The role of parents in protecting Colombian adolescents from delinquency and marijuana use.

OBJECTIVES: To identify general and differentiating risk and protective factors from domains of culture and ecology, peer, family, and personality, related to adolescent delinquency and marijuana use, and to study the protective role of the parent-child mutual attachment in offsetting cultural and ecological risk factors, leading to less delinquency and marijuana use. DESIGN: Cross-sectional analyses of interview data collected in Colombia. PARTICIPANTS: A total of 2837 Colombian adolescents, 12 to 17 years of age. SETTING: Adolescents were interviewed in their homes. MAIN MEASURES: Independent variables included measures from 4 domains: culture and ecology, peer, family, and personality. The dependent variables were delinquency and marijuana use. RESULTS: Several risk factors, such as tolerance of deviance and sensation seeking, were similarly related to both delinquency and marijuana use, suggesting that a common cause underlies the propensity to engage in different deviant behaviors. Some risk factors were more involved in delinquency and other risk factors were more highly related to the adolescent's marijuana use. Finally, when violence is endemic and illegal drugs are readily available, a close parent-child bond was capable of mitigating these risk factors, leading to less marijuana use and delinquency. CONCLUSIONS: The findings have implications for public health policy related to interventions in countries in which violence and drug use are prevalent. The results point to interventional procedures aimed at adolescents vulnerable to marijuana use and delinquency as well as efforts aimed at specific vulnerabilities in these areas. For example, reducing the risk factors and enhancing the protective factors for marijuana use and delinquency may result in less adolescent marijuana use and delinquency.     

Psychiatric morbidity is related to a chain of prenatal and perinatal adversities

BACKGROUND: Most studies on the effects of early risk factors on future mental health focus on specific obstetric complications as risk factors for specific disorders. However, obstetric complications rarely occur in isolation, and the same holds for psychiatric problems. AIMS: To study prenatal and perinatal risk factors for psychiatric multimorbidity in early adulthood and to determine whether these differ from risk factors for monomorbidity. STUDY DESIGN: Monomorbidity and multimorbidity of six types of psychiatric disorders were determined by a standardised psychiatric interview. Using univariate and multivariate logistic and ordinal logistic regression, associations of mono- and multimorbidity with prospectively collected early risk factors were examined. SUBJECTS: Two hundred and eighty-five young adults selected from a prospective birth cohort on the basis of their Obstetric Optimality Scores. OUTCOME MEASURES: Six types of psychiatric disorder and their co-occurrence. RESULTS: Monomorbidity was related to isolated early risk factors such as low birth weight or a low Apgar score, and to an accumulation of unfavourable pre- and perinatal events. Multimorbidity on the other hand, was only related to a chain of pre- and perinatal adversities. CONCLUSION: Research and prevention strategies should not focus solely on isolated early risk factors, but also on the entire pre- and perinatal situation.     

Factors of early infancy and recurrent use of antibiotic therapy

Aim : To analyse the role of early infant-related, parent-related, family functioning and social relation factors during the infant's first 3 mo of life and their associations with later recurrent treatments with antibiotics. Methods : In an unselected population-based study, parents expecting their first child were followed from pregnancy until the infant was 18 mo of age. Informed consent to participate was obtained from 1443 women expecting their first child and their spouses. The parents of 817 children reported the number of preceding antibiotic treatments at two times (when the child was 9 and 18 mo old). The outcome measure was the number of antibiotic treatments (options: none, 1–5, ±6). The factors associated with later use of antibiotics were collected during the first 3 mo of the infant's life. The variable factors included infant-related, parent-related, family functioning and social relation factors. Results : The final regression analysis showed the potent factors associated with recurrent use of antibiotics: male gender (OR 2.8, 95% CI: 1.6–4.8), frequent physician consultations in early infancy (OR 3.1, 95% CI: 1.8–5.3) and the father's need for outside support (OR 2.2, 95% CI: 1.3–3.8).
Conclusions : In addition to early infant-related medical factors, family factors may be associated with frequent medical consultations and the decision to administer antibiotics to the infant. In the prevention of antibiotic overuse, social and psychological factors should be considered.     

Prepregnancy health status and the risk of preterm delivery

BACKGROUND: Despite extensive evaluation, our understanding of risk factors for premature delivery is incomplete. OBJECTIVE: To examine whether a woman's health status and risk factors before pregnancy are associated with a woman's risk of preterm delivery, independent of risk factors that occur during pregnancy. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort of pregnant women in the San Francisco Bay area who delivered a singleton infant (n = 1619). MAIN OUTCOME MEASURE: Preterm delivery (<37 weeks' gestational age). RESULTS: Sociodemographic characteristics alone explained 13.0% of the risk of preterm delivery, whereas risk factors that occurred before pregnancy explained 39.8% and risk factors that occurred during pregnancy explained 47.1%. After we adjusted for sociodemographic characteristics, prepregnancy risk factors, and pregnancy risk factors, women who reported poor physical function during the month before conception were nearly twice as likely to experience a preterm delivery (odds ratio, 1.97; 95% confidence interval, 1.18-3.30) as women with better physical function. CONCLUSION: A broader focus on the health of women prior to pregnancy may improve rates of preterm delivery.     

影响肾母细胞瘤预后的Cox模型分析

对１２年收治的资料完整的小儿肾母细胞瘤（ＷＴ）６７例统一进行形态学分类，统计流行病学、形态学、临床症状、实验室检查、治疗等２９个与ＷＴ有关的因素并输入ＣＥＣｏｘ模型分析，结果有８个单因素，即分型、分化、肿瘤包膜浸润、血管瘤栓、淋巴结转移、治疗方式等与ＷＴ预后有关。多因素Ｃｏｘ模型分析绍果：临床分期、组织分化、治疗方式三个因素与ＷＴ预后有关。讨论Ｃｏｘ模型在预后分析应用中的特点，多因素相互间的内在联系、互相制约的关系，以正确认识并指导临床。     

Comparison of risk factors for recurrent respiratory infections between urban and rural preschool children in Yiwu, China

Background

Many studies have shown an association between the risk of increased recurrent respiratory infections and socioeconomic and fostering factors, but often only a few risk factors have been studied. This study aimed to identify and compare such factors between urban and rural preschool children.

Methods

Case control studies were conducted in Yiwu urban and rural areas respectively in Zhejiang Province. A structured questionnaire was used to collect information on infl uencing factors such as socioeconomic factors, fostering factors, and housing conditions. The chisquare test was used to compare the distribution of some health related factors between urban and rural children. Risk factor analyses were also made in urban and rural children respectively. Univariate and multivariate analyses were made using the binary logistic regression.

Results

Multivariate analysis showed that maternal age (OR=0.94, 95%CI: 0.89?C0.99), asthma (OR=2.34, 95%CI: 1.22?C4.48), rickets (OR=5.03, 95%CI: 2.10?C12.05), snack (OR=1.62, 95%CI: 1.19?C2.20), traffi c mode (OR=1.38, 95%CI: 1.03?C1.86), living with patients with chronic respiratory system disease (OR=1.79, 95%CI: 1.02?C3.15), and indoor passive smoking (OR=1.46, 95%CI: 1.02?C2.10) were the influencing factors for recurrent respiratory infections in urban children. Rickets (OR=3.77, 95% CI: 1.13?C12.65) and passive smoking (OR=2.33, 95% CI: 1.17?C4.65) were the infl uencing factors for recurrent respiratory infections in rural children.

Conclusions

Public health measures against risk factors should be taken to prevent the occurrence of recurrent respiratory infections in urban and rural children respectively.     

Quels facteurs étiologiques chez les enfants tunisiens ? À propos d'une enquête épidémiologique

The objective of our work was to discuss the influence of étiological factors : organic and environnemental factors particular of our sample, according to the french Classification of Mental disorders in children and adolescents (FCMCA). We proceeded a retrospective study carrying on 1452 files of new consulting to the child and the teenager psychiatry service at Sfax. It came out again some that : the organic factors represented a rate of 49% dominated by the somatic illness antecedents in the childhood (19%) and convulsions or epilepsies (19%); environnemental factors were present in 59% of cases, dominated by the particular sociofamilial context: 27% (FCMCA) the mental unrests of parents: 24% and the affective tie rupture: 9,5%. The elevated rate of these tow factors and their frequent intrication, recovered in our study, rejoin the previous studies. From this constatation, measures to preventive aim have been proposed.     

基于高通量检测发现并验证胆道闭锁血清标志物

目的：探讨与胆道闭锁发病机制相关的血清分子标志物。 方法：收集复旦大学附属儿科医院收治的胆道闭锁患儿与胆总管囊肿患儿的血清,利用高通量抗体芯片技术检测血清中细胞因子水平,采用GSH-CAA-X00进行数据分析。根据抗体芯片检测结果,通过复习文献选取部分分子标志物采用ELISA法进行扩大样本验证。 结果：胆道闭锁患儿5例,胆总管囊肿患儿3例。47/1 002个蛋白在两组表达差异有统计学意义（P均＜0.05）,且两者倍数相差在1.2倍以上,在胆道闭锁患儿血清中表达上调34个,下调13个。选取IL-6、IL-8和IL-10指标在50例胆道闭锁患儿和30例胆总管囊肿患儿中采用ELISA法进行验证,结果显示IL-6、IL-8和IL-10在胆道闭锁患儿血清中浓度均高于胆总管囊肿患儿。 结论：利用血清抗体芯片分析技术,能够对血清样本中的多种蛋白进行高通量化地检测分析,并筛选出部分具有临床诊断价值的胆道闭锁血清标记蛋白,为进一步探索胆道闭锁发病机制以及诊断策略奠定新的研究基础。     

Nontraditional cardiovascular risk factors in pediatric metabolic syndrome

OBJECTIVE: To study the relationships between nontraditional cardiovascular (CV) risk factors and components of the metabolic syndrome in Native Canadian children, a population at risk of future CV disease. STUDY DESIGN: CV risk factors were evaluated in a population-based study of a Canadian Oji-Cree community, involving 236 children aged 10 to 19 years. RESULTS: Using an age- and sex-specific case definition, 18.6% of the children met criteria for pediatric metabolic syndrome. As the number of metabolic syndrome component criteria increased, C-reactive protein, leptin, and ratio of apolipoprotein B to apolipoprotein A1 levels rose (all P < .0001) and adiponectin concentration decreased (P = .0006). Principal factor analysis using both traditional and nontraditional CV risk factors revealed 5 underlying core traits, defined as follows: adiposity, lipids/adiponectin, inflammation, blood pressure, and glucose. CONCLUSIONS: Nontraditional CV risk factors accompany the accrual of traditional risk factors early in the progression to pediatric metabolic syndrome. Furthermore, inclusion of these factors in factor analysis suggests that 5 core traits underlie the early development of an enhanced CV risk factor profile in Native children.     

Risk factors for childhood overweight: a prospective study from birth to 9.5 years

OBJECTIVES: To ascertain risk factors for the development of overweight in children at 9.5 years of age. STUDY DESIGN: This was a prospective study of 150 children from birth to 9.5 years of age, with assessment of multiple hypothesized risk factors drawn from research reports. RESULTS: Five independent risk factors for childhood overweight were found. The strongest was parent overweight, which was mediated by child temperament. The remaining risk factors were low parent concerns about their child's thinness, persistent child tantrums over food, and less sleep time in childhood. Possible mechanisms by which each of these factors influence weight gain are outlined. Two different pathways to childhood overweight/obesity were found, depending on degree of parental overweight. CONCLUSIONS: There is evidence of considerable interaction between parent and child characteristics in the development of overweight. Several of the identified risk factors are amenable to intervention possibly leading to the development of early prevention programs.     

Environmental risk factors for type 1 diabetes in Rome and province.

BACKGROUND: In subjects genetically susceptible to type 1 diabetes, exposure to environmental factors during the gestational period, the neonatal period, and the first years of life is thought to play an important role in triggering the immune process leading to beta cell destruction. AIMS: To investigate risk factors for inhabitants of continental Italy. METHODS: A case-control study of 150 type 1 diabetes cases and 750 control subjects (age range 6-18 years) was carried out in Rome and its province, measuring the exposure to environmental risk factors. RESULTS: Three environmental factors were found to occur significantly more in the diabetic group than in the controls. During the mothers' pregnancies, the one risk factor which proved to be higher in diabetics than in controls was maternal infectious disease. During the neonatal period, no risk factors associated with the disease were detected. During early life, eczema and a short duration of breast feeding (less than three months), occurred significantly more in diabetic cases than controls. CONCLUSION: Eczema and breast feeding for less than three months are risk factors for type 1 diabetes in a southern European population. The type, duration, and mode of treatment for infectious diseases during pregnancy need additional investigation as risk factors for type 1 diabetes.     

Environmental risk factors for type 1 diabetes in Rome and province

Background: In subjects genetically susceptible to type 1 diabetes, exposure to environmental factors during the gestational period, the neonatal period, and the first years of life is thought to play an important role in triggering the immune process leading to ß cell destruction. Aims: To investigate risk factors for inhabitants of continental Italy. Methods: A case-control study of 150 type 1 diabetes cases and 750 control subjects (age range 6–18 years) was carried out in Rome and its province, measuring the exposure to environmental risk factors. Results: Three environmental factors were found to occur significantly more in the diabetic group than in the controls. During the mothers'' pregnancies, the one risk factor which proved to be higher in diabetics than in controls was maternal infectious disease. During the neonatal period, no risk factors associated with the disease were detected. During early life, eczema and a short duration of breast feeding (less than three months), occurred significantly more in diabetic cases than controls. Conclusion: Eczema and breast feeding for less than three months are risk factors for type 1 diabetes in a southern European population. The type, duration, and mode of treatment for infectious diseases during pregnancy need additional investigation as risk factors for type 1 diabetes.     

Low back pain in schoolchildren: the role of mechanical and psychosocial factors

Background: Low back pain (LBP) in schoolchildren with no apparent clinical cause is known to be a common problem, but considerably less is understood regarding the aetiology of such pain. Aim: To assess the role of both mechanical and psychosocial factors (including emotional and behavioural problems and other somatic pain complaints) in childhood LBP. Methods: A cross sectional study was carried out in a population of 1446 schoolchildren aged 11–14 years. Information on these potential risk factors for LBP was sought using a self complete questionnaire and a five day bag weight diary. Results: Mechanical factors such as physical activity and school bag weight were not associated with LBP. However, strong associations with LBP were observed for emotional problems, conduct problems, troublesome headaches, abdominal pain, sore throats, and daytime tiredness. Conclusion: Results suggest that psychosocial factors rather than mechanical factors are more important in LBP occurring in young populations and could possibly be a reflection of distress in schoolchildren.     

Low back pain in schoolchildren: the role of mechanical and psychosocial factors.

BACKGROUND: Low back pain (LBP) in schoolchildren with no apparent clinical cause is known to be a common problem, but considerably less is understood regarding the aetiology of such pain. Aim: To assess the role of both mechanical and psychosocial factors (including emotional and behavioural problems and other somatic pain complaints) in childhood LBP. METHODS: A cross sectional study was carried out in a population of 1446 schoolchildren aged 11-14 years. Information on these potential risk factors for LBP was sought using a self complete questionnaire and a five day bag weight diary. RESULTS: Mechanical factors such as physical activity and school bag weight were not associated with LBP. However, strong associations with LBP were observed for emotional problems, conduct problems, troublesome headaches, abdominal pain, sore throats, and daytime tiredness. CONCLUSION: Results suggest that psychosocial factors rather than mechanical factors are more important in LBP occurring in young populations and could possibly be a reflection of distress in schoolchildren.     

Acute and recurrent pancreatitis in children: etiological factors

OBJECTIVES: To describe the clinical picture and outcome, and to assess the etiological factors of acute and recurrent pancreatitis in children. METHODS: Thirty-six (65.5%) patients with acute and 19 (34.5%) with recurrent pancreatitis were studied. Mean age was 126 (41.3 SD) months; 27 (49.1%) were females. SETTING: A pediatric referral hospital. PERIOD: 2000-2005. DESIGN: Cross-sectional. VARIABLES: Clinical and laboratory data and etiological factors. STATISTICS: Chi2-test, Fisher test, OR, confidence interval, Student t-test and Mann-Whitney U-test. RESULTS: The most frequent symptom in acute and recurrent pancreatitis was abdominal pain, followed by vomiting and ileus. The severity of pancreatitis and complications were similar in both groups. Biliary stones, family history of pancreatitis, drug ingestion and hypercalcemia occurred in both groups. Abdominal trauma and acute hepatitis A occurred in patients with acute pancreatitis; triglyceride>5.65 mmol/L, pancreas divisum and DeltaF508 mutation occurred in patients with recurrent pancreatitis. No difference was observed when frequency factors between study groups were compared. CONCLUSIONS: The clinical picture and etiological factors were similar in both groups. Since one out of every three children with acute pancreatitis in this series presented recurrences, it was not considered to be a 'benign disease'. Fifteen different etiological factors were identified in two-thirds of the cases.     

Neonatal antecedents for cerebral palsy in extremely preterm babies and interaction with maternal factors

BACKGROUND: Preterm delivery is associated with an increased risk of cerebral palsy (CP). The greatest risk is for infants born <28 weeks' gestation. AIMS: To identify significant neonatal risk factors for CP and explore the interactions between antenatal and neonatal risk factors, among extremely preterm infants of 27 weeks' gestation or less. STUDY DESIGN: Nested case control design. METHODS: Infants born between 1989 and 1996, at 24-27 weeks' gestation, were evaluated: 30 with CP at 2 years corrected age and 120 control infants matched for gestation age. Neonatal variables were compared using matched analyses with the interaction between antenatal and neonatal factors being examined using logistic regression analyses. RESULTS: Risk factors for CP on matched analyses included patent ductus arteriosus requiring surgical ligation, peri-intraventricular haemorrhage, moderate to severe ventricular dilatation, periventricular leukomalacia (PVL) and need for home oxygen. Independent neonatal predictors were ventricular dilatation (OR 7.3; 95% CI 1.6, 32.3), PVL (OR 29.8; 95% CI 5.6, 159.1) and home oxygen use (OR 3.4; 95% CI 1.2, 9.4). No interaction terms in the logistic models were significant between the previously identified pregnancy risk factors of absence of antenatal steroids and intrauterine growth restriction and the neonatal risk factors. CONCLUSIONS: PVL is the most powerful independent predictor of CP in extremely preterm infants of 27 weeks' gestation or less and appears to be uninfluenced by antenatal factors.     

Parental burnout in relation to sociodemographic, psychosocial and personality factors as well as disease duration and glycaemic control in children with Type 1 diabetes mellitus

Aim: To examine associations between burnout and sociodemographic, psychosocial, personality and medical factors in parents of children with Type 1 Diabetes Mellitus (T1DM). Methods: A total of 252 parents of children with T1DM participated in a population‐based study. We used self‐report questionnaires to assess symptoms of burnout and background factors. Results: Psychosocial background factors were significantly associated with burnout in parents, whereas there were no associations between sociodemographic or medical factors and burnout. For both genders, parental burnout was associated with low social support, lack of leisure time, financial concerns and a perception that the child’s disease affects everyday life. Low self‐esteem and high need for control were risk factors for maternal burnout. Conclusion: In the screening of risk factors for long‐term stress in parents of children with T1DM, we should recognize parents’ attitudes as well as situational psychosocial issues. In clinics, we need to pay attention to the day‐to‐day life circumstances in the support of these parents. Certain factors were associated with the risk for burnout only for mothers, which warrant further investigation of gender aspects. Continued research about the causal relationship between the parental responsibility, psychosocial factors and burnout is warranted.     

Child health services in transition: II. Mothers' perceptions of 18-month-old children in the light of socio-economic status and some subjective factors

AIMS: To analyse mothers' self-assessed quality of interaction with their children and their opinions about child difficulty with respect to socio-economic status and subjective factors: postnatal depression, social isolation, sense of coherence and locus of control. METHODS AND MATERIAL: A comprehensive questionnaire was completed by 1039 mothers of 18-mo-old children participating in the baseline measurements of a Swedish multicentre study developing and testing a new psychosocial model for the child health services. RESULTS: All subjective factors, including the number of factors, showed significant associations with perceived interaction and difficultness. Effect sizes of subjective factors ranged from about 0.3 to 1 SD for interaction, and from about 0.2 to 0.8 SD for difficultness. As for difficultness, effect sizes were larger for boys. There were no associations between high socio-economic status and high-quality interaction or low child difficultness: the few significant differences in fact favoured low-status children. CONCLUSION: The results provided some contradictory findings to the well-known association between high socio-economic status and favourable outcome. This result is of practical relevance for interventions: supportive programmes cannot be limited to areas and families of low socio-economic status. Positive effects may ensue if subjective factors like those studied here can be promoted among parents and children through the child health services.     

Specificity of putative psychosocial risk factors for psychiatric disorders in children and adolescents

BACKGROUND: Most psychosocial risk factors appear to have general rather than specific patterns of association with common childhood and adolescence disorders. However, previous research has typically failed to 1) control for comorbidity among disorders, 2) include a wide range of risk factors, and 3) examine sex by developmental stage effects on risk factor-disorder associations. This study tests the specificity of putative psychosocial risk factors while addressing these criticisms. METHODS: Eight waves of data from the Great Smoky Mountains Study (N = 1,420) were used, covering children in the community age 9-16 years old. Youth and one parent were interviewed up to seven times using the Child and Adolescent Psychiatric Assessment, providing a total of 6,674 pairs of interviews. A wide range of putative neighborhood, school, peer, family, and child risk factors, and common and comorbid youth disorders were assessed. RESULTS: The majority of putative risk factors were specific to one disorder or one disorder domain. A unique or 'signature set' of putative risk factors was identified for each disorder. Several putative risk factors were associated with a disorder in preadolescent males, preadolescent females, adolescent males, or adolescent females only. CONCLUSIONS: Our findings support the need to define risk factors and disorders narrowly, to control comorbidity and other risk factors, and to consider developmental patterns of specificity by sex.     

儿童产超广谱β-内酰胺酶菌株感染危险因素分析

目的：研究儿童产超广谱β-内酰胺酶（ESBLs）菌株感染的危险因素。方法：回顾性分析2009年2月至2011年1月242例下呼吸道感染住院患儿的临床资料,应用单因素分析和非条件logistic回归分析进行产ESBLs菌株感染的危险因素调查。结果：单因素分析显示6个因素与产ESBLs菌株感染有关：反复口鼻腔吸痰（OR=2.279,P<0.01）、气管插管（OR=3.101,P<0.01）、应用第三代头孢菌素大于3 d（OR=3.628,P<0.01）、入住儿科重症监护病房（PICU）（OR=2.378,P<0.01）、留置鼻饲管（OR=2.460,P<0.01）、预防应用抗生素（OR=1.747,P<0.05）。非条件logistic多元回归分析显示,应用第三代头孢菌素大于3 d（OR=5.672,P<0.01）、反复口鼻腔吸痰（OR=3.917,P<0.01）、气管插管（OR=3.717,P<0.01）、留置鼻饲管（OR=2.961,P<0.01）、入住PICU（OR=3.237,P<0.01）为产ESBLs感染菌的独立危险因素。结论：产ESBLs菌株感染为多因素所致,其中主要与第三代头孢菌素的使用、侵袭性操作、入住PICU密切相关。