. METHODS: In a prospective case-control study, 39 singleton preterm infants without prenatal abnormalities born during an 18 month period were studied together with their families. The population consisted of 19 very preterm infants (less than 32 weeks) and 20 randomised moderate preterm infants (32-35 weeks), and the control group comprised 39 full term infants. Contacts with medical services, child health services, and the social welfare system were registered, and family function and life events were studied. RESULTS: The preterm children were more often readmitted to hospital (odds ratio (OR) 6.6, 95% confidence interval (CI) 2.0 to 22.1) and had more outpatient attendances (OR 5.6, 95% CI 2.1 to 15.0) during their first year of life. Mothers in the preterm group more often used temporary parental allowance than the control mothers (p < 0.001). The number of contacts with the child health services and the social welfare system did not differ significantly from the controls. Neither was there any significant difference with regard to family function or life events at 4 years of age. CONCLUSIONS: A large proportion of the premature children used specialist care during the first years of life. However, the families of the preterm infants were socially well adapted up to four years after birth compared with the control families.     

Interrelationship between diarrhea and vitamin A deficiency: is vitamin A deficiency a risk factor for diarrhea?

A cross-sectional study, a follow-up study and an evaluation of impact of community-based distribution of vitamin A capsules (200,000 IU) were conducted in Omdurman (Sudan) between November, 1988, and March, 1989. In the cross-sectional survey 1441 children less than 5 years of age participated, which established the baseline values for plasma retinol-binding protein. During the follow-up period 290 cases of diarrhea occurred. Low concentrations of plasma retinol-binding protein (less than 1.85 mg/dl) proved to be a risk factor for diarrhea, especially in girls. The relative risk increased after the second year of life. Children who received vitamin A supplementation before commencement of the study had a lower incidence of diarrhea. The protective effect of vitamin A supplementation was greater in girls (relative risk, 0.297; 95% confidence interval, 0.240 to 0.368) than in boys (relative risk, 0.404; 95% confidence interval, 0.352 to 0.464).     

Vitamin A levels and severity of measles. New York City.

Recent studies show that vitamin A levels decrease during measles and that vitamin A therapy can improve measles outcome in children in the developing world. Vitamin A levels of children with measles have not been studied in developed countries. We therefore measured vitamin A levels in 89 children with measles younger than 2 years and in a reference group in New York City, NY. Vitamin A levels in children with measles ranged from 0.42 to 3.0 mumol/L; 20 (22%) were low. Children with low levels were more likely to have fever at a temperature of 40 degrees C or higher (68% vs 44%), to have fever for 7 days or more (54% vs 23%), and to be hospitalized (55% vs 30%). Children with low vitamin A levels had lower measles-specific antibody levels. No child in the reference group had a low vitamin A level. Our data show that many children younger than 2 years in New York City have low vitamin A levels when ill with measles, and that such children seem to have lower measles-specific antibody levels and increased morbidity. Clinicians may wish to consider vitamin A therapy for children younger than 2 years with severe measles. Additional studies of vitamin A in measles and other infectious diseases, and in vaccine efficacy trials, should be done.