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PubMed2002

Polychlorinated biphenyls, TEQs, children, and data analysis.

The data analyses in the publications reviewed in Kimbrough et al (1) and Kimbrough and Krouskas (2) are discussed. All of the studies involve infants exposed in utero to small amounts of polychlorinated biphenyls (PCBs) and/or other chlorinated hydrocarbons. Because of missing sampling data, attrition of the cohorts over time, the use of TEQvalues (toxic equivalence) for some congeners of PCBs (polychlorinated biphenyls), PCDDs (polychlorinated dibenzo-p-dioxins) and PCDFs (polychlorinated dibenzofurans), the correlations reported by the authors between chemical exposure and adverse outcomes are not convincing. For the most part the exposures in these cohorts in the US and in Europe were within the ranges observed in the general population, and in many biological samples the level of organochlorines were below the limit of detection of the analytical method. Appropriate evaluation of such data is difficult given the many existing confounders. Many comparisons were made in the different studies. The observed differences were not consistent across studies and most likely occurred by chance. None of the observed differences reported in the children represent clinical disease.

Analysis of Variance↗

PubMedDate not supplied

Determination of fluoride intake from urinary fluoride excretion data in children drinking fluoridated school milk.

Twenty-four-hour urine samples were collected from each of thirteen 5- to 6-year-old children both under customary conditions of fluoride intake (i.e. usual diet including milk containing 0.5 mg fluoride and usual oral hygiene procedures with fluoride toothpaste) and during a 4-day study period in which their customary fluoride intake was replaced with standard fluoride doses. The 24-hour fluoride excretion under customary conditions of fluoride intake was 0.30 mg and in response to fluoride doses in the range of 0.5-2.0 mg it was in the range 0.26-0.61 mg. Using data obtained during the study period for all subjects combined, the fluoride intake from all sources under customary conditions was estimated as 0.76 mg, representing a fractional fluoride excretion of 39%. It is concluded that these children are possibly receiving suboptimal amounts of fluoride.

Animals↗

PubMed2004

Electrophysiological recording of deep tendon reflexes: normative data in children and in adults.

OBJECTIVE: Latency measurement of myoelectric deep tendon (T) reflex responses is not usually performed in EMG laboratories. We investigated the optimal conditions of reliable recording of T reflex in children and adults. METHODS: Two hundred and sixty-eight normal subjects (139 males, 129 females, age rank 2 days-80 years) were studied. T reflexes were recorded from soleus and rectus femoris muscles (children and adults) and from triceps brachialis, biceps brachialis and flexor carpi radialis (adults). Specially devised hammers were used. They were fitted with a spring switch system in order to trigger the trace display on the EMG machine. Distinct technical options for the synchronisation delay assessment were tested. The nerve conduction velocities along reflex pathways were computed by referring the T wave latencies to subject's height. RESULTS: Reliable recordings could be obtained in all cases, with a strong linear correlation of the response latency with height. T reflex conduction velocities increased as the log value of subject age. Normative data from birth to 80 years are provided. CONCLUSION: T reflex recording represents a painless and easily performed technique. It may be helpful for the assessment of proximal conduction velocities, especially in children during maturation of the peripheral nervous system.

Adolescent↗

PubMed1999

A mathematical model for the analysis of cross-sectional brain glucose metabolism data in children.

1. The authors present here a 5-parameter developmental function designed to describe quantitatively the time-course of changes in glucose metabolism with age. This function consists of a plateau phase which is described by the rate of increase with age and the height of the plateau, followed by a decline phase characterized by the rate of decrease to adult levels. These two phases are separated by a distinct point in time, at which the transition between the two phases occurs. 2. The model is designed to fit published data showing that glucose metabolic rate in frontal cortex at birth is about 60% of adult values (mean adult value is 24 mumol/100 g/min) and increases to slightly less than triple adult value by age 3. The metabolic rate remains at this level until the age of approximately 8 years when it starts the decline to adult values. 3. A procedure is presented which allows the approximate computation of the 98% confidence contours in data space for the developmental function. The computation is based on the joint probability function obtained from the model covariance matrix. 4. The newly designed 5-parameter developmental function is well suited to describe maturational changes of glucose metabolism. Due to its excellent model identifiability and the interpretability of individual parameters, this function is better suited for description of maturational changes than the gamma-function. Furthermore, this function may provide a useful framework for interpretation of other data sets during development.

Adolescent↗

PubMed2000

Bronchoalveolar lavage and esophageal pH monitoring data in children with "difficult to treat" respiratory symptoms.

Gastroesophageal reflux (GER) may be associated with chronic or recurrent asthma-like symptoms secondary to bronchoconstrictor reflexes and/or inhalation of gastric content. The presence of lipid-laden alveolar macrophages has been proposed as an index to establish the degree of gastric aspiration. We evaluated 20 children with "difficult to treat" respiratory symptoms and a clinical history suggestive of GER. All children underwent 24-hr esophageal pH monitoring (pHm) and fiberoptic bronchoscopy with bronchoalveolar lavage (BAL). The amount of lipid per single macrophage was determined by a semiquantitative method, using fluorescence microscopy to detect Nile-Red-stained BAL cells and calculating a lipid-laden macrophage index (LLMI). Eleven children had positive pHm recordings, suggesting the presence of GER (pH-positive patients), and 9 had negative pHm records (pH-negative patients). The pH-positive patients had higher percentages of neutrophils and higher LLMI than the pH-negative children (P < 0.05). There were no correlations between the pHm records and either % BAL neutrophils or LLMI in pH-positive or pH-negative patients (P > 0.05; each correlation). In contrast, a single correlation was found between % BAL neuytrophils and LLMI, both in the pH-positive and in the pH-negative patients (r = 0.72, P = 0.02 and r = 0.71, P = 0.04, respectively). These data demonstrate that a significant proportion of pH-positive patients with respiratory symptoms have BAL abnormalities that suggest airway inflammation and gastric content aspiration. However, the intensity of GER as indicated by pH monitoring does not correspond with BAL data in all patients.

Bronchoalveolar Lavage↗

PubMed1995

[Perioperative fasting in children: current data].

Perioperative fasting aims at decreasing the incidence of gastric content inhalation during anesthesia. Current knowledge concerning gastric emptying and the epidemiology of pulmonary aspiration authorizes new perioperative fasting guidelines. If prolonged fasting does not guarantee gastric emptiness at the induction of anesthesia, shortening preoperative fasting by allowing clear fluids two hours before surgery does not modify gastric content and does not increase the risk of gastric content aspiration, while enhancing the patient comfort by reduction of the fasting period. On the other hand, after surgery, the mandatory intake of water significantly increases the incidence of postoperative vomiting. Therefore new guidelines may be applied for children operated in ambulatory surgery settings: 1) clear fluids may be allowed until 2-3 hours before operation, 10 ml.kg-1, or even ad libitum for some authors (by clear fluids one means water, tea, coffee, apple juice, syrup with water); 2) drinking is not absolutely necessary before discharge from day care surgery unit and should be left to the child's own assessment.

Child↗

PubMed2004

Ghrelin gene polymorphisms and ghrelin, insulin, IGF-I, leptin and anthropometric data in children and adolescents.

BACKGROUND: Previous investigations on the ghrelin gene reported three common polymorphisms (Arg51Gln, Leu72Met, and Gln90Leu), but their role in overweight and obese individuals remains to be clarified. OBJECTIVE: To ascertain whether these genetic variants could influence ghrelin secretion and play a part in predisposing to earlier onset of obesity or in modulating the overweight phenotype in childhood. DESIGN AND METHODS: Mutational analysis of the entire ghrelin gene and total and acylated plasma determinations were performed in 81 obese or overweight children and adolescents (46 were obese and 35 overweight: Ob/Ow). We also recruited 168 normal-weight healthy controls (72 young adults and 96 children) for mutational or plasma ghrelin analysis. RESULTS: Median total and acylated plasma ghrelin concentrations were significantly lower in Ob/Ow individuals than in controls (175 pg/ml compared with 345 pg/ml, P<0.0001, and 95 pg/ml compared with 114 pg/ml, P<0.0001, respectively). The ghrelin gene variants showed similar allele frequencies in the Ob/Ow individuals and in controls; in the former, they were not associated with any change in total and acylated circulating ghrelin concentrations or anthropometric data. The Leu72Met status was associated with a positive family history for obesity (75% for Leu72Met compared with 39% for Leu72Leu, P=0.03) and with a greater percentage of newborns born 'large for gestational age' (33% for Leu72Met compared with 5% for Leu72Leu, P=0.03), but in the control group it was related to a lower mean body mass index z-score (-0.03 for Leu72Met and -0.47 for Leu72Leu, P=0.04). CONCLUSION: Our present findings do not support the hypothesis that the ghrelin gene polymorphisms have a relevant impact in the secretion of total and acylated ghrelin.

Adolescent↗

PubMed2005

Cerebral oligodendrogliomas in adults and children. Current data and perspectives.

Cerebral oligodendrogliomas represent more than 30% of glial tumors in adults. Mean age at diagnosis is 41 for grade A and 45(1/2) for grade B, epilepsy being the main revealing symptom (91.5% of A, 76% of B). Survival at 5, 10 and 15 years is respectively 75.5%, 51% and 22.4% for grade A (median: 136 months), and 45.2%, 31.3% and 0% for grade B (median: 52 months). It is influenced by age at diagnosis: median, before 40 years of age, is 12 years for A and 8(1/2) for B; between 40 and 60, is 12 years for A and 4(1/2) for B; over 60, is 4 years for A and 1(1/2) for B. In children, they represent less than 2.5% of cerebral tumors and include 23% grade A and 77% grade B (48.5% WHO grade II and 51.5% WHO grade III). Mean age at surgical removal is 9.5 +/- 5 years. One third are hemispheric, 2/3 are revealed by epilepsy. A complete surgical removal is performed in 60%. Mean survival is 13 years (154 +/- 20 months), with a mortality at 5 and 10 years of 60% +/- 9%, and a risk of recurrence of 54% +/- 9% at 5 years and 46.5% +/- 10.5% at 5 years. The main differential diagnosis of grade A oligo is dysembryoplastic neuroepithelial tumors (DNT). Inversely, thalamic locations, most often grade B, generally present with a motor deficit; complete removal can be achieved in only 15%. The only efficient treatment is chemotherapy, requiring search for chemosensitivity (1p19q deletion, expression of MGMT gene, analysis by MR-spectroscopy and TEP). Logically, surgical debulking should be as wide as possible, but with preservation of neurological and cognitive functions with the help of modern imaging progresses (fMRI, diffusion and perfusion MRI, tractography, PET) and operative techniques (navigation, cortical stimulation, and even opertaive MRI). Tumors presenting clinical and radiological progression should be removed. Operative mortality varies from 0 to 6%, transient morbidity from 20 to 25%, definit morbidity from 5 to 10%. Radiotherapy does not significantly modify survival whatever the delivered dose. The important point is the patient's radiosensitivity: survival is 148 months for radiosensitive patients versus 12 months for non responsive patients. Studies and development of pretherapeutic assays of tumoral radiosensitivity will be a fundamental research axis (PET, sample studies).

Adult↗

PubMed1989

Screening panoramic radiographs in children: prevalence data and implications.

The purpose of this paper was to review the rationale for the radiographic screening of asymptomatic pediatric patients and to report the prevalence of selected pathologic and developmental conditions using panoramic radiographs. Three observers participated in this retrospective study that utilized panoramic radiographs from 849 subjects, aged 3-9 years, chosen randomly from the School of Dentistry treatment records of the University of North Carolina at Chapel Hill. Findings indicated that 2.4% of the subjects had supernumerary teeth, 7.8% were missing permanent teeth, 9.1% had ectopic eruption, 0.1% had radiolucencies of the jaws, and 0.1% had radiopacities of the jaws. These prevalences are discussed in light of recent evidence concerning the risk/benefit ratio of the panoramic radiograph. We conclude that the panoramic radiograph is a poor projection for screening the dental needs of asymptomatic healthy children; alternative screening protocols should be examined.

Child↗

PubMed1987

Phase contrast microscopy of the urine sediment for the diagnosis of glomerular and nonglomerular bleeding-data in children and adults with normal creatinine clearance.

In a pediatric and in an adult group of patients with hematuria and normal creatinine clearance overnight urine examination was carried out on 2 nonconsecutive days by means of phase contrast microscopy by two independent observers working in two different institutions. In this way it was possible to distinguish between patients on the basis of dysmorphic (glomerular) and isomorphic (nonglomerular) red cells in urine and to correlate the findings with the final diagnosis. A clear-cut indication (more than 80% of isomorphic and/or dysmorphic red cells) was obtained in 163 patients (102 of pediatric age) and final diagnosis of hematuria correlated with red-cell microscopy findings in 96.4% of glomerular diseases and in all cases of nonglomerular origin. Mixed hematuria (50-75% of dysmorphic red cells) was found in 2 cases of renal tuberculosis, 2 cases of polycystic kidney disease and in 1 child with viral meningoencephalitis with a bladder stone. The data indicate that the method is safe and accurate but further experience must be gathered for the many etiologies of glomerular and nonglomerular diseases hitherto not studied.

Adolescent↗

PubMed1998

Prevalence of headache in children of a school from Curitiba, Brazil, comparing data obtained from children and parents.

This study analyzed prevalence, frequency and cause of headache among 460 children ranging from 10 to 14 years-old from a Brazilian school. A questionnaire was handed both to children and parents to know if there would be differences among children and parental reports. The lifetime prevalence of headache was 93.5% (children reports) and 93.3% (parental reports). The last year prevalence was 90% (children) and 89.8% (parents). Headache episodes were frequent in 17.6% (children) and 18.5% (parents). The most often reported cause was "flu" (39.1% by children, and 46.7% by parents). This study demonstrated that the prevalence of headache in children is high; moreover, there were noted few differences between data obtained from children and parents. So, we could say that when the objective of a epidemiologic study is to determine the prevalence of headache in children, both children and parental reports may be used.

Adolescent↗

PubMed1986

Lesbian mothers and their children: a comparison with solo parent heterosexual mothers and their children.

Two types of single-parent households and their effects on children ages 3-11 years were compared. One type comprised 50 homosexual mothers and their 56 children, and the other was a group of 40 heterosexual mothers and their 48 children. There were 30 daughters and 26 sons of homosexual mothers and 28 daughters and 20 sons of heterosexual mothers. The sexual identity and social relationships of the children were assessed in relation to the sexual orientation of the mothers. The samples consisted of families from rural and urban areas in 10 American states. All have lived without adult males (18 years or older) in the household for a minimum of 2 years (average 4). Families with heterosexual mothers were matched to families with homosexual mothers on age and race of mother; length of mother and child separation from father; educational level and income of mother; and number, age, and sex of children. Data are reported from childrens' tests designed to provide information on general intelligence, core-morphologic sexual identity, gender-role preferences, family and peer group relationships, and adjustment to the single-parent family. No significant differences were found between the two types of households for boys and few significant differences for girls. Concerns that being raised by a homosexual mother might produce sexual identity conflict and peer group stigmatization were not supported by the research findings. Data also revealed more similarities than differences in parenting experiences, marital history, and present living situations of the two groups of mothers. The postulated compromised parental fitness of lesbian mothers, commonly asserted in child custody cases, is not supported by these data.

Adult↗

PubMed2006

Accuracy of HCV-RNA PCR tests for diagnosis or exclusion of vertically acquired HCV infection.

The aim of the study was to estimate the sensitivity, specificity, positive (PPV) and negative (NPV) predictive values, and likelihood ratios for HCV-RNA PCR tests for the early diagnosis or exclusion of HCV infection in vertically exposed children. Data were included for children with confirmed HCV infection status from a European multi-center study. Confirmation was dependent on antibody status at or beyond 18 months, the 'gold standard' measure of infection status against which the use of qualitative HCV-RNA PCR tests was assessed. Of the 547 children included in this analysis, 193 were HCV-infected and 354 were not. Sensitivity of the HCV-RNA PCR test was low at birth (22%), but increased to 85% by 6 months. Specificity of RNA PCR was constant over age at 98%. The PPV of the PCR test rose from 33% at birth to 78% at 9 months of age, while NPV ranged from 96% to 99%. The high positive likelihood ratios from 1 month of age indicate strong evidence to diagnose infection but the negative likelihood ratios were consistent with weak evidence to exclude infection. The results suggest that the first qualitative HCV-RNA PCR test should be delayed until after the first month of life given the low sensitivity in the first few weeks. Although a negative test result after this time indicates probable absence of infection, this should be confirmed with a negative anti-HCV antibody test between 9 and 15 months of age as negative PCR results can be observed in infected children with fluctuations in viremia.

Age Factors↗

PubMedDate not supplied

Physical exercise program for children with bronchial asthma.

A long-term physical exercise program was established for a large number of children with bronchial asthma. Asthmatic children were first taught to swim on their backs to prevent breathing problems customary for beginners using other strokes. They concurrently participated in gymnasium exercises, and the program was later completed with outdoor running. Program effectiveness was evaluated by monitoring asthmatic symptoms, changes in medication, and changes in the activity and physical fitness of the children. Data collected from 121 children showed that during the first year in the program the number of days with asthmatic symptoms decreased in a large majority of the patients while medication was decreased. School absenteeism and hospitalization dropped markedly. Parental evaluation of the children indicated much improvement in 51.2%, improvement in 40.5%, unchanged condition in 7.4%, and deterioration of general health was only reported in one child (0.8%). The same extent of improvement continued during the second year. The Cooper test was applied for the first time to such an exercise program and indicated that the participating asthmatic children performed as well as a control group of nonasthmatic children, and the cardiovascular efficiency of the asthmatics was actually better.

Adolescent↗

PubMed2001

The italian determiner system in normal acquisition, specific language impairment, and childhood aphasia.

The paper presents a comparison of the development of the Italian determiner system in three different populations: normally developing children, a child recovering from childhood aphasia from the age of 3 years, 9 months, and 11 specific language impairment (SLI) children. Data from Italian normal children provide evidence for the hypothesis (1) that no prefunctional stage exists as far as the determiner system is concerned and (2) that the syntactic properties of determiners play an essential triggering role early on. The analysis of the determiner system in the aphasic child has a double interest. On the one hand, it may help to shed light on some of the intriguing questions concerning this type of disorder; on the other, it may be relevant for the discussion of the notion of agrammatism. Results of the morphosyntactic analysis reveal that, apart from timing differences, recovery from childhood aphasia shares important features with normal development. Differently from mean length of utterance (MLU)-matched normal controls and the aphasic child, SLI children omit determiners significantly more often than almost any other functional category or free morpheme. We will argue that the reasons for the SLI children's atypical behavior have to be sought in the nonaccessibility to or in the misappreciation of one fundamental syntactic property of determiners: their role as elements that assign argumenthood to nominal expressions (Szabolcsi, 1987; Longobardi, 1994).

Aphasia↗

PubMed2005

[Estimation of the dietary intake of pesticide residues based on new consumption data for children].

The risk assessment of pesticide residues is based on the estimation of their dietary intake. Models based on a new national consumption survey were developed to estimate the short- and long-term dietary intake of pesticide residues for children from 2 to under 5 years, allowing a realistic risk assessment to be made. The recommended methods are described. At the national level, the new models shall replace the previous methods for evaluating dietary intake.

Child↗

PubMed1997

Short- and long-term (final height) data in children with normal variant short stature treated with growth hormone.

UNLABELLED: Seventeen children with normal variant short stature and a predicted height below -2 SDS were treated with growth hormone (GH) six times a week for a period of 5 years. Patients were randomly selected to receive three different doses of GH, group 1 (n = 6) 3 IU/m2 per day, group 2 (n = 6) 4.5 IU/m2 per day and group 3 (n=5) 3 IU/m2 per day in the 1st year and 4.5 IU/m2 per day thereafter. There was a significant increase in height after 1 and 2 years for all patients and for all subgroups. However, this increase was not dependent on GH dose. The decrease in height velocity during the 2nd year was not prevented by the increase of GH dose in group 3. The change of predicted height after 2 years was +0.75 SDS (according to Tanner Whitehouse). Fourteen children have been treated for 4 years and 8 children for 5 years without a further change in height prediction. Nine patients have reached final height which was 2.4 cm (+0.41 SDS) above pretreatment height prediction. Final height was nearly identical to predicted height after 1 year of therapy. CONCLUSION: An increment in height prediction was observed during the first 2 years of GH treatment and maintained thereafter. However, there was only a minor increase in final height over predicted height which does not justify the general use of GH in children with normal variant short stature.

Adolescent↗

PubMed2006

Gradients in the health status and developmental risks of young children: the combined influences of multiple social risk factors.

OBJECTIVES: To analyze child vulnerability as a profile of multiple risk factors for poorer health based on race/ethnicity, social class (maternal education and family poverty status), child health insurance coverage, and maternal mental health. Profiles are examined in relation to disparities in the health status and developmental risks of young children. DATA SOURCES: Cross-sectional data on 2,068 children ages 4-35 months from the 2000 National Survey of Early Childhood Health. STUDY DESIGN: Multiple logistic regression models are used to examine risk profiles in relation to child health status and developmental risk (based on parent concerns about development). The profiles are also examined in relation to three measures of basic access to health care: telephone contact with a physician, well-child visit in the past year, and missed or delayed needed care. PRINCIPAL FINDINGS: About one-third of (or 3.1 million) young children in the United States have two or more risk factors (RF) for poor health. Controlling for other family factors, having more RFs is associated with poorer health status (i.e., percent reported "good/fair/poor" vs. "excellent/very good") and being higher risk for developmental delays. For example, the likelihood of having either poorer health or higher developmental risk increases with each RF (vs. zero): 1 RF (OR = 1.70, CI: 1.20-2.38), 2 RFs (OR = 3.28, CI: 2.27-4.73), 3 RFs (OR = 4.69, CI: 2.84-7.73), 4 RFs (OR = 14.58, CI: 4.98-42.64). Higher RFs were also associated with poorer health care access. CONCLUSIONS: This study demonstrates a dose-response relationship of higher risk profiles with poorer child health status and higher developmental risk. Because children with higher profiles of risk are also more likely to lack access to care, this suggests that children who most need care have the greatest difficulty obtaining it. Addressing health gradients for vulnerable children will require explicit attention to these multiple, overlapping risk factors.

Black or African American↗