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Biomedical subjects

Richard Reading

Publications and source records attributed to Richard Reading.

6 recordsLinked to original sources
PubMed2006

Evidence for sexual transmission of genital herpes in children.

INTRODUCTION: Genital herpes in a prepubertal child presents a child protection clinician with a difficult problem: how likely is it that transmission occurred as a consequence of sexual abuse? Published guidelines on the management of sexually transmitted infections in children provide varying recommendations and refer to a limited literature. OBJECTIVE: To review the evidence for the likelihood of sexual transmission in a child with proven genital herpes. METHODS: Structured literature search for reports of series of children presenting with genital herpes where an assessment for possible sexual transmission or child sexual abuse had been made. RESULTS: Five suitable papers were identified. Although just over half of reported cases of genital herpes in children had evidence suggestive of a sexual mode of transmission, the quality of assessment of possible sexual abuse was too weak to enable any reliable estimation of its likelihood. Sexual transmission is reported more commonly in older children (aged > or =5 years), in children presenting with genital lesions alone and where type 2 herpes simplex virus is isolated. CONCLUSIONS: Child protection clinicians should be aware of the weakness of the evidence on the likelihood of sexual transmission of genital herpes in prepubertal children. The US guidance that child sexual abuse is "suspicious" reflects the evidence better than the UK guidance that it is "probable". A larger, more up-to-date, methodologically sound, population based study is required.

Adolescent↗
PubMed2006

Deprivation and incidence of epilepsy in children.

OBJECTIVE: To determine differences in the incidence of epilepsy associated with deprivation. DESIGN: Cross-sectional study of new cases of epilepsy presenting over 3 years linked to census based population and deprivation data. SETTING: Norfolk UK. PATIENTS: Children aged 29 days to 14 years presenting to the only district hospital serving the study area. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Incidence of epilepsy in quartiles of areas defined by Townsend deprivation score. RESULTS: Overall annual incidence of epilepsy was 6.63 cases per 10,000. There was no association between epilepsy incidence and deprivation with rates of 6.5, 8.0, 4.1 and 7.9 per 10,000 per year, respectively, in areas with increasing levels of deprivation. Proportions of children investigated for possible epilepsy and of children treated for epilepsy showed no social variation. CONCLUSIONS: We did not find social inequalities in the incidence of epilepsy in children. Nor was there evidence for the inverse care law in the investigation or treatment of epilepsy in children.

Adolescent↗
PubMed2004

Atopic dermatitis and the hygiene hypothesis: a case-control study.

BACKGROUND: The notion that lack of exposure to infection in early life leads to development of atopic disease has come to be known as the hygiene hypothesis. It has arisen from observations of the rapidly rising prevalence of atopic diseases in recent decades and the lower prevalence of atopy with rising birth order. Direct evidence for the hypothesis to date is inconsistent. METHODS: A case-control study set in Norfolk, UK of 602 children aged 1-5 years. Cases and controls were defined using the UK Diagnostic Criteria for atopic dermatitis (AD) and a range of direct and indirect methods were used to measure exposure to infection during infancy. Odds ratios (OR) for the effect of these measures were calculated using logistic regression with adjustment for possible biological and social confounding factors. RESULTS: Reduced odds of AD were associated with rising birth order (OR for one older sibling 0.59, 95% CI: 0.42, 0.84 and for >or=2 older siblings 0.49, 95% CI: 0.31, 0.77). None of the measures of infection reduced the odds of AD significantly, either in the unadjusted or adjusted analyses. None of the measures of infection explained the protective effect of older siblings. CONCLUSIONS: Increased exposure to infection does not explain the reduced risk of AD in second and subsequent siblings. More generally, these data cast doubt on the hygiene hypothesis as a causal explanation for AD in young children.

Case-Control Studies↗
PubMed2004

Infant immunization and family size.

BACKGROUND: To investigate whether a delay in infant immunization is associated with the number of older siblings. METHODS: A cohort analysis of cumulative immunization uptake in 616 children aged 1-4 years recruited for a case-control study of atopic dermatitis in Norwich, UK was performed. The main outcome measures were the age of third pertussis and MMR immunizations. Delayed immunization was defined as a pertussis immunization age 6 months or greater, and MMR immunization aged 16 months or greater. RESULTS: Having a larger number of older siblings was associated with a delay in pertussis immunization (6.2 per cent for children with no older siblings versus 23.3 per cent for children with two or more older siblings), but not in MMR immunization. CONCLUSION: Infants with older siblings are at greater risk of pertussis infection from intrafamilial contagion yet are less likely to be immunized on time.

Child Health Services↗
PubMed2003

Household and neighbourhood risks for injury to 5-14 year old children.

Injuries in childhood are strongly related to poverty at the household level and to living in a deprived neighbourhood, but it is not clear whether these effects are independent. In this prospective population study, all injuries to 5-14 year old children living in the city of Norwich, UK, and presented at the hospital Accident and Emergency Department over a 13 month period were recorded (N=3526). Information on the population of resident children and household composition was assembled from the health authority population register. Neighbourhood information was extracted from the census and local surveys. Unadjusted risks were calculated for individual and neighbourhood factors, followed by multilevel modelling in which predictors were included at three levels: individual, enumeration district and social area (neighbourhood). The overall injury rate was 16.44 per 100 children per year. Injury rates between neighbourhoods varied two-fold and were highest in more deprived areas. In the final multilevel model injury risk was related to gender (boys vs. girls OR=1.35), age of child (OR=1.07 per year), number of adults in the household (OR=0.91 per adult), and age gap between child and eldest female (15-24 years vs. 25-34 years, OR=1.15). Injury rates were also related to social area deprivation, although variations in injury rates between neighbourhoods were not wholly explained by deprivation. The adjusted odds ratio between the most and least deprived social areas was 1.35. Excluding less serious injuries did not substantially change the results. The risks were very similar to those found in a previous study of pre-school children, with the same neighbourhoods identified as high and low risk as before. This evidence that neighbourhood factors independently influence injury risk over and above individual and household factors supports the use of area-based policies to reduce injuries in children.

Child↗