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PubMed1978

[Evaluation of evidential data of diabetic children (author's transl)].

On the basis of the evidential data of 365 children with diabetes mellitus the interrelation between certain data and the manifestation of the diabetes mellitus has been examined. There is a positive correlation between the birth weight and the body length observed at the manifestation. The number of extremely tall children is higher than expected with regard to the population. Equally, the age of parents at the time of birth of their diabetic children is relatively higher when compared to the average of the population. In addition, there are seasonal changes; the most frequent manifestation of diabetes is seen in the months January and October, and--surprisingly--is lowest in May.

Adolescent↗

PubMed2002

Prospective analysis of pediatric pseudophakia: myopic shift and postoperative outcomes.

PURPOSE: Limited data exist about long-term refractive changes in eyes of children with intraocular lens (IOL) implantation. Information of postoperative results should allow more accurate predictions for IOL power implantation in children. Data regarding IOL complications, including secondary membranes, myopic shift, stereopsis, and pseudophakic glaucoma should also be reported. METHODS: In a prospective study, the refractive errors of all pediatric patients between 12 months and 18 years who had cataract surgery and IOL implantation were evaluated at 4 weeks, 3 months, 6 months, 1 year, and every 6 months thereafter. All patients were followed for a minimum of 3 years. RESULTS: Fifty-two eyes of 42 patients met inclusion criteria. Forty-two eyes had developmental cataracts. There were 10 bilateral cases. Of the 52 eyes, 85% had 20/40 vision or better. Visual acuity of 20/30 or better was achieved in 95% of bilateral eyes. In unilateral cataracts, visual acuity was 20/50 or better in 74% of eyes. Mean follow-up time was 5.45 years with a range of 3 to 10.5 years. Mean follow-up by age group ranged between 4.38 and 6.35 years. Children operated on at 12 months to 2 years of age had a mean myopic shift of -5.96 D; children operated on at 3 and 4 years of age had a -3.66 D shift; children operated on at 5 and 6 years of age had a shift of -3.40 D; children operated on at 7 and 8 years of age had a shift of -2.03 D; children operated on at 9 and 10 years of age had a mean shift of -1.88 D; children operated on at 11 to 14 years of age had a shift of -0.97 D; children operated on at 15 to 18 years of age had -0.38 D shift. No cases of pediatric pseudophakic glaucoma were observed. Secondary membrane occurred in 72% of eyes when the capsule was left intact. The operated eye showed a greater mean myopic shift than the nonoperated eye. No statistically significant difference in refractive change was found comparing amblyopic to nonamblyopic eyes or traumatic to nontraumatic cataracts. CONCLUSIONS: The greatest rate of refractive growth or change occurred between 1 and 3 years of age. After age 3 years, the rate of refractive growth followed a more linear trend. Based on this study, we have provided a guide for selecting IOL power in pediatric cataract cases using current formulas with the understanding that new formulas will need to be devised to better predict IOL power in children.

Adolescent↗

PubMed2003

Does this child have acute otitis media?

CONTEXT: Acute otitis media (AOM) is one of the most common problems in pediatrics. An accurate diagnosis of AOM can guide proper treatment and follow-up. OBJECTIVE: To systematically review the literature regarding precision and accuracy of history taking and physical examination in diagnosing AOM in children. DATA SOURCES: We searched MEDLINE for English-language articles published from 1966 through May 2002. Bibliographies of retrieved articles and textbooks were also searched. STUDY SELECTION: We located studies with original data on the precision or accuracy of history or physical examination for AOM in children. Of 397 references initially identified, 6 met inclusion criteria for analysis. DATA EXTRACTION: Two authors independently reviewed and abstracted data to calculate likelihood ratios (LRs) for symptoms and signs. DATA SYNTHESIS: Four studies of symptoms used clinical diagnosis as the criterion standard and were limited by incorporation bias. Ear pain is the most useful symptom (positive LRs, 3.0-7.3); fever, upper respiratory tract symptoms, and irritability are less useful. One study of clinical signs used tympanocentesis as the criterion standard, and we adjusted the results to correct for verification bias. A cloudy (adjusted LR, 34; 95% confidence interval [CI], 28-42), bulging (adjusted LR, 51; 95% CI, 36-73), or distinctly immobile (adjusted LR, 31; 95% CI, 26-37) tympanic membrane on pneumatic otoscopy are the most useful signs for detecting AOM. A distinctly red tympanic membrane is also helpful (adjusted LR, 8.4; 95% CI, 6.7-11) whereas a normal color makes AOM much less likely (adjusted LR, 0.2; 95% CI, 0.19-0.21). CONCLUSIONS: Although many of the studies included in this analysis are limited by bias, a cloudy, bulging, or clearly immobile tympanic membrane is most helpful for detecting AOM. The degree of erythema may also be useful since a normal color makes otitis media unlikely whereas a distinctly red tympanic membrane increases the likelihood significantly.

Acute Disease↗

PubMed2006

The association between birth season and future development of childhood asthma.

The aim of this study was to examine a possible association between birth season (date of birth) and future development of asthma in children. A case-control study was designed to include asthmatic children aged 2-7 years, living in the city of Beer-Sheva, in southern Israel, registered in one pediatric center. Controls were healthy children matched for age and registered at the same clinic. Demographic data, past medical history, and asthma history and severity were collected using the computerized medical charts and asthma registry. A structured telephone questionnaire was used to complete the data. Children with a history of prematurity or chronic significant illness were excluded from the study. Sixty-six children and 69 controls were enrolled in the study. There were significantly more males in the asthmatic group compared to controls (P = 0.003). History of bronchiolitis or recurrent wheezing episodes in the first year, family history of asthma, and Middle-Eastern origin were significantly more common among asthmatic children than controls (P < 0.001). Asthmatic children were more likely to be born between March and June and least likely to be born between October and December, compared to controls (P < 0.05). Multivariate logistic regression analysis revealed three variables to be independent significant risk factors for development of asthma: birth season between March and June, acute bronchiolitis or recurrent wheezing episodes during first year of life, and male gender. Birth season during late winter and spring is associated with asthma during childhood.

Asthma↗

PubMed2001

Indices of adipose tissue distribution, apolipoproteins B and AI, lipoprotein (a), and triglyceride concentration in children aged 4-11 years: the Third National Health and Nutrition Examination Survey.

This study examined the association of body fat distribution with serum apolipoproteins, lipoprotein (a), and triglyceride, risk factors for cardiovascular morbidity, in a representative sample of U.S. black, white, and Hispanic children. Data from the Third National Health and Nutrition Examination Survey for children aged 4-11 years revealed the mean waist-to-hip ratio (WHR) varied consistently with age, gender, and ethnic group. Levels were highest in Mexican Americans. WHR showed significant negative associations with apo AI concentration and positive associations with apo B and the ratio of apo B to apo AI independent of age but not body mass index (BMI). Associations of WHR with serum triglyceride concentration were independent of age and BMI. Other indices of body fat distribution were not superior to WHR. Lp (a) was not consistently associated with WHR. In conclusion, after controlling for BMI and age, body fat distribution was not significantly associated with apo AI and apo B with few exceptions. Nor was Lp (a) significantly associated with body fat distribution. Casual serum triglyceride levels were significantly positively associated with WHR independent of age and BMI in non-Hispanic white and Mexican American children.

Adipose Tissue↗

PubMed2005

AIDS, drought, and child malnutrition in southern Africa.

OBJECTIVE: To investigate trends in child malnutrition in six countries in southern Africa, in relation to the HIV epidemic and drought in crop years 2001/2 and 2002/3. DESIGN: Epidemiological analysis of sub-national and national surveys with related data. SETTING: Data from Lesotho, Malawi, Mozambique, Swaziland, Zambia and Zimbabwe, compiled and analysed under UNICEF auspices. SUBJECTS: Secondary data: children 0-5 years for weight-for-age; HIV prevalence data from various sources especially antenatal clinic surveillance. RESULTS: Child nutritional status as measured by prevalence of underweight deteriorated from 2001 onwards in all countries except Lesotho, with very substantial increases in some provinces/districts (e.g. from 5 to 20% in Maputo (Mozambique, 1997-2002), 17 to 32% in Copperbelt (Zambia, 1999-2001/2) and 11 to 26% in Midlands province (Zimbabwe, 1999-2002)). Greater deterioration in underweight occurred in better-off areas. Areas with higher HIV/AIDS prevalences had (so far) lower malnutrition rates (and infant mortality rates), presumably because more modern areas--with greater reliance on trade and wage employment--have more HIV/AIDS. Areas with higher HIV/AIDS showed more deterioration in child nutrition. A significant area-level interaction was found of HIV/AIDS with the drought period, associated with particularly rapid deterioration in nutritional status. CONCLUSIONS: First, the most vulnerable may be households in more modern areas, nearer towns, to whom resources need to be directed. Second, the causes of this vulnerability need to be investigated. Third, HIV/AIDS amplifies the effect of drought on nutrition, so rapid and effective response will be crucial if drought strikes again. Fourth, expanded nutritional surveillance is now needed to monitor and respond to deteriorating trends. Finally, with or without drought, new means are needed of bringing help, comfort and assistance to the child population.

Acquired Immunodeficiency Syndrome↗

PubMed1996

The Pictorial Scale of Perceived Competence and Social Acceptance: does it work with low-income urban children?

The present study represents a twofold investigation wherein (a) the construct validity of the Pictorial Scale of Perceived Competence and Social Acceptance for Young Children (PSPCSA) and (b) the developmental appropriateness of the PSPCSA were empirically examined for urban Head Start children. Data were collected from a sample of 476 African-American children (48-64 months) representing children enrolled in a large metropolitan Head Start program. In the first study, neither replication of the test author's statistical procedures nor a series of exploratory factor analyses produced psychologically meaningful constructs. A second study tested the assumption that the PSPCSA administration format is developmentally appropriate for preschool children. Results from this study did not support the assumption that the PSPCSA is developmentally appropriate for preschool children. Implications for establishing valid assessment methods for urban Head Start children were discussed.

Black or African American↗

PubMed1991

Children with chronic illness: family and parent demographic characteristics and psychosocial adjustment.

This paper presents the results of an epidemiologic study that compares and contrasts psychosocial characteristics of parents and family units of children with chronic illness or physical disability (chronic health problems) with those of healthy children. Data were derived from the Ontario Child Health Study of 1869 randomly selected families, with 3294 children aged 4 to 16 years. In the absence of significant differences between parents and families of children with chronic illness alone and those with physical disability, these groups were combined for analysis, for which odds ratios (OR) or t tests were used. Significant positive findings included increased rates of parental treatment for "nerves" (mothers' OR = 2.1, fathers' OR = 1.9) and increased maternal negative affect scores (Bradburn Affect Balance Scale) (P less than .001) among parents of children with chronic health problems. Important negative findings (95% confidence interval of the OR included 1) included no increase in single-parent families (OR = 1.2), social isolation (OR = 1.0), or alcohol problems (OR = 1.2) among parents of children with chronic health problems. Categorically defined family dysfunction did not differ between the two groups (OR = 1.1). These data contrast with several clinic-based studies and suggest that, in a widely generalizable population survey, families of children with chronic health problems including physical disability do not suffer a marked excess of dysfunction, although some indicators of individual parent psychosocial problems were modestly elevated.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1994

Perinatal determinants among children who later develop IDDM.

OBJECTIVE: The aim of this study was to investigate whether children who develop insulin-dependent diabetes mellitus (IDDM) differ in some aspects from a matched control group at the time of birth. RESEARCH DESIGN AND METHODS: We studied all children who were born in Denmark during the period 1973-1977 and admitted to a Danish hospital with a diagnosis of IDDM during 1978-1989. The study was conducted by combining two nationwide registries, The National Patient Registry and The Birth Registry. RESULTS: The criteria were fulfilled by 837 children. Data regarding the age of the parents, the number of previous pregnancies of the mother, the month of birth, and the birth weight and length of the children who developed IDDM were compared with the data of an age- and sex-matched control group of 837 children without IDDM. We did not detect any significant differences between the two groups with respect to the parameters studied. CONCLUSIONS: No differences in perinatal determinants could be demonstrated among Danish children who develop IDDM compared with children without diabetes.

Adolescent↗

PubMed1997

Respiratory syncytial virus immune globulin intravenous.

OBJECTIVE: To review the clinical data detailing the use of respiratory syncytial virus immune globulin intravenous (RSV-IGIV) in infants and children. DATA SOURCES; A MEDLINE search (1990-1996) was used to identify all publications that dealt with RSV-IGIV clinical trials, pharmacology, and pharmacokinetics in infants and children. Bibliographies of articles were also used. STUDY SELECTION: All abstracts and clinical trials were reviewed. DATA EXTRACTION: Study design, population, efficacy, and safety data were retained. DATA SYNTHESIS: RSV-IGIV is an immunoglobulin product with serum neutralizing titers against RSV. It has been shown to reduce hospital stay, admissions, intensive care unit admissions, and mechanical ventilation days in infants and children with RSV pneumonia or bronchiolitis who are younger than 24 months of age and were born prematurely, or have bronchopulmonary dysplasia. RSV-IGIV is well tolerated by infants and children. CONCLUSIONS: RSV-IGIV is an effective prophylactic agent against serious RSV disease in select groups of infants and children.

Bronchiolitis↗

PubMed1997

Nutrient intake and blood pressure in the Dietary Intervention Study in Children.

Delineating the role that diet plays in blood pressure levels in children is important for guiding dietary recommendations for the prevention of hypertension. The purpose of this study was to investigate relationships between dietary nutrients and blood pressure in children. Data were analyzed from 662 participants in the Dietary Intervention Study in Children who had elevated low-density lipoprotein cholesterol and were aged 8 to 11 years at baseline. Three 24-hour dietary recalls, systolic pressure, diastolic pressure, height, and weight were obtained at baseline, 1 year, and 3 years. Nutrients analyzed were the micronutrients calcium, magnesium, and potassium; the macronutrients protein, carbohydrates, total fat, saturated fat, polyunsaturated fat, and monounsaturated fat; dietary cholesterol; and total dietary fiber. Baseline and 3-year longitudinal relationships were examined through multivariate models on diastolic and systolic pressures separately, controlling for height, weight, sex, and total caloric intake. The following associations were found in longitudinal analyses: analyzing each nutrient separately, for systolic pressure, inverse associations with calcium (P < .05); magnesium, potassium, and protein (all P < .01); and fiber (P < .05), and direct associations with total fat and monounsaturated fat (both P < .05); for diastolic pressure, inverse associations with calcium (P < .01); magnesium and potassium (both P < .05), protein (P < .01); and carbohydrates and fiber (both P < .05), and direct associations with polyunsaturated fat (P < .01) and monounsaturated fat (P < .05). Analyzing all nutrients simultaneously, for systolic pressure, direct association with total fat (P < .01); for diastolic pressure, inverse associations with calcium (P < .01) and fiber (P < .05), and direct association with total and monounsaturated fats (both P < .05). Results from this sample of children with elevated low-density lipoprotein cholesterol indicate that dietary calcium, fiber, and fat may be important determinants of blood pressure level in children.

Age Factors↗

PubMed1988

The California Child Health and Development Studies of the School of Public Health, University of California at Berkeley.

The Child Health and Development Studies are prospective longitudinal studies on medical and social aspects of pregnancies and on the health and development of children. Data have been assembled on about 20,000 pregnancies occurring in one hospital between 1959 and 1967, and on follow-up of the children through adolescence. A currently ongoing project updates certain vital statistics of the entire study population. The data assembled in this longitudinal study supported a wide range of research projects, several of which proved to be important for the health of mothers and children. Notwithstanding, subsets of the assembled data, with potential value for public health, have not yet been explored. The data archive has been made accessible to the research community at large so that other significant research topics can be investigated. In the following article, brief descriptions are given of the history and design of the Child Health and Development Studies, of the contents of the data archive, and of the major areas of research that have been explored. Procedures to obtain access to the data and to the user's manual are explained, and a bibliography is included.

Adolescent↗

PubMed2001

Impacts of Medicaid managed care on children.

OBJECTIVE: To assess the impact of switching from a fee-for-service (FFS) delivery system to managed care on access to, use of, and satisfaction with health care for children. DATA SOURCES/STUDY SETTING: A 1998 survey of Medicaid recipients in rural Minnesota. STUDY DESIGN: Using a quasi-experimental framework, we compare the experiences of children on Medicaid living in counties that had switched to managed care with those of children living in counties operating under FFS Medicaid. We address the impact of Medicaid managed care (MMC) on access to, use of, and satisfaction with care. DATA COLLECTION METHODS: A stratified random sample of children on Medicaid was drawn based on Medicaid enrollment files. Telephone interviews were conducted with the child's parent or guardian between March and June 1998. An overall response rate of 70 percent was achieved, yielding a sample of 1,106 children (814 in MMC and 792 in Medicaid FFS). PRINCIPAL FINDINGS: We find very few significant differences in access to, use of, or satisfaction with health care services for children under MMC relative to FFS. MMC did not change the patterns of health care service use or the location at which care is delivered, two major goals of MMC initiatives. CONCLUSIONS: Our results suggest that the Medicaid program's shift from FFS to managed care had little impact on the pattern of children's health care use, the location at which they obtained care, or the satisfaction with the care they received.

Child↗

PubMed2006

Maternal depressive symptoms at 2 to 4 months post partum and early parenting practices.

OBJECTIVE: To determine whether maternal depressive symptoms, reported when infants are 2 to 4 months old, are associated with mothers' early parenting practices. DESIGN: Secondary data analyses collected from the National Evaluation of Healthy Steps for Young Children. Data sources included newborn enrollment questionnaires and parent interviews when infants were 2 to 4 months old. Maternal depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale. SETTING: Twenty-four pediatric practices across the United States. PARTICIPANTS: A total of 5565 families enrolled in Healthy Steps; 4874 mothers (88%) completed 2- to 4-month interviews and provided Center for Epidemiologic Studies Depression Scale data; 17.8% of mothers reported having depressive symptoms. MAIN OUTCOME MEASURES: Ten parenting practices assessed in 3 domains: safety (sleep position and lowering water temperature), feeding (cereal, water, or juice; continuing breastfeeding), and practices to promote child development (showing books, playing with infant, talking to infant, and following 2 or more routines). RESULTS: Mothers with and without depressive symptoms reported similar uses of safety and feeding practices. Mothers with depressive symptoms had reduced odds of continuing breastfeeding (adjusted odds ratio [AOR], 0.73; 95% confidence interval [CI], 0.61-0.88), showing books (AOR, 0.81; 95% CI, 0.68-0.97), playing with the infant (AOR, 0.70; 95% CI, 0.54-0.90), talking to the infant (AOR, 0.74; 95% CI, 0.63-0.86), and following routines (AOR, 0.61; 95% CI, 0.52-0.72). CONCLUSION: Maternal depressive symptoms are common in early infancy and contribute to unfavorable parenting practices.

Adult↗

PubMed2005

Causes of lead toxicity in a Nigerian city.

BACKGROUND: Up to 70% of young Nigerian children have been reported to have blood lead concentrations > or =10 microg/dl. AIMS: To better elucidate risk factors for lead toxicity among Nigerian families with children at risk for lead toxicity. METHODS: Two geographic wards in Jos, Nigeria were selected for study, one previously reported to have a high mean blood lead level (37 (SD 13) microg/dl) and one with a lower mean blood lead level (17 (SD 10) microg/dl) in young children. Data pertaining to potential risk factors for lead exposure were collected from children and adults in 34 households. RESULTS: The mean (SD) blood lead concentration of 275 subjects, aged 3 weeks to 90 years, was 8.7 (5.7) microg/dl (range 1-34 microg/dl); 92 (34%) had concentrations > or =10 microg/dl. In multivariate analysis, an age of 5 years and under, flaking house paint, residence near a gasoline seller, male gender, increasing maternal and paternal education, and use of a lead ore eye cosmetic were independently associated with greater blood lead concentration. Vehicle ownership was associated with reduced lead concentration. Compared with the low-lead ward, residence in the high-lead ward remained significantly associated with greater lead values, indicating that additional factors likely contribute to lead exposure. CONCLUSION: Although the cause of increased lead levels in Jos appears to be multi-factorial, several remediable sources contribute to lead exposure in Nigeria.

Adolescent↗

PubMed2004

[Analysis on causes of death of childhood leukemia from 1981 to 2000 in the city of Tianjin].

OBJECTIVE: Leukemia is a major cause of death of children in China, which accounts for 50 % of all cancers of children. Data from Tianjin Cancer Hospital was analyzed for mortality of leukemia in children under 20 years from 1981 to 2000 in the city of Tianjin. METHODS: All physicians and medical staff of the hospitals and clinics in the registry area were responsible for filling out the report forms for every new case diagnosed as malignant tumors. Death certificates for malignant tumors have been registered at the local police station and the residential files were checked. All cancer cases with insufficient information were traced to his/her family and relevant persons worked in the clinic. Tianjin Cancer Registry Center periodically conducted an active re-checking program to review all patient records on cancers that was not registered in this period. Tumors diagnosed in this study were coded according to the International Classification of Diseases for Oncology (ICD-O). Mortality rates were calculated by age, sex and date of death. RESULTS: The types of acute lymphoid leukemia, acute myeloid leukemia and chronic myeloid leukemia were the most common types of childhood leukemia in Tianjin, comprised 69.3%, 20.9 % and 8.0%, respectively. The mortality for childhood leukemia decreased slowly during the period of 1981 to 2000 in Tianjin. Mortality and morbidity ratios were 0.51. CONCLUSION: Combined with characteristics of individual forms of childhood leukemia mortality, further epidemiological research is needed to prevent childhood leukemia.

Adolescent↗

PubMed1998

Overview of issues in improving quality of care for children.

OBJECTIVE: To provide a framework for a research agenda-setting conference on quality of care for children. DATA SOURCES/STUDY SETTING: Literature review. CONCLUSIONS: Research on quality of care for children has lagged behind its counterpart for adults. Defining key issues and questions in seven topic areas-the health of children; the efficacy and effectiveness of health services for children; assessing quality of care; improving quality of care within health services delivery systems; assessing and improving quality at the community level; getting financial incentives right; and disseminating information about the results of research investigations-will facilitate the development of an effective research strategy. Ultimately, enhanced information in these areas will lead to improvements in the processes and outcomes of care for children.

Child↗

PubMed2005

Prokinetic drug therapy in children: a review of current options.

OBJECTIVE: To review the pharmacology, safety, and efficacy of the prokinetic agents metoclopramide and erythromycin in children. DATA SOURCES: English-language literature was accessed using MEDLINE (1970-June 2004) with metoclopramide, erythromycin, macrolides, gastroesophageal reflux, and gastrointestinal motility as the search terms. STUDY SELECTION AND DATA EXTRACTION: Abstracts and original research articles were included. Preference was given to published controlled trials. Articles providing descriptions of pharmacology, safety, and effectiveness of metoclopramide and erythromycin for the treatment of gastroesophageal reflux (GER) were also used in this review. DATA SYNTHESIS: Some authors advocate using a prokinetic agent along with acid suppression for treatment of GER in children. The 2 prokinetic agents most commonly used are erythromycin and metoclopramide. Erythromycin has numerous observational reports and controlled trials demonstrating its efficacy in improving feeding tolerance in children. Adverse drug reactions associated with its use were uncommon in prospective controlled trials. Few data support the use of metoclopramide for management of GER, and the potential adverse effects associated with its use need to be considered before prescribing. CONCLUSIONS: The literature supports the use of erythromycin as a prokinetic agent. Many children with GER are adequately controlled with acid suppression alone; however, if use of a prokinetic agent is warranted, erythromycin in combination with acid suppression should be considered. Given the lack of prospective controlled studies demonstrating metoclopramide's efficacy and safety in the treatment of GER in children, metoclopramide should not be considered a treatment option.

Child↗