Biomedical subjects
D M Fergusson
Publications and source records attributed to D M Fergusson.
Morbidity during the preschool years.
The prevalence of illness was studied in a birth cohort of Christchurch children during the period from birth to 5 years. By 5 years children had made an average of 18.0 family doctor consultations for morbidity and a further 4.7 for preventive health care procedures; 38% had been admitted to hospital on at least one occasion and 62% had made one or more attendances at a hospital outpatient department. The majority of general practitioner consultations involved four major groups of conditions: respiratory illness; integumental lesions; gastrointestinal illness and accidents. Hospital admissions were dominated by six groups of conditions: respiratory illness, minor surgery, accidents, feeding and management problems, admissions relating to the child's home environment and gastrointestinal illness. Two thirds of hospital outpatient attendances were accounted for by five groups of conditions: accidents; musculoskeletal conditions; respiratory illness; vision problems and congenital heart murmur.
Humidification in viral croup: a controlled trial.
Sixteen children (mean age 1.9 years) admitted to hospital with viral croup were assigned randomly to either a high humidity atmosphere or room air. No other treatment was given. During the initial 12 h both groups of patients showed a similar rate of recovery as measured by pulse rate, respiration rate, transcutaneous oxygen (TcO2), transcutaneous carbon dioxide (TcCO2) and a clinical rating. No therapeutic benefit was demonstrated from the provision of a high humidity atmosphere. The widespread use of humidification in the management of croup requires reappraisal.
The antidiuretic hormone response to therapy for acute asthma.
The plasma antidiuretic hormone concentrations in eight asthmatic children were measured at the onset of an acute severe attack and were repeated 24 h later. Conventional therapy and maintenance fluid intake resulted in a significant fall in antidiuretic hormone concentrations without abnormal changes in other biochemical indicators of dehydration.
Early hospital admissions and subsequent behaviour problems in 6 year olds.
The relation between admission to hospital during the preschool years and teacher and maternal ratings of child behaviour problems at age 6 years was studied in a birth cohort of New Zealand children. There was a slight but consistent trend for reported behaviour problems to increase with increasing length of hospital stay, however, control for family and social factors suggested that this correlation was spurious. Children admitted to hospital tended to come from socially disadvantaged backgrounds and from families reporting large numbers of life events, and independently of this social background and life events were related to childhood behaviour problems. When the effects of family social background and life events were controlled for, there was no significant association between duration of hospital stay and reports of child behaviour problems. It is concluded that there is little evidence to suggest that in a modern paediatric setting, admission to hospital has any significant effect on the child's subsequent behavioural pattern.
Relationship of family life events, maternal depression, and child-rearing problems.
The relationship between maternal reports of child-rearing problems, family life events, and maternal depressive symptoms was studied in a birth cohort of children in New Zealand. Rates of child-rearing problems showed a steady increase with both increasing levels of family life events and maternal depressive symptoms. Log-linear modeling of the results suggested that the apparent correlation between family life events and reports of child-rearing problems was mediated by the effects of maternal depression so that women subject to large numbers of adverse life events suffered increased rates of depression and in turn reported higher rates of problem behavior in their children. There was no significant correlation between family life events and reports of child-rearing problems when the effects of maternal depressive symptoms were taken into account. The findings tend to suggest that the previously reported association between family life events and child-rearing problems arises because life events provoke depressive symptoms in women and in turn this alters the way in which they perceive or evaluate their children's behavior.
Domestic swimming pool accidents to pre-school children.
The frequency of accidents in domestic swimming pools was studied retrospectively for a sample of 1123 Christchurch children. During the period from birth to five years, a total of 94 such accidents were reported. While most were trivial and readily rectified by rapid adult intervention, we found six children who clearly might have drowned in a domestic swimming pool but for adult vigilance and a certain amount of luck. These findings underline the fact that current mortality statistics merely reflect the minority of such incidents in which either parental vigilance or luck does not operate. Children with pools on their own or neighbouring properties were two and a half times more likely to be involved in accidents involving domestic pools. We reiterate our plea for the introduction of a uniform and well enforced set of domestic swimming pool safety regulations.
Spread of rotavirus within families: a community based study.
The spread of rotavirus infection was studied over four weeks in a sample of 28 families exposed to a child with rotavirus infection. The results showed a high incidence of intrafamilial infection, with 46% of members of these families developing rotavirus infections compared with none in another series of 18 families. Children in the families with an index case were more frequently affected than adults: 75% of the children developed rotavirus infection but only 33% of the adults. Children tended to suffer the infection in a more severe form. Intrafamily contact is clearly important in transmitting rotavirus infection, and preventive measures should aim at reducing the likelihood of such cross infection.
Acute respiratory infection in childhood: the factors which influence hospital admission.
A study of 100 children admitted to hospital with acute respiratory infection revealed that general practitioners remain the major referral source. Changing financial factors do not appear to have influenced this process. Sixty percent of children had a mild illness, requiring a short period hospital stay, but their referral was on a medical rather than a social basis.
Attitudes of mothers of five-year-old children to compulsory child health provisions.
The attitudes of a sample of 1123 mothers of five-year-old children participating in the Christchurch Child Development Study, to a series of issues relating to the compulsory protection of children were studied. The issues examined were: the introduction of car seat restraint legislation, compulsory fencing of domestic swimming pools, the desirability of linking child health care provisions to family benefit payments and the desirability of water fluoridation. Contrary to common assumptions, this sample showed strong support for the introduction of compulsory methods for protecting child health: approximately 90% of respondents favoured car restraint and pool fencing provisions, two-thirds were in favour of linking family benefit payments to routine child health care provisions but less than half were in favour of water fluoridation. The implications of these findings for the introduction of compulsory child health provisions are discussed.
Asthma, air pollution and climate: a Christchurch study.
The relationship of hospital attendances for acute asthma attacks to air pollution levels in Christchurch was studied over the winter months of 1981. Attendances for acute asthma did not increase with increases in air pollution; indeed, higher pollution tended to be characterised by lower hospital attendances. This trend increased when multiple regression analysis was used to control the effects of climatic factors.
The safety standards of domestic swimming pools 1980-1982.
The accessibility and safety standards of domestic swimming pools were studied for a sample of 1118 five-year-old children. Comparison with data collected in 1980 indicated two major trends. First, there has been an increase in the number of children in this birth cohort who had a swimming pool on their property or on a neighbouring property: in 1980 31 percent of children were living on a property with a swimming pool or had neighbours with a swimming pool; in 1982 this figure had risen to 41 percent. Coupled with this increasing number of swimming pools there was a marked decline in pool safety standards. In 1980 one in five pools lacked any safety features whereas in 1982 nearly half of the pools surveyed lacked these features. This situation of an increasing number of domestic pools associated with declining safety standards may be a factor in the increasing number of child drownings in domestic swimming pools in New Zealand. The mothers were also questioned about their attitudes to fencing legislation or by-laws requiring adequate pool fencing and gates. This showed strong support with 86 percent of mothers being in favour of such regulations and only 9 percent declaring disagreement with such a move.
Costing of treatment strategies in the case of childhood respiratory illness.
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Parental asthma, parental eczema and asthma and eczema in early childhood.
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Childhood disadvantage and the planning of pregnancy.
The relationship between the planning of pregnancy and subsequent childhood childhood disadvantage in the areas of health, education and family conditions was studied prospectively to the age of 3 years in a birth cohort of New Zealand children. Unplanned children showed a systematic pattern of disadvantage in nearly all areas studied. However, multivariate analysis suggested that the apparent association between the planning of pregnancy and subsequent childhood disadvantage arose largely from a series of social and contextual factors associated with pregnancy planning practices. In particular, unplanned children tended to come from socially disadvantaged home backgrounds and these backgrounds were independently associated with an increased risk of childhood disadvantage. Further, a disproportionate number of unplanned children were ex-nuptial and the levels of disadvantage experienced of these children tended to reflect more their ex-nuptial status than the direct effects of failure to plan the pregnancy. It is concluded that when the effects of maternal social background and the nuptial status of the child are taken into account, the effects of planning of pregnancy on levels of childhood disadvantage for this birth cohort were almost negligible.
Inhaled Fenoterol powder in asthma: a long term study.
A study was designed to assess the long term efficacy of Fenoterol powder in asthmatic children. The design included an initial assessment period and a further evaluation after six months, in which Fenoterol or placebo treatments were administered on consecutive days. Objective measurements were obtained from PEFR and FEV1. A diary record was kept to monitor compliance and side effects. A minimum dose of 200 mcg Fenoterol powder was prescribed three times per day. The bronchodilator action of Fenoterol was sustained after a period of six months, in the absence of significant side effects.
Asthma and infant diet.
The relationship of milk diet and solid feeding practices during the first 4 months of life to rates of early childhood asthma was studied prospectively in a birth cohort of 1110 children. The results of the analysis showed no significant association between rates of asthma and breast feeding or solid feeding practices. This was true for children both of asthmatic and non-asthmatic parentage. It is concluded that there is no evidence to indicate that early breast feeding had any detectable effect on the risk of subsequent asthma in this birth cohort. However, the possibility still remains that breast feeding may have a prophylactic effect for children from highly atopic families.