血清25-羟维生素D水平与婴幼儿食物过敏的关系研究

目的 探讨血清25-羟维生素D水平与婴幼儿食物过敏的关系,并分析食物过敏的危险因素。方法 纳入≤3岁确诊食物过敏的40例婴幼儿作为研究组,同时选取40例年龄匹配的健康儿童作为对照组。比较2组血清25-羟维生素D水平,并分析筛选食物过敏的可能危险因素。结果 2组血清25-羟维生素D水平比较差异无统计学意义（P>0.05）;在食物过敏组中维生素D缺乏与不足患儿所占比例更高（P<0.05）。血清25-羟维生素D水平在IgE介导的食物过敏与非IgE介导的食物过敏患儿中比较,差异无统计学意义（P>0.05）。单因素Logistic回归分析结果表明,过敏性疾病家族史、湿疹史及低维生素D水平可能是食物过敏的危险因素（P<0.05）。多因素Logistic回归分析表明,湿疹史是食物过敏的独立危险因素（P<0.05）。结论 食物过敏患儿维生素D缺乏和不足者较多,但食物过敏和健康婴幼儿的血清25-羟维生素D水平差异无统计学意义;有湿疹史的婴幼儿,发生食物过敏的风险更高。     

Food allergy in Singapore: opening a new chapter

With the exception of shellfish, the overall food allergy rates in Singapore have not reached the epidemic proportions of the West. The rates of egg, milk and fish allergies remain low. However, the patterns of some food allergies in Singapore have changed over the last decade. For example, peanut allergy, once rare in Singapore, is now the most common cause of anaphylaxis in children. Studies analysing lifestyle practices, particularly with respect to prevention of food allergy, are necessary in order for practitioners to understand global differences and maintain this low prevalence.     

Prevalence of overweight and obesity in Australian children and adolescents: reassessment of 1985 and 1995 data against new standard international definitions.

OBJECTIVE: To review the prevalence of overweight and obesity in Australian children and adolescents in two national samples, 10 years apart, using the new standard international definitions of the International Obesity Task Force Childhood Obesity Working Group. DESIGN: Body mass index (BMI) cut-off points defining overweight and obesity were applied to the individual BMI values in the two cross-sectional samples. SETTING: Australian community. PARTICIPANTS: 8,492 schoolchildren aged 7-15 years (Australian Health and Fitness Survey, 1985) and 2,962 children aged 2-18 years (National Nutrition Survey, 1995). MAIN OUTCOME MEASURE: Prevalence of overweight and obesity. RESULTS: In the 1985 sample, 9.3% of boys and 10.6% of girls were overweight and a further 1.7% [corrected] of boys and 1.6% [corrected] of girls were obese. In the 1995 sample, overall 15.0% of boys (varied with age from 10.4% to 20.0%) and 15.8% of girls (varied with age from 14.5% to 17.2%) were overweight, and a further 4.5% of boys (2.4%-6.8%) and 5.3% of girls (4.2%-6.3%) were obese. The prevalence of overweight and obesity in the 1995 sample peaked at 12-15 years in boys and 7-11 years in girls. In schoolchildren aged 7-15 years, the rates represent a relative risk of overweight in 1995 compared with 1985 of 1.79 (95% CI, 1.59-2.00) and of obesity of 3.28 (95% CI, 2.51-4.29). Compared with previous estimates from these samples, the revised prevalence data are slightly higher for the 1985 data and considerably higher for the 1995 data. CONCLUSION: The secular trend of increasing overweight and obesity in the decade from 1985 and the high prevalence rates in Australian children and adolescents are a major public health concern.     

Latex allergy in an Australian population of children and adolescents with spinal dysfunction

OBJECTIVES: To determine the prevalence of latex allergy in an Australian population of children and adolescents with spinal cord dysfunction and a comparison population of their siblings without spinal dysfunction. DESIGN AND SETTING: Cross-sectional study of all patients with spinal cord dysfunction attending the single tertiary spinal dysfunction clinic in Western Australia, and of their siblings closest in age. SUBJECTS: 104 patients with spinal dysfunction born 1978-1996 inclusive, and 50 siblings. MAIN OUTCOME MEASURES: Prevalence estimates and adjusted odds ratio estimates of the risk of having a history of latex allergy and of testing latex-specific IgE positive. RESULTS: Of the patients, 15.4% (95% CI, 9.1%-23.8%) had a history of latex allergy compared with none (95% CI, 0-5.8%) of the siblings. Of the 84 patients tested, 36.9% (95% CI, 26.6%-48.1%) were latex-specific IgE positive compared with 15.4% (95% CI, 4.4%-35.9%) of the 26 siblings tested. For patients, every operation after the first increased the risk of a positive IgE result cumulatively by 41% (odds ratio, 1.41; 95% CI, 1.18-1.68). CONCLUSIONS: The prevalence of latex sensitivity and clinical allergy in children and adolescents with spinal dysfunction in Australia is as high as that seen in the United States, and is related to latex exposure during surgery. The management policy regarding latex exposure for patients with spinal dysfunction requires urgent consideration.     

Anaphylaxis during general anaesthesia: one-year survey from a British allergy clinic

INTRODUCTION: Anaphylaxis during general anaesthesia is a major concern. Early recognition and management of anaphylaxis, as well as its future prevention, remain a challenge for the anaesthetists, while for the allergists, the elucidation of the causal agents may be difficult. We aimed to describe our experience in our drug allergy clinic. METHODS: We retrospectively reviewed 23 consecutive adult patients who presented with anaphylaxis during anaesthesia from March 1, 2005 to February 28, 2006. RESULTS: Out of the 23 patients (12 females, 11 males) with mean age (+/- SD) of 53.1 +/- 15.8 years, 15 patients were found to have a positive skin test to at least one neuromuscular blocking agent (NMBA); all of them showed cross-sensitivity with one or more NMBA(s). Three patients had a positive skin test to opioids, two patients to gelofusine, two patients to penicillin, and one patient each to povidone-iodine and chlorhexidine. Two patients had negative test results to agents used during their anaesthesia. Four patients had double positive skin tests to different families of drugs/agents. 18 patients had severe reaction-grade 3, and 15 of them tested positive for NMBA(s). Serum tryptase levels were known in nine patients. We did not encounter any latex or hypnotics sensitisation. CONCLUSION: NMBA was the commonest cause of anaphylaxis during general anaesthesia, occurring in 65% in our series.     

Use of cromolyn in combined gastrointestinal allergy.

A double-blind clinical trial was undertaken to evaluate the efficacy of orally given cromolyn sodium vs that of pacebo in the management of food allergy. Fourteen children, aged 2 to 15 years, with milk allergy and concomitant allergies to one or more foods were given cromolyn or placebo. Eleven had positive intradermal skin reactions or coproantibodies to offending antigens. Treatment was begun while the children were receiving elimination diets; they were challenged with specific antigen only after 48 hours of drug administration. Crossover took place if the initial agent was ineffective. Cromolyn afforded protection in 11 of 13 trials, whereas placebo was effective in only three of nine trials. By chi 2 analysis, the drug's effect was statistically significant.     

Height centile curve for child and adolescents in Shaanxi province

Objective:It has been recommended that age-related centile curves of anthropometric indexes(such as height,weight)be used rountinly to evaluate the growth and development statues in children.Prewsented here is the age-related height centile curves for children aged 0-18 years in Shaanxi,China,1995.Methods:Data of the Shaanxi population were retrieved from The Third Nationwide Growth Survey to construct the age-related height centile curves.The LMS method was used for curve fitting;all analyses were carried out on the basis of different sexes through a special program for LMS(λ-median-coefficient)method which was devised by Cole TJ.Results:Centile curves for boys and girls,showing similar age-related features but girls‘ puberty coming two years earlier than boys‘.The period of puberty growth increment was about 2 years longer for boys.At age 18,boys were taller than girls for about 14 cm.Compared with beight standard of NCHS(national center of bealth statistics).Shaanxi children were taller than American children before 14 years for boys,12 years for girls,but after 15 years for boys and 13 years for girls,Shaanxi chilgren were shorter than American ones.At age 18,Shaanxi children was 5.6 cm for boys and 4.9 cm for girls shorter than NCHS.Shaanxi children‘s height increase range from 1958 to 1995 at the same age was 4.9-15.1 cm,with the mean of 9.59 cm for boys,and 3.7-12.5 cm,with the mean of 8.38 cm for girls.Between 1958-1995,the increasing velocity every ten years were 2.57 cm for boys and 2.26 cm for girls,which indicated that the children have reached the optimum.Conclusion:By means of LMS method,we constructed age-related height centile curves for Shaanxi children aged 0-18 years,these height centile curves are the first one for the Chinese children.It can be used as a reference for assessing growth and development status of Shaanxi children aged 0-18 years.     

Opioid overdose mortality in Australia, 1964-1997: birth-cohort trends.

OBJECTIVE: To examine trends in rates of opioid overdose deaths from 1964 to 1997 in different birth cohorts. DESIGN: Age-period-cohort analysis of national data from the Australian Bureau of Statistics. MAIN OUTCOME MEASURES: Annual population rates of death attributed to opioid dependence or accidental opioid poisoning in people aged 15-44 years, by sex and birth cohort (in five-year intervals, 1940-1944 to 1975-1979). RESULTS: The rate of opioid overdose deaths increased 55-fold between 1964 and 1997, from 1.3 to 71.5 per million population aged 15-44 years. The rate of opioid overdose deaths also increased substantially over the eight birth cohorts, with an incidence rate ratio of 20.70 (95% confidence interval, 13.60-31.46) in the 1975-1979 cohort compared with the 1940-1944 cohort. The age at which the cumulative rate of opioid overdose deaths reached 300 per million fell in successive cohorts (for men, from 28 years among those born 1955-1959 to 22 years among those born 1965-1974; for women, from 33 years among those born 1955-1959 to 27 years among those born 1965-1969). CONCLUSIONS: Heroin use in Australia largely began in the early 1970s and rates of heroin use have markedly increased in birth cohorts born since 1950.     

Invasive Haemophilus influenzae type b disease in Sydney children 1985-1987: a population-based study

OBJECTIVE: To determine the incidence and age distribution of invasive Haemophilus influenzae type b (Hib) disease in children (0-14 years) in the Sydney Statistical Division (SSD). DESIGN: Retrospective ascertainment from a defined population, 1985-1987. Eligible cases had Hib isolated from a normally sterile site or endoscopically proven epiglottitis. SETTING: Sydney Statistical Division, which had a population of children aged 0-4 years of 229 165 in 1986. PATIENTS: Cases were identified from all potential sources of relevant recorded information. MAIN OUTCOMES: There were 292 eligible cases. Among 284 previously well children, those under 18 months of age contributed 81 of 143 cases (57%) of meningitis and 22 of 71 (71%) of cellulitis/arthritis but only 8 of 91 (11%) of epiglottitis and 4 of 18 (22%) of infection in other foci. Overall, 9% of cases had occurred by 6 months of age, 42% by 18 months and 55% by 24 months. The annual incidence of invasive Hib disease was 38.5 per 100,000 children aged 0-4 years. In areas with the lowest proportion of young children (less than 5.5%), the incidence of Hib disease in the first 12 months of life was significantly lower than in the remainder of Sydney, although there were no differences in overall disease incidence in the age group 0-4 years. CONCLUSIONS: This study indicates that approximately 1 in 500 urban Australian children develop invasive Hib disease by their fifth birthday. Vaccination of children in Sydney with a conjugate Hib vaccine at 18 months of age would result in a greater potential reduction in Hib disease than in the United States, where universal vaccination at this age is current policy.     

食物过敏患儿十二指肠黏膜组织内IL-4和IL-5 mRNA的表达

目的：探讨食物过敏患儿十二指肠黏膜组织内IL-4和IL-5 mRNA的表达。方法：取18例食物过敏患儿和16例胃镜检查正常儿童（对照组）十二指肠黏膜活检组织,进行病理检查,并采用RT-PCR检测其中IL-4和IL-5 mRNA的表达。常规生化方法检测血清IgE水平。结果：食物过敏患儿十二指肠黏膜组织内IL-4、IL-5 mRNA水平及血清IgE水平高于对照组（P〈0．05）;食物过敏患儿十二指肠黏膜组织内IL-4、IL-5 mRNA水平与血清IgE水平呈正相关（r分别为0．674、0．586,P均〈0．05）,而与肠黏膜组织的炎症程度无相关性。结论：食物过敏反应可诱导肠黏膜内免疫细胞分泌IL-4和IL-5,并协同刺激局部IgE的分泌。     

Increased expenditure on Australian health and medical research and changes in numbers of publications determined using PubMed

OBJECTIVE: To determine temporal trends in PubMed publications for Australian authors compared with changes in funding for health and medical research (HMR). DESIGN: Retrospective observational study. SETTING: Internet-based bibliometric study that collated Australian HMR expenditure from the Australian Institute of Health and Welfare and Australian (and other) research publications from PubMed. MAIN OUTCOME MEASURES: Australian expenditure on HMR and numbers of PubMed-cited publications from 1980 to 2004, with subgroup analyses for universities, clinical trials, and genetic and biotechnology research, and comparison with similar results from the United Kingdom and New Zealand. RESULTS: From 1980-81 to 2003-04, Australian HMR expenditure increased from $66 million to $1503 million and total Australian PubMed publications increased from 844 to 13 836. From 1995-96 to 2003-04, Australian publications for university-derived research and for clinical trials increased at a fairly constant rate. Genetic and biotechnology publications increased about fivefold (49 to 277) between 1990-91 and 2003-04. Between 1990 and 2004, total publications increased from 1754 to 3288 for New Zealand and from 12 401 to 19 600 for the UK. CONCLUSIONS: There is an association between increased funding for HMR and increased publications, as determined using PubMed, in the past 10 years. Using PubMed may be a simple way to track output from HMR expenditure.     

2000-2008年惠州市0～6岁儿童健康状况分析

目的:调查分析惠州市0~6岁儿童健康状况的变化状况。方法:对惠州市2000~2008年12 197名儿童保健资料进行营养不良、贫血、佝偻病和肥胖患病率分析。结果:0~6岁儿童营养不良、贫血和佝偻病患病率分别由2000年的0.79%、3.21%和1.42%下降到2008年的0.28%、2.76%和0.15%;儿童肥胖率则由2.87%升高到4.41%,农村儿童各指标增幅更大。结论:肥胖影响儿童健康,婴幼儿和农村儿童为重点预防对象。     

Economic costs of urinary incontinence in community-dwelling Australian women

OBJECTIVE: To estimate the economic cost of urinary incontinence in community-dwelling Australian women aged 18 years and over for the year 1998. DESIGN: Extrapolation of data from studies of women with incontinence to the Australian population of women aged 18 years and over in 1998. Main outcome measures: Estimated prevalence of urinary incontinence in 1998, and estimated cost in Australian dollars of resource use and personal costs related to management of incontinence. RESULTS: An estimated 1835628 community-dwelling women over the age of 18 years had urinary incontinence in 1998. The total annual cost of this urinary incontinence is estimated at $710.44 million, or $387 per incontinent woman, comprising $338.47 million in treatment costs and $371.97 million in personal costs. An estimated 60% of women with incontinence in 1998 were aged 40 years or over. Assuming the prevalence of incontinence remains constant and, allowing for inflation, we project that the total annual cost in 20 years' time will be $1267.85 million, 93% ($1.18 billion) of which will constitute costs associated with women aged over 40 years. CONCLUSIONS: Urinary incontinence imposes a considerable drain on Australian healthcare resources. More research is needed to understand the magnitude of the problem and potential gains from continence promotion.     

Incidence of autism spectrum disorders in children in two Australian states

AIM: To ascertain the incidence of autism spectrum disorders in Australian children. SETTING: New South Wales (NSW) and Western Australia (WA), July 1999 to December 2000. DESIGN: Data were obtained for WA from a prospective register and for NSW by active surveillance. MAIN OUTCOME MEASURES: Newly recognised cases of autism spectrum disorders (defined as autistic disorder, Asperger disorder and pervasive developmental disorder not otherwise specified [PDD-NOS]) in children aged 0-14 years; incidence was estimated in 5-year age bands (0-4 years, 5-9 years, 10-14 years). RESULTS: In WA, 252 children aged 0-14 years were identified with autism spectrum disorder (169 with autistic disorder and 83 with Asperger disorder or PDD-NOS). Comparable figures in NSW were 532, 400 and 132, respectively. Most children were recognised with autistic disorder before school age (median age, 4 years in WA and 3 years in NSW). Incidence of autistic disorder in the 0-4-years age group was 5.5 per 10,000 in WA (95% CI, 4.5-6.7) and 4.3 per 10,000 in NSW (95% CI, 3.8-4.8). Incidence was lower in older age groups. The ratio of all autism spectrum disorders to autistic disorder alone was 1.5:1 in WA and 1.3:1 in NSW, and rose with age (1.8:1 and 2.9:1 in 10-14-year-olds in WA and NSW, respectively). CONCLUSIONS: These are the first reported incidence rates for autism for a large Australian population and are similar to rates reported from the United Kingdom. Ongoing information gathering in WA and repeat active surveillance in NSW will help to monitor any future changes.     

Seatbelts and the law: how well do we protect Australian children?

About a thousand Australian children are seriously injured in motor vehicle accidents each year, despite 92% using seatbelts or child restraints. Premature graduation of children to adult seatbelts, misuse of seatbelts and use of lap-only belts increase the risk of injury or death. In Australia, use of a child restraint or booster seat is not mandatory for children aged > 1 year, while other countries mandate their use for children up to 5-12 years old. Australian parents are confused about the safest restraint and seating position, particularly for children aged > 2 years. Australian child restraint legislation needs to be reviewed to increase the rate of optimal restraint use.     

宁波某地区1955例儿童过敏原检测结果分析

目的通过儿童过敏原检测为儿童过敏性疾病的预防和诊治提供依据。方法应用HOB公司提供的欧博克过敏原特异性IgE（sIgE）抗体检测,采用酶联免疫吸附法（ELISA）快速试纸条技术检测1 955例儿童血清中6种吸入性和7种食入性过敏原的总IgE抗体和sIgE抗体。结果 1 955例儿童过敏原检出总IgE阳性有1 686例,占86.2%;过敏原sIgE阳性有563例,占28.8%;其总IgE升高有386例,占68.6%,总IgE在正常范围内有177例,占31.4%。对于过敏原sIgE阳性者,吸入性以屋尘螨/粉尘螨为主,有309例,占54.9%;食入性以牛奶为主,有188例,占33.4%。结论宁波某地区儿12岁以下儿童过敏原依次为屋尘螨/粉尘螨、牛奶、屋尘、猫/狗毛皮屑、牛羊肉等。总IgE不能用来诊断或排除过敏,其升高仅意味着过敏的概率相对较高。     

Control of hepatitis A through routine vaccination of children.

CONTEXT: The impact of routine hepatitis A vaccination of children living in large communities with elevated disease rates has not been evaluated. OBJECTIVE: To determine the effect of routine vaccination of children on disease incidence in a community with recurrent hepatitis A epidemics. DESIGN, SETTING, AND PARTICIPANTS: Community-based demonstration project conducted from January 12, 1995, through December 31, 2000, in Butte County, California, among children aged 2 to 17 years. INTERVENTION: In 1995, vaccination was offered to children aged 2 to 12 years during vaccination clinics conducted on 2 occasions 6 to 12 months apart at most schools in the county. In 1996-2000, vaccine was distributed to community health care clinicians, who vaccinated eligible children without charge. Vaccine was also available at health department clinics, selected child care centers, and other sites. MAIN OUTCOME MEASURES: Hepatitis A vaccination coverage, hepatitis A incidence, and vaccine effectiveness. RESULTS: During the study period, 29 789 (66.2%) of an estimated 44 982 eligible children received at least 1 vaccine dose; 17 681 (39.3%) received a second dose. The number of hepatitis A cases among the entire county population declined 93.5% during the study period, from 57 cases in 1995 to 4 in 2000, the lowest number of cases reported in the county since hepatitis A surveillance began in 1966. The 2000 incidence rate of 1.9 per 100 000 population was the lowest of any county in the state. Of the 245 cases reported during the 6-year period, 40 (16.3%) occurred among children 17 years of age or younger, of which 16 (40%) occurred in 1995 and only 1 in 2000. One of the 27 case patients eligible for vaccination had been vaccinated, having received the first dose 3 days before symptom onset. The estimated protective vaccine efficacy was 98% (95% confidence interval, 86%-100%). CONCLUSIONS: In this population, hepatitis A vaccine was highly effective in preventing disease among recipients. Childhood vaccination appears to have decreased hepatitis A incidence among children and adults and controlled the disease in a community with recurrent epidemics.