Predictors for snoring in children with rhinitis at age 5

Snoring is often found in allergic diseases and may be an early manifestation of more serious sleep-disordered breathing. We aimed to investigate whether the risk factors for snoring among pre-school children with rhinitis are similar to those for allergic diseases in a birth cohort. The study cohort was drawn from participants in the Childhood Asthma Prevention Study (CAPS). This is a randomized controlled trial of dietary intervention and house dust mite avoidance during the first 5 years of life, aimed at reducing the risk of acquiring asthma and other allergic conditions in children at high-risk for allergic diseases. Parents of children with symptoms of rhinitis at age 5 years (n = 219 out of 516 cohort members) were asked if their child snored: 127 (60%) reported some snoring and 56 (26%) snored more than three times per week. Multiple logistic regression analyses indicated that children who were first-born (adjusted odds ratio, 2.50, 95% CI 1.20-5.21), were exposed to maternal tobacco smoke during the first year of life (2.40, 1.1-5.25), or who had asthma (2.51, 1.14-5.55) and/or eczema (2.29, 1.02-5.13) at age 5 years were more likely to snore. Birth-weight, body mass index at age 4.5, spirometry, and breastfeeding were not related to snoring. Risk factors for snoring are similar to risk factors for allergic disorders. Snoring may be part of the allergic spectrum of diseases. Our data may contribute to clinician's ability to effectively screen for snoring in preschool children.     

Target setting in intensive insulin management is associated with metabolic control: the Hvidoere Childhood Diabetes Study Group Centre Differences Study 2005

Swift PGF, Skinner TC, de Beaufort CE, Cameron FJ, Åman J, Aanstoot H‐J, Castaño L, Chiarelli F, Daneman D, Danne T, Dorchy H, Hoey H, Kaprio EA, Kaufman F, Kocova M, Mortensen HB, Njølstad PR, Phillip M, Robertson KJ, Schoenle EJ, Urakami T, Vanelli M, Ackermann RW, Skovlund SE for the Hvidoere Study Group on Childhood Diabetes. Target setting in intensive insulin management is associated with metabolic control: the Hvidoere Childhood Diabetes Study Group Centre Differences Study 2005. Objective: To evaluate glycaemic targets set by diabetes teams, their perception by adolescents and parents, and their influence on metabolic control. Methods: Clinical data and questionnaires were completed by adolescents, parents/carers and diabetes teams in 21 international centres. HbA1c was measured centrally. Results: A total of 2062 adolescents completed questionnaires (age 14.4 ± 2.3 yr; diabetes duration 6.1 ± 3.5 yr). Mean HbA 1c = 8.2 ± 1.4% with significant differences between centres (F = 12.3; p < 0.001) range from 7.4 to 9.1%. There was a significant correlation between parent (r = 0.20) and adolescent (r = 0.21) reports of their perceived ideal HbA1c and their actual HbA1c result (p < 0.001), and a stronger association between parents' (r = 0.39) and adolescents' (r = 0.4) reports of the HbA1c they would be happy with and their actual HbA1c result. There were significant differences between centres on parent and adolescent reports of ideal and happy with HbA1c (8.1 < F > 17.4;p < 0.001). A lower target HbA1c and greater consistency between members of teams within centres were associated with lower centre HbA1c (F = 16.0; df = 15; p < 0.001). Conclusions: Clear and consistent setting of glycaemic targets by diabetes teams is strongly associated with HbA1c outcome in adolescents. Target setting appears to play a significant role in explaining the differences in metabolic outcomes between centres.     

Physical activity and overweight in children and adolescents using intensified insulin treatment

Aim:  To describe physical activity and inactivity and parameters associated with overweight in a population-based study of children and adolescents on intensive insulin treatment.
Methods:  Physical activity and inactivity were evaluated in 723 type 1 diabetic subjects, 240 children aged 6–10 yr and 483 adolescents aged 11–19 yr, using a questionnaire that can estimate total amount of time spent on inactivity and light, moderate and vigorous activity.
Results:  Overall, 54% of the participants do not fulfil the international recommendations of 60 min of moderate-to-vigorous activity per day. Girls are less active than boys in childhood (70 vs. 88 min/d, p = 0.01) and in adolescence (47 vs. 57 min/d, p = 0.02). Furthermore, this study shows that those who are more active are also those who seldom skip meals (p < 0.001). Forty-three percent of the participants watch TV for more than 2 h a day, and TV viewing was found to be related to overweight in children and adolescents with type 1 diabetes [OR: 2.5 (1.40–4.54), p = 0.002]. No statistical differences in physical activity were noted between the different intensified insulin regimens. Patients wearing insulin pumps were not less active.
Conclusion:  To increase physical activity to recommended level and limit TV viewing should be an important issue in education of all children and adolescents with type 1 diabetes, independent of insulin regimen.     

Health care of young children in foster care

Greater numbers of infants and young children with increasingly complicated and serious physical, mental health, and developmental problems are being placed in foster care. All children in foster care need to receive initial health screenings and comprehensive assessments of their medical, mental, dental health, and developmental status. Results of these assessments must be included in the court-approved social services plan and should be linked to the provision of individualized comprehensive care that is continuous and part of a medical home. Pediatricians have an important role in all aspects of the foster care system.     

Incidence and prevalence of type 1 diabetes in children aged <15 yr in Castilla-Leon (Spain)

OBJECTIVES: To determine the incidence and prevalence of type 1 diabetes in children younger than 15 yr in the Autonomous Community of Castilla-Leon (Spain). RESEARCH DESIGN AND METHODS: All type 1 diabetic cases with onset at <15 yr of age were recorded during 2003-2004. Identified case subjects were ascertained from several sources and the capture-recapture method was used to estimate the completeness of ascertainment. For prevalence, all patients younger than 15 yr with type 1 diabetes at the beginning and at the end of the study were identified. RESULTS: Over the study period, 130 children aged 0-14 yr were diagnosed with type 1 diabetes. The average observed incidence of type 1 diabetes in this population was 22.22/100 000/yr (95% CI 14.57-29.81). Age-standardized incidence was 22.01/100 000/yr (95% CI 18.18-25.83). The highest incidence was observed in the 5-9 yr age-group (32.45/100 000/yr, 95% CI 24.31-40.59). The prevalence at the beginning and at the end of the study was 1.01/1000 and 1.18/1000, respectively. CONCLUSION: Castilla-Leon appears to have one of the highest incidences of childhood type 1 diabetes in Spain, with recent incidence approaching those of some northern European countries.     

TLR4基因3’未翻译区11367位点多态性与儿童哮喘相的相关性

目的探讨TLR4基因3’未翻译区(3’UTR)11367位点的多态性在儿童哮喘人群中的分布及其与患儿特应质、肺炎支原体感染、过敏原和肺功能参数的关系。方法本研究纳入哮喘患儿222例,正常对照290例。采用单管双向等位基因特异性扩增技术(SB-ASA)检测TLR4基因3’UTR 11367位点的基因多态性。使用被动凝集法检测血清肺炎支原体抗体滴度。通过皮肤点刺试验(Skin prick test,SPT)检测常见过敏原。结果哮喘组中TLR4 G11367C位点基因型GG、GC/CC的频率分别是89.6%和10.4%,等位基因G、C的频率分别是93.8%和6.2%,与对照组相比差异无统计学意义(P>0.05);相较于GC型,GG型的哮喘患儿湿疹史更高(P=0.024,OR=2.957,95%CI为1.117～7.828),屋尘螨过敏程度也较GC型重(P=0.021);GG型和GC型患儿肺功能水平没有显著性差异。结论 TLR4基因3’UTR基因多态性与儿童哮喘易感性不相关,但与哮喘患儿有无湿疹史及屋尘螨的过敏程度相关。     

No evidence for linkage in the promoter region of the inducible nitric oxide synthase gene (NOS2) in a Danish type 1 diabetes population

Exposure of human pancreatic islets to a mixture of cytokines induces expression of inducible nitric oxide synthase (iNOS), impairs beta-cell function and induces apoptosis. Exposing human islets to high amounts of NO from chemical NO-donors causes DNA strand breaks and mitochondrial damage, suggesting that NO is deleterious to human beta-cells. Hence, we consider the gene encoding iNOS in beta-cells, NOS2, a candidate gene for type 1 diabetes in humans. In the present study we have tested three identified polymorphisms within the promoter sequence of the human NOS2 gene in a type 1 diabetic family material comprising 154 affected sib-pair families and 103 affected simplex families (1143 individuals in total). PCR-based amplification of the polymorphic loci were established. Linkage analysis was performed using the extended transmission disequilibrium testing (ETDT). A Bsal RFLP was found not to be polymorphic in 20 type 1 diabetic patients and 14 healthy control subjects and was not analysed further. In affected cases a nine allele CCTTT repeat and a bi-allelic TAAA repeat revealed allelewise Petdt of 0.52 and 0.60, respectively. ETDT applied to (TAAA)n; (CCTTT)n haplotypes demonstrated random transmission from heterozygous parents to affected offspring. In conclusion, the tested polymorphisms within the NOS2 gene promoter did not show evidence for linkage to type 1 diabetes in a Danish family material.     

Treatment-related deaths during induction and first remission of acute myeloid leukaemia in children treated on the Tenth Medical Research Council Acute Myeloid Leukaemia Trial (MRC AML10)

Between 1988 and 1995, 341 children with acute myeloid leukaemia (AML) were treated on the Medical Research Council Acute Myeloid Leukaemia Trial (MRC AML10). The 5-year overall survival was 57%, much improved on previous trials. However, there were 47 deaths (13. 8%), 11 of which were associated with bone marrow transplantation (BMT). The treatment-related mortality was significant at 13.8%, but decreased in the latter half of the trial from 17.8% in 1998-91 to 9. 6% in 1992-95 (P = 0.03%). The main causes of death were infection (65.9%), haemorrhage (19.1%) and cardiac failure (19.1%). Fungal infection was a significant problem, causing 23% of all infective deaths. Haemorrhage occurred early in treatment, in children with initial white cell counts >100 x 109/l (P = 0.001), and was more common in those with M4 and M5 morphology. Cardiac failure only occurred from the third course of chemotherapy onwards, with 78% (7/9) in conjunction with sepsis as a terminal event. Some deaths could be prevented by identifying those most at risk, and with prompt recognition and aggressive management of complications of treatment. Future options include the prophylactic use of antifungal agents, and the use of cardioprotectants or alternatives to conventional anthracyclines to decrease cardiac toxicity.     

Management of nephroblastoma in childhood: Clinical study of two forms of maintenance chemotherapy

This report presents results of the first multicentre study of the treatment of nephroblastoma in the United Kingdom. Of 114 children entered in the trial, 108 with localised tumours and without identified metastases were treated by nephrectomy and a 4-day course of actinomycin D, followed by radiotherapy: they were then allocated randomly either to receive further courses of actinomycin D or to receive vincristine for a period of 2 years from diagnosis. The children have so far been followed for periods of between 27 and 69 months; at this stage the superiority of vincristine (in the dose given) to further actinomycin D in preventing local recurrence and metastasis borders on significance; the difference between survival rates also suggests an advantage for vincristine but is not statistically significant. The actuarial survival and continuous disease-free rates at 2 years were 77·7% and 53·6% respectively in the actinomycin D group compared with 87·8% and 79·4% in the vincristine group.