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Sample records for cohort study children

  1. Early growth in children with coeliac disease: a cohort study.

    PubMed

    Kahrs, Christian R; Magnus, Maria C; Stigum, Hein; Lundin, Knut E A; Størdal, Ketil

    2017-06-13

    We aimed to study growth during the first 2 years of life in children later diagnosed with coeliac disease compared with children without, in a time with changing epidemiology and improved diagnostics. A prospective population-based pregnancy cohort study. The nationwide Norwegian Mother and Child Cohort Study. 58 675 children born between 2000 and 2009 with prospectively collected growth data. Coeliac disease was identified through combined data from questionnaires and the Norwegian Patient Register. The differences in height and weight at age 0, 3, 6, 8, 12, 15-18 and 24 months using internally standardised age and gender-specific z-scores. Linear regression and mixed models were used. During a median follow-up of 8.6 years (range 4.6-14.2), 440 children (0.8%) were diagnosed with coeliac disease at a mean age of 4.4 years (range 1.5-8.5). Children with coeliac disease had significantly lower z-scores for height from 12 months (-0.09 standard deviation scores (SDS), 95% CI -0.18 to -0.01) and weight from 15 to 18 months of life (-0.09 SDS, 95% CI -0.18 to -0.01) compared with cohort controls. The longitudinal analysis from 0 to 24 months yielded a significant reduction in height z-score per year (-0.07 SDS, 95% CI -0.13 to -0.01) but not for weight among children with coeliac disease. Excluding children diagnosed before age 2 years gave similar results. This study indicates that growth retardation in children later diagnosed with coeliac disease commonly starts at 12 months of age, and precedes clinical symptoms that usually bring the suspicion of diagnosis. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  2. Association of croup with asthma in children: A cohort study.

    PubMed

    Lin, Sheng-Chieh; Lin, Hui-Wen; Chiang, Bor-Luen

    2017-09-01

    Asthma and croup are common inflammatory airway diseases involving the bronchus in children. However, no study has reported the effects of urbanization, sex, age, and bronchiolitis on the association of croup and its duration with asthma development. We used the Taiwan Longitudinal Health Insurance Database (LHID) to perform this population-based cohort study; here, the cluster effect caused by hospitalization was considered to evaluate the association between croup and asthma development and the risk factors for asthma in children of different age groups. We evaluated children with croup aged <12 years (n = 1204) and age-matched control patients (n = 140,887) by using Cox proportional hazards regression analysis within a hospitalization cluster. Of all 142,091 patients, 5799 (including 155 with croup [419 per 1000 person-y] and 5644 controls [106 per 1000 person-y]) had asthma during the 5-year follow-up period. During the 5-year follow-up period, the hazard ratios (HRs [95% CIs]) for asthma were 2.10 (1.81-2.44) in all children with croup, 2.13 (1.85-2.46) in those aged 0 to 5 years, and 2.22 (1.87-2.65) in those aged 6 to 12 years. Children with croup aged 7 to 9 years had a higher HR for asthma than did those in other age groups. Boys with croup had a higher HR for asthma. The adjusted HR for asthma was 1.78 times higher in children with croup living in urban areas than in those living in rural areas. In conclusion, our analyses indicated that sex, age, bronchiolitis, and urbanization level are significantly associated with croup and asthma development. According to our cumulative hazard rate curves, younger children with croup should be closely monitored for asthma development for at least 3 years.

  3. Recurrent episodes of injury in children: an Australian cohort study.

    PubMed

    Cameron, Cate M; Spinks, Anneliese B; Osborne, Jodie M; Davey, Tamzyn M; Sipe, Neil; McClure, Roderick J

    2016-08-19

    Objective The aim of the present study was to compare sociodemographic characteristics of children with single versus recurrent episodes of injury and provide contemporary evidence for Australian injury prevention policy development.Methods Participants were identified from the Environments for Healthy Living: Griffith Birth Cohort Study 2006-11 (n=2692). Demographic data were linked to the child's hospital emergency and admissions data from birth to December 2013. Data were dichotomised in two ways: (1) injured or non-injured; and (2) single or recurrent episodes of injury. Multivariate logistic regression was used for analysis.Results The adjusted model identified two factors significantly associated with recurrent episodes of injury in children aged <3 years. Children born to mothers <25 years were almost fourfold more likely to have recurrent episodes of injury compared with children of mothers aged ≥35 years (adjusted odds ratio (aOR)=3.68; 95% confidence interval (CI) 1.44-9.39) and, as a child's age at first injury increased, odds of experiencing recurrent episodes of injury decreased (aOR=0.97; 95% CI 0.94-0.99). No differences were found in sociodemographic characteristics of children aged 3-7 years with single versus recurrent episodes of injury (P>0.1).Conclusion National priorities should include targeted programs addressing the higher odds of recurrent episodes of injury experienced by children aged <3 years with younger mothers or those injured in the first 18 months of life.What is known about the topic? Children who experience recurrent episodes of injury are at greater risk of serious or irrecoverable harm, particularly when repeat trauma occurs in the early years of life.What does the paper add? The present study identifies key factors associated with recurrent episodes of injury in young Australian children. This is imperative to inform evidence-based national injury prevention policy development in line with the recent expiry of the National

  4. Child Maltreatment in the "Children of the Nineties": A Cohort Study of Risk Factors

    ERIC Educational Resources Information Center

    Sidebotham, Peter; Heron, Jon

    2006-01-01

    Aim: To analyze the multiple factors affecting the risk of maltreatment in young children within a comprehensive theoretical framework. Methods: The research is based on a large UK cohort study, the Avon Longitudinal Study of Parents and Children. Out of 14,256 children participating in the study, 293 were investigated by social services for…

  5. Critical Pertussis Illness in Children, A Multicenter Prospective Cohort Study

    PubMed Central

    Berger, John T.; Carcillo, Joseph A.; Shanley, Thomas P.; Wessel, David L.; Clark, Amy; Holubkov, Richard; Meert, Kathleen L.; Newth, Christopher J.L.; Berg, Robert A.; Heidemann, Sabrina; Harrison, Rick; Pollack, Murray; Dalton, Heidi; Harvill, Eric; Karanikas, Alexia; Liu, Teresa; Burr, Jeri S.; Doctor, Allan; Dean, J. Michael; Jenkins, Tammara L.; Nicholson, Carol E.

    2013-01-01

    Objective Pertussis persists in the United States despite high immunization rates. The present report characterizes the presentation and acute course of critical pertussis by quantifying demographic data, laboratory findings, clinical complications, and critical care therapies required among children requiring admission to the pediatric intensive care unit (PICU). Design Prospective cohort study. Setting Eight PICUs comprising the Eunice Kennedy Shriver National Institute for Child Health and Human Development Collaborative Pediatric Critical Care Research Network and 17 additional PICUs across the United States. Patients Eligible patients had laboratory confirmation of pertussis infection, were < 18 years of age, and died in the PICU or were admitted to the PICU for at least 24 hours between June 2008 and August 2011. Interventions None. Measurements and Main Results 127 patients were identified. Median age was 49 days, and 105 (83%) patients were < 3 months of age. Fifty-five (43%) required mechanical ventilation. Twelve (9.4%) died during initial hospitalization. Pulmonary hypertension was found in 16 patients (12.5%), and was present in 75% of patients who died, compared with 6% of survivors (p< 0.001). Median white blood cell count (WBC) was significantly higher in those requiring mechanical ventilation (p<0.001), those with pulmonary hypertension (p<0.001) and non-survivors (p<0.001). Age, sex and immunization status did not differ between survivors and non-survivors. Fourteen patients received leukoreduction therapy (exchange transfusion (12), leukopheresis (1) or both (1)). Survival benefit was not apparent. Conclusions Pulmonary hypertension may be associated with mortality in pertussis critical illness. Elevated WBC is associated with the need for mechanical ventilation, pulmonary hypertension, and mortality risk. Research is indicated to elucidate how pulmonary hypertension, immune responsiveness, and elevated WBC contribute to morbidity and mortality

  6. Relationship Satisfaction Among Mothers of Children With Congenital Heart Defects: A Prospective Case-Cohort Study

    PubMed Central

    Solberg, Øivind; Holmstrøm, Henrik; Landolt, Markus A.; Eskedal, Leif T.; Vollrath, Margarete E.

    2013-01-01

    Objective To assess the level of partner relationship satisfaction among mothers of children with different severity of congenital heart defects (CHD) compared with mothers in the cohort. Methods Mothers of children with mild, moderate, or severe CHD (n = 182) and a cohort of mothers of children without CHD (n = 46,782) from the Norwegian Mother and Child Cohort Study were assessed at 5 time points from pregnancy to 36 months postpartum. A 5-item version of the Relationship Satisfaction scale was used, and relevant covariates were explored. Results The trajectories of relationship satisfaction among mothers of children with varying CHD severity did not differ from the trajectories in the cohort. All women in the cohort experienced decreasing relationship satisfaction from 18 months after delivery up to 36 months after delivery. Conclusions Having a child with CHD, regardless of severity, does not appear to exacerbate the decline in relationship satisfaction. PMID:23792348

  7. Head Start and Urban Children's School Readiness: A Birth Cohort Study in 18 Cities

    ERIC Educational Resources Information Center

    Zhai, Fuhua; Brooks-Gunn, Jeanne; Waldfogel, Jane

    2010-01-01

    In this study, the authors used data from a large longitudinal birth cohort study of primarily low-income children in urban areas, the Fragile Families and Child Wellbeing Study (FFCWS), to investigate the effects of Head Start participation on children's school readiness. The fact that their sample was mainly made up of disadvantaged families…

  8. Design and Cohort Characteristics of the Social Spectrum Study: A Multicenter Study of the Autism Spectrum among Clinically Referred Children

    ERIC Educational Resources Information Center

    Duvekot, Jorieke; Hoopen, Leontine W.; Slappendel, Geerte; van der Ende, Jan; Verhulst, Frank C.; van der Sijde, Ad; Greaves-Lord, Kirstin

    2017-01-01

    This paper provides an overview of the design and cohort characteristics of the Social Spectrum Study: a clinical cohort study that used a two-phase sampling design to identify children at risk for ASD. After screening 1281 children aged 2.5-10 years who had been consecutively referred to one of six mental health services in the Netherlands,…

  9. Social and Behavioural Outcomes in Children Diagnosed with Autism Spectrum Disorders: A Longitudinal Cohort Study

    ERIC Educational Resources Information Center

    Russell, Ginny; Golding, Jean; Norwich, Brahm; Emond, Alan; Ford, Tamsin; Steer, Colin

    2012-01-01

    Objective: To compare social and behavioural outcomes between children formally diagnosed with autism spectrum disorders (ASD) with those of children who displayed autistic traits at preschool age, but remained undiagnosed as teenagers. Method: A secondary analysis of data from a birth cohort study, the Avon Longitudinal Study of Parents and…

  10. Social and Behavioural Outcomes in Children Diagnosed with Autism Spectrum Disorders: A Longitudinal Cohort Study

    ERIC Educational Resources Information Center

    Russell, Ginny; Golding, Jean; Norwich, Brahm; Emond, Alan; Ford, Tamsin; Steer, Colin

    2012-01-01

    Objective: To compare social and behavioural outcomes between children formally diagnosed with autism spectrum disorders (ASD) with those of children who displayed autistic traits at preschool age, but remained undiagnosed as teenagers. Method: A secondary analysis of data from a birth cohort study, the Avon Longitudinal Study of Parents and…

  11. Impact of Parent Involvement on Children's Development and Academic Performance: A Three-Cohort Study.

    ERIC Educational Resources Information Center

    Marcon, Rebecca A.

    This study examined the possibility of a "threshold" of parent involvement with their children's preschools, that can lead to positive child outcomes in a sample of hard-to-engage families. Three cohorts of preschool children were studied, most from low-income, single-parent families. Teachers were interviewed to determine extent of contact they…

  12. A Prospective Cohort Study Comparing Workload in Children with and without Developmental Coordination Disorder

    ERIC Educational Resources Information Center

    Rivilis, Irina; Liu, Jian; Cairney, John; Hay, John A.; Klentrou, Panagiota; Faught, Brent E.

    2012-01-01

    The purpose of this prospective cohort study was to assess how cardiorespiratory fitness (CRF) of children with probable developmental coordination disorder (DCD) changes over a period of 4.7 years relative to a group of typically developing controls. A school-based sample of children in a large region of Ontario, Canada with 75 out of a possible…

  13. Increased risk of herpes zoster in children with cancer: A nationwide population-based cohort study.

    PubMed

    Lin, Hsiao-Chuan; Chao, Yu-Hua; Wu, Kang-Hsi; Yen, Ting-Yu; Hsu, Yu-Lung; Hsieh, Tsung-Hsueh; Wei, Hsiu-Mei; Wu, Jhong-Lin; Muo, Chih-Hsin; Hwang, Kao-Pin; Peng, Ching-Tien; Lin, Cheng-Chieh; Li, Tsai-Chung

    2016-07-01

    Herpes zoster is rare in healthy children, but immunocompromised persons have an increased risk of herpes zoster and severe diseases. Considering the very limited information on herpes zoster in children with cancer, we performed a nationwide population-based cohort study to estimate the incidence of herpes zoster in children with cancer and to explore the association between the 2 diseases.Data were obtained from the National Health Research Institutes Database in Taiwan. A total of 4432 children with newly diagnosed cancer between 2000 and 2007 were identified as the cancer cohort, and 17,653 children without cancer frequency-matched by sex and age at entry were considered the noncancer cohort. The association between herpes zoster and childhood cancer was determined.Children with cancer had a higher risk of herpes zoster. The incidence rate of herpes zoster was higher in the cancer cohort than in the noncancer cohort (20.7 vs 2.4 per 10,000 person-years; IRR = 8.6; 95% CI = 4.8-15.6). The cumulative incidence was significantly higher in the cancer cohort (P < 0.0001). Leukemia, lymphoma, and solid tumor were all associated with the increased risk, and leukemia had the highest magnitude of strength of association.This nationwide population-based cohort study demonstrated that children with cancer were associated with an increased risk of herpes zoster. In addition to early antiviral treatment, vaccination with heat-treated zoster vaccine or adjuvanted subunit vaccine could be an appropriate policy to decrease the incidence in children with cancer.

  14. Ten years of progress in the Hokkaido birth cohort study on environment and children's health: cohort profile--updated 2013.

    PubMed

    Kishi, Reiko; Kobayashi, Sachiko; Ikeno, Tamiko; Araki, Atsuko; Miyashita, Chihiro; Itoh, Sachiko; Sasaki, Seiko; Okada, Emiko; Kobayashi, Sumitaka; Kashino, Ikuko; Itoh, Kumiko; Nakajima, Sonomi

    2013-11-01

    The Hokkaido Study on Environment and Children's Health is an ongoing cohort study that began in 2002. The study consists of two prospective birth cohorts, the Sapporo cohort (n = 514) and the Hokkaido large-scale cohort (n = 20,940). The primary goals of this study are to first examine the potential negative effects of perinatal environmental chemical exposures on birth outcomes, including congenital malformations and growth retardation; second, to evaluate the development of allergies, infectious diseases and neurodevelopmental disorders and perform longitudinal observations of the children's physical development to clarify the causal relationship between these outcomes and environmental chemicals; third, to identify individuals genetically susceptible to environmental chemicals; finally, to identify the additive effects of various environmental factors in our daily life, such as secondhand smoke exposure or low folate intake during early pregnancy. In this paper, we introduce our recent progress in the Hokkaido study with a cohort profile updated in 2013. For the last ten years, we followed pregnant women and their offspring, measuring various environmental chemicals, i.e., PCB, OH-PCB and dioxins, PFCs (Perfluorinated Compounds), Organochlorine pesticides, Phthalates, bisphenol A and mercury. We discovered that the concentration of toxic equivalents (TEQ) of dioxin and other specific congeners of PCDF or PCDD have effects on birth weight, infants' neurodevelopment and immune function. There were significant gender differences in these effects; our results suggest that male infants have more susceptibility to those chemical exposures than female infants. Interestingly, we found maternal genetic polymorphisms in AHR, CYP1A1 or GSTs that significantly modified the dioxin concentrations in maternal blood, suggesting different dioxin accumulations in the bodies of individuals with these genotypes, which would lead to different dioxin exposure levels. These genetic

  15. Children's Development and Parental Input: Evidence From the UK Millennium Cohort Study.

    PubMed

    Hernández-Alava, Mónica; Popli, Gurleen

    2017-04-01

    In this study, we use the UK Millennium Cohort Study to estimate a dynamic factor model of child development. Our model follows the children from birth until 7 years of age and allows for both cognitive and noncognitive abilities in children. We find a significant self-productivity effect in both cognitive and noncognitive development, as well as some evidence of dynamic dependence across different abilities. The activities that parents carry out with children at home (parental investment) have a significant effect on children's development; we find substantial evidence of two distinct latent parental investment variables with differential effects across the two abilities.

  16. Head Start and Urban Children's School Readiness: A Birth Cohort Study in 18 Cities

    ERIC Educational Resources Information Center

    Zhai, Fuhua; Brooks-Gunn, Jeanne; Waldfogel, Jane

    2011-01-01

    We used longitudinal data from a birth cohort study, the Fragile Families and Child Wellbeing Study, to investigate the links between Head Start and school readiness in a large and diverse sample of urban children at age 5 (N = 2,803; 18 cities). We found that Head Start attendance was associated with enhanced cognitive ability and social…

  17. STATUS REPORT, BEGIN TO DEVELOP COMPLETE OPERATIONS MANUALS FOR THE COHORT: PREPARE TO IMPLEMENT A COHORT STUDY OF CHILDREN'S ENVIRONMENTAL HEALTH

    EPA Science Inventory

    As a precursor to the National Children's Study (NCS), the North Carolina Cohort Study (NC Cohort Study) will provide the opportunity to field test procedures to better inform the implementation of the NCS. In order to test some of the study hypotheses, it will be important to ob...

  18. Maternal smoking during pregnancy and primary headache in school-aged children: a cohort study.

    PubMed

    Fabbri, Carlos E; Barbieri, Marco A; Silva, Antônio M; Gutierrez, Manoel R; Bettiol, Heloisa; Speciali, José G; Rona, Roberto J

    2012-03-01

    It is not known whether smoking by mothers during pregnancy is associated with headache in their offspring. Two prospective cohorts of 869 children aged 10-11 years from Ribeirão Preto (RP) and 805 children aged 7-9 years from São Luís (SL) were studied. Data on maternal smoking were collected at birth. Primary headache was defined as a reporting of ≥2 episodes of headache in the past 2 weeks, without any associated organic symptoms. Prevalence of headache was 28.1% in RP and 13.1% in SL as reported by the mothers and 17.5% in RP and 29.4% in SL as reported by the children. Agreement between mothers' report and children's self-report of primary headache in the child was poor. After adjustment, children whose mothers smoked ≥10 cigarettes per day during pregnancy presented higher prevalence of primary headache than their counterparts in both cohorts, as reported by the mother and in RP as reported by the children. Maternal smoking during pregnancy was associated with headache in 7- to 11-year-olds. With one exception, the consistency of the results, despite poor agreement between maternal and children reports of headache, indicates that maternal smoking during pregnancy may contribute to headaches in their children.

  19. Educational achievements of children of parents with multiple sclerosis: A nationwide register-based cohort study.

    PubMed

    Moberg, J Y; Magyari, M; Koch-Henriksen, N; Thygesen, L C; Laursen, B; Soelberg Sørensen, P

    2016-11-01

    Little is known about the impact of parental multiple sclerosis (MS) on offspring's educational attainment. The objective of the study was to examine educational achievements in offspring of parents with MS compared with matched children of parents without MS in a nationwide register-based cohort study. Children of all Danish-born residents with onset between 1950 and 1986 were identified by linking the Danish Multiple Sclerosis Registry with the Civil Registration System. Twins, children with MS, and emigrated persons were excluded. The reference cohort consisted of randomly drawn individuals from the Civil Registration System without parental MS matched 8:1 to the MS offspring by sex and year of birth. Information about education was linked to the cohorts from nationwide educational registries. We included 4177 children of MS parents and 33,416 reference persons. Children of MS parents achieved statistically significant higher average grades than the reference cohort in their final exam of basic school with a mean grade difference of 0.46 (95 % CI 0.22-0.69; p = 0.0002). We found no difference in achievement of educational level above basic school (OR 1.04; 95 % CI 0.98-1.10; p = 0.20). There was a trend toward more MS offspring attaining health-related educations (OR 1.10; 95 % CI 1.00-1.21; p = 0.06). In conclusion, children of MS parents showed a small advantage in grade point average in final examinations in basic school, and they more often tended toward health-related educations. This study revealed no negative consequences of parental MS on grades and highest educational level achieved.

  20. Care at first-level facilities for children with severe pneumonia in Bangladesh: a cohort study.

    PubMed

    Chowdhury, Enayet K; El Arifeen, Shams; Rahman, Muntasirur; Hoque, Dm Emdadul; Hossain, M Altaf; Begum, Khadija; Siddik, Ashraf; Begum, Nazma; Sadeq-ur Rahman, Qazi; Akter, Tasnima; Haque, Twaha M; Al-Helal, Za Motin; Baqui, Abdullah H; Bryce, Jennifer; Black, Robert E

    2008-09-06

    Guidelines on integrated management of childhood illness (IMCI) for severe pneumonia recommend referral to hospitals. However, in many settings, children who are referred do not actually attend hospital, which severely limits appropriate care. We aimed to assess the safety and effectiveness of modified guidelines that allowed most children with severe pneumonia to be treated locally in first-level facilities, with referral only for those with danger signs or other severe classifications. We did an observational cohort study in ten first-level health facilities in Matlab, rural Bangladesh that had implemented IMCI guidelines. We assessed children with severe pneumonia who were aged between 2 and 59 months, and for whom we could obtain complete information, in two cohorts: 261 children who presented to these facilities between May, 2003, and April, 2004 (before implementation of the modified guidelines) and 1271 children between September, 2004, and August, 2005 (after full implementation). We obtained information about the characteristics and management of their illness, including referrals and admissions to hospital, from facility records. Staff visited households to obtain details of treatment, socioeconomic information, and final outcome, including mortality data. 245 (94%) of 261 children who had severe pneumonia were referred to hospital before the guidelines were modified, compared with 107 (8%) of 1271 after implementation (p<0.0001). 94 (36%) children with severe pneumonia received correct management before the guidelines were modified, compared with 1145 (90%) children after implementation (p<0.0001). Before modification of the guidelines, three children with severe pneumonia who presented at first-level facilities died, with a case-fatality rate of 1.1%; after modification, seven children died, with a case-fatality rate of 0.6% (p=0.39). Local adaptation of the IMCI guidelines, with appropriate training and supervision, could allow safe and effective

  1. Development in Children with Achondroplasia: A Prospective Clinical Cohort Study

    ERIC Educational Resources Information Center

    Ireland, Penelope J.; Donaghey, Samantha; McGill, James; Zankl, Andreas; Ware, Robert S.; Pacey, Verity; Ault, Jenny; Savarirayan, Ravi; Sillence, David; Thompson, Elizabeth; Townshend, Sharron; Johnston, Leanne M.

    2012-01-01

    Aim: Achondroplasia is characterized by delays in the development of communication and motor skills. While previously reported developmental profiles exist across gross motor, fine motor, feeding, and communication skills, there has been no prospective study of development across multiple areas simultaneously. Method: This Australasian…

  2. Development in Children with Achondroplasia: A Prospective Clinical Cohort Study

    ERIC Educational Resources Information Center

    Ireland, Penelope J.; Donaghey, Samantha; McGill, James; Zankl, Andreas; Ware, Robert S.; Pacey, Verity; Ault, Jenny; Savarirayan, Ravi; Sillence, David; Thompson, Elizabeth; Townshend, Sharron; Johnston, Leanne M.

    2012-01-01

    Aim: Achondroplasia is characterized by delays in the development of communication and motor skills. While previously reported developmental profiles exist across gross motor, fine motor, feeding, and communication skills, there has been no prospective study of development across multiple areas simultaneously. Method: This Australasian…

  3. Protocol for the Women And Their Children's Health (WATCH) study: a cohort of pregnancy and beyond.

    PubMed

    Hure, Alexis J; Collins, Clare E; Giles, Warwick B; Wright, Ian M R; Smith, Roger

    2012-01-01

    The developmental origins of health and disease is a conceptual framework that helps explain the links between our early life exposures and later health outcomes, and is a burgeoning field of research. In this report, we describe the study protocol used in a prospective cohort of women recruited during pregnancy, with postnatal follow-up of the mothers and offspring. The Women And Their Children's Health (WATCH) cohort (n = 180 women) is being conducted at the John Hunter Hospital, Australia (from June 2006). Women attended study visits during pregnancy at 19, 24, 30, and 36 weeks' gestation. Postnatal follow-up of the women and their offspring occurred at 3-month intervals during the first year after birth and annually thereafter, until age 4 years. Fetal ultrasound scans were performed at each pregnancy visit. Pregnancy and birth data were obtained from hospital records. Data collection has included maternal and child anthropometric, biochemical, dietary, physical activity, socioeconomic, medical, and other variables. The 2 most novel components of our prospective cohort study are (1) the regular and systematic tracking of fetal and child growth and body composition, starting in the second trimester of pregnancy and continuing to age 4 years, and (2) the detailed maternal and child dietary data collection, including biochemical parameters. Detailed cohorts that collect data on the early nutritional, physiological, and social determinants of health are valuable. Despite its relatively small sample size, many hypotheses on developmental origins can be tested or piloted using data collected from the WATCH cohort.

  4. Prenatal exposure to perfluroalkyl substances and children's IQ: The Taiwan maternal and infant cohort study.

    PubMed

    Wang, Yan; Rogan, Walter J; Chen, Hsin-Yi; Chen, Pau-Chung; Su, Pen-Hua; Chen, Hsiao-Yen; Wang, Shu-Li

    2015-10-01

    Perfluoroalkyl substances (PFASs) are a group of fluorinated organic substances that are widely used in consumer products and are often detectable in human tissues. Human studies on prenatal exposure to PFASs and neurodevelopment in children are few and inconsistent. In the Taiwan Maternal and Infant Cohort Study, we collected serum samples from pregnant women during the third trimester and measured concentrations of 9 PFASs using a high performance liquid chromatography system. A subsample of their children was assessed with full scale intelligence quotient (FSIQ), verbal IQ (VIQ) and performance IQ (PIQ) at both age 5 (n=120) and 8 years (n=120). We used multivariate linear regression models to examine prenatal PFAS exposure in relation to IQ scores at each age period. Prenatal perfluoroundecanoic acid (PFUnDA) concentrations were inversely associated with children's PIQ scores at age 5 years, with an adjusted coefficient (β) of -1.6 (95% confidence interval [CI]: (-3.0, -0.2). When children reached 8 years, most of the prenatal PFASs showed inverse association with children's FSIQ, VIQ and PIQ scores. Among them, prenatal perfluorononanoic acid (PFNA) reached significance. Children with higher prenatal PFNA levels had lower VIQ with an adjusted β of -2.1 (95% CI: -3.9, -0.2). We found two prenatal PFAS exposure, both long-chain PFASs, in association with decreased IQ test scores in children. Our findings suggest more studies on long-chain PFASs and children's neurodevelopment. Copyright © 2015 Elsevier GmbH. All rights reserved.

  5. [Pregnancy-related anxiety and subthreshold autism trait in preschool children based a birth cohort study].

    PubMed

    Sun, Yanli; Shao, Ting; Yao, Yuyou; Tao, Huihui; Ni, Lingling; Yan, Shuangqin; Gu, Chunli; Cao, Hui; Huang, Kun; Tao, Fangbiao

    2016-02-01

    To analyze the associations between pregnancy-related anxiety and the prevalence of subthreshold autism trait (SAT) in preschool children. Baseline data came from the Ma'anshan Birth Cohort Study, a part of the China-Anhui Birth Cohort Study (C-ABCS). All the participants were enrolled among pregnant women who received prenatal health care in 4 municipal medical centers during Oct. 2008 to Oct. 2010. A total of 5 084 pregnant women were recruited at the beginning and 4 669 singleton live births were included until childbirth. The situation about pregnancy-specific anxiety during trimester and third trimester of women were evaluated by Pregnancy-specific Anxiety Questionnaire (PAQ). Between April 2014 and April 2015, the cohort was followed up again, and the Clancy Autism Behavior Scale (CABRS) filled out by parents was used for telling the SAT children from the healthy children among 3 663 preschool children. Univariate and binary regression model was used to estimate associations between the pregnancy-related anxiety during trimester and third trimester and the subthreshold autism trait in children. During the pregnancy, the detected rates of women with pregnancy-specific anxiety in trimester and the third trimester were 25.5%(935/3 663), 13.9%(501/3 592) respectively, and the detected rate of maternal pregnancy-specific anxiety in both periods was 7.7%(278/3 592). There were 290 positive children with SAT and the detection rate was 7.9%. After controlling possible confounding factors including children's genders, place of residence, supplement folic acid during pregnancy, preterm birth, exposure to second-hand smoke during pregnancy, the father (mother) cultural levels, the father (mother) nature of work and family income, the results of multinomial logistic regression analysis showed that maternal pregnancy-specific anxiety in trimester was the risk factor for SAT in preschool children (OR=1.51, 95% CI: 1.11-2.04), and there was no association between maternal

  6. Tamsulosin and the spontaneous passage of ureteral stones in children: A multi-institutional cohort study

    PubMed Central

    Tasian, Gregory E.; Cost, Nicholas G.; Granberg, Candace F.; Pulido, Jose E.; Rivera, Marcelino; Schwen, Zeyad; Schulte, Marion; Fox, Janelle A.

    2014-01-01

    Purpose Tamsulosin is associated with increased passage of ureteral stones in adults, but its effectiveness in children is uncertain. We determined the association between tamsulosin and the spontaneous passage of ureteral stones in children. Methods We performed a multi-institutional retrospective cohort study of children ≤ 18 years who presented between 2007 and 2012 with a ureteral stone ≤ 10 mm and were managed with tamsulosin or oral analgesics alone. The outcome was spontaneous stone passage defined as radiographic clearance and/or patient report of passage. Subjects prescribed tamsulosin were matched with subjects prescribed analgesics alone using nearest neighbor propensity score matching to adjust for treatment selection. Conditional logistic regression models were used to estimate the association between tamsulosin and spontaneous passage of ureteral stones, adjusting for stone size and location. Results Of 449 children with ureteral stones, 334 were eligible for inclusion, and complete data were available for 274 children from 4 institutions (99 tamsulosin; 175 analgesics alone). Following case matching, there were no differences in patient age, gender, weight, height, stone size, or stone location between the 99 subjects prescribed tamsulosin and the 99 propensity-score matched subjects prescribed analgesics alone. In the tamsulosin cohort, 55% of ureteral stones passed versus 44% in the analgesics alone cohort (p = 0.03). In multivariate analysis adjusting for stone size and location, tamsulosin was associated with spontaneous passage of ureteral stones (OR 3.31; 95% CI 1.49–7.34). Conclusions The odds of spontaneous passage of ureteral stones were higher in children prescribed tamsulosin versus analgesics alone. PMID:24518765

  7. Overweight and school performance among primary school children: the PIAMA birth cohort study.

    PubMed

    Veldwijk, Jorien; Fries, Marieke C E; Bemelmans, Wanda J E; Haveman-Nies, Annemien; Smit, Henriëtte A; Koppelman, Gerard H; Wijga, Alet H

    2012-03-01

    The aim of this study was to assess the association between overweight and school performance among primary school children prospectively and including a broad range of potential confounding factors. In addition it was investigated what factors mediate this association. For this purpose, data of 2,159 12-year-old children who participated in the Prevention and Incidence of Asthma and Mite Allergy (PIAMA) birth cohort study were used. Two indicators of school performance were parental reported when children were 12 years of age and included (i): the score on a standardized achievement test that Dutch children have to complete at the end of their primary education (Cito)-test and (ii): the teacher's advice regarding a child's potential performance level in secondary education. Children's height and weight were measured by a trained research assistant at the age of 8 and by their parents at the age of 12. Overweight was defined using age and gender specific cut-off points. Multivariate regression analyses were performed to assess the association between overweight and school performance. Besides, both confounder and mediation analyses were conducted. Results showed lower Cito-test scores and lower teacher's school-level advice among overweight children. These associations were no longer significant when adjusting for parental educational level, skipping breakfast, and screen time. This study found no independent association between overweight and school performance among primary school children. Results showed strong confounding by parental educational level.

  8. Quantification of the energy gap in young overweight children. The PIAMA birth cohort study.

    PubMed

    van den Berg, Saskia W; Boer, Jolanda M A; Scholtens, Salome; de Jongste, Johan C; Brunekreef, Bert; Smit, Henriette A; Wijga, Alet H

    2011-05-17

    Overweight develops gradually as a result of a long term surplus on the balance between energy intake and energy expenditure. Aim of this study was to quantify the positive energy balance responsible for excess body weight gain (energy gap) in young overweight children. Reported data on weight and height were used of 2190 Dutch children participating in the PIAMA birth cohort study. Accumulated body energy was estimated from the weight gain observed between age 2 and age 5-7. Energy gap was calculated as the difference in positive energy balance between children with and without overweight assuming an energy efficiency of 50%. Ten percent of the children were overweight at the age of 5-7 years. For these children, median weight gain during 4-years follow-up was 13.3 kg, as compared to 8.5 kg in the group of children who had a normal weight at the end of the study. A daily energy gap of 289-320 kJ (69-77 kcal) was responsible for the excess weight gain or weight maintenance in the majority of the children who were overweight at the age of 5-7 years. The increase in daily energy requirement to maintain the 4.8 kilograms excess weight gain among overweight children at the end of the study was approximately 1371 kJ. An energy gap of about 289-320 kJ per day over a number of years can make the difference between normal weight and overweight in young children. Closing the energy gap in overweight children can be achieved by relatively small behavior changes. However, much more effort is required to lose the excess weight gained.

  9. Quantification of the energy gap in young overweight children. The PIAMA birth cohort study

    PubMed Central

    2011-01-01

    Background Overweight develops gradually as a result of a long term surplus on the balance between energy intake and energy expenditure. Aim of this study was to quantify the positive energy balance responsible for excess body weight gain (energy gap) in young overweight children. Methods Reported data on weight and height were used of 2190 Dutch children participating in the PIAMA birth cohort study. Accumulated body energy was estimated from the weight gain observed between age 2 and age 5-7. Energy gap was calculated as the difference in positive energy balance between children with and without overweight assuming an energy efficiency of 50%. Results Ten percent of the children were overweight at the age of 5-7 years. For these children, median weight gain during 4-years follow-up was 13.3 kg, as compared to 8.5 kg in the group of children who had a normal weight at the end of the study. A daily energy gap of 289-320 kJ (69-77 kcal) was responsible for the excess weight gain or weight maintenance in the majority of the children who were overweight at the age of 5-7 years. The increase in daily energy requirement to maintain the 4.8 kilograms excess weight gain among overweight children at the end of the study was approximately 1371 kJ. Conclusions An energy gap of about 289-320 kJ per day over a number of years can make the difference between normal weight and overweight in young children. Closing the energy gap in overweight children can be achieved by relatively small behavior changes. However, much more effort is required to lose the excess weight gained. PMID:21586130

  10. Differences in uptake of immunisations and health examinations among refugee children compared to Danish-born children: a cohort study.

    PubMed

    Moller, Sanne Pagh; Hjern, Anders; Andersen, Anne-Marie Nybo; Norredam, Marie

    2016-04-01

    Refugee children and their families constitute a vulnerable group regarding health and access to care. In a register-based cohort design, we examined differences in uptake of immunisations and child health examinations between refugee children and Danish-born children, including predictors of uptake among refugee children. Refugee children (n = 16,701) who, between January 1993 and December 2010, obtained residency permits in Denmark were included and matched in a 1:6 ratio on age and sex with Danish-born children (n = 100,206). Personal identification numbers were cross-linked to the National Danish Health Service Register, identifying all contacts for immunisation and child health examinations. We estimated hazard ratios (HR) of uptake. Refugee children had a lower uptake of all immunisations compared to Danish-born children. The lowest uptake was found for immunisation against diphtheria, tetanus, pertussis and polio (HR = 0.50; 95 % confidence interval (CI) 0.48-0.51). Participation in child health examinations was also lower among refugee children with the lowest at the last child health examination at age 5 (HR = 0.48; 95 % CI 0.47-0.50). Adjusting the analysis for parental income increased the HRs by 10-20 %. This Danish register-based study using nationwide data revealed a lower uptake of routine immunisations and child health examinations among refugee children compared to Danish-born children. •Uptake of immunisation and child health examination is associated with low household income, unemployment and low educational status among the parents. •Uptake may be even lower among refugee families as they constitute a vulnerable group regarding access to healthcare. What is New: •Refugee children had lower uptake of immunisations and child health examinations compared to Danish-born children. •Several predictors of uptake were identified including region of origin and duration of residence.

  11. Food insecurity and children's mental health: a prospective birth cohort study.

    PubMed

    Melchior, Maria; Chastang, Jean-François; Falissard, Bruno; Galéra, Cédric; Tremblay, Richard E; Côté, Sylvana M; Boivin, Michel

    2012-01-01

    Food insecurity (which can be defined as inadequate access to sufficient, safe, and nutritious food that meets individuals' dietary needs) is concurrently associated with children's psychological difficulties. However, the predictive role of food insecurity with regard to specific types of children's mental health symptoms has not previously been studied. We used data from the Longitudinal Study of Child Development in Québec, LSCDQ, a representative birth cohort study of children born in the Québec region, in Canada, in 1997-1998 (n = 2120). Family food insecurity was ascertained when children were 1½ and 4½ years old. Children's mental health symptoms were assessed longitudinally using validated measures of behaviour at ages 4½, 5, 6 and 8 years. Symptom trajectory groups were estimated to identify children with persistently high levels of depression/anxiety (21.0%), aggression (26.2%), and hyperactivity/inattention (6.0%). The prevalence of food insecurity in the study was 5.9%. In sex-adjusted analyses, children from food-insecure families were disproportionately likely to experience persistent symptoms of depression/anxiety (OR: 1.79, 95% CI 1.15-2.79) and hyperactivity/inattention (OR: 3.06, 95% CI 1.68-5.55). After controlling for immigrant status, family structure, maternal age at child's birth, family income, maternal and paternal education, prenatal tobacco exposure, maternal and paternal depression and negative parenting, only persistent hyperactivity/inattention remained associated with food insecurity (fully adjusted OR: 2.65, 95% CI 1.16-6.06). Family food insecurity predicts high levels of children's mental health symptoms, particularly hyperactivity/inattention. Addressing food insecurity and associated problems in families could help reduce the burden of mental health problems in children and reduce social inequalities in development.

  12. Association of bacteria and viruses with wheezy episodes in young children: prospective birth cohort study.

    PubMed

    Bisgaard, Hans; Hermansen, Mette Northman; Bønnelykke, Klaus; Stokholm, Jakob; Baty, Florent; Skytt, Nanna Lassen; Aniscenko, Julia; Kebadze, Tatiana; Johnston, Sebastian L

    2010-10-04

    To study the association between wheezy symptoms in young children and the presence of bacteria in the airways. Birth cohort study. Clinical research unit in Copenhagen. Children of asthmatic mothers, from age 4 weeks to 3 years, with planned visits and acute admissions to the research clinic. Frequency of bacteria and virus carriage in airway aspirates during wheezy episodes and at planned visits without respiratory symptoms. 984 samples (361 children) were analysed for bacteria, 844 (299 children) for viruses, and 696 (277 children) for both viruses and bacteria. Wheezy episodes were associated with both bacterial infection (odds ratio 2.9, 95% confidence interval 1.9 to 4.3; P<0.001) and virus infection (2.8, 1.7 to 4.4; P<0.001). The associations of bacteria and viruses were independent of each other. Acute wheezy episodes in young children were significantly associated with bacterial infections similar to but independent of the association with virus infections.

  13. Traffic-Related Air Pollution and Asthma Hospital Readmission in Children: a Longitudinal Cohort Study

    PubMed Central

    Newman, Nicholas C.; Ryan, Patrick H.; Huang, Bin; Beck, Andrew F.; Sauers, Hadley S.; Kahn, Robert S.

    2014-01-01

    Objective To examine the association between exposure to traffic-related air pollution (TRAP) and hospital readmission for asthma or bronchodilator-responsive wheezing. Study design A population-based cohort of 758 children ages 1–16 years, admitted for asthma or bronchodilator-responsive wheezing was assessed for asthma readmission within 12 months. TRAP exposure was estimated using a land use regression model using the home address at index admission; TRAP was dichotomized at the sample median (0.37 μg/m3). Covariates included allergen-specific IgE, tobacco smoke exposure, and social factors obtained at enrollment. Associations between TRAP exposure and readmission were assessed using logistic regression and Cox proportional hazards. Results Study participants were 58% were African American (AA), 32% white; 19% were readmitted within 12 months. Children with higher TRAP exposure were readmitted at a higher rate overall (21% v. 16%, p = 0.05); this association was not significant after adjusting for covariates (adjusted OR 1.4; 95% CI 0.9–2.2). Race modified the observed association: white children with high TRAP exposure had three-fold increased odds of asthma readmission (OR 3.0; 95% CI 1.1–8.1), compared with low exposed whites. TRAP exposure among AA children was not associated with increased readmission (OR.1.1; 95% CI 0.6–1.8). TRAP exposure was associated with decreased time to readmission for high TRAP-exposed white children (HR 3.2; 95% CI 1.5–6.7) vs. AA children (HR 1.0; 95% CI 0.7–1.4); AA children had a higher readmission rate overall. Conclusions TRAP exposure is associated with increased odds of readmission in white children; this relationship was not observed in AA children. PMID:24680015

  14. Parental drinking and adverse outcomes in children: A scoping review of cohort studies

    PubMed Central

    Felix, Lambert; Keating, Patrick; McCambridge, Jim

    2015-01-01

    Abstract Introduction and Aims There is a growing interest in measuring alcohol's harms to people other than the drinker themselves. ‘Children of alcoholics’ and foetal alcohol spectrum disorder have received widespread attention. Less is known about how children are affected by post‐natal exposure to parental drinking other than alcohol abuse/dependence. In this scoping review, we aim to assemble and map existing evidence from cohort studies on the consequences of parental alcohol use for children, and to identify limitations and gaps in this literature. Design and Methods Systematic review methods were used. Electronic databases were searched (1980 to October 2013) and a total of 3215 abstracts were screened, 326 full text papers examined and 99 eligible for inclusion according to selection criteria including separation of exposure and outcome measurement in time and report of a quantitative effect size. Results The main finding is the large literature available. Adolescent drinking behaviour was the most common outcome measure and outcomes other than substance use were rarely analysed. In almost two of every three published associations, parental drinking was found to be statistically significantly associated with a child harm outcome measure. Several limitations in the literature are noted regarding its potential to address a possible causal role of parental drinking in children's adverse outcomes. Discussion and Conclusions This study identifies targets for further study and provides a platform for more targeted analytic investigations which ascertain risk of bias, and which are capable of considering the appropriateness of causal inferences for the observed associations. [Rossow I, Felix L, Keating P, McCambridge J. Parental drinking and adverse outcomes in children: A scoping review of cohort studies. Drug Alcohol Rev 2016;35:397–405] PMID:26332090

  15. INTERIM REPORT, DEVELOP A COMMUNITY INVOLVEMENT STRATEGY: PREPARE TO IMPLEMENT A COHORT STUDY OF CHILDREN'S ENVIRONMENTAL HEALTH

    EPA Science Inventory

    Introduction

    The National Children's Study (NCS) is an ambitious undertaking: a 20-year prospective cohort

    study
    that will investigate the relationships between a broad range of environmental factors and the health

    and well-being of children. Approximately 10...

  16. Area and Family Effects on the Psychopathology of the Millennium Cohort Study Children and Their Older Siblings

    ERIC Educational Resources Information Center

    Flouri, Eirini; Tzavidis, Nikos; Kallis, Constantinos

    2010-01-01

    Background: To model and compare contextual (area and family) effects on the psychopathology of children nested in families nested in areas. Method: Data from the first two sweeps of the UK's Millennium Cohort Study were used. The final study sample was 9,630 children clustered in 6,052 families clustered in 1,681 Lower-layer Super Output Areas.…

  17. Area and Family Effects on the Psychopathology of the Millennium Cohort Study Children and Their Older Siblings

    ERIC Educational Resources Information Center

    Flouri, Eirini; Tzavidis, Nikos; Kallis, Constantinos

    2010-01-01

    Background: To model and compare contextual (area and family) effects on the psychopathology of children nested in families nested in areas. Method: Data from the first two sweeps of the UK's Millennium Cohort Study were used. The final study sample was 9,630 children clustered in 6,052 families clustered in 1,681 Lower-layer Super Output Areas.…

  18. INTERIM REPORT, DEVELOP A COMMUNITY INVOLVEMENT STRATEGY: PREPARE TO IMPLEMENT A COHORT STUDY OF CHILDREN'S ENVIRONMENTAL HEALTH

    EPA Science Inventory

    Introduction

    The National Children's Study (NCS) is an ambitious undertaking: a 20-year prospective cohort

    study
    that will investigate the relationships between a broad range of environmental factors and the health

    and well-being of children. Approximately 10...

  19. Occlusal characteristics in 3-year-old children--results of a birth cohort study.

    PubMed

    Wagner, Yvonne; Heinrich-Weltzien, Roswitha

    2015-08-07

    Aim of this prospective study was to determine prevalence of malocclusion and associated risk factors in 3-year-old Thuringian children. Subjects (n = 377) were participants in a regional oral health programme, a birth cohort study with the aim to prevent caries (German Clinical Trials Register DRKS00003438). Children received continuous dental care since birth. Occlusal characteristics (overjet, overbite, anterior open bite, canine relationship and posterior crossbite) were measured at the age of 3 years by one calibrated clinician using a vernier caliper (accuracy 0.1 mm; Münchner Modell 042-751-00, Germany). A regular parent survey was conducted to assess risk factors for development of malocclusion. Three hundred seventy seven children (mean age 3.31 ± 0.70 years; 52.5% male) were examined. Children had a mean overjet of 2.4 ± 0.8 mm and the mean overbite was 0.8 ± 1.2 mm; 58.8 % of the children had a normal overjet ≤ 3 mm and 88.8% a normal overbite with < [Formula: see text] overlap. Prevalence of malocclusion was 45.2% (10.9% anterior open bite, 41.2% increased overjet ≥ 3 mm, 40.8% Class II/III canine relationship, 3.4% posterior crossbite). All children who sucked the thumb had a malocclusion. Children who used a pacifier had greater odds of having a malocclusion at age of 3 years than children without pacifier use (OR = 3.36; 95% CI: 1.87-6.05). Malocclusion and dental trauma were associated, but not statistically significant (OR = 1.83; 95% CI: 0.99-3.34; p = 0.062). Malocclusion was not associated with gender, migration background, low socioeconomic status, preterm birth, special health care needs, breathing or dietary patterns (p > 0.05). Non-nutritive sucking habits were important risk factors for development of a malocclusion in the primary dentition.

  20. A regional cohort study of the treatment of critically ill children with bronchiolitis.

    PubMed

    Carroll, Christopher L; Faustino, Edward Vincent S; Pinto, Matthew G; Sala, Kathleen A; Canarie, Michael F; Li, Simon; Giuliano, John S; The Northeast Pediatric Critical Care Research Consortium

    2016-12-01

    To describe the treatment practices in critically ill children with RSV bronchiolitis across four regional PICUs in the northeastern United States, and to determine the factors associated with increased ICU length of stay in this population. We conducted a retrospective cohort study of children who were admitted with RSV bronchiolitis between July 2009 and July 2011 to the PICUs of Connecticut Children's Medical Center, Yale-New Haven Children's Hospital, Maria Fareri Children's Hospital, and Baystate Children's Hospital. Data were collected regarding clinical characteristics and intensive care course among these hospitals. During the study period, 323 children were admitted to one of the four ICUs with RSV bronchiolitis. Despite similar mortality risk scores among ICUs, there was considerable variation in the use of therapies, particularly intubation and mechanical ventilation, in which there was greater than a 3.5-fold increased risk of intubation between sites with the highest and lowest frequency of intubation (odds ratio: 3.8; 95% confidence interval: 2.2-6.4). Albuterol was the most commonly used respiratory treatment, followed by chest physiotherapy, high-flow nasal cannula, and hypertonic saline. Longer stays in the ICU were associated with more frequent use of therapies, specifically invasive mechanical ventilation, inhaled corticosteroids, intrapulmonary percussive ventilation, and chest physiotherapy. Even within a close geographic region, there is significant variation in the treatment provided to critically ill children with RSV bronchiolitis. None of these treatments were associated with shorter durations of hospitalization in this population and some, such as mechanical ventilation, were associated with longer ICU lengths of stay.

  1. Environmental noise and incident mental health problems: A prospective cohort study among school children in Germany.

    PubMed

    Dreger, Stefanie; Meyer, Nicole; Fromme, Hermann; Bolte, Gabriele

    2015-11-01

    Environmental noise is considered a threat to public health as 20% of the EU population is exposed to health influencing noise levels. An association of noise and mental health problems in children has been suggested by some studies, but results are not consistent and there are no longitudinal studies of this association. Our aim was to investigate the influence of different environmental noise sources at children's homes on incident mental health problems in school-aged children. A cohort study of children from first (t0) to fourth grade (t1) of primary school was conducted. Different environmental noise sources (day/night separately) at children's home were assessed via parental annoyance reports. Increased noise exposure between t0 and t1 was the exposure variable. Incident mental health problems were assessed with the parental version of the Strengths and Difficulties Questionnaire (SDQ). RRs and 95% CIs were analysed to investigate the association between different noise sources and incident mental health problems. The study population consisted of 583 boys and 602 girls. The most common increase in noise exposure between t0 and t1 was road traffic noise day (26.38%). After adjusting for covariates exposure to road traffic night was significantly associated with the total difficulties score (RR=2.06; 95% CI=1.25-3.40), emotional symptoms (RR=1.69, 95% CI=1.04-2.72), and conduct problems (RR=1.57, 95% CI=1.04-2.38). Noise by neighbours during the day was associated with conduct problems (RR=1.62, 95% CI=1.11-2.40) and hyperactivity (RR=1.69, 95% CI=1.08-2.65). Aircraft noise day and construction work day were not associated with any of the SDQ categories at a significant level. Environmental noise is an important public health problem. This is the first study to investigate the association of a broad range of noise sources and incident mental health problems in children in a cohort study. Our results suggest that exposure to noise at children's home is

  2. Risk score to stratify children with suspected serious bacterial infection: observational cohort study

    PubMed Central

    Brent, Andrew J; Lakhanpaul, Monica; Thompson, Matthew; Collier, Jacqueline; Ray, Samiran; Ninis, Nelly; Levin, Michael; MacFaul, Roddy

    2011-01-01

    Objectives To derive and validate a clinical score to risk stratify children presenting with acute infection. Study design and participants Observational cohort study of children presenting with suspected infection to an emergency department in England. Detailed data were collected prospectively on presenting clinical features, laboratory investigations and outcome. Clinical predictors of serious bacterial infection (SBI) were explored in multivariate logistic regression models using part of the dataset, each model was then validated in an independent part of the dataset, and the best model was chosen for derivation of a clinical risk score for SBI. The ability of this score to risk stratify children with SBI was then assessed in the entire dataset. Main outcome measure Final diagnosis of SBI according to criteria defined by the Royal College of Paediatrics and Child Health working group on Recognising Acute Illness in Children. Results Data from 1951 children were analysed. 74 (3.8%) had SBI. The sensitivity of individual clinical signs was poor, although some were highly specific for SBI. A score was derived with reasonable ability to discriminate SBI (area under the receiver operator characteristics curve 0.77, 95% CI 0.71 to 0.83) and risk stratify children with suspected SBI. Conclusions This study demonstrates the potential utility of a clinical score in risk stratifying children with suspected SBI. Further work should aim to validate the score and its impact on clinical decision making in different settings, and ideally incorporate it into a broader management algorithm including additional investigations to further stratify a child's risk. PMID:21266341

  3. Hours of television viewing and sleep duration in children: a multicenter birth cohort study.

    PubMed

    Marinelli, Marcella; Sunyer, Jordi; Alvarez-Pedrerol, Mar; Iñiguez, Carmen; Torrent, Maties; Vioque, Jesús; Turner, Michelle C; Julvez, Jordi

    2014-05-01

    This study used longitudinal data to examine potential associations between hours of television viewing and sleep duration in children. To examine the association between hours of television viewing and sleep duration in preschool and school-aged children. Longitudinal, multicenter study among birth cohorts in Menorca, Sabadell, and Valencia from the Spanish Infancia y Medio Ambiente (environment and childhood) project. The study sample included 1713 children (468 from Menorca, 560 from Sabadell, and 685 from Valencia). Parent-reported child television viewing duration measured in hours per day at 2 and 4 years of age in Sabadell and Valencia and at 6 and 9 years of age in Menorca. Parent-reported child sleep duration measured in hours per day at 2 and 4 years of age in Sabadell and Valencia and at 6 and 9 years of age in Menorca. In cross-sectional analysis, children with longer periods of television viewing reported at baseline (≥ 1.5 hours per day) had shorter sleep duration. Longitudinally, children with reported increases in television viewing duration over time (from <1.5 to ≥ 1.5 hours per day) had a reduction in sleep duration at follow-up visits. Results were similar when examining television viewing duration as a continuous variable, with each 1 hour per day of increased viewing decreasing sleep duration at follow-up visits (β = -0.11; 95% CI, -0.18 to -0.05). Associations were similar when television viewing duration was assessed during weekends and after adjusting for potential intermediate factors (child executive function and attention-deficit/hyperactivity disorder symptoms) and confounders (child physical activity level, parental mental health status, maternal IQ, and maternal marital status). Children spending longer periods watching television had shorter sleep duration. Changes in television viewing duration were inversely associated with changes in sleep duration in longitudinal analysis. Parents should consider avoiding long periods of

  4. Literacy Outcomes for Primary School Children Who Are Deaf and Hard of Hearing: A Cohort Comparison Study

    ERIC Educational Resources Information Center

    Harris, Margaret; Terlektsi, Emmanouela; Kyle, Fiona E.

    2017-01-01

    Purpose: In this study, we compared the language and literacy of two cohorts of children with severe-profound hearing loss, recruited 10 years apart, to determine if outcomes had improved in line with the introduction of newborn hearing screening and access to improved hearing aid technology. Method: Forty-two children with deafness, aged 5-7…

  5. Comparison of treatment modalities in syndromic children with obstructive sleep apnea--a randomized cohort study.

    PubMed

    Sudarsan, Shyam Sudhakar; Paramasivan, Vijaya Krishnan; Arumugam, Senthil Vadivu; Murali, Sathiya; Kameswaran, Mohan

    2014-09-01

    Obstructive Sleep Apnea (OSA) is a common medical problem in adults that is becoming increasingly recognized in children. It occurs in the pediatric age group, from newborns to teens. More recently, many specialists have estimated OSA prevalence to be between 5 and 6%. However, in syndromic children, the prevalence of OSA can be from 50 to 100%, having a significant effect on their Quality-of-Life. As they are a challenging population for management, it is essential to evaluate them thoroughly before planning appropriate intervention. To compare the efficacy of Adenotonsillectomy (T&A) and Continuous Positive Airway Pressure (CPAP) in syndromic children [Down syndrome (DS) and Mucopolysaccharidoses (MPS)] with Obstructive Sleep Apnea (OSA). In a prospective, randomized, cohort comparative study, 124 syndromic children (DS and MPS) aged between 6 and 12 years were recruited from a private MPS support group and the Down Syndrome Society, Chennai. A standard assessment was performed on all children who entered the study including a full overnight Polysomnogram (PSG), Epworth Sleepiness Scale-Children (ESS-C) and Quality-of-Life (QOL) tool OSA-18. The children with positive PSG who consented for the study (n = 80) were randomly distributed to two groups, T&A group & CPAP group. The children were followed up with repeat PSG, clinical evaluation, ESS-C and Quality-of-Life (QOL) tool OSA-18 for a period of 1 year. Follow-up was available for 73 syndromic children. Both the groups, T&A group and CPAP group, showed statistically significant (p < 0.05) improvement in Apnea-Hypoapnea Index (AHI), ESS-C, QOL from the intervention. In our study, T&A showed equal outcome compared to CPAP. The contrasting feature between the two groups was that CPAP use gave immediate sustained improvement while T&A gave gradual progressive improvement of symptoms over a period of 1 year. On average, T&A gives equal outcomes as CPAP and it can be suggested as a first-line treatment in this group

  6. Whooping cough in school age children with persistent cough: prospective cohort study in primary care.

    PubMed

    Harnden, Anthony; Grant, Cameron; Harrison, Timothy; Perera, Rafael; Brueggemann, Angela B; Mayon-White, Richard; Mant, David

    2006-07-22

    To estimate the proportion of school age children with a persistent cough who have evidence of a recent Bordetella pertussis infection. Prospective cohort study (October 2001 to March 2005). General practices in Oxfordshire, England. 172 children aged 5-16 years who presented to their general practitioner with a cough lasting 14 days or more who consented to have a blood test. Serological evidence of a recent Bordetella pertussis infection; symptoms at presentation; duration and severity of cough; sleep disturbance (parents and child). 64 (37.2%, 95% confidence interval 30.0% to 44.4%) children had serological evidence of a recent Bordetella pertussis infection; 55 (85.9%) of these children had been fully immunised. At presentation, children with whooping cough were more likely than others to have whooping (odds ratio 2.85, 95% confidence interval 1.39 to 5.82), vomiting (4.35, 2.04 to 9.25), and sputum production (2.39, 1.14 to 5.02). Children with whooping cough were also more likely to still be coughing two months after the start of their illness (85% v 48%; P = 0.001), continue to have more than five coughing episodes a day (P = 0.049), and cause sleep disturbance for their parents (P = 0.003). For school age children presenting to primary care with a cough lasting two weeks or more, a diagnosis of whooping cough should be considered even if the child has been immunised. Making a secure diagnosis of whooping cough may prevent inappropriate investigations and treatment.

  7. Indoor factors and behavioural problems in children: the GINIplus and LISAplus birth cohort studies.

    PubMed

    Casas, Lidia; Tiesler, Carla; Thiering, Elisabeth; Brüske, Irene; Koletzko, Sibylle; Bauer, Carl-Peter; Wichmann, H-Erich; von Berg, Andrea; Berdel, Dietrich; Krämer, Ursula; Schaaf, Beate; Lehmann, Irina; Herbarth, Olf; Sunyer, Jordi; Heinrich, Joachim

    2013-03-01

    Indoor microbial agents exposure is associated to depressive symptoms in adults and persistent exposure to indoor mould is associated to poorer cognitive function in children. In our study, we aimed to assess the effects of the exposure to indoor factors associated with increased microbial exposure (mould, dampness and pets) on behavioural problems in children aged 10 years, participating in two German birth cohorts. A total of 4860 children were followed until the age of 10 years, and the strengths and difficulties questionnaire (SDQ) was administered to the parents. Indoor factors were assessed through parental reported questionnaires in periodical surveys. Logistic and multinomial regressions adjusting for potential confounders were performed. Prevalences of borderline/abnormal total scores in the SDQ at 10 years of age were higher in children exposed to mould (aOR=1.23, 95%CI=1.00-1.56), dampness (aOR=1.51, 95%CI=1.10-2.07), and pets (aOR=1.48, 95%CI=1.20-1.94). The dimension "emotional symptoms" showed statistically significant risk estimates for mould and pets, meanwhile "conduct problems" and "hyperactivity/inattention" dimensions only did for pets. No significant associations were found for the "peer relationship problems" dimension. We found a significant strong interaction between dampness and pet, the risk of borderline/abnormal scores in the "total difficulties" scale and the "emotional symptoms" dimension for pets' was at least twice the risk in children with reported dampness than in children without. Our findings point to a potential effect of microbial exposure on children's behavioural problems, especially on emotional disorders, probably mediated through neurotoxicity and immune system activation. Copyright © 2012 Elsevier GmbH. All rights reserved.

  8. Risk factors of rotavirus diarrhea in hospitalized children in Sanglah Hospital, Denpasar: a prospective cohort study.

    PubMed

    Salim, Hendra; Karyana, I Putu Gede; Sanjaya-Putra, I Gusti Ngurah; Budiarsa, Soetjiningsih; Soenarto, Yati

    2014-03-26

    Diarrhea is a major public health concern throughout the world because the prevalence of morbidity of diarrhea has not changed significantly in the past decade. It remains the third leading cause of death among children less than 5 years of age. Recent surveillance studies have shown that rotavirus is a significant cause of pediatric hospitalization and death due to diarrhea. Indonesia has limited data on risk factors, disease burden, and deaths in children due to rotavirus diarrhea. The objective of this study was to examine the above mentioned factors related to rotavirus diarrhea in hospitalized children in Sanglah Hospital, Denpasar. A prospective cohort study was conducted at Sanglah Hospital Denpasar from April 2009 to December 2011. The present study was part of a nationwide study on Extension for Hospital-based Surveillance and Strain Characterization of Rotavirus Diarrhea Indonesia involving four hospitals throughout Indonesia as a part of the Asian Rotavirus Surveillance Network. We studied children aged <5 years who were hospitalized with acute diarrhea, and analyzed their stool samples using an immunoassay that detects the rotavirus antigen. A total of 656 patients met the inclusion criteria for this study. Of 5805 patients under the age of 5 who were hospitalized between April 2009 and December 2011, the prevalence of diarrhea among hospitalized pediatric patients was 11.3% and the prevalence of rotavirus diarrhea was 49.8%. The male to female ratio of those affected by rotavirus was 1.6:1. The occurrence of vomiting was significantly higher in rotavirus diarrhea than in non-rotavirus diarrhea (RR, 1.4; 95% CI, 1.08 to 1.70; p = 0.004). Diarrhea remains an important cause of hospitalization in children, and rotavirus was the most important etiology. We found that boys had a greatest risk of rotavirus infection than girls. Good nutritional status and breastfeeding provided the same protection against rotavirus and non-rotavirus diarrhea.

  9. Risk factors of rotavirus diarrhea in hospitalized children in Sanglah Hospital, Denpasar: a prospective cohort study

    PubMed Central

    2014-01-01

    Background Diarrhea is a major public health concern throughout the world because the prevalence of morbidity of diarrhea has not changed significantly in the past decade. It remains the third leading cause of death among children less than 5 years of age. Recent surveillance studies have shown that rotavirus is a significant cause of pediatric hospitalization and death due to diarrhea. Indonesia has limited data on risk factors, disease burden, and deaths in children due to rotavirus diarrhea. The objective of this study was to examine the above mentioned factors related to rotavirus diarrhea in hospitalized children in Sanglah Hospital, Denpasar. Methods A prospective cohort study was conducted at Sanglah Hospital Denpasar from April 2009 to December 2011. The present study was part of a nationwide study on Extension for Hospital-based Surveillance and Strain Characterization of Rotavirus Diarrhea Indonesia involving four hospitals throughout Indonesia as a part of the Asian Rotavirus Surveillance Network. We studied children aged <5 years who were hospitalized with acute diarrhea, and analyzed their stool samples using an immunoassay that detects the rotavirus antigen. Results A total of 656 patients met the inclusion criteria for this study. Of 5805 patients under the age of 5 who were hospitalized between April 2009 and December 2011, the prevalence of diarrhea among hospitalized pediatric patients was 11.3% and the prevalence of rotavirus diarrhea was 49.8%. The male to female ratio of those affected by rotavirus was 1.6:1. The occurrence of vomiting was significantly higher in rotavirus diarrhea than in non-rotavirus diarrhea (RR, 1.4; 95% CI, 1.08 to 1.70; p = 0.004). Conclusions Diarrhea remains an important cause of hospitalization in children, and rotavirus was the most important etiology. We found that boys had a greatest risk of rotavirus infection than girls. Good nutritional status and breastfeeding provided the same protection against rotavirus and

  10. Characteristics of trafficked adults and children with severe mental illness: a historical cohort study.

    PubMed

    Oram, Siân; Khondoker, Mizanur; Abas, Melanie; Broadbent, Matthew; Howard, Louise M

    2015-12-01

    Evidence regarding the mental health needs of trafficked people is limited; however, prevalence of depression and post-traumatic stress disorder is high among trafficked people who are in contact with shelter services. We aimed to investigate the sociodemographic and clinical characteristics of trafficked people with severe mental illness. We did a historical cohort study of trafficked people in contact with secondary mental health services in South London, UK, between Jan 1, 2006, and July 31, 2012. We searched and retrieved comprehensive clinical electronic health records for over 200 000 patients from the Case Register Interactive Search database to identify trafficked patients. A matched cohort of non-trafficked adults was generated by simple computer-generated random selection of potential controls for each case within the parameters of matching criteria. We extracted data on sociodemographic and clinical characteristics and abuse history, and used multiple imputation to deal with missing data. We fitted logistic regression models to compare trafficked and non-trafficked patients. We identified 133 trafficked patients, including 37 children. 78 (81%) of 96 adults and 25 (68%) of 37 children were female. 19 (51%) of 37 children were trafficked for sexual exploitation. Among both adults and children, the most commonly recorded diagnoses were post-traumatic stress disorder, severe stress, or adjustment disorder (27 adults [28%] and ten children [27%]) and affective disorders (33 adults [34%] and ten children [27%]). Records documented childhood physical or sexual abuse among trafficked adults (41 [43%]) and children (28 [76%]), and adulthood abuse among trafficked adults (58 [60%]). Trafficked adults were more likely to be compulsorily admitted as a psychiatric inpatient than non-trafficked adults (adjusted odds ratio 7·61, 95% CI 2·18-26·60; p=0·002) and had longer admissions (1·48, 1·01-2·15; p=0·045). No association was found between trafficking

  11. Internationally adopted children with cleft lip and/or palate: A retrospective cohort study.

    PubMed

    Werker, C L; de Wilde, H; Mink van der Molen, A B; Breugem, C C

    2017-04-23

    The treatment approach for internationally adopted children with cleft lip and/or palate differs from locally born children with cleft lip and/or palate. They are older at initial presentation, may have had treatment abroad of different quality, and are establishing new and still fragile relationships with their adoptive parents. The aim of this study was to describe the characteristics and initial care and treatment of this group. A retrospective cohort study was performed including all internationally adopted children with cleft lip and/or palate presenting to the cleft team outpatient clinic in the Wilhelmina Children's Hospital between January 1994 and December 2014. Medical records of all patients were reviewed; information concerning demographic characteristics, characteristics at initial presentation, and treatment were obtained. A total number of 132 adopted patients were included: 15% had cleft lip, 7% had cleft palate, and 78% had cleft lip and palate. The average age at the time of adoption was 26.5 months. In most cases, China was the country of origin. Seventy-eight percent had surgery in their country of origin, primarily lip repair. Fistulae in need of revision surgery were found in 8% of the patients. Pharyngoplasty was needed in 48% of the patients. No significant differences were found for mean age at adoption, gender, cleft type, and one- or two-stage palatal closure. Internationally adopted children with cleft lip and/or palate are a very diverse group of patients with challenging treatment. These children undergo surgery late and frequently need additional surgery. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  12. Comparison of handheld rebound tonometry with Goldmann applanation tonometry in children with glaucoma: a cohort study.

    PubMed

    Dahlmann-Noor, Annegret Hella; Puertas, Renata; Tabasa-Lim, Shenille; El-Karmouty, Ahmed; Kadhim, Mustafa; Wride, Nicholas Kloster; Lewis, Amanda; Grosvenor, Dawn; Rai, Poornima; Papadopoulos, Maria; Brookes, John; Bunce, Catey; Khaw, Peng Tee

    2013-01-01

    To test agreement of two methods to measure intraocular pressure (IOP): rebound tonometry (RBT) and gold standard Goldmann applanation tonometry (GAT) in children with glaucoma. Observational prospective cohort study. Tertiary paediatric glaucoma clinic at a single centre. 102 individuals attending a paediatric glaucoma clinic, mean (SD) age 11.85 (3.17), of whom 53 were male. Intraocular pressure, central corneal thickness, child preference for measurement method. Limits of agreement for intraobserver and interobserver were, respectively, (-2.71, 2.98) mm Hg and (-5.75, 5.97) mm Hg. RBT frequently gave higher readings than GAT and the magnitude of disagreement depend on the level of IOP being assessed. Differences of 10 mm Hg were not uncommon. RBT was the preferred method for 70% of children. There is poor agreement between RBT and GAT in children with glaucoma. RBT frequently and significantly overestimates IOP. However, 'normal' RBT readings are likely to be accurate and may spare children an examination under anaesthesia (EUA). High RBT readings should prompt the practitioner to use another standard method of IOP measurement if possible, or consider the RBT measurement in the context of clinical findings before referring the child to a specialist clinic or considering EUA.

  13. Asthma in children born after infertility treatment: findings from the UK Millennium Cohort Study

    PubMed Central

    Carson, C.; Sacker, A.; Kelly, Y.; Redshaw, M.; Kurinczuk, J.J.; Quigley, M.A.

    2013-01-01

    STUDY QUESTION Is asthma more common in children born after subfertility and assisted reproduction technologies (ART)? SUMMARY ANSWER Yes. Asthma, wheezing in the last year and anti-asthmatic medication were all more common in children born after a prolonged time to conception (TTC). This was driven specifically by an increase in children born after ART. WHAT IS KNOWN ALREADY Few studies have investigated any association between ART and asthma in subsequent children, and findings to date have been mixed. A large registry-based study found an increase in asthma medication in ART children but suggests underlying infertility is the putative risk factor. Little is known about asthma in children after unplanned or mistimed conceptions. STUDY DESIGN, SIZE, DURATION The Millennium Cohort Study is a UK-wide, prospective study of 18 818 children recruited at 9 months of age. Follow-up is ongoing. This study analyses data from follow-up surveys at 5 and 7 years of age (response rates of 79 and 70%, respectively). PARTICIPANTS/MATERIALS, SETTING, METHODS Singleton children whose natural mothers provided follow-up data were included. Mothers reported whether their pregnancy was planned; planners provided TTC and details of any ART. The population was divided into ‘unplanned’ (unplanned and unhappy), ‘mistimed’ (unplanned but happy), ‘planned’ (planned, TTC < 12 months), ‘untreated subfertile’ (planned, TTC >12 months), ‘ovulation induced’ (received clomiphene citrate) and ‘ART’ (IVF or ICSI). The primary analysis used the planned children as the comparison group; secondary analysis compared the treatment groups to the children born to untreated subfertile parents. Outcomes were parent report of asthma and wheezing at 5 and 7 years, derived from validated questions in the International Study of Asthma and Allergies in Childhood, plus use of anti-asthmatic medications. A total of 13 041 (72%) children with full data on asthma and confounders were included

  14. Musculoskeletal complaints among 11-year-old children and associated factors: the PIAMA birth cohort study.

    PubMed

    Hulsegge, Gerben; van Oostrom, Sandra H; Picavet, H Susan J; Twisk, Jos W R; Postma, Dirkje S; Kerkhof, Marjan; Smit, Henriëtte A; Wijga, Alet H

    2011-10-15

    Musculoskeletal complaints (MSC) are common among children, often persist into adolescence, and increase the risk of MSC in adulthood. Knowledge regarding determinants of MSC among children is limited. The aim of this study was to determine the prevalence of MSC at age 11 years and to examine associations with sociodemographic factors, growth and development factors, mental health, tiredness, and lifestyle. Data from a Netherlands birth cohort study, the Prevention and Incidence of Asthma and Mite Allergy (PIAMA) Study (n = 2,638), were used (1996-2009). MSC were defined as complaints about the back, an upper extremity, a lower extremity, or any of these sites. Logistic regression analyses using a forward stepwise procedure were performed on multiply imputed data. The 1-year period prevalences of back, upper extremity, and lower extremity complaints that lasted at least 1 month were 2.8%, 4.8%, and 10.9%, respectively. Only poorer mental health was consistently associated with all 3 types of complaints. Poorer mental health, daytime tiredness, early pubertal development, being physically active at age 11 years, and weight-for-height z score were associated with having any MSC. This study showed that MSC, especially lower extremity complaints, are common among 11-year old-children and that only poorer mental health status is associated with MSC at all anatomic sites.

  15. Asthmatic symptoms, physical activity, and overweight in young children: a cohort study.

    PubMed

    Eijkemans, Marianne; Mommers, Monique; de Vries, Sanne I; van Buuren, Stef; Stafleu, Annette; Bakker, Ingrid; Thijs, Carel

    2008-03-01

    Prevalence of asthma and overweight has increased simultaneously during the past decades. Several studies have reported an association between these two health problems, but it is unclear whether this relation is causal. We hypothesize that children with asthmatic symptoms are less physically active, which may contribute to the development of overweight. The study included children from the KOALA Birth Cohort Study who were invited at 4 to 5 years of age to wear an Actigraph accelerometer for 5 days (n = 305; 152 boys). Information on wheezing was gathered by repeated questionnaires completed by parents at child ages 7 months and 1, 2, and 4 to 5 years. Questionnaires on physical activity were completed at child age 4 to 5 years, and height, weight, and abdominal circumference were measured. Accelerometer data were expressed as mean counts per minute, minutes per day performing vigorous activity, and moderate-to-vigorous physical activity during > or = 1 minute. Children who had wheezed in the last 12 months showed very similar activity levels compared with children who had never wheezed. By contrast, boys who had wheezed at least once but not in the last 12 months were more physically active than boys who had never wheezed (geometric mean: 694 vs 625 cpm; adjusted geometric mean ratio: 1.11). This was not found for girls. Similar results were found in parent-reported physical activity data. No association was found between wheezing at any age and overweight at the age of 4 to 5 years. These results do not support our hypothesis and previous studies that showed that wheezing children are less physically active. Our data provide no evidence that asthmatic symptoms induce a lower physical activity level and more overweight. Additional research could concentrate on the effect of physical activity and overweight on the development of asthmatic symptoms.

  16. BMI changes in children and adolescents attending a specialized childhood obesity center: a cohort study

    PubMed Central

    2013-01-01

    Background Multidisciplinary group therapies for obese children and adolescents are effective but difficult to implement. There is a crucial need to evaluate simpler management programs that target the obese child and his family. This study aimed to determine changes in body mass indexes (BMI) after individual family-based obesity intervention with a pediatrician in a specialized obesity center for child and adolescent. Methods This cohort study included 283 patients (3.3 to 17.1 years, mean 10.7 ± 2.9) attending the Pediatric Obesity Care Program of the Geneva University Hospitals. Medical history and development of anthropometric were assessed in consultations. Pediatricians used an integrative approach that included cognitive behavioral techniques (psycho-education, behavioral awareness, behavioral changes by small objectives and stimulus control) and motivational interviewing. Forty five children were also addressed to a psychologist. Results Mean follow-up duration was 11.4 ± 9.8 months. The decrease in BMI z-score (mean: -0.18 ± 0.40; p < .001) was significant for 49.5% of them. It was dependant of age, BMI at baseline (better in youngest and higher BMI) and the total number of visits (p = .025). Additional psychological intervention was associated with reduced BMI z-score in children aged 8 to 11 years (p = .048). Conclusions Individual family obesity intervention induces a significant weight reduction in half of the children and adolescents, especially in the youngest and severely obese. This study emphasizes the need to encourage trained pediatricians to provide individual follow up to these children and their family. Our study also confirms the beneficial effect of a psychological intervention in selected cases. PMID:24369093

  17. BMI changes in children and adolescents attending a specialized childhood obesity center: a cohort study.

    PubMed

    Maggio, Albane B R; Saunders Gasser, Catherine; Gal-Duding, Claudine; Beghetti, Maurice; Martin, Xavier E; Farpour-Lambert, Nathalie J; Chamay-Weber, Catherine

    2013-12-26

    Multidisciplinary group therapies for obese children and adolescents are effective but difficult to implement. There is a crucial need to evaluate simpler management programs that target the obese child and his family. This study aimed to determine changes in body mass indexes (BMI) after individual family-based obesity intervention with a pediatrician in a specialized obesity center for child and adolescent. This cohort study included 283 patients (3.3 to 17.1 years, mean 10.7 ± 2.9) attending the Pediatric Obesity Care Program of the Geneva University Hospitals. Medical history and development of anthropometric were assessed in consultations. Pediatricians used an integrative approach that included cognitive behavioral techniques (psycho-education, behavioral awareness, behavioral changes by small objectives and stimulus control) and motivational interviewing. Forty five children were also addressed to a psychologist. Mean follow-up duration was 11.4 ± 9.8 months. The decrease in BMI z-score (mean: -0.18 ± 0.40; p < .001) was significant for 49.5% of them. It was dependent of age, BMI at baseline (better in youngest and higher BMI) and the total number of visits (p = .025). Additional psychological intervention was associated with reduced BMI z-score in children aged 8 to 11 years (p = .048). Individual family obesity intervention induces a significant weight reduction in half of the children and adolescents, especially in the youngest and severely obese. This study emphasizes the need to encourage trained pediatricians to provide individual follow up to these children and their family. Our study also confirms the beneficial effect of a psychological intervention in selected cases.

  18. MEFV gene mutations and cardiac phenotype in children with familial Mediterranean fever: a cohort study

    PubMed Central

    2014-01-01

    Background Familial Mediterranean fever (FMF) is the most common autoinflammatory disorder in the world. It is characterized by recurrent febrile inflammatory attacks of serosal and synovial membranes. MEFV gene mutations are responsible for the disease and its protein product, pyrin or marenostrin, plays an essential role in the regulation of the inflammatory reactions. Although the disease may carry a potential for cardiovascular disorders because of sustained inflammation during its course, the spectrum of cardiac involvement in children with FMF has not been well studied. We aimed at defining the frequency and spectrum of cardiac affection in children with FMF. The correlation between these affections and MEFV gene mutations was searched for to establish the relationship between cardiac phenotype and the patient's genotype in FMF. Methods The present work is a cohort study including 55 patients with the clinical diagnosis of FMF based on the Tel-Hashomere criteria, confirmed by genetic analysis showing homozygous or compound heterozygous mutation of MEFV genes. Fifty age- and sex-matched normal children were included as controls. The entire study group underwent detailed cardiac examination, 12-lead ECG and echocardiography. All data was statistically analysed using SPSS version-15. Results Patients had an average age of 8.5+/−4.2 years; with an average disease duration of 2.1+/−2.2 years; 28 were males. All controls showed no MEVF gene mutations. The most frequent gene mutation of the studied cases was E148Q mutation seen in 34% of cases and the most frequent compound mutation was E148Q/V726A seen in 16.6% of cases. Echocardiographic examination revealed pericardial effusion in nine patients. Twelve had aortic regurgitation; nine had mitral regurgitation and six had pulmonary regurgitation. The most common mutation associated with pericardial effusion was E148Q/V726A in 5/9 of cases. Valvular involvement were significantly more common in FMF patients

  19. Etiology of community acquired pneumonia among children in India: prospective, cohort study

    PubMed Central

    Mathew, Joseph L.; Singhi, Sunit; Ray, Pallab; Hagel, Eva; Saghafian–Hedengren, Shanie; Bansal, Arun; Ygberg, Sofia; Sodhi, Kushaljit Singh; Kumar, B V Ravi; Nilsson, Anna

    2015-01-01

    Background Childhood community acquired pneumonia (CAP) is a significant problem in developing countries, and confirmation of microbial etiology is important for individual, as well as public health. However, there is paucity of data from a large cohort, examining multiple biological specimens for diverse pathogens (bacteria and viruses). The Community Acquired Pneumonia Etiology Study (CAPES) was designed to address this knowledge gap. Methods We enrolled children with CAP (based on WHO IMCI criteria of tachypnea with cough or breathing difficulty) over 24 consecutive months, and recorded presenting symptoms, risk factors, clinical signs, and chest radiography. We performed blood and nasopharyngeal aspirate (NPA) bacterial cultures, and serology (Mycoplasma pneumoniae, Chlamydophila pneumoniae). We also performed multiplex PCR for 25 bacterial/viral species in a subgroup representing 20% of the cohort. Children requiring endotracheal intubation underwent culture and PCR of bronchoalveolar lavage (BAL) specimens. Findings We enrolled 2345 children. NPA and blood cultures yielded bacteria in only 322 (13.7%) and 49 (2.1%) children respectively. In NPA, Streptococcus pneumoniae (79.1%) predominated, followed by Haemophilus influenzae (9.6%) and Staphylococcus aureus (6.8%). In blood, S. aureus (30.6%) dominated, followed by S. pneumoniae (20.4%) and Klebsiella pneumoniae (12.2%). M. pneumoniae and C. pneumoniae serology were positive in 4.3% and 1.1% respectively. Multiplex PCR in 428 NPA specimens identified organisms in 422 (98.6%); of these 352 (82.2%) had multiple organisms and only 70 (16.4%) had a single organism viz. S. pneumoniae: 35 (50%), Cytomegalovirus (CMV): 13 (18.6%), Respiratory Syncytial Virus (RSV): 9 (12.9%), other viruses: 6 (8.7%), S. aureus: 5 (7.1%), and H. influenzae: 2 (2.9%). BAL PCR (n = 30) identified single pathogens in 10 (S. pneumoniae–3, CMV–3, S. aureus–2, H. influenzae–2) and multiple pathogens in 18 children. There were

  20. Pulmonary Function and Incident Bronchitis and Asthma in Children: A Community-Based Prospective Cohort Study

    PubMed Central

    Lee, Yungling Leo; Hwang, Bing-Fang; Chen, Yu-An; Chen, Jer-Min; Wu, Yi-Fan

    2012-01-01

    Background Previous studies revealed that reduction of airway caliber in infancy might increase the risks for wheezing and asthma. However, the evidence for the predictive effects of pulmonary function on respiratory health in children was still inconsistent. Methods We conducted a population-based prospective cohort study among children in 14 Taiwanese communities. There were 3,160 children completed pulmonary function tests in 2007 and follow-up questionnaire in 2009. Poisson regression models were performed to estimate the effect of pulmonary function on the development of bronchitis and asthma. Results After adjustment for potential confounders, pulmonary function indices consistently showed protective effects on respiratory diseases in children. The incidence rate ratios of bronchitis and asthma were 0.86 (95% CI 0.79–0.95) and 0.91 (95% CI 0.82–0.99) for forced expiratory volume in 1 second (FEV1). Similar adverse effects of maximal mid-expiratory flow (MMEF) were also observed on bronchitis (RR = 0.73, 95% CI 0.67–0.81) and asthma (RR = 0.85, 95% CI 0.77–0.93). We found significant decreasing trends in categorized FEV1 (p for trend = 0.02) and categories of MMEF (p for trend = 0.01) for incident bronchitis. Significant modification effects of traffic-related air pollution were noted for FEV1 and MMEF on bronchitis and also for MMEF on asthma. Conclusions Children with high pulmonary function would have lower risks on the development of bronchitis and asthma. The protective effect of high pulmonary function would be modified by traffic-related air pollution exposure. PMID:22457716

  1. Pulmonary function and incident bronchitis and asthma in children: a community-based prospective cohort study.

    PubMed

    Lee, Yungling Leo; Hwang, Bing-Fang; Chen, Yu-An; Chen, Jer-Min; Wu, Yi-Fan

    2012-01-01

    Previous studies revealed that reduction of airway caliber in infancy might increase the risks for wheezing and asthma. However, the evidence for the predictive effects of pulmonary function on respiratory health in children was still inconsistent. We conducted a population-based prospective cohort study among children in 14 Taiwanese communities. There were 3,160 children completed pulmonary function tests in 2007 and follow-up questionnaire in 2009. Poisson regression models were performed to estimate the effect of pulmonary function on the development of bronchitis and asthma. After adjustment for potential confounders, pulmonary function indices consistently showed protective effects on respiratory diseases in children. The incidence rate ratios of bronchitis and asthma were 0.86 (95% CI 0.79-0.95) and 0.91 (95% CI 0.82-0.99) for forced expiratory volume in 1 second (FEV₁). Similar adverse effects of maximal mid-expiratory flow (MMEF) were also observed on bronchitis (RR = 0.73, 95% CI 0.67-0.81) and asthma (RR = 0.85, 95% CI 0.77-0.93). We found significant decreasing trends in categorized FEV₁ (p for trend = 0.02) and categories of MMEF (p for trend = 0.01) for incident bronchitis. Significant modification effects of traffic-related air pollution were noted for FEV₁ and MMEF on bronchitis and also for MMEF on asthma. Children with high pulmonary function would have lower risks on the development of bronchitis and asthma. The protective effect of high pulmonary function would be modified by traffic-related air pollution exposure.

  2. A Retrospective Cohort Study of Glossopharyngeal Nerve Taste in Children with Recurrent Acute Tonsillitis.

    PubMed

    Hill, Courtney A; Dang, Suveera; Beach, Michael; Chen, Eunice Y

    2017-01-01

    Objective To compare glossopharyngeal taste between healthy children and those with recurrent acute tonsillitis. Study Design Retrospective cohort study. Setting Pediatric clinics in a tertiary care medical center and satellite location. Subjects and Methods Smell and taste testing was administered to 80 well children and 64 children with recurrent acute tonsillitis (age range, 6-17 years). Smell testing was performed with the NIH Toolbox Odor Identification Test, with scores based on national averages for age and sex. Validated Taste Strips were placed on the midline of the tongue at the circumvallate papillae in random tastant order and in increasing concentrations to test sweet, salty, sour, and bitter. Ordinal logistic regression was used for multivariate analysis. Results The healthy and tonsillitis groups were similar, with mean ages of 11.3 and 10.8 years ( P = .34), respectively. The tonsillitis group had fewer boys (n = 18 vs 43, P = .002), higher mean body mass index (BMI) percentile (n = 72.2 vs 59.8, P = .01), and more subjects with public or no insurance (n = 24 vs 13, P = .004). Univariate analysis revealed no statistically significant differences in rate of normal overall taste (67.2% vs 60%, P = .39) and in sweet (79.7% vs 82.5%, P = .67), salty (85.9% vs 82.8%, P = .82), sour (64.1% vs 70%, P = .48), and bitter (90.6% vs 86.3%, P = .45). In multivariate analysis, smell ability, sex, BMI percentile, parent BMI, and insurance type did not affect overall taste or sweet, salty, sour, or bitter alone. Conclusion Despite controlling for potential intrinsic (sex, smell, BMI) and extrinsic (parent BMI, insurance type) confounders, there was no statistically significant difference in taste among children with recurrent acute tonsillitis as compared with healthy children.

  3. Acute Viral Respiratory Illnesses in Andean Children: a Household-Based Cohort Study

    PubMed Central

    Budge, Philip J.; Griffin, Marie R.; Edwards, Kathryn M.; Williams, John V.; Verastegui, Hector; Hartinger, Stella M.; Johnson, Monika; Klemenc, Jennifer M.; Zhu, Yuwei; Gil, Ana I.; Lanata, Claudio F.; Grijalva, Carlos G.

    2014-01-01

    Background Few community studies have measured the incidence, severity, and etiology of acute respiratory illness (ARI) among children living at high-altitude in remote rural settings. Methods We conducted active, household-based ARI surveillance among children aged <3 years in rural highland communities of San Marcos, Cajamarca, Peru from May 2009 through September 2011 (RESPIRA-PERU study). ARI (defined by fever or cough) were considered lower respiratory tract infections (LRTI) if tachypnea, wheezing, grunting, stridor, or retractions were present. Nasal swabs collected during ARI episodes were tested for respiratory viruses by real-time reverse-transcriptase polymerase chain reaction. ARI incidence was calculated using Poisson regression. Results During 755.1 child-years of observation among 892 children in 58 communities, 4,475 ARI were observed, yielding an adjusted incidence of 6.2 ARI/child-year (95% CI 5.9 – 6.5). Families sought medical care for 24% of ARI, 4% were classified as LRTI, and 1% led to hospitalization. Two of five deaths among cohort children were attributed to ARI. One or more respiratory virus was detected in 67% of 3957 samples collected. Virus-specific incidence rates per 100 child-years were: rhinovirus, 236; adenovirus, 73; parainfluenza virus, 46; influenza, 37; respiratory syncytial virus, 30; and human metapneumovirus, 17. Respiratory syncytial virus, metapneumovirus, and parainfluenza virus 1-3 comprised a disproportionate share of LRTI compared to other etiologies. Conclusions In this high-altitude rural setting with low population density, ARI in young children were common, frequently severe, and associated with a number of different respiratory viruses. Effective strategies for prevention and control of these infections are needed. PMID:24378948

  4. Dietary patterns and the risk of rhinitis in primary school children: a prospective cohort study

    PubMed Central

    Liu, Xudong; Wong, Claudie Chiu-Yi; Yu, Ignatius T. S.; Zhang, Zilong; Tan, Lixing; Lau, Arthur P. S.; Lee, Albert; Yeoh, Eng Kiong; Lao, Xiang Qian

    2017-01-01

    This study was to investigate the association between dietary patterns and rhinitis in primary school children. 1,599 students without rhinitis at baseline survey were selected from a primary school children cohort. Information on food consumption, respiratory symptoms, and confounders was collected using questionnaires. Dietary patterns were defined using principal component analysis. Logistic regression was performed to calculate odds ratio (OR) with 95% confidence intervals (95% CI). The incidence of rhinitis during 12 months follow-up was 21.2%. Three patterns were extracted and labeled as pattern I, II and III. Dietary pattern II which had higher factor loadings of legumes, butter, nuts and potatoes was associated with an increased risk of rhinitis (OR: 1.34, 95% CI: 1.01–1.87) when the highest tertile of pattern score was compared to the lowest tertile, after adjusted for confounders. Besides, every 1-unit increase of score of pattern II was also associated with an increased risk of rhinitis (OR: 1.19, 95% CI: 1.05–1.35). Neither pattern I nor Pattern III was observed to be associated with risk of rhinitis. A diet with higher levels of consumption of legumes, butter, nuts and potatoes may increase the risk of allergic rhinitis in primary school children. PMID:28294150

  5. Health effects of the 2012 Valencia (Spain) wildfires on children in a cohort study.

    PubMed

    Vicedo-Cabrera, Ana M; Esplugues, Ana; Iñíguez, Carmen; Estarlich, Marisa; Ballester, Ferran

    2016-06-01

    In July 2012, two simultaneous wildfires burnt a big area in Valencia (Spain), where a birth cohort study (INMA) is being developed. The heavy smoke covered the whole INMA study area for several days. We aimed at evaluating the 2012 Valencia wildfire effects on the health of children enrolled in the INMA-Valencia cohort. Two weeks after the extinction of the wildfires, a phone survey was conducted and finally 460 individuals were enrolled. We considered a wildfire period (12-day interval when they were active) and a control period (12-day interval just before wildfires). Parents were asked about respiratory symptoms experienced during both periods, and during wildfires only about the preventive measures adopted and the perception of exposure, along with individual data collected through the different follow-up surveys of the cohort. Conditional logistic regression models were applied, and we included interaction terms for asthma/rhinitis and level of perception of exposure; 82.4 % perceived smoke smell outdoors, 40 % indoors and more than 90 % of the families observed the presence of ash. An adjusted odds ratio of 3.11 [95 % confidence interval 1.62-5.97] for itchy/watery eyes and 3.02 [1.41-6.44] for sore throat was obtained. Significant interaction terms for rhinitis and asthma in itchy/watery eyes and sneezing, and only asthma for sore throat were obtained. Exposure to wildfire smoke was associated with increased respiratory symptoms in this child population, particularly affecting susceptible individuals with asthma or rhinitis.

  6. Cohort profile: UK Millennium Cohort Study (MCS).

    PubMed

    Connelly, Roxanne; Platt, Lucinda

    2014-12-01

    The UK Millennium Cohort Study (MCS) is an observational, multidisciplinary cohort study that was set up to follow the lives of children born at the turn of the new century. The MCS is nationally representative and 18 552 families (18 827 children) were recruited to the cohort in the first sweep. There have currently been five main sweeps of data collection, at ages 9 months and 3, 5, 7 and 11 years. A further sweep of data collection is planned for age 14 years. A range of health-related data have been collected as well as measures concerning child development, cognitive ability and educational attainment. The data also include a wealth of information describing the social, economic and demographic characteristics of the cohort members and their families. In addition, the MCS data have been linked to administrative data resources including health records. The MCS provides a unique and valuable resource for the analysis of health outcomes and health inequalities. The MCS data are freely available to bona fide researchers under standard access conditions via the UK Data Service (http://ukdataservice.ac.uk) and the MCS website provides detailed information on the study (http://www.cls.ioe.ac.uk/mcs).

  7. Literacy Outcomes for Primary School Children Who Are Deaf and Hard of Hearing: A Cohort Comparison Study.

    PubMed

    Harris, Margaret; Terlektsi, Emmanouela; Kyle, Fiona E

    2017-03-01

    In this study, we compared the language and literacy of two cohorts of children with severe-profound hearing loss, recruited 10 years apart, to determine if outcomes had improved in line with the introduction of newborn hearing screening and access to improved hearing aid technology. Forty-two children with deafness, aged 5-7 years with a mean unaided loss of 102 DB, were assessed on language, reading, and phonological skills. Their performance was compared with that of a similar group of 32 children with deafness assessed 10 years earlier and also a group of 40 children with normal hearing of similar single word reading ability. English vocabulary was significantly higher in the new cohort although it was still below chronological age. Phonological awareness and reading ability had not significantly changed over time. In both cohorts, English vocabulary predicted reading, but phonological awareness was only a significant predictor for the new cohort. The current results show that vocabulary knowledge of children with severe-profound hearing loss has improved over time, but there has not been a commensurate improvement in phonological skills or reading. They suggest that children with severe-profound hearing loss will require continued support to develop robust phonological coding skills to underpin reading.

  8. Hearing in school-aged children with trisomy 21 - results of a longitudinal cohort study in children identified at birth.

    PubMed

    Yaneza, M M C; Hunter, K; Irwin, S; Kubba, H

    2016-12-01

    To report the prevalence of hearing problems and the hearing sequelae in school-aged children with trisomy 21 in a longitudinal study. All children with trisomy 21 were identified via schools, community-based child development centres, general practitioners, or the universal newborn hearing screen. Audiological data and otorhinolaryngological problems were prospectively entered in to the Audiological Surveillance Programme database from each visit. Retrospective review of the Audiological Surveillance Programme database in the Glasgow area (United Kingdom) of all children reviewed between 2004 and 2012. All pre-teenaged children with trisomy 21 of school age (aged 5-12 years old). Hearing thresholds, aetiology of hearing loss and management of hearing loss was determined for the cohort of children. A total of 102 children were included. Fifty-four had normal hearing. Twenty-six had fluctuating otitis media with effusion; five had hearing in normal limits, six were managed with hearing aids, fourteen were managed conservatively, and one had ventilation tube insertion. Fifteen had persistent otitis media with effusion; four had ventilation tube insertion; and nine were managed with hearing aids. Seven had mixed hearing loss with four required hearing aids. Otitis media with effusion was the commonest cause of hearing impairment; effusions may fluctuate through the pre-teenaged years, and thus, hearing aids are beneficial. Ventilation tube insertion and bone-conducting hearing aids were useful when ear-level hearing aids were not tolerated. Mixed hearing loss occurred in later years as sensorineural hearing loss developed on a background of otitis media with effusion. © 2015 John Wiley & Sons Ltd.

  9. Cardiovascular safety of stimulants in children with attention-deficit/hyperactivity disorder: a nationwide prospective cohort study.

    PubMed

    Dalsgaard, Søren; Kvist, Anette Primdal; Leckman, James F; Nielsen, Helena Skyt; Simonsen, Marianne

    2014-08-01

    The purpose of this study was to determine whether stimulant users are at higher risk of a later cardiovascular event than are non-users, examining this association in both a national cohort and a population-based sample of children and adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD). We also aim to examine a possible dose-response relationship in such an association. We conducted a longitudinal, prospective cohort study of all children born in Denmark between 1990 and 1999. Within this cohort, children with ADHD were identified. Data from national health registers on psychiatric and somatic diagnoses, stimulant prescriptions, cardiovascular risk factors, pre- and perinatal and sociodemographic covariates in all children and their parents were merged, using the unique personal identification number. Hazard ratios (HR) for cardiovascular events were estimated using Cox regression, adjusted for other known risk factors. In the total population (n=714,258 contributing a total of 6,767,982 person-years) use of stimulants increased the risk of a cardiovascular event; adjusted HR=1.83 (1.10-3.04). In children with ADHD (n=8300) stimulant treatment also increased the risk of a cardiovascular event (adjusted HR=2.20 [2.15-2.24]), with a complex time-dependent dose-response relationship. This is the first nationwide cohort study of the cardiovascular safety of stimulants in children and adolescents, and it represents, to our knowledge, the longest prospective follow-up study. Cardiovascular events were rare but twice as likely in stimulant users as in non-users, both in the total national population and in children with ADHD. We found a complex, time- and dose-dependent interrelationship between cardiovascular adverse events and stimulant treatment in children and adolescents. Our results suggest a safety signal with an increased risk of cardiovascular disease associated with stimulant treatment in children and adolescents, even after adjusting

  10. Why are poorer children at higher risk of obesity and overweight? A UK cohort study.

    PubMed

    Goisis, Alice; Sacker, Amanda; Kelly, Yvonne

    2016-02-01

    There is limited evidence on which risk factors attenuate income inequalities in child overweight and obesity; whether and why these inequalities widen as children age. Eleven thousand nine hundred and sixty five singletons had complete data at age 5 and 9384 at age 11 from the Millennium Cohort Study (UK). Overweight (age 5 : 15%; age 11 : 20%) and obesity (age 5 : 5%; age 11 : 6%) were defined using the International Obesity Taskforce body mass index cut-points. To measure socioeconomic inequalities, we used quintiles of family income and as risk factors, we considered markers of maternal health behaviours and of children's physical activity, sedentary behaviours and diet. Binary and multinomial logistic regression models were used. The unadjusted analyses revealed stark income inequalities in the risk of obesity at age 5 and 11. At age 5, children in the bottom income quintile had 2.0 (95% CI: 1.4-2.8) increased relative risk of being obese whilst at age 11 they had 3.0 (95% CI: 2.0-4.5) increased risk compared to children in the top income quintile. Similar income inequalities in the risk of overweight emerged by age 11. Physical activity and diet were particularly important in explaining inequalities. Income inequalities in obesity and overweight widened significantly between age 5 and 11 and a similar set of risk factors protected against upward and promoted downward movements across weight categories. To reduce income inequalities in overweight and obesity and their widening across childhood the results support the need of early interventions which take account of multiple risk factors. © The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association.

  11. Hemodialysis vascular access in children and adolescents: a ten-year retrospective cohort study.

    PubMed

    Souza, Regina Araujo de; Oliveira, Eduardo Araujo; Silva, José Maria Penido; Lima, Eleonora Moreira

    2011-12-01

    The complications of vascular access have been the major cause of hospitalization among patients with end stage renal disease (ESRD) on Haemodialysis (HD). Despite recommendations to decrease the use of central venous catheter (CVC) it still represents the main access for children and adolescents who start HD. This study aimed to evaluate, through a retrospective cohort study, the initial type, the incidence of complications and reasons for failure of vascular access in children and adolescents aged 0 to younger than 18 years who started HD from 1997 to 2007. 251 accesses were studied in 61 patients, 97 arteriovenous fistula (AVF) and 154 temporary uncuffed CVC. 51% of study patients began HD with CVC. The mean age of patients at the start of HD was 12.5 years. The predominant underlying disease was glomerulonephritis (46%). The main cause of CVC removal was infection in 35%. The mean survival of the uncuffed CVC was 40 days. AVF primary failure was detected in 37.8% of the fistulas. Considering the patent fistulas, the main cause of failure was thrombosis (84%). Infection did not caused any loss of AVF. When comparing the two types of access we find a risk of infection 34 times higher in patients using CVC against AVF. Infection was the major cause of CVC removal, and our results suggest that uncuffed CVC must be avoided for ESRD children and adolescents on HD and replaced by AVF or cuffed CVC, whenever it is feasible. Thrombosis was the main cause of AVF loss, urging the need of implementation of a program for early detection of access failure.

  12. Polish mother and child cohort study (REPRO_PL)--methodology of follow-up of the children.

    PubMed

    Polańska, Kinga; Hanke, Wojciech; Jurewicz, Joanna; Sobala, Wojciech; Madsen, Christian; Nafstad, Per; Magnus, Per

    2011-12-01

    A prospective cohort study design gives the opportunity for identification, update of different exposures and their verification by biomarker measurements. The aim of The Polish Mother and Child Cohort Study (REPRO_PL) is to evaluate the impact of exposure to different environmental factors during pregnancy and, after birth, on the pregnancy outcome, children's health and neurodevelopment. REPRO_PL cohort was established in 2007. From the cohort of 1300 mother-child pairs, 300 children are followed-up until they are two years old to asses the exposure, health status and neurodevelopment. Children are examined twice: at one and two years of age by a pediatrician and a psychologist/child development specialist. During each visit, detailed questionnaire is conducted with the mothers and supplemented with the information from the medical charts to have appropriate recognition of the child's health and development. Additionally, the current health status of the child is checked and his/her biometry is performed. A urine sample is collected from each child for the verification of environmental tobacco smoke (ETS) and polycyclic aromatic hydrocarbons (PAH) exposure. Some children have a blood sample collected for the assessment of the lead and cadmium levels. Child's neurodevelopment is assessed based on Bayley Scales for Infant and Toddler Development (Bayley-III). The results of the study will become available within the next few years and will help to determine the impact of the environmental exposures on children's health and neurodevelopment. REPRO_PL cohort is a middle-sized cohort, very much focused on specific research questions with the potential for future extension and cooperation.

  13. The respiratory health of urban indigenous children aged less than 5 years: study protocol for a prospective cohort study.

    PubMed

    Hall, Kerry K; Chang, Anne B; Sloots, Theo P; Anderson, Jennie; Kemp, Anita; Hammill, Jan; Otim, Michael; O'Grady, Kerry-Ann F

    2015-05-14

    Despite the burden of acute respiratory illnesses (ARI) among Aboriginal and Torres Strait Islander children being a substantial cause of childhood morbidity and associated costs to families, communities and the health system, data on disease burden in urban children are lacking. Consequently evidence-based decision-making, data management guidelines, health resourcing for primary health care services and prevention strategies are lacking. This study aims to comprehensively describe the epidemiology, impact and outcomes of ARI in urban Aboriginal and Torres Strait Islander children (hereafter referred to as Indigenous) in the greater Brisbane area. An ongoing prospective cohort study of Indigenous children aged less than five years registered with a primary health care service in Northern Brisbane, Queensland, Australia. Children are recruited at time of presentation to the service for any reason. Demographic, epidemiological, risk factor, microbiological, economic and clinical data are collected at enrolment. Enrolled children are followed for 12 months during which time ARI events, changes in child characteristics over time and monthly nasal swabs are collected. Children who develop an ARI with cough as a symptom during the study period are more intensely followed-up for 28 (±3) days including weekly nasal swabs and parent completed cough diary cards. Children with persistent cough at day 28 post-ARI are reviewed by a paediatrician. Our study will be one of the first to comprehensively evaluate the natural history, epidemiology, aetiology, economic impact and outcomes of ARIs in this population. The results will inform studies for the development of evidence-based guidelines to improve the early detection, prevention and management of chronic cough and setting of priorities in children during and after ARI. Australia New Zealand Clinical Trial Registry Registration Number: 12614001214628 . Registered 18 November 2014.

  14. Outdoor temperature, precipitation, and wind speed affect physical activity levels in children: a longitudinal cohort study

    PubMed Central

    Edwards, Nicholas M.; Myer, Gregory D.; Kalkwarf, Heidi J.; Woo, Jessica G.; Khoury, Philip R.; Hewett, Timothy E.; Daniels, Stephen R.

    2015-01-01

    Objective Evaluate effects of local weather conditions on physical activity in early childhood. Methods Longitudinal prospective cohort study of 372 children, 3 years old at enrollment, drawn from a major US metropolitan community. Accelerometer-measured (RT3) physical activity was collected every 4 months over 5 years and matched with daily weather measures: day length, heating/cooling degrees (degrees mean temperature < 65°F or ≥ 65°F, respectively), wind, and precipitation. Mixed regression analyses, adjusted for repeated measures, were used to test the relationship between weather and physical activity. Results Precipitation and wind speed were negatively associated with total physical activity and moderate-vigorous physical activity (P<0.0001). Heating and cooling degrees were negatively associated with total physical activity and moderate-vigorous physical activity and positively associated with inactivity (all P<0.0001), independent of age, sex, race, BMI, day length, wind, and precipitation. For every 10 additional heating degrees there was a five-minute daily reduction in moderate-vigorous physical activity. For every additional 10 cooling degrees there was a 17-minute reduction in moderate-vigorous physical activity. Conclusions Inclement weather (higher/lower temperature, greater wind speed, more rain/snow) is associated with less physical activity in young children. These deleterious effects should be considered when planning physical activity research, interventions, and policies. PMID:25423667

  15. Insulin pump failures in Italian children with Type 1 diabetes: retrospective 1-year cohort study.

    PubMed

    Rabbone, I; Minuto, N; Bonfanti, R; Marigliano, M; Cerutti, F; Cherubini, V; d'Annunzio, G; Frongia, A P; Iafusco, D; Ignaccolo, G; Lombardo, F; Schiaffini, R; Toni, S; Tumini, S; Zucchini, S; Pistorio, A; Scaramuzza, A E

    2017-05-01

    Insulin pump failure and/or malfunction requiring replacement have not been thoroughly investigated. This study evaluated pump replacement in children and adolescents with Type 1 diabetes using insulin pump therapy. Data were collected for all participants younger than 19 years, starting insulin pump therapy before 31 December 2013. For each child, age, disease duration, date of insulin pump therapy initiation, insulin pump model, failure/malfunction/replacement yes/no and reason were considered for the year 2013. Data were returned by 40 of 43 paediatric centres belonging to the Diabetes Study Group of the Italian Society of Paediatric Endocrinology and Diabetology. In total, 1574 of 11 311 (13.9%) children and adolescents with Type 1 diabetes were using an insulin pump: 29.2% Animas VIBE(™) , 9.4% Medtronic MiniMed 715/515(™) , 34.3% Medtronic MiniMed VEO(™) , 24.3% Accu-Check Spirit Combo(™) and 2.8% other models. In 2013, 0.165 insulin pump replacements per patient-year (11.8% due to pump failure/malfunction and 4.7% due to accidental damage) were recorded. Animas VIBE(™) (22.1%) and Medtronic MiniMed VEO(™) (17.7%) were the most replaced. In a large cohort of Italian children and adolescents with Type 1 diabetes, insulin pump failure/malfunction and consequent replacement are aligned with rates previously reported and higher in more sophisticated pump models. © 2016 Diabetes UK.

  16. Pertussis vaccination and wheezing illnesses in young children: prospective cohort study

    PubMed Central

    Henderson, John; North, Kate; Griffiths, Mancell; Harvey, Ian; Golding, Jean

    1999-01-01

    Objectives To examine the relation between pertussis vaccination and the prevalence of wheezing illnesses in young children. Design Prospective cohort study. Setting Three former health districts comprising Avon Health Authority. Subjects 9444 of 14 138 children enrolled in the Avon longitudinal study of pregnancy and childhood and for whom data on wheezing symptoms, vaccination status, and 15 environmental and biological variables were available. Main outcome measures Episodes of wheezing from birth to 6 months, 7-18 months, 19-30 months, and 31-42 months. These time periods were used to derive five categories of wheezing illness: early wheezing (not after 18 months); late onset wheezing (after 18 months); persistent wheezing (at every time period); recurrent wheezing (any combination of two or more episodes for each period); and intermittent wheezing (any combination of single episodes of reported wheezing). These categories were stratified according to parental self reported asthma or allergy. Results Unadjusted comparisons of the defined wheezing illnesses in vaccinated and non-vaccinated children showed no significant association between pertussis vaccination and any of the wheezing outcomes regardless of stratification for parental asthma or allergy. Wheeze was more common in non-vaccinated children at 18 months, and there was a tendency for late onset wheezing to be associated with non-vaccination in children whose parents did not have asthma, but this was not significant. After adjustment for environmental and biological variables, logistic regression analyses showed no significant increased relative risk for any of the wheezing outcomes in vaccinated children: early wheezing (0.99, 95% confidence interval 0.80 to 1.23), late onset wheezing (0.85, 0.69 to 1.05), persistent wheezing (0.91, 0.47 to 1.79), recurrent wheezing (0.96, 0.72 to 1.26), and intermittent wheezing (1.06, 0.81 to 1.37). Conclusions No evidence was found that pertussis

  17. Dengue Infection in Children in Ratchaburi, Thailand: A Cohort Study. II. Clinical Manifestations

    PubMed Central

    Sirivichayakul, Chukiat; Limkittikul, Kriengsak; Chanthavanich, Pornthep; Jiwariyavej, Vithaya; Chokejindachai, Watcharee; Pengsaa, Krisana; Suvannadabba, Saravudh; Dulyachai, Wut; Letson, G. William; Sabchareon, Arunee

    2012-01-01

    Background Dengue infection is one of the most important mosquito-borne diseases. More data regarding the disease burden and the prevalence of each clinical spectrum among symptomatic infections and the clinical manifestations are needed. This study aims to describe the incidence and clinical manifestations of symptomatic dengue infection in Thai children during 2006 through 2008. Study Design This study is a school-based prospective open cohort study with a 9,448 person-year follow-up in children aged 3–14 years. Active surveillance for febrile illnesses was done in the studied subjects. Subjects who had febrile illness were asked to visit the study hospital for clinical and laboratory evaluation, treatment, and serological tests for dengue infection. The clinical data from medical records, diary cards, and data collection forms were collected and analyzed. Results Dengue infections were the causes of 12.1% of febrile illnesses attending the hospital, including undifferentiated fever (UF) (49.8%), dengue fever (DF) (39.3%) and dengue hemorrhagic fever (DHF) (10.9%). Headache, anorexia, nausea/vomiting and myalgia were common symptoms occurring in more than half of the patients. The more severe dengue spectrum (i.e., DHF) had higher temperature, higher prevalence of nausea/vomiting, abdominal pain, rash, diarrhea, petechiae, hepatomegaly and lower platelet count. DHF cases also had significantly higher prevalence of anorexia, nausea/vomiting and abdominal pain during day 3–6 and diarrhea during day 4–6 of illness. The absence of nausea/vomiting, abdominal pain, diarrhea, petechiae, hepatomegaly and positive tourniquet test may predict non-DHF. Conclusion Among symptomatic dengue infection, UF is most common followed by DF and DHF. Some clinical manifestations may be useful to predict the more severe disease (i.e., DHF). This study presents additional information in the clinical spectra of symptomatic dengue infection. PMID:22389735

  18. Correlates of children's independent outdoor play: Cross-sectional analyses from the Millennium Cohort Study.

    PubMed

    Aggio, Daniel; Gardner, Benjamin; Roberts, Justin; Johnstone, James; Stubbs, Brendon; Williams, Genevieve; López Sánchez, Guillermo Felipe; Smith, Lee

    2017-12-01

    Time spent outdoors is associated with higher levels of physical activity. To date, correlates of independent outdoor play have not been investigated. This study aimed to identify potential demographic, behavioural, environmental and social correlates of children's independent outdoor play. Data were from the Millennium Cohort Study when children were aged 7 years. Parents reported whether their children played out unsupervised (yes/no) as well as the above mentioned correlates of unsupervised outdoor play. Children's physical activity levels were measured using waist worn accelerometry. Multiple logistic regression was used to examine associations between correlates and odds of independent (unsupervised) outdoor play. Adjusted multiple linear regression was used to estimate associations between independent outdoor play and objective measures of physical activity. Activity was measured as average daily moderate-to-vigorous activity, steps, and sedentary behaviour. 3856 (n = 29%) participants were categorised as engaging in independent outdoor play. Older age, being white British, being in poverty, living in close proximity to both family friends and family, having fewer internalising problems, having more externalising conduct problems and fewer pro-social behaviours were associated with higher odds of independent outdoor play. Independent outdoor play was associated with > 2 additional minutes of moderate-to-vigorous activity (B = 2.21 95% CI, 1.09 to 3.34), > 330 additional steps per day (B = 336.66 95% CI 209.80 to 463.51), and nearly 5 min less time spent sedentary per day (B = - 4.91 95% CI - 7.54, - 2.29) Younger children, those from a higher socio-economic-status, those isolated in location from family friends and family, and those with high levels of prosocial behaviour have lower levels of independent outdoor play. Independent outdoor play was associated with higher levels of physical activity and less time sedentary. Future interventions to

  19. Why are poorer children at higher risk of obesity and overweight? A UK cohort study

    PubMed Central

    Sacker, Amanda

    2016-01-01

    Background: There is limited evidence on which risk factors attenuate income inequalities in child overweight and obesity; whether and why these inequalities widen as children age. Method: Eleven thousand nine hundred and sixty five singletons had complete data at age 5 and 9384 at age 11 from the Millennium Cohort Study (UK). Overweight (age 5 : 15%; age 11 : 20%) and obesity (age 5 : 5%; age 11 : 6%) were defined using the International Obesity Taskforce body mass index cut-points. To measure socioeconomic inequalities, we used quintiles of family income and as risk factors, we considered markers of maternal health behaviours and of children’s physical activity, sedentary behaviours and diet. Binary and multinomial logistic regression models were used. Results: The unadjusted analyses revealed stark income inequalities in the risk of obesity at age 5 and 11. At age 5, children in the bottom income quintile had 2.0 (95% CI: 1.4–2.8) increased relative risk of being obese whilst at age 11 they had 3.0 (95% CI: 2.0–4.5) increased risk compared to children in the top income quintile. Similar income inequalities in the risk of overweight emerged by age 11. Physical activity and diet were particularly important in explaining inequalities. Income inequalities in obesity and overweight widened significantly between age 5 and 11 and a similar set of risk factors protected against upward and promoted downward movements across weight categories. Conclusions: To reduce income inequalities in overweight and obesity and their widening across childhood the results support the need of early interventions which take account of multiple risk factors. PMID:26659411

  20. Hyperuricemia and Progression of CKD in Children and Adolescents: The Chronic Kidney Disease in Children (CKiD) Cohort Study

    PubMed Central

    Rodenbach, Kyle E.; Schneider, Michael F.; Furth, Susan L.; Moxey-Mims, Marva M.; Mitsnefes, Mark M.; Weaver, Donald J.; Warady, Bradley A.; Schwartz, George J.

    2015-01-01

    Background Hyperuricemia is associated with essential hypertension in children. No previous studies have evaluated the effect of hyperuricemia on progression of chronic kidney disease (CKD) in children. Study Design Prospective observational cohort study. Setting & Participants Children and adolescents (n=678 cross-sectional; n=627 longitudinal) with a median age of 12.3 (IQR, 8.6–15.6) years enrolled at 52 North American sites of the CKD in Children (CKiD) study. Predictor Serum uric acid (<5.5, 5.5–7.5, and >7.5 mg/dL). Outcomes Composite endpoint of either >30% decline in glomerular filtration rate (GFR) or initiation of renal replacement therapy. Measurements Age, sex, race, blood pressure status, GFR, CKD etiology, urine proteincreatinine ratio (<0.5, 0.5 to <2.0, ≥2.0 mg/mg), age- and sex-specific BMI >95th percentile, use of diuretics, and serum uric acid. Results 162, 294, and 171 participants had initial uric acid < 5.5, 5.5–7.5, or > 7.5 mg/dL, respectively. Older age, male sex, lower GFR, and BMI > 95th percentile were associated with higher uric acid. We observed 225 instances of the composite endpoint over five years. In a multivariable parametric time-to-event analysis, compared to participants with initial uric acid <5.5 mg/dL, those with uric acid of 5.5–7.5 or >7.5 mg/dL had 17% shorter (relative time, 0.83; 95% CI, 0.62–1.11) or 38% shorter (relative time, 0.62; 95% CI, 0.45–0.85) times to event, respectively. Hypertension, lower GFR, glomerular CKD etiology, and elevated urine protein-creatinine ratio were also associated with faster times to the composite endpoint. Limitations The study lacked sufficient data to examine how use of specific medications might influence serum uric acid and CKD progression. Conclusions Hyperuricemia is a previously undescribed, independent risk factor for faster progression of CKD in children and adolescents. It is possible that treatment of children and adolescents with CKD with urate-lowering therapy

  1. A Multicenter Cohort Study of Inferior Vena Cava Filter Use in Children.

    PubMed

    Blevins, Erin M; Glanz, Karen; Huang, Yuan-Shung V; Raffini, Leslie; Shinohara, Russell T; Witmer, Char

    2015-12-01

    To describe inferior vena cava (IVC) filter use in pediatric patients admitted to U.S. children's hospitals and to determine factors associated with prophylactic placement. This retrospective multicenter cohort study utilized data from the Pediatric Health Information Systems (PHIS) administrative database, with 44 participating children's hospitals. Subjects included for analysis were less than 21 years of age, admitted to a PHIS hospital between January 1, 2004 and December 31, 2012 and had a procedure code for IVC filter placement. ICD-9-CM discharge codes were used to identify subjects with a venous thromboembolism (VTE). Pharmaceutical billing codes were used to identify anticoagulation use. During this 9-year-study period, 276 subjects met the inclusion criteria. The median age of subjects was 15 years (range 1 month-20 years). Subjects had an ICD-9-CM code for VTE 76% of the time and were started on anticoagulation after IVC filter placement 77% of the time. The mean number of IVC filters placed per year was 6 per 100,000 admissions (SD-1.4), which was constant throughout the study period (P = 0.12). The median number of filters placed by center was 4.5 (range 0-32). In multivariate analysis, subjects undergoing orthopedic surgery were more likely to have prophylactic placement of an IVC filter (OR 4.5; 95%CI 1.8-11). IVC filter placement in pediatric patients remains a rare event and is most common in adolescents. Unlike in adults, pediatric IVC filter placement does not appear to be increasing over time and is predominantly used in the setting of a venous thrombotic event. © 2015 Wiley Periodicals, Inc.

  2. Naturally Acquired Immunity Against Rotavirus Infection and Gastroenteritis in Children: Paired Reanalyses of Birth Cohort Studies.

    PubMed

    Lewnard, Joseph A; Lopman, Benjamin A; Parashar, Umesh D; Bar-Zeev, Naor; Samuel, Prasanna; Guerrero, M Lourdes; Ruiz-Palacios, Guillermo M; Kang, Gagandeep; Pitzer, Virginia E

    2017-08-01

    Observational studies in socioeconomically distinct populations have yielded conflicting conclusions about the strength of naturally acquired immunity against rotavirus gastroenteritis (RVGE), mirroring vaccine underperformance in low-income countries. We revisited birth cohort studies to understand naturally acquired protection against rotavirus infection and RVGE. We reanalyzed data from 200 Mexican and 373 Indian children followed from birth to 2 and 3 years of age, respectively. We reassessed protection against RVGE, decomposing the incidence rate into the rate of rotavirus infection and the risk of RVGE given infection, and tested for serum antibody correlates of protection using regression models. Risk for primary, secondary, and subsequent infections to cause RVGE decreased per log-month of age by 28% (95% confidence interval [CI], 12%-41%), 69% (95% CI, 30%-86%), and 64% (95% CI, -186% to 95%), respectively, in Mexico City, and by 10% (95% CI, -1% to 19%), 51% (95% CI, 41%-59%) and 67% (95% CI, 57%-75%), respectively, in Vellore. Elevated serum immunoglobulin A and immunoglobulin G titers were associated with partial protection against rotavirus infection. Associations between older age and reduced risk for RVGE or moderate-to-severe RVGE given infection persisted after controlling for antibody levels. Dissimilar estimates of protection against RVGE may be due in part to age-related, antibody-independent risk for rotavirus infections to cause RVGE.

  3. Type 1 diabetes risk in children born to women with fertility problems: a cohort study in 1.5 million Danish children.

    PubMed

    Hargreave, Marie; Kjaer, Susanne K; Jørgensen, Marit E; Jensen, Allan

    2016-12-01

    While some studies have indicated that children born following fertility treatment are at an increased risk for insulin resistance and higher blood glucose levels, no study to date has investigated the risk of type 1 diabetes. In this large population-based cohort study we aim to assess the association between maternal fertility problems and the risk of type 1 diabetes in children. Information on all children, born in Denmark from 1987 to 2010, was extracted from the Civil Registration System and linked with the Danish Infertility Cohort to identify maternal fertility status. Diabetes information was obtained from the National Patient Register and the Childhood Diabetes Register. A Cox proportional hazard model was used to calculate hazard ratios and 95% confidence intervals. A total of 1 550 519 children made up the study cohort, of whom 110 393 (7.1%) were born to women with fertility problems. In all, 313 children born to women with fertility problems (0.36%) and 5176 children born to women without fertility problems (0.28%) were diagnosed with type 1 diabetes. The risk of type 1 diabetes was not affected by maternal fertility status (hazard ratio 1.01, 95% CI 0.90-1.13) when taking into account birth year, sex, history of parental diabetes, parental age and age at diagnosis. Our results showed no association between maternal fertility problems and risk of type 1 diabetes in children. © 2016 Nordic Federation of Societies of Obstetrics and Gynecology.

  4. Prenatal exposure to metronidazole and risk of childhood cancer: a retrospective cohort study of children younger than 5 years.

    PubMed

    Thapa, P B; Whitlock, J A; Brockman Worrell, K G; Gideon, P; Mitchel, E F; Roberson, P; Pais, R; Ray, W A

    1998-10-01

    To evaluate the role of in utero exposure to metronidazole (a carcinogen in some animal models) and the risk of subsequent cancer, the authors conducted a retrospective cohort study of childhood cancer. The cohort included 328,846 children younger than 5 years born to women enrolled in Tennessee Medicaid at any time between the last menstrual period (LMP) and the date of delivery. The cohort was identified by linking files of Tennessee Medicaid mothers ages 15-44 years and children and the children's birth and death certificates for the period January 1, 1975 through December 31, 1992. Exposure data were obtained from Medicaid pharmacy records and exposure was defined as filling a metronidazole prescription that had at least a day's supply between the 30 days prior to the LMP and the date of delivery. Study cases were cohort children diagnosed with a first primary cancer before age 5 years, identified by linking the cohort with a statewide childhood cancer database for the study period. Cohort members contributed 1,172,696 person-years of follow-up for analysis, with children exposed (8.1%) and not exposed (91.9%) in utero to metronidazole contributing 79,716 and 1,092,980 person-years, respectively. Of 952 children younger than 5 years in the statewide cancer database, 175 met study eligibility criteria. Of these, 42 had leukemia, 30 had central nervous system (CNS) tumors, 28 had neuroblastoma, and 75 had other cancers. Using Poisson regression modeling, children exposed to metronidazole in utero had no significant increase in adjusted relative risk (RR) for all cancers (RR: 0.81; 95% confidence interval [95% CI], 0.41-1.59), leukemia (no exposed case), CNS tumors (RR: 1.23; 95% CI, 0.29-5.21), neuroblastomas (RR: 2.60; 95% CI, 0.89-7.59), and other cancers (RR: 0.57; 95% CI, 0.18-1.82). The authors conclude that although there was no increase in risk for all cancers associated with in utero exposure to metronidazole, the observed increased risk for

  5. Risk of leukaemia in children infected with enterovirus: a nationwide, retrospective, population-based, Taiwanese-registry, cohort study.

    PubMed

    Lin, Jiun-Nong; Lin, Cheng-Li; Lin, Ming-Chia; Lai, Chung-Hsu; Lin, Hsi-Hsun; Yang, Chih-Hui; Sung, Fung-Chang; Kao, Chia-Hung

    2015-10-01

    The association between enterovirus infections in children and risk of leukaemia is unclear. We aimed to assess the risk of leukaemia after enterovirus infection in children. We did a nationwide retrospective cohort study by analysing data from the National Health Insurance Research Database (NHIRD) in Taiwan. Children with enterovirus infections aged younger than 18 years were identified. With use of computer-generated random numbers, children not infected with enterovirus were randomly selected and frequency matched (1:1) with children infected with enterovirus by sex, age, urbanisation level, parental occupation, and index year of enterovirus infection. We only included children with complete baseline data for age and sex and who had at least three clinic visits with the diagnosis of enterovirus infection. The diagnosis date of the first clinic visit for the enterovirus infection was defined as the index date for initiation of follow-up person-year measurement and participants. All study patients were followed up until they developed leukaemia, were lost to follow-up, withdrew from the NHI programme, or until the end of the study without leukaemia (censored). Our primary endpoint was a diagnosis of leukaemia during follow-up. Insurance claims data for 3 054 336 children younger than 18 years were randomly selected from all insured children in the NHIRD. We identified 282 360 children infected with enterovirus and 282 355 children not infected with enterovirus between Jan 1, 2000, and Dec 31, 2007. The incidence density rates of leukaemia were 3·26 per 100 000 person-years for the enterovirus-infected and 5·84 per 100 000 person-years for the non-enterovirus-infected cohorts. The risk of leukaemia was significantly lower in the enterovirus-infected cohort than in the non-enterovirus-infected cohort (adjusted subhazard ratio [SHR] 0·44, 95% CI 0·31-0·60; p<0·0001). Children infected with enterovirus have a reduced risk of both lymphocytic

  6. Allergic profiles of mothers and fathers in the Japan Environment and Children's Study (JECS): a nationwide birth cohort study.

    PubMed

    Yamamoto-Hanada, Kiwako; Yang, Limin; Ishitsuka, Kazue; Ayabe, Tadayuki; Mezawa, Hidetoshi; Konishi, Mizuho; Shoda, Testsuo; Matsumoto, Kenji; Saito, Hirohisa; Ohya, Yukihiro

    2017-01-01

    The Japan Environment and Children's Study (JECS) is a nationwide, multicenter, prospective birth cohort investigation launched by the Ministry of Environment in Japan. The purpose of the JECS is to evaluate the influence of prenatal and postnatal exposures to environmental factors on the postnatal health of the children. In this study, we evaluated the allergic characteristics of parents within the JECS cohort. This study covered a wide geographical area and encompassed 15 regional centers. We obtained information regarding doctor diagnosed allergic diseases by using maternal and/or paternal self-administered questionnaires during the first trimester of pregnancy. Blood samples were also obtained from mothers and/or fathers to detect serum IgE concentrations. The prevalences of asthma, allergic rhinitis (hay fever), atopic dermatitis, and food allergy were 10.9, 36.0, 15.7 and 4.8%, respectively, among 99,013 mothers; these prevalences among 49,991 fathers were 10.8, 30.3, 11.2 and 3.3%, respectively. Any positive antigen-specific IgE sensitization was found in 73.9% of mothers. The most abundant antigen sensitization in mothers was to Japanese cedar (55.6%), followed by Der p 1 (48%); only 1.0% of mothers were sensitized to egg white. This is the first epidemiological report on allergic disorders and allergen sensitization of parents during pregnancy among the Japanese general population.

  7. The contribution of housing renovation to children's blood lead levels: a cohort study.

    PubMed

    Spanier, Adam J; Wilson, Stephen; Ho, Mona; Hornung, Richard; Lanphear, Bruce P

    2013-08-27

    Routine renovation of older housing is a risk factor for childhood lead poisoning, but the contribution to children's blood lead levels is poorly defined for children with lower exposure levels. We examined a prospective cohort of 276 children followed from 6 to 24 months of age. We conducted surveys of renovation activities and residential lead hazards and obtained blood lead level (B-Pb) every six months. We analyzed B-Pb in a repeated measures design using a mixed effects linear model. Parent reported interior renovation ranged from 11 to 25% of housing units at the four, 6-month periods. In multivariable analysis, children whose housing underwent interior renovation had a 12% higher mean B-Pb by two years of age compared with children whose housing units were not renovated (p < 0.01). The time between renovation and the child blood lead sample was associated with higher B-Pb (p-value for trend <0.01); compared to children in non-renovated housing, children whose housing units underwent renovation in the prior month had a 17% higher mean B-Pb at two years of age, whereas children whose housing renovation occurred in the prior 2-6 months had an 8% higher mean B-Pb. We also found an association between higher paint lead loading, measured using an X-ray fluorescence (XRF) based paint lead index, and child B-Pb (p = 0.02); for every 10 mg/cm2 increase in paint lead loading index there was a 7.5% higher mean childhood B-Pb. In an analysis of data collected before the recent changes to Environmental Protection Agency's Lead, Renovation, Repair and Painting Rule, routine interior housing renovation was associated with a modest increase in children's B-Pb. These results are important for the provision of clinical advice, for housing and public health professionals, and for policymakers.

  8. Birth cohort study on the effects of desert dust exposure on children's health: protocol of an adjunct study of the Japan Environment & Children's Study.

    PubMed

    Kanatani, Kumiko T; Adachi, Yuichi; Sugimoto, Nobuo; Noma, Hisashi; Onishi, Kazunari; Hamazaki, Kei; Takahashi, Yoshimitsu; Ito, Isao; Egawa, Miho; Sato, Keiko; Go, Tohshin; Kurozawa, Youichi; Inadera, Hidekuni; Konishi, Ikuo; Nakayama, Takeo

    2014-06-23

    Desert dust is estimated to constitute about 35% of aerosol in the troposphere. Desertification, climatic variability and global warming all can contribute to increased dust formation. This study aims to examine possible health effects of desert dust exposure on pregnant women and their children. The purpose of this report was to present the study protocol. This 4-year birth cohort study began in 2011 as an adjunct study of the Japan Environment & Children's Study (JECS) involving three regions: Kyoto, Toyama and Tottori. The JECS participants of the three regions above who also agreed to participate in this adjunct study were enrolled prior to delivery. Light Detecting and Ranging (LIDAR) with a polarisation analyser, which can distinguish mineral dust particles from other particles, is used for exposure measurements. Outcomes are allergic symptoms for mothers and development of asthma and other allergic or respiratory diseases for their children. Data are acquired in a timely manner by connecting local LIDAR equipment to an online questionnaire system. Participants answer the online questionnaire using mobile phones or personal computers. The study protocol was approved by the ethics committees of Kyoto University, University of Toyama and Tottori University. All participants provided written informed consent. The results of this study will be published in peer-reviewed journals and disseminated to the scientific community and general public. UMIN000010826. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  9. Do children born to teenage parents have lower adult intelligence? A prospective birth cohort study

    PubMed Central

    Khatun, Mohsina; Al Mamun, Abdullah; Scott, James; William, Gail M.; Clavarino, Alexandra; Najman, Jake M.

    2017-01-01

    Teenage motherhood has been associated with a wide variety of negative offspring outcomes including poorer cognitive development. In the context of limitations of previous research, this paper assesses the contemporary relevance of this finding. In this study we investigate the long-term cognitive status (IQ) among 21 year adult offspring born to teenage parents using the Mater University Study of Pregnancy- a prospective birth cohort study, which recruited all pregnant mothers attending a large obstetrical hospital in Brisbane, Australia, from 1981 to 1983. The analyses were restricted to a sub-sample of 2643 mother-offspring pair. Offspring IQ was measured using the Peabody Picture Vocabulary Test at 21 year. Parental age was reported at first clinic visit. Offspring born to teenage mothers (<20 years) have -3.0 (95% Confidence Interval (CI): -4.3, -1.8) points lower IQ compared to children born to mothers ≥20 years and were more likely to have a low IQ (Odds Ratio (OR) 1.7; 95% CI: 1.3, 2.3). Adjustment for a range of confounding and mediating factors including parental socioeconomic status, maternal IQ, maternal smoking and binge drinking in pregnancy, birthweight, breastfeeding and parenting style attenuates the association, though the effect remains statistically significant (-1.4 IQ points; 95% CI: -2.8,-0.1). Similarly the risk of offspring having low IQ remained marginally significantly higher in those born to teenage mothers (OR 1.3; 95% CI: 1.0, 1.9). In contrast, teenage fatherhood is not associated with adult offspring IQ, when adjusted for maternal age. Although the reduction in IQ is quantitatively small, it is indicative of neurodevelopmental disadvantage experienced by the young adult offspring of teenage mothers. Our results suggest that public policy initiatives should be targeted not only at delaying childbearing in the population but also at supporting early life condition of children born to teenage mothers to minimize the risk for

  10. Do children born to teenage parents have lower adult intelligence? A prospective birth cohort study.

    PubMed

    Khatun, Mohsina; Al Mamun, Abdullah; Scott, James; William, Gail M; Clavarino, Alexandra; Najman, Jake M

    2017-01-01

    Teenage motherhood has been associated with a wide variety of negative offspring outcomes including poorer cognitive development. In the context of limitations of previous research, this paper assesses the contemporary relevance of this finding. In this study we investigate the long-term cognitive status (IQ) among 21 year adult offspring born to teenage parents using the Mater University Study of Pregnancy- a prospective birth cohort study, which recruited all pregnant mothers attending a large obstetrical hospital in Brisbane, Australia, from 1981 to 1983. The analyses were restricted to a sub-sample of 2643 mother-offspring pair. Offspring IQ was measured using the Peabody Picture Vocabulary Test at 21 year. Parental age was reported at first clinic visit. Offspring born to teenage mothers (<20 years) have -3.0 (95% Confidence Interval (CI): -4.3, -1.8) points lower IQ compared to children born to mothers ≥20 years and were more likely to have a low IQ (Odds Ratio (OR) 1.7; 95% CI: 1.3, 2.3). Adjustment for a range of confounding and mediating factors including parental socioeconomic status, maternal IQ, maternal smoking and binge drinking in pregnancy, birthweight, breastfeeding and parenting style attenuates the association, though the effect remains statistically significant (-1.4 IQ points; 95% CI: -2.8,-0.1). Similarly the risk of offspring having low IQ remained marginally significantly higher in those born to teenage mothers (OR 1.3; 95% CI: 1.0, 1.9). In contrast, teenage fatherhood is not associated with adult offspring IQ, when adjusted for maternal age. Although the reduction in IQ is quantitatively small, it is indicative of neurodevelopmental disadvantage experienced by the young adult offspring of teenage mothers. Our results suggest that public policy initiatives should be targeted not only at delaying childbearing in the population but also at supporting early life condition of children born to teenage mothers to minimize the risk for

  11. Access to Care and Children's Primary Care Experiences: Results from a Prospective Cohort Study

    PubMed Central

    Seid, Michael; Stevens, Gregory D

    2005-01-01

    Objective To examine whether and how different kinds of access to care (financial, potential, and realized) predict parent-report child primary care experiences in an urban community sample. Data Sources/Study Setting A prospective cohort study was performed. Baseline survey data were collected (67 percent response rate) from 3,406 parents of kindergarten through sixth grade students in a large urban school district in California during the 1999–2000 school year. A 1-year survey (80.4 percent response rate) resulted in a final sample of 2,738. Study Design Data were analyzed using multiple regression models with robust estimation. The dependent variable was Time 2 parent reports of primary care experiences, assessed via the Parents' Perceptions of Primary Care (P3C) measure. The independent variables were financial access (insurance status), potential access (presence of a regular source of care), and realized access (foregone care), controlling for child and family characteristics (race/ethnicity, parent's language, mother's education level, and child chronic health condition status) and baseline P3C scores. Data Collection Data were collected by mail, telephone, and in person in English, Spanish, Vietnamese, and Tagalog. Principal Findings Controlling for baseline P3C scores and child and family characteristics, having no health insurance at both baseline and Time 2 was associated with a 6.2-point lower Time 2 P3C score, relative to having had health insurance at both time points. Having a regular provider at Time 2 (either always having had one or gaining one during the year) was associated with, on average, a 10-point higher Time 2 P3C score, compared to children without a regular provider (either never having had one or losing one during the year). Episodes of foregone care during the year were associated with 10.7 points lower Time 2 P3C scores, relative to children whose parents did not report foregone care. Similar relationships were found between all

  12. Sugar, dental caries and the incidence of acute rheumatic fever: a cohort study of Māori and Pacific children.

    PubMed

    Thornley, Simon; Marshall, Roger J; Bach, Katie; Koopu, Pauline; Reynolds, Gary; Sundborn, Gerhard; Ei, Win Le Shwe Sin

    2017-04-01

    To determine whether dental caries, as an indicator of cumulative exposure to sugar, is associated with the incidence of acute rheumatic fever and chronic rheumatic heart disease, in Māori and Pacific children aged 5 and 6 years at their first dental visit. A cohort study was undertaken which linked school dental service records of caries with national hospital discharge and mortality records. Cox models were used to investigate the strength of the association between dental caries and rheumatic fever incidence. A total of 20 333 children who were free of rheumatic heart disease at enrolment were available for analysis. During a mean follow-up time of 5 years, 96 children developed acute rheumatic fever or chronic rheumatic heart disease. After adjustment for potential confounders, children with five or more primary teeth affected by caries were 57% (95% CI: 20% to 106%) more likely to develop disease during follow-up, compared to children whose primary teeth were caries free. The population attributable to the risk for caries in this cohort was 22%. Dental caries is positively associated with the incidence of acute rheumatic fever and chronic rheumatic heart disease in Māori and Pacific children. Sugar intake, an important risk factor for dental caries, is also likely to influence the aetiology of rheumatic fever. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  13. Toxicity biomarkers among US children compared to a similar cohort in France: a blinded study measuring urinary porphyrins

    PubMed Central

    Kern, Janet K.; Geier, David A.; Ayzac, Françoise; Adams, James B.; Mehta, Jyutika A.; Geier, Mark R.

    2010-01-01

    The purpose of this blinded study was to evaluate potential environmental toxicity in a cohort of neurotypical children (n = 28) living in a suburban area of north-central Texas in the United States (US) with a comparable age- and gender-matched cohort of neurotypical children (n = 28) living in a suburban area of southeastern France using urinary porphyrin testing: uroporphyrin (uP), heptacarboxyporphyrin (7cxP), hexacarboxyporphyrin (6cxP), pentacarboxyporphyrin (5cxP), precoproporphyrin (prcP), and coproporphyrin (cP). Results showed significantly elevated 6cxP, prcP (an atypical, mercury-specific porphyrin), and cP levels, and increasing trends in 5cxP levels, among neurotypical children in the USA compared to children in France. Data suggest that in US neurotypical children, there is a significantly increased body-burden of mercury (Hg) compared to the body-burden of Hg in the matched neurotypical children in France. The presence of lead contributing to the higher levels of cP also needs to be considered. Further, other factors including genetics can not be completely ruled out. PMID:24482554

  14. Inflammatory bowel disease in immigrants to Canada and their children: a population-based cohort study.

    PubMed

    Benchimol, Eric I; Mack, David R; Guttmann, Astrid; Nguyen, Geoffrey C; To, Teresa; Mojaverian, Nassim; Quach, Pauline; Manuel, Douglas G

    2015-04-01

    The risk of inflammatory bowel disease (IBD) contributed by the environment can be elucidated by assessing the risk in migrants from low prevalence to Western countries. The incidence of IBD in immigrants to Canada and their Canadian-born children was compared with nonimmigrants. A population-based cohort of IBD patients derived from health administrative data was linked to immigration data to determine the standardized incidence of IBD in immigrants to Ontario, Canada, by region of birth between 1994 and 2010. The hazard contributed by younger age at immigration was determined. Incidence for Ontario-born children of immigrant mothers was compared with the children of nonimmigrants. In 2,144,660 immigrants, incidence of IBD was 7.3/100,000 person-years compared with 23.9/100,000 in 12,036,921 nonimmigrants (incidence rate ratio (IRR) 0.34, 95% CI 0.26-0.44). Incidence was lowest risk in East Asians (IRR 0.14, 95% CI 0.11-0.18) and highest in Western Europeans/North Americans (IRR 0.59, 95% CI 0.46-0.75). Increased age at immigration was associated with decreased risk of IBD (HR 0.986, 95% CI 0.982-0.990), a 14% increased risk per younger decade of life at immigration. Children of immigrants from the Middle East/North Africa, South Asia, Sub-Saharan Africa, and North America/Western Europe had similar risk of IBD as children of nonimmigrants; however, the incidence remained lower among children of immigrants from other regions. Younger age at arrival to Canada increased the risk of IBD in immigrants. Canadian-born children of immigrants from some regions assumed the high Canadian incidence of IBD, indicating that the underlying risk is activated with earlier life exposure to the Canadian environment in certain groups.

  15. Abdominal obesity and metabolic syndrome burden in adolescents--Penn State Children Cohort study.

    PubMed

    He, Fan; Rodriguez-Colon, Sol; Fernandez-Mendoza, Julio; Vgontzas, Alexandros N; Bixler, Edward O; Berg, Arthur; Imamura Kawasawa, Yuka; Sawyer, Marjorie D; Liao, Duanping

    2015-01-01

    To investigate the association between abdominal obesity and metabolic syndrome (MetS) burden in a population-based sample of adolescents, we used data from 421 adolescents who completed the follow-up examination in the Penn State Children Cohort study. Dual-energy x-ray absorptiometry (DXA) was used to assess abdominal obesity, as measured by android/gynoid fat ratio (A/G ratio), android/whole body fat proportion (A/W proportion), visceral (VAT) and subcutaneous fat (SAT) areas. Continuous metabolic syndrome score (cMetS), calculated as the sum of the age and sex-adjusted standardized residual (Z-score) of five established MetS components, was used to assess the MetS burden. Linear regression models were used to analyze the impact of DXA measures on cMetS components. All models were adjusted for age, race, sex, and general obesity. We found abdominal obesity is significantly associated with increased cMetS. With 1 standard deviation (SD) increase in A/G ratio, A/W proportion, VAT area, and SAT area, cMetS increased by 1.34 (SE=0.17), 1.25 (SE=0.19), 1.67 (SE=0.17), and 1.84 (SE=0.20) units, respectively. At individual component level, strongest association was observed between abdominal obesity and insulin resistance (IR) than lipid-based or blood pressure-based components. VAT and SAT had a stronger impact on IR than android ratio-based DXA measurements. In conclusion, abdominal obesity is associated with higher MetS burden in adolescent population. The association between abdominal obesity and IR measure is the strongest, suggesting the key impact of abdominal obesity on IR in adolescents MetS burden.

  16. Abdominal Obesity and Metabolic Syndrome Burden in Adolescents-Penn State Children Cohort Study

    PubMed Central

    He, Fan; Rodriguez-Colon, Sol; Fernandez-Mendoza, Julio; Vgontzas, Alexandros N.; Bixler, Edward O.; Berg, Arthur; Kawasawa, Yuka Imamura; Sawyer, Marjorie D.; Liao, Duanping

    2014-01-01

    INTRODUCTION To investigate the association between abdominal obesity and metabolic syndrome (MetS) burden in a population-based sample of adolescents. METHODS We used the data from 421 adolescents who completed the follow-up examination in the Penn State Children Cohort study. Dual-energy x-ray absorptiometry (DXA) was used to assess abdominal obesity, as measured by android/gynoid fat ratio (A/G ratio), android/whole body fat proportion (A/W proportion), visceral (VAT) and subcutaneous fat (SAT) areas. Continuous metabolic syndrome score (cMetS), calculated as the sum of the age and sex-adjusted standardized residual (Z-score) of five established MetS components, was used to assess the MetS burden. Linear regression models were used to analyze the impact of DXA measures on cMetS and individual cMetS components. All models were adjusted for age, race, sex, and general obesity. RESULTS Abdominal obesity is significantly associated with increased cMetS. With 1 standard deviation (SD) increase in A/G ratio, A/W proportion, VAT area, and SAT area, cMetS increased by 1.34 (SE=0.17), 1.25 (SE=0.19), 1.67 (SE=0.17), and 1.84 (SE=0.20) units, respectively. At individual component level, strongest association was observed between abdominal obesity and insulin resistance than lipid-based or blood pressure-based components. VAT and SAT had a stronger impact on insulin resistance than android ratio-based DXA measurements. CONCLUSIONS Abdominal obesity is associated with higher MetS burden in adolescent population. The association between abdominal obesity and insulin resistance measure is the strongest, suggesting the key impact of abdominal obesity on insulin resistance in adolescents Mets burden. PMID:25220887

  17. Use of antibiotics in children younger than two years in eight countries: a prospective cohort study

    PubMed Central

    Rogawski, Elizabeth T; Platts-Mills, James A; Seidman, Jessica C; John, Sushil; Mahfuz, Mustafa; Ulak, Manjeswori; Shrestha, Sanjaya K; Soofi, Sajid Bashir; Yori, Pablo Penataro; Mduma, Estomih; Svensen, Erling; Ahmed, Tahmeed; Lima, Aldo AM; Bhutta, Zulfiqar A; Kosek, Margaret N; Lang, Dennis R; Gottlieb, Michael; Zaidi, Anita KM; Kang, Gagandeep; Bessong, Pascal O; Houpt, Eric R; Guerrant, Richard L

    2017-01-01

    Abstract Objective To describe the frequency and factors associated with antibiotic use in early childhood, and estimate the proportion of diarrhoea and respiratory illnesses episodes treated with antibiotics. Methods Between 2009 and 2014, we followed 2134 children from eight sites in Bangladesh, Brazil, India, Nepal, Pakistan, Peru, South Africa and the United Republic of Tanzania, enrolled in the MAL-ED birth cohort study. We documented all antibiotic use from mothers’ reports at twice-weekly visits over the children’s first two years of life. We estimated the incidence of antibiotic use and the associations of antibiotic use with child and household characteristics. We described treatment patterns for diarrhoea and respiratory illnesses, and identified factors associated with treatment and antibiotic class. Findings Over 1 346 388 total days of observation, 16 913 courses of antibiotics were recorded (an incidence of 4.9 courses per child per year), with the highest use in South Asia. Antibiotic treatment was given for 375/499 (75.2%) episodes of bloody diarrhoea and for 4274/9661 (44.2%) episodes of diarrhoea without bloody stools. Antibiotics were used in 2384/3943 (60.5%) episodes of fieldworker-confirmed acute lower respiratory tract illness as well as in 6608/16742 (39.5%) episodes of upper respiratory illness. Penicillins were used most frequently for respiratory illness, while antibiotic classes for diarrhoea treatment varied within and between sites. Conclusion Repeated antibiotic exposure was common early in life, and treatment of non-bloody diarrhoea and non-specific respiratory illnesses was not consistent with international recommendations. Rational antibiotic use programmes may have the most impact in South Asia, where antibiotic use was highest. PMID:28053364

  18. Cisplatin Nephrotoxicity and Longitudinal Growth in Children With Solid Tumors: A Retrospective Cohort Study.

    PubMed

    Jiménez-Triana, Clímaco Andres; Castelán-Martínez, Osvaldo D; Rivas-Ruiz, Rodolfo; Jiménez-Méndez, Ricardo; Medina, Aurora; Clark, Patricia; Rassekh, Rod; Castañeda-Hernández, Gilberto; Carleton, Bruce; Medeiros, Mara

    2015-08-01

    Cisplatin, a major antineoplastic drug used in the treatment of solid tumors, is a known nephrotoxin. This retrospective cohort study evaluated the prevalence and severity of cisplatin nephrotoxicity in 54 children and its impact on height and weight.We recorded the weight, height, serum creatinine, and electrolytes in each cisplatin cycle and after 12 months of treatment. Nephrotoxicity was graded as follows: normal renal function (Grade 0); asymptomatic electrolyte disorders, including an increase in serum creatinine, up to 1.5 times baseline value (Grade 1); need for electrolyte supplementation <3 months and/or increase in serum creatinine 1.5 to 1.9 times from baseline (Grade 2); increase in serum creatinine 2 to 2.9 times from baseline or need for electrolyte supplementation for more than 3 months after treatment completion (Grade 3); and increase in serum creatinine ≥3 times from baseline or renal replacement therapy (Grade 4).Nephrotoxicity was observed in 41 subjects (75.9%). Grade 1 nephrotoxicity was observed in 18 patients (33.3%), Grade 2 in 5 patients (9.2%), and Grade 3 in 18 patients (33.3%). None had Grade 4 nephrotoxicity. Nephrotoxicity patients were younger and received higher cisplatin dose, they also had impairment in longitudinal growth manifested as statistically significant worsening on the height Z Score at 12 months after treatment. We used a multiple logistic regression model using the delta of height Z Score (baseline-12 months) as dependent variable in order to adjust for the main confounder variables such as: germ cell tumor, cisplatin total dose, serum magnesium levels at 12 months, gender, and nephrotoxicity grade. Patients with nephrotoxicity Grade 1 where at higher risk of not growing (OR 5.1, 95% CI 1.07-24.3, P=0.04). The cisplatin total dose had a significant negative relationship with magnesium levels at 12 months (Spearman r=-0.527, P=<0.001).

  19. School Readiness among Children of Immigrants in the US: Evidence from a Large National Birth Cohort Study

    PubMed Central

    Han, Wen-Jui; Lee, RaeHyuck; Waldfogel, Jane

    2012-01-01

    Using the Early Childhood Longitudinal Study-Birth Cohort (n ≈ 6,800), we examined the factors explaining variation in school readiness in a large and nationally representative sample of children in immigrant and non-immigrant families. In OLS regression models with rich controls to account for selection, we found that language background was a key factor in explaining children of immigrants’ expressive language and early reading at kindergarten, whereas both socioeconomic status and language background helped explain their performance in math. PMID:22711952

  20. Restrained and external-emotional eating patterns in young overweight children-results of the Ulm Birth Cohort Study.

    PubMed

    Hirsch, Oliver; Kluckner, Viktoria J; Brandt, Stephanie; Moss, Anja; Weck, Melanie; Florath, Ines; Wabitsch, Martin; Hebebrand, Johannes; Schimmelmann, Benno G; Christiansen, Hanna

    2014-01-01

    Childhood obesity is one of the greatest public health challenges in Western countries. Abnormal eating behavior is thought to be a developmental trajectory to obesity. The Eating Pattern Inventory for Children (EPI-C) has not been used for children as young as eight years, and possible associations with body weight have not yet been established. Five hundred and twenty-one children of the Ulm Birth Cohort Study (UBCS; age eight) filled out the EPI-C and BMI was assessed. Adequacy of the scales was tested with confirmatory factor analysis and a MANOVA and cluster analysis established associations between eating patterns and BMI. The factor structure of the EPI-C was confirmed (GFI = .968) and abnormal eating behavior was associated with overweight (χ(2)(8) =79.29, p<.001). The EPI-C is a valid assessment tool in this young age group. Overweight children consciously restrain their eating.

  1. Recovery from stunting and cognitive outcomes in young children: evidence from the South African Birth to Twenty Cohort Study.

    PubMed

    Casale, D; Desmond, C

    2016-04-01

    In this study we analyse the implications for cognitive function of recovery from stunting in early childhood. More specifically, we test whether children who met the definition for stunted at age 2, but not at age 5, perform better in cognitive tests than children who remain stunted over this period. The sample is drawn from the Birth to Twenty Cohort Study, a prospective data set of children born in 1990 in urban South Africa. The measure of cognitive function that we use is based on the Revised Denver Prescreening Developmental Questionnaire implemented when the children were age 5. We employ multivariate regression in the analysis to control for child-specific characteristics, socio-economic status, the home environment and caregiver inputs. We find that recovery from stunting is not uncommon among young children in our sample. However, children who recover from stunting by age 5 still perform significantly worse on cognitive tests than children who do not experience early malnutrition, and almost as poorly as children who remain stunted. These findings suggest that the timing of nutritional inputs in the early years is key in a child's cognitive development, with implications for school readiness and achievement.

  2. Severe early childhood caries and social determinants in three-year-old children from Northern Thailand: a birth cohort study.

    PubMed

    Peltzer, Karl; Mongkolchati, Aroonsri

    2015-09-14

    The purpose of this study was to investigate the prevalence and social risk factors of severe early childhood caries in three-year-old children in Northern Thailand, using a birth-cohort study The data utilized in this study were from the prospective cohort study of Thai children (PCTC) from the 28 to 38 weeks gestational age until the children reached the age of 36 months (N = 597) in Mueang Nan district, Northern Thailand. Questionnaires were administered at different time points and dental examination was conducted at the age of 3 years of the child. 44.1% of the 3 year old children had S-ECC. In multivariate logistic regression analysis, environmental factors (the use of rain or well water as drinking water, no schooling of mother of child, being male), and risk behaviour (sleeping with a bottle at 30 months) were associated with S-ECC. Further, in bivariate analysis, psychological distress in the mother, lack of spousal relationship support, suckle to sleep when going to bed, introduction of soft drinks at 12 months, having had more frequently sweet food, and less than daily tooth brushing before 30 months were associated with S-ECC. A very high rate of S-ECC was observed, and oral health may be influenced by social factors.

  3. Perfluoroalkyl acids in children and their mothers: Association with drinking water and time trends of inner exposures--Results of the Duisburg birth cohort and Bochum cohort studies.

    PubMed

    Wilhelm, Michael; Wittsiepe, Jürgen; Völkel, Wolfgang; Fromme, Hermann; Kasper-Sonnenberg, Monika

    2015-10-01

    Perfluoroalkyl acids (PFAAs) are widely distributed in the environment and humans are globally exposed with them. Contaminated drinking water can considerably contribute to the inner exposure levels. We report the results of a human biomonitoring study with mother-child pairs living in two German cities, one city with PFAA contaminated drinking water in the sub μg/l-range (Bochum) and the other one without contamination (Duisburg). Furthermore, we studied time trends of exposure levels within the Duisburg cohort study. We measured seven PFAAs (PFOS, PFOA, PFHxS, PFNA, PFBS, PFDeA, PFDoA) in blood samples by high performance liquid chromatography and tandem mass spectrometry. Samples were taken during pregnancy, from umbilical cord blood (2000-2002), 6-7 years (5th follow-up) and 8-10 years after birth (7th follow-up). The consumption of drinking water was recorded by a standardized questionnaire. Statistical analyses were calculated with multiple linear regression models. Children and mothers from Bochum showed higher PFOS and PFOA plasma concentrations than from Duisburg. The median concentrations (μg/l) for children were: PFOS 4.7 vs. 3.3; PFOA 6.0 vs. 3.6μg/l (p≤0.05). Consumption of >0.7 l (children) and >0.9 l (mothers) drinking water/day was associated with 13-18% higher PFOS, PFOA and PFHxS concentrations in children (p≤0.01), and 22% higher PFOA in mothers (p≤0.05). Within the Duisburg cohort, PFAA levels in children peaked in the 5th follow-up study (medians (μg/l): cord plasma: 2.7 (PFOS); 1.9 (PFOA); 5th follow-up: 3.6 (PFOS); 4.6 (PFOA); 7th follow-up: 3.3 (PFOS); 3.6 (PFOA)). PFOS concentrations in mothers declined from pregnancy to the 5th follow-up (medians: 8.7 vs. 4.0μg/l). Residents exposed to PFOS and PFOA through drinking water showed significantly higher PFOS and PFOA concentrations in blood plasma. Although PFAA concentrations in the children slightly decreased from the 5th to the 7th follow-up, we detected increasing exposure

  4. Three-year cohort study of the role of environmental factors in the respiratory health of children in Hamilton, Ontario. Epidemiologic survey design, methods, and description of cohort

    SciTech Connect

    Kerigan, A.T.; Goldsmith, C.H.; Pengelly, L.D.

    1986-06-01

    The relative importance of the effect of outdoor environmental factors (suspended particulates, sulphur dioxide) and indoor environmental factors (parental smoking, gas cooking), on the respiratory health of children is still unclear. To answer these questions, a 3-yr cohort analytic study has been conducted in Hamilton, Ontario between 1978 and 1981. The prevalence of respiratory symptoms and indoor environmental factors was determined by an interviewer-administered questionnaire. Pulmonary function measures included both the forced expiratory maneuver and the single- and multiple-breath nitrogen washouts. Outdoor air quality was measured by a comprehensive network of suspended particulate and sulphur dioxide monitors. There were 3345 children 7 to 10 yr of age studied in the first year, a response rate of 95.4%, 3,727 in the second year, and 3168 in the third year; 75.6% of the initial cohort were studied in both Year 2 and Year 3. Comprehensive quality control in the study included measurement of the repeatability of both the questionnaire and pulmonary function data. Repeatability was acceptable except for variables derived from the single-breath nitrogen washout (correlation between initial and repeat closing volume vital capacity was 0.14). Cigarette smoking in Year 3 was reported in 4.8% of the children. The distribution of other covariables was not uniform, and the prevalence of parental smoking and gas cooking was greatest in the industrial area with the highest particulate pollution. Future analysis of these data will require the effect of these covariables to be distinguished from that caused by outdoor air pollution.

  5. The Association Between Cyanosis and Thromboelastometry (ROTEM) in Children With Congenital Heart Defects: A Retrospective Cohort Study.

    PubMed

    Laskine-Holland, Marie-Laure; Kahr, Walter H A; Crawford-Lean, Lynn; Humpl, Tilman; Honjo, Osami; Foreman, Celeste; Jain, Mehr; O'Leary, James D

    2017-01-01

    Children with congenital heart defects (CHD) have quantitative and qualitative differences in coagulation compared with healthy children. Secondary to polycythemia and increased deformability of red blood cells, cyanosis may be an important confounding factor for altered whole-blood coagulation in this population with potential implications for interpreting intraoperative thromboelastometry (TEM) for children with CHD undergoing major surgery. The primary aim of the study was to evaluate the association between cyanosis in children with CHD and measures of whole-blood coagulation determined using TEM (ROTEM [Tem International, GmbH, Munich, Germany]). In this retrospective cohort study, children who underwent congenital cardiac surgery in a 12-month period between April 2014 and 2015 were investigated. Children who were receiving antiplatelet or anticoagulant medications in the preoperative period were excluded. Eligible children were categorized by the presence of cyanosis, defined as an oxyhemoglobin concentration ≤85%. Multivariable linear regression analyses were used to determine the relationship between cyanosis and TEM outcomes (primary outcome, fibrinogen/fibrin polymerization [FibTEM] maximal clot firmness [MCF]) adjusting for potential confounding factors. Three hundred forty-five TEM profiles from 320 children were included in the cohort for analysis. Twenty-two percent (76/345) of children had cyanotic CHD. Clot firmness measured using the FibTEM assay was decreased in cyanotic children compared with noncyanotic children, median difference (95% confidence interval) interim [2 (0-3) mm; P = .01], and maximal [2 (1-3) mm; P = .01] clot firmness. The association between cyanosis and fibrinogen/fibrin polymerization clot firmness was not significant (A10, P = .7; MCF, P = .7) after adjusting for confounding factors (hematocrit, platelet count, and sex). There was a significant association between cyanosis and intrinsically activated clot firmness (A10, P

  6. INTERIM REPORT, DEVELOP A SAMPLING STRATEGY: PREPARE TO IMPLEMENT A COHORT STUDY OF CHILDREN'S ENVIRONMENTAL HEALTH

    EPA Science Inventory

    Overview

    The goal of the National Children's Study (NCS) is to collect information on environmental and

    social factors in the lives of children, starting before birth and continuing until age 21, to inform

    researchers about their effects on the health and dev...

  7. INTERIM REPORT, DEVELOP A SAMPLING STRATEGY: PREPARE TO IMPLEMENT A COHORT STUDY OF CHILDREN'S ENVIRONMENTAL HEALTH

    EPA Science Inventory

    Overview

    The goal of the National Children's Study (NCS) is to collect information on environmental and

    social factors in the lives of children, starting before birth and continuing until age 21, to inform

    researchers about their effects on the health and dev...

  8. Cohort Profile: Footprints in Time, the Australian Longitudinal Study of Indigenous Children

    PubMed Central

    Thurber, Katherine A; Banks, Emily; Banwell, Cathy

    2015-01-01

    Indigenous Australians experience profound levels of disadvantage in health, living standards, life expectancy, education and employment, particularly in comparison with non-Indigenous Australians. Very little information is available about the healthy development of Australian Indigenous children; the Longitudinal Study of Indigenous Children (LSIC) is designed to fill this knowledge gap. This dataset provides an opportunity to follow the development of up to 1759 Indigenous children. LSIC conducts annual face-to-face interviews with children (aged 0.5–2 and 3.5–5 years at baseline in 2008) and their caregivers. This represents between 5% and 10% of the total population of Indigenous children in these age groups, including families of varied socioeconomic and cultural backgrounds. Study topics include: the physical, social and emotional well-being of children and their caregivers; language; culture; parenting; and early childhood education. LSIC is a shared resource, formed in partnership with communities; its data are readily accessible through the Australian Government Department of Social Services (see http://dss.gov.au/lsic for data and access arrangements). As one of very few longitudinal studies of Indigenous children, and the only national one, LSIC will enable an understanding of Indigenous children from a wide range of environments and cultures. Findings from LSIC form part of a growing infrastructure from which to understand Indigenous child health. PMID:25011454

  9. Cohort Profile: Footprints in Time, the Australian Longitudinal Study of Indigenous Children.

    PubMed

    Thurber, Katherine A; Banks, Emily; Banwell, Cathy

    2015-06-01

    Indigenous Australians experience profound levels of disadvantage in health, living standards, life expectancy, education and employment, particularly in comparison with non-Indigenous Australians. Very little information is available about the healthy development of Australian Indigenous children; the Longitudinal Study of Indigenous Children (LSIC) is designed to fill this knowledge gap.This dataset provides an opportunity to follow the development of up to 1759 Indigenous children. LSIC conducts annual face-to-face interviews with children (aged 0.5-2 and 3.5-5 years at baseline in 2008) and their caregivers. This represents between 5% and 10% of the total population of Indigenous children in these age groups, including families of varied socioeconomic and cultural backgrounds. Study topics include: the physical, social and emotional well-being of children and their caregivers; language; culture; parenting; and early childhood education.LSIC is a shared resource, formed in partnership with communities; its data are readily accessible through the Australian Government Department of Social Services (see http://dss.gov.au/lsic for data and access arrangements). As one of very few longitudinal studies of Indigenous children, and the only national one, LSIC will enable an understanding of Indigenous children from a wide range of environments and cultures. Findings from LSIC form part of a growing infrastructure from which to understand Indigenous child health. © The Author 2014. Published by Oxford University Press on behalf of the International Epidemiological Association.

  10. Autism spectrum disorders in children of parents with inflammatory bowel disease – a nationwide cohort study in Denmark

    PubMed Central

    Andersen, Ane Birgitte Telén; Ehrenstein, Vera; Erichsen, Rune; Frøslev, Trine; Sørensen, Henrik Toft

    2014-01-01

    Purpose Inflammatory bowel disease (IBD) and autism spectrum disorders (ASD) may share genetic and environmental risk factors. We examined whether parental IBD is associated with an increased risk of ASD in offspring. Methods We conducted a registry-based nationwide cohort study including children born alive in Denmark from January 1, 1994 to December 31, 2009, with follow-up throughout 2010. IBD in parents and ASD in offspring were identified using inpatient and outpatient hospital diagnoses. We computed risk of ASD and crude and adjusted incidence rate ratios (aIRRs) with 95% confidence intervals (CI) using Cox proportional-hazards regression. We evaluated the risk of ASD according to maternal and paternal IBD, and separately for maternal and paternal Crohn’s disease (CD) and ulcerative colitis (UC). Children with parents free of IBD were the comparison cohort. Results We identified 1,005,330 children during the study period. Among them, 11,888 (1.2%) had a parent with IBD and 8,087 (0.8%) had a diagnosis of ASD during up to 17 years of follow-up. The 10-year risks of ASD were 0.7% among children of parents with IBD and 0.9% among children of parents without IBD. The aIRR for ASD among children with parental IBD was 0.8 (95% CI: 0.6–1.0), and results were similar regardless of parent of IBD origin or whether a parent had CD or UC. The estimates were similar for different ASD subtypes. Conclusion We found no evidence of an increased risk of ASD among children born to parents with IBD. PMID:24855384

  11. Pertussis vaccination and wheezing illnesses in young children: prospective cohort study. The Longitudinal Study of Pregnancy and Childhood Team.

    PubMed

    Henderson, J; North, K; Griffiths, M; Harvey, I; Golding, J

    1999-05-01

    To examine the relation between pertussis vaccination and the prevalence of wheezing illnesses in young children. Prospective cohort study. Three former health districts comprising Avon Health Authority. 9444 of 14 138 children enrolled in the Avon longitudinal study of pregnancy and childhood and for whom data on wheezing symptoms, vaccination status, and 15 environmental and biological variables were available. Episodes of wheezing from birth to 6 months, 7-18 months, 19-30 months, and 31-42 months. These time periods were used to derive five categories of wheezing illness: early wheezing (not after 18 months); late onset wheezing (after 18 months); persistent wheezing (at every time period); recurrent wheezing (any combination of two or more episodes for each period); and intermittent wheezing (any combination of single episodes of reported wheezing). These categories were stratified according to parental self reported asthma or allergy. Unadjusted comparisons of the defined wheezing illnesses in vaccinated and non-vaccinated children showed no significant association between pertussis vaccination and any of the wheezing outcomes regardless of stratification for parental asthma or allergy. Wheeze was more common in non-vaccinated children at 18 months, and there was a tendency for late onset wheezing to be associated with non-vaccination in children whose parents did not have asthma, but this was not significant. After adjustment for environmental and biological variables, logistic regression analyses showed no significant increased relative risk for any of the wheezing outcomes in vaccinated children: early wheezing (0.99, 95% confidence interval 0.80 to 1.23), late onset wheezing (0.85, 0.69 to 1.05), persistent wheezing (0.91, 0.47 to 1.79), recurrent wheezing (0.96, 0.72 to 1.26), and intermittent wheezing (1.06, 0.81 to 1.37). No evidence was found that pertussis vaccination increases the risk of wheezing illnesses in young children. Further follow

  12. Traffic-Related Air Pollution and Asthma Onset in Children: A Prospective Cohort Study with Individual Exposure Measurement

    PubMed Central

    Jerrett, Michael; Shankardass, Ketan; Berhane, Kiros; Gauderman, W. James; Künzli, Nino; Avol, Edward; Gilliland, Frank; Lurmann, Fred; Molitor, Jassy N.; Molitor, John T.; Thomas, Duncan C.; Peters, John; McConnell, Rob

    2008-01-01

    Background The question of whether air pollution contributes to asthma onset remains unresolved. Objectives In this study, we assessed the association between asthma onset in children and traffic-related air pollution. Methods We selected a sample of 217 children from participants in the Southern California Children’s Health Study, a prospective cohort designed to investigate associations between air pollution and respiratory health in children 10–18 years of age. Individual covariates and new asthma incidence (30 cases) were reported annually through questionnaires during 8 years of follow-up. Children had nitrogen dioxide monitors placed outside their home for 2 weeks in the summer and 2 weeks in the fall–winter season as a marker of traffic-related air pollution. We used multilevel Cox models to test the associations between asthma and air pollution. Results In models controlling for confounders, incident asthma was positively associated with traffic pollution, with a hazard ratio (HR) of 1.29 [95% confidence interval (CI), 1.07–1.56] across the average within-community interquartile range of 6.2 ppb in annual residential NO2. Using the total interquartile range for all measurements of 28.9 ppb increased the HR to 3.25 (95% CI, 1.35–7.85). Conclusions In this cohort, markers of traffic-related air pollution were associated with the onset of asthma. The risks observed suggest that air pollution exposure contributes to new-onset asthma. PMID:18941591

  13. Visually impaired Swedish children. The 1980 cohort study--a 19-year ophthalmological follow-up.

    PubMed

    Blohmé, J; Tornqvist, K

    2000-10-01

    To assess the ophthalmological outcome in a cohort of visually impaired children in a geographically defined area. A 19-year follow-up of medical records, interview and, if needed, re-examination of the initial 128 patients, born 1962-1976. Follow-up was possible in 123 patients (96%); 76 (59%) were still visually impaired, 17 (13%) were deceased, while 30 (23%) had acquired a visual function > or = 0.3. The chances of gaining a visual function outside the WHO limits for visual impairment was significantly higher for patients without additional impairments (p=0.0023). The initial ophthalmologic diagnosis remained unchanged in 88%. The diagnoses with improved visual development included albinism and congenital nystagmus, while retinal diseases showed poorer results. An increase in visual function could be seen even in the initially older age-groups, indicating a maturation of visual function beyond what is usually considered the limit of plasticity of the visual system.

  14. School screening and parental reminders in increasing dental care for children in need: a retrospective cohort study

    PubMed Central

    Nelson, Suchitra; Mandelaris, Jason; Ferretti, Gerald; Heima, Masahiro; Spiekerman, Charles; Milgrom, Peter

    2013-01-01

    Objective To assess follow-up dental care received by children given baseline screening and referrals as part of an ongoing clinical trial. Methods A retrospective study with two cohorts of kindergarten children who had baseline and follow-up (nine months later) dental exams was used. The parents/caregivers of children with routine restorative or urgent needs at baseline received a referral letter and telephone reminders to seek care for their child. Children with referrals were evaluated at follow-up exam for the receipt of care. A baseline caregiver questionnaire provided information on the individual and family characteristics of the children. Results A total of 303 children had dental exams at both time periods. At baseline, 42% (126/303) received referrals and among the referred group19% (24/126) received follow-up care. A greater proportion with urgent referrals (10/30, 33%) received care than those with routine referrals (14/96, 15%). Baseline dmft and DMFT was similar between children who did/did not receive follow-up care (P=0.178 and 0.491 respectively). Children receiving referrals had caregivers with less education, higher Medicaid participation, fewer routine care visits, poorer self-rating of teeth, and a higher proportion of children reporting tooth pain. Children without receipt of follow-up care had caregivers who were more likely to report not visiting a dentist within the last five years and a greater number of missed days from work due to tooth problems. Conclusion The rate of dental utilization was low even with school screening, referral and parental reminders among poor, largely minority inner-city kindergarten children. PMID:22316214

  15. Early exposure to thimerosal-containing vaccines and children's cognitive development. A 9-year prospective birth cohort study in Poland.

    PubMed

    Mrozek-Budzyn, Dorota; Majewska, Renata; Kiełtyka, Agnieszka

    2015-03-01

    The controversial topic of the early exposure to mercury is regarding ethylmercury, which is present in the thimerosal-containing vaccines (TCVs). The objective of this study was to determine the relationship between the early exposure to TCVs and cognitive development in children during the first 9 years of life. The cohort included 318 children vaccinated in an early period (neonatal and up to 6 months) against hepatitis B and diphtheria-tetanus-pertussis (DTP) using formulation with or without thimerosal. The children's development was assessed using the Fagan test (6th month of life), the Bayley Scales of Infant Development (BSID)-II (12th-36th month), the Raven test (5th, 8th year), and the Wechsler Intelligence Scale for Children (WISC-R) (6th, 7th, 9th year). Results were determined by multivariable linear and logistic regression, adjusted to potential confounders. Children exposed and not exposed to TCVs in the neonatal period had similar outcomes of cognitive-developmental tests; only the results of BSID-II at the 36th month and WISC-R at the 9th year were significantly higher for those exposed to TCVs. Developmental test results in children exposed to TCVs up to the 6th month of life also did not depend on thimerosal dose. TCV administration in early infancy did not affect children's cognitive development.

  16. Celiac disease in a large cohort of children and adolescents with recurrent headache: A retrospective study.

    PubMed

    Nenna, Raffaella; Petrarca, Laura; Verdecchia, Paola; Florio, Matteo; Pietropaoli, Nicoletta; Mastrogiorgio, Gerarda; Bavastrelli, Maria; Bonamico, Margherita; Cucchiara, Salvatore

    2016-05-01

    The clinical picture of celiac disease is changing with the emergence of subclinical forms and growing evidence reporting associated neurological disorders. To establish the prevalence of celiac disease in children suffering from recurrent headache. In our retrospective study we collected charts from 1131 children attending our tertiary care Centre for Paediatric Headache over the period 2001-2012. They were screened for celiac disease and positive patients were referred to our Operative Unit for Coeliac disease and confirmed positive children underwent upper endoscopy with multiple duodenal biopsies. Celiac children started a gluten-free diet. 883 children (481 females; median age, 9.8 years, range 3-19) performed celiac disease screening, and among them, 11 children (7 females; median age, 8.2 years, range: 4.8-13.9) were diagnosed with celiac disease. Seven children (5 females, median age, 11.9 years, range: 10.3-13.9) had been diagnosed as celiac prior to the neurological evaluation. The prevalence of celiac disease in our sample is 2.04% vs. 1.2% of the general population (p=0.034). Our study demonstrates, on a large series, that celiac disease prevalence is doubled in patients with chronic headache. Screening for celiac disease could be advised as part of the diagnostic work-up in these paediatric patients, particularly among pharmacological non-responders. Copyright © 2016 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  17. Maternal occupational exposure to asthmogens during pregnancy and risk of asthma in 7-year-old children: a cohort study

    PubMed Central

    Christensen, Berit Hvass; Thulstrup, Ane Marie; Hougaard, Karin Sørig; Skadhauge, Lars R; Hansen, Kirsten Skamstrup; Frydenberg, Morten; Schlünssen, Vivi

    2013-01-01

    Objectives The objective of this study was to examine whether maternal exposure to asthmogens during pregnancy is associated with the development of asthma in 7-year-old Danish children, taking atopic status and sex into consideration. Design The study is a prospective follow-up of a birth cohort. Setting and participants A total of 41 724 women and their children from The Danish National Birth Cohort were categorised according to maternal occupational exposure. Exposure information was obtained by combining job title in pregnancy and 18 months after pregnancy with a commonly used asthma Job Exposure Matrix. Primary and secondary outcome measures Primary outcome was parent-reported asthma among their 7-year-old children in an internet-based questionnaire. Secondary outcome was asthma among the same children with or without atopic dermatitis and among boys and girls, respectively. Results Prenatal exposure to low molecular weight (LMW) agents was borderline associated with asthma in children with OR 1.17 (0.95 to 1.44) for children with atopic dermatitis and 1.10 (0.98 to 1.22) for children without. Maternal postnatal exposure was associated with asthma (OR 1.15 (1.04 to 1.28). After mutual adjustment,postnatal exposure (OR 1.13 (0.99 to 1.29) and the combined effects of prenatal and postnatal exposure (OR 1.34 (1.19 to 1.51)) seem to increase the risk of asthma in children. No significant associations were observed for other prenatal or postnatal exposures. The gender of the child did not modify the aforementioned associations. Conclusions Maternal occupational exposures during pregnancy do not seem to be a substantial risk factor for the development of asthma in 7-year-old children. Maternal prenatal and postnatal exposures to LMW agents may predispose the propensity of the children to develop asthma. Future studies should prioritise the characterisation of the timing of exposure in relation to the birth. PMID:23585388

  18. Perinatal risk factors for development of celiac disease in children, based on the prospective Norwegian Mother and Child Cohort Study.

    PubMed

    Emilsson, Louise; Magnus, Maria Christine; Størdal, Ketil

    2015-05-01

    There have been inconsistent reports of prenatal and perinatal factors that affect risk for development of celiac disease. We assessed the association of fetal growth, birth weight, and mode of delivery with development of celiac disease within the Norwegian Mother and Child (MoBa) Cohort Study. The MoBa cohort contains pregnancy information on 95,200 women and data on their 114,500 children, which were collected in Norway from 1999 through 2008; it is linked to the Medical Birth Registry. Women and children with celiac disease were identified from the National Patient Registry and from women's responses to MoBa questionnaires. We calculated odds ratios (ORs) for celiac disease by using a multivariable logistic regression model, adjusting for maternal celiac disease, sex of children, and children's age (model 1); in a second model, we adjusted for age of gluten introduction and duration of breastfeeding (model 2). We identified 650 children with celiac disease and 107,828 controls in the MoBa database. We found no association between birth weight or height with celiac disease (born small for gestational age was not associated). Celiac disease was not associated with mode of delivery (cesarean section, model 1: OR, 0.84; 95% confidence interval [CI], 0.65-1.09, and model 2: OR, 0.83; 95% CI, 0.63-1.09). Maternal celiac disease, adjusted for age and sex of the children (OR, 12.45; 95% CI, 8.29-18.71) and type 1 diabetes (model 1: OR, 2.58; 95% CI, 1.19-5.53, and model 2: OR, 2.61; 95% CI, 1.14-5.98) were associated with development of celiac disease in children, whereas maternal type 2 diabetes and gestational diabetes were not. On the basis of analysis of the Norwegian MoBa cohort, development of celiac disease in children is significantly associated with sex of the child, maternal celiac disease, and type 1 diabetes but not with intrauterine growth. Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.

  19. Behavioural sleep problems in children with attention-deficit/hyperactivity disorder (ADHD): protocol for a prospective cohort study.

    PubMed

    Lycett, Kate; Sciberras, E; Mensah, F K; Gulenc, A; Hiscock, H

    2014-02-12

    Children with attention-deficit/hyperactivity disorder (ADHD) commonly experience behavioural sleep problems, yet these difficulties are not routinely assessed and managed in this group. Presenting with similar symptoms to ADHD itself, sleep problems are complex in children with ADHD and their aetiology is likely to be multifactorial. Common internalising and externalising comorbidities have been associated with sleep problems in children with ADHD; however, this relationship is yet to be fully elucidated. Furthermore, limited longitudinal data exist on sleep problems in children with ADHD, thus their persistence and impact remain unknown. In a diverse sample of children with ADHD, this study aims to: (1) quantify the relationship between sleep problems and internalising and externalising comorbidities; (2) examine sleep problem trajectories and risk factors; and (3) examine the longitudinal associations between sleep problems and child and family functioning over a 12-month period. A prospective cohort study of 400 children with ADHD (150 with no/mild sleep problems, 250 with moderate/severe sleep problems) recruited from paediatric practices across Victoria, Australia. The children's parents and teacher provide data at baseline and 6-month and 12-month post enrolment. Parent report of child's sleep problem severity (no, mild, moderate, severe); specific sleep domain scores assessed using the Child Sleep Habits Questionnaire; internalising and externalising comorbidities assessed by the Anxiety Disorders Interview Schedule for Children IV/Parent version. Multiple variable logistic and linear regression models examining the associations between key measures, adjusted for confounders identified a priori. Ethics approval has been granted. Findings will contribute to our understanding of behavioural sleep problems in children with ADHD. Clinically, they could improve the assessment and management of sleep problems in this group. We will seek to publish in leading

  20. Postoperative Pain Management in Children of Hispanic Origin: A Descriptive Cohort Study

    PubMed Central

    Brown, Rebecca; Fortier, Michelle A.; Zolghadr, Sheeva; Gulur, Padma; Jenkins, Brooke N.; Kain, Zeev N.

    2015-01-01

    Background It has been established that pain is frequently undertreated in children following outpatient surgery. Very few studies, however, have investigated this phenomenon in ethnically diverse populations. Methods This study included 105 families of children age 2–15 years of Hispanic origin and low income undergoing outpatient tonsillectomy and adenoidectomy surgery. Participating parents completed baseline and demographic packets. Recorded postoperative pain ratings and administration of analgesics at home for one week were collected during home visits. Results Despite the high (70%, 99% CI[57%, 82%]) incidence of significant pain in the first 24 hours home, 32% (95% CI[20%, 45%]) of the children received 0–1 dose of analgesia. Overall, 21% children (99% CI[11%, 35%]) received 4 or less total doses of pain medication over the entire week following surgery. Of the total analgesic doses administered to children in the week following surgery, only 44% (99% CI[40%, 47%]) were in accepted ranges. Conclusions Despite experiencing significant postoperative pain, Hispanic children assessed in this study received suboptimal analgesic therapy at home. PMID:26505577

  1. Are there changes in the nutritional status of children of Oportunidades families in rural Chiapas, Mexico? A cohort prospective study.

    PubMed

    García-Parra, Esmeralda; Ochoa-Díaz-López, Héctor; García-Miranda, Rosario; Moreno-Altamirano, Laura; Solís-Hernández, Roberto; Molina-Salazar, Raúl

    2016-01-16

    In Mexico, despite that the fact that several social programs have been implemented, chronic undernutrition is still a public health problem affecting 1.5 million children of <5 years. Chiapas ranks first in underweight and stunting at national level with a stunting prevalence of 31.4 % whereas for its rural population is 44.2 %. The purpose of this paper is to determine if the nutritional status of a cohort of children living in poor rural communities under Oportunidades has changed. We were interested in assessing the nutrition evolution of the children who were initially diagnosed as stunted and of those who were diagnosed as normal. Oportunidades is an anti-poverty program of the Mexican government consisting mainly in monetary transfers to the families living in alimentary poverty. A 9-year cohort prospective study was conducted with nutritional evaluations of 222 children. Anthropometric indices were constructed from measurements of weight, height, and age of the children whose nutritional status was classified following WHO standards. The results showed that although these children were Oportunidades beneficiaries for 9 years and their families improved their living conditions, children still had a high prevalence of stunting (40.1 %) and 69.6 % had not recovered yet. Children who were initially diagnosed with normal nutritional status and became stunted 2 years later had a higher risk (relative risk (RR) 5.69, 2.95-10.96) of continuing stunted at school age and adolescence. Oportunidades has not impacted, as expected, the nutritional status of the study population. These findings pose the question: Why has not the nutritional status of children improved, although the living conditions of their families have significantly improved? This might be the result of an adaptation process achieved through a decrease of growth velocity. It is important to make efforts to watch the growth of the children during their first 3 years of age, to focus on improving the

  2. Utilization and costs of conventional and alternative pharmaceuticals in children: results from the German GINIplus and LISAplus birth cohort studies.

    PubMed

    Italia, Salvatore; Batscheider, Ariane; Heinrich, Joachim; Wenig, Christina; Bauer, Carl Peter; Koletzko, Sibylle; Lehmann, Irina; Herbarth, Olf; von Berg, Andrea; Berdel, Dietrich; Hoffmann, Barbara; Schaaf, Beate; Wolfenstetter, Silke B

    2012-10-01

    The socioeconomic determinants for drug utilization, especially in children, have not been investigated sufficiently so far. The study's aim was the estimation of prevalences and determinants of conventional, homeopathic and phytotherapeutic drugs and expenditures. Population-based data on drug utilization of 3,642 children in two German birth cohorts (GINIplus and LISAplus, 10-year follow-up) were collected using a self-administered questionnaire. For analysis, the reported drugs (use within the last four weeks) were classified into the therapeutic categories of 'conventional medicine', 'homeopathy', 'phytotherapy' and 'others'. Drug costs were estimated using pharmaceutical identification numbers. In all, 42.3% of the children reported drug use; 24.1% of the drugs were homeopathic and 11.5% were phytotherapeutic. The proportion of children who took at least one homeopathic remedy was 14.3%. Drugs prescribed by physicians were dominated by conventional medicine (76.5%), whereas in non-prescribed drugs, both homeopathy and conventional medicine accounted for 37% each. Boys (OR = 0.78) used less homeopathy than girls. Income showed only a weak influence. Education had a strong effect on the use of phytotherapy such that children of mothers with higher school education (>10 years vs. <10 years) used more phytotherapy (OR = 2.01). If out-of-pocket payments arose (n = 613), the mean was €20. On average, total drug expenditures summed up to €39 in 4 weeks for drug users if only clearly identifiable prices for drugs were considered (58% of all data). Utilization of homeopathy is common in children from the analyzed cohort. User profiles of homeopathy and phytotherapy differ from each other and should be analyzed separately. Copyright © 2012 John Wiley & Sons, Ltd.

  3. Gender differences of children's developmental trajectory from 6 to 60 months in the Taiwan Birth Cohort Pilot Study.

    PubMed

    Lung, For-Wey; Chiang, Tung-Liang; Lin, Shio-Jean; Feng, Jui-Ying; Chen, Po-Fei; Shu, Bih-Ching

    2011-01-01

    The parental report instrument is the most efficient developmental detection method and has shown high validity with professional assessment instruments. The reliability and validity of the Taiwan Birth Cohort Study (TBCS) 6-, 18- and 36-month scales have already been established. In this study, the reliability and validity of the 60-month scale was tested. The gender differences in children's longitudinal gross motor, fine motor, language and social development were also investigated. Using the dataset from the Taiwan Birth Cohort Pilot Study (TBCS-p), 2048 infants were followed up when they were 6-, 18-, 36- and 60-month-old. At the final stage, 1620 children were followed up. Development of the children was measured using the TBCS 6-, 18-, 36-, and 60-month developmental scales. The reconstructed TBCS 60-month scale yielded 16 items measuring children's development in the four dimensions of gross motor, fine motor, language and social. The scale yielded an internal consistency of 0.39-0.71. Structural equation modeling also showed good construct and predictive validity, in that the 6-, 18-, and 36-month scales were predictive of the 60-month scale. No gender differences between the gross motor dimension was found. Gender had an effect on the fine motor dimension at 36 and 60 months, language dimension at 36 months, and social dimension at 18, 36 and 60 months. Gender had a transient effect in language development and social development a continuous effect from 18 to 60 months. Thus different gender norms may need to be established to prevent misdiagnosis. The TBCS scale is a valid and reliable developmental screening instrument that can be used in continuous surveillance of children's development in community and clinical settings from 6 months to 5 years of age.

  4. [International cohort studies].

    PubMed

    Ahrens, W; Pigeot, I

    2012-06-01

    Among observational studies, cohort studies, i.e. longitudinal observations of selected population groups, provide the highest possible evidence of a causal association between specific risk factors (exposure) and the occurrence of disease in populations. Besides the fact that many exposures cannot be investigated in experimental designs, cohort studies have the advantage over randomized clinical trials that they are conducted in free living populations and not in restrictive, clinical settings. In this paper we describe the aims and features of international cohorts that have been selected because of their impact, their size or their endpoints. We do not only present the study designs and survey instruments used but we also highlight some of the most important results gained by these studies. Most of these prospective studies investigated common chronic diseases in the elderly, such as cancer, diabetes, cardiovascular or neurodegenerative diseases, osteoporosis and ophthalmologic disorders. Newer cohorts and recent reassessments of existing cohorts almost always include the collection and storage of biological samples. In recent years technological developments allowed the implementation of cutting edge measurement procedures, such as imaging techniques for phenotyping. Finally, we discuss on the one hand whether these designs can be transferred to the German situation and on the other hand to what degree the results obtained from foreign cohorts can be generalized for the German population. We conclude with recommendations for future cohort studies.

  5. Swimming pool attendance, asthma, allergies, and lung function in the Avon Longitudinal Study of Parents and Children cohort.

    PubMed

    Font-Ribera, Laia; Villanueva, Cristina M; Nieuwenhuijsen, Mark J; Zock, Jan-Paul; Kogevinas, Manolis; Henderson, John

    2011-03-01

    Cross-sectional studies have reported inconsistent findings for the association between recreational swimming pool attendance and asthma and allergic diseases in childhood. To examine whether swimming in infancy and childhood was associated with asthma and allergic symptoms at age 7 and 10 years in a UK longitudinal population-based birth cohort, the Avon Longitudinal Study of Parents and Children. Data on swimming were collected by questionnaire at 6, 18, 38, 42, 57, 65, and 81 months. Data on rhinitis, wheezing, asthma, eczema, hay fever, asthma medication, and potential confounders were collected through questionnaires at 7 and 10 years. Spirometry and skin prick testing were performed at 7 to 8 years. Data for analysis were available for 5,738 children. At age 7 years, more than 50% of the children swam once per week or more. Swimming frequency did not increase the risk of any evaluated symptom, either overall or in atopic children. Children with a high versus low cumulative swimming pool attendance from birth to 7 years had an odds ratio of 0.88 (95% confidence interval, 0.56-1.38) and 0.50 (0.28-0.87), respectively, for ever and current asthma at 7 years, and a 0.20 (0.02-0.39) standard deviation increase in the forced midexpiratory flow. Children with asthma with a high versus low cumulative swimming had an odds ratio for current asthma at 10 years of 0.34 (0.14-0.80). This first prospective longitudinal study suggests that swimming did not increase the risk of asthma or allergic symptoms in British children. Swimming was associated with increased lung function and lower risk of asthma symptoms, especially among children with preexisting respiratory conditions.

  6. Swimming Pool Attendance, Asthma, Allergies, and Lung Function in the Avon Longitudinal Study of Parents and Children Cohort

    PubMed Central

    Font-Ribera, Laia; Villanueva, Cristina M.; Nieuwenhuijsen, Mark J.; Zock, Jan-Paul; Kogevinas, Manolis; Henderson, John

    2011-01-01

    Rationale: Cross-sectional studies have reported inconsistent findings for the association between recreational swimming pool attendance and asthma and allergic diseases in childhood. Objectives: To examine whether swimming in infancy and childhood was associated with asthma and allergic symptoms at age 7 and 10 years in a UK longitudinal population-based birth cohort, the Avon Longitudinal Study of Parents and Children. Methods: Data on swimming were collected by questionnaire at 6, 18, 38, 42, 57, 65, and 81 months. Data on rhinitis, wheezing, asthma, eczema, hay fever, asthma medication, and potential confounders were collected through questionnaires at 7 and 10 years. Spirometry and skin prick testing were performed at 7 to 8 years. Data for analysis were available for 5,738 children. Measurements and Main Results: At age 7 years, more than 50% of the children swam once per week or more. Swimming frequency did not increase the risk of any evaluated symptom, either overall or in atopic children. Children with a high versus low cumulative swimming pool attendance from birth to 7 years had an odds ratio of 0.88 (95% confidence interval, 0.56–1.38) and 0.50 (0.28–0.87), respectively, for ever and current asthma at 7 years, and a 0.20 (0.02–0.39) standard deviation increase in the forced midexpiratory flow. Children with asthma with a high versus low cumulative swimming had an odds ratio for current asthma at 10 years of 0.34 (0.14–0.80). Conclusions: This first prospective longitudinal study suggests that swimming did not increase the risk of asthma or allergic symptoms in British children. Swimming was associated with increased lung function and lower risk of asthma symptoms, especially among children with preexisting respiratory conditions. PMID:20889905

  7. Effect of adenotonsillectomy on attention deficit-hyperactivity disorder in children with adenotonsillar hypertrophy: A prospective cohort study.

    PubMed

    Ahmadi, Mohammad Saeed; Poorolajal, Jalal; Masoomi, Fatemeh Sadat; Haghighi, Mohammad

    2016-07-01

    This study was conducted to explore the effect of adenotonsillectomy on the improvement of attention deficit hyperactivity disorder (ADHD) symptoms in children with adenotonsillar hypertrophy. This prospective cohort study was conducted on 59 children aged 6-12 years with adenotonsillar hypertrophy and ADHD who were candidates for adenotonsillectomy at Besat Hospital, Hamadan University of Medical Sciences, in 2014. The status of ADHD was evaluated at baseline and one and three months after surgery using Conners' Rating Scales. Of 59 children with ADHD (35 boys and 24 girls), 41 improved one month after surgery and 51 after three months. Only 8 children had no improvement. The Conners' score decreased significantly from 71.37 at baseline to 61.31 (P = 0.001) and 49.14 (P = 0.001) one and three months after surgery, respectively. The score of attention deficit and hyperactivity decreased from 1.76 and 2.10 at baseline to 1.52 and 1.83 after one month (P = 0.001) and to 1.24 and 1.52 after three months (P = 0.001), respectively. The results were statistically significant for both boys and girls. This study indicated that adenotonsillectomy can significantly improve ADHD in children with adenotonsillar hypertrophy and help them return to normal life. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  8. A prospective study of dental anxiety in a cohort of children followed from 5 to 9 years of age.

    PubMed

    Tickle, Martin; Jones, Clare; Buchannan, Katie; Milsom, Keith M; Blinkhorn, Anthony S; Humphris, Gerry M

    2009-07-01

    The development of dental anxiety in children is poorly understood. The aims of this study were to measure changes in dental anxiety over time and to examine the relationship between anxiety, dental care, and other factors. A prospective cohort study of children in the north-west of England followed from 5 to 9 years of age. The participants were clinically examined and their parents completed the same questionnaire at 5 and 9 years. The majority (54.3%N = 38) of participants who were anxious at 5 years were no longer anxious at 9 years, but a large proportion of children who were anxious at 5 remained anxious at 9 years of age (45.7%N = 32). During the follow-up period, a larger proportion of children developed anxiety (11.7%N = 85) than the proportion of children who were reported as being anxious at baseline (8.8%N = 70). At 9 years of age, dental anxiety was significantly associated with girls; parental anxiety; a history of extraction; and irregular, asymptomatic dental visiting. These factors were also significantly associated with dental anxiety at 5 years old. Dental anxiety was cumulative in the study population over time, and its development influenced by multiple variables. Results suggest that adverse conditioning and vicarious learning are both important in the development of this condition.

  9. 6MP adherence in a multiracial cohort of children with acute lymphoblastic leukemia: a Children's Oncology Group study.

    PubMed

    Bhatia, Smita; Landier, Wendy; Hageman, Lindsey; Kim, Heeyoung; Chen, Yanjun; Crews, Kristine R; Evans, William E; Bostrom, Bruce; Casillas, Jacqueline; Dickens, David S; Maloney, Kelly W; Neglia, Joseph P; Ravindranath, Yaddanapudi; Ritchey, A Kim; Wong, F Lennie; Relling, Mary V

    2014-10-09

    Durable remissions in children with acute lymphoblastic leukemia (ALL) require a 2-year maintenance phase that includes daily oral 6-mercaptopurine (6MP). Adherence to oral 6MP among Asian-American and African-American children with ALL is unknown. We enrolled 298 children with ALL (71 Asian Americans, 68 African Americans, and 159 non-Hispanic whites) receiving oral 6MP for the maintenance phase. Adherence was measured electronically for 39 803 person-days. Adherence declined from 95.0% (month 1) to 91.8% (month 5, P < .0001). Adherence rates were significantly (P < .0001) lower in Asian Americans (90.0% ± 4.9%) and African Americans (87.1% ± 4.4%), as compared with non-Hispanic whites (95.2% ± 1.3%). Race-specific sociodemographic characteristics helped explain poor adherence (African Americans: low maternal education [less than a college degree: 78.9%, vs at least college degree: 94.6%; P < .0001]; Asian Americans: low-income households [<$50 000: 84.5%, vs ≥$50 000: 96.7%; P = .04]; households without mothers as full-time caregivers [85.6%] vs households with mothers as full-time caregivers [97.2%; P = .05]). Adherence rate below 90% was associated with increased relapse risk (hazard ratio, 3.9; P = .01). Using an adherence rate <90% to define nonadherence, 20.5% of the participants were nonadherers. We identify race-specific determinants of adherence, and define a clinically relevant level of adherence needed to minimize relapse risk in a multiracial cohort of children with ALL. This trial was registered at www.clinicaltrials.gov as #NCT00268528.

  10. Predicting complications from acute cough in pre-school children in primary care: a prospective cohort study.

    PubMed Central

    Hay, Alastair D; Fahey, Tom; Peters, Tim J; Wilson, Andrew

    2004-01-01

    BACKGROUND: There is uncertainty about which children with cough are most and least likely to experience complications. AIM: To derive a clinical prediction rule for complications in pre-school children presenting to primary care with acute cough. Design of study: Prospective cohort study. SETTING: Eight general practices in Leicestershire, United Kingdom. METHOD: Pre-school children with cough for < or =28 days and without asthma were recruited. Sociodemographic, clinical history, and examination data were collected and univariable logistic regression used to explore the associations with complications. These were defined as any new symptom, sign or diagnosis identified by a primary care clinician at a parent initiated reconsultation, or hospital admission, before cough resolution. Those factors with stronger relationships (P< 0.2) were then modelled using multivariable logistic regression to identify the factors independently associated with complications. RESULTS: The pre-test probability of complications was 10%. On univariable analysis, fever (odds ratio [OR] = 4.86; 95% confidence interval [CI] = 1.74 to 13.6), chest signs (OR = 2.72; CI = 1.06 to 6.96), and tachypnoea (OR = 3.80; CI = 1.22 to 11.8) were associated with complications. On multivariable analysis, only fever (OR = 5.56; CI = 1.75 to 17.6) and chest signs (OR = 2.88; CI = 1.02 to 8.05) were independently associated with complications. These ORs translate into post-test probabilities of complications of 6% for children with neither fever nor chest signs, 18% for children with chest signs, 28% for children with fever, and 40% for children with fever and chest signs. CONCLUSIONS: If validated, this clinical prediction rule could be used to individualise the management of acute cough in pre-school children. PMID:14965400

  11. Parents' mental health and children's cognitive and social development: families in England in the Millennium Cohort Study.

    PubMed

    Mensah, Fiona K; Kiernan, Kathleen E

    2010-11-01

    The development of children of parents who are experiencing mental health difficulties is a continuing cause of concern for professionals working in health, social care and education as well as policy makers. In light of this interest our study investigates the interplay between the mental health of mothers and fathers and family socioeconomic resources, and the impact for children's cognitive and social development. The study uses survey data from the Millennium Cohort Study linked with the Foundation Stage Profile assessment for children in the primary year of school in England between 2005 and 2006. The study includes 4,781 families from England where both parents' mental health had been assessed using the Kessler 6 scale. Associations between parents' mental health and children's cognitive and social development were estimated using regression models. Multivariate models were used to explore the mediating role of the families' socioeconomic resources. Gender interaction models were used to explore whether effects of parents' mental health differ for girls and boys. The study finds lower attainment in communication, language and literacy, mathematical development and personal, social and emotional development among children whose parents were experiencing high levels of psychological distress. Parents' age and qualifications and families' socioeconomic resources strongly mediated the effects of parents' psychological distress on children's attainment, and although independent effects of mother's mental health were maintained, effects of father's mental health were not. Stronger effects of mothers' mental health were found for boys than for girls. These findings highlight the interplay between the mental health of parents, families' socioeconomic resources and children's development which speaks for the need for close integration of mental health and social interventions to improve the well being of families.

  12. Physical and mental development of children after levonorgestrel emergency contraception exposure: a follow-up prospective cohort study.

    PubMed

    Zhang, Lin; Ye, Weiping; Yu, Wen; Cheng, Linan; Shen, Lixiao; Yang, Zujing

    2014-07-01

    Levonorgestrel (LNG), a dedicated emergency contraception (EC) product, has been available over-the-counter in China for more than 14 yr. Although LNG-EC is considered to have no effects on the developing fetus if the contraceptive fails and pregnancy occurs, there have been a few studies specifically examining this issue. The purpose of this study was to compare the physical and mental development of children born after LNG-EC failure with that of a cohort of children born to mothers with no history of exposure to LNG or any teratogenic substances. A group of 195 children who were exposed to LNG-EC during their mothers' conception cycle (study group) were matched to a group of 214 children without exposure to LNG (control group). The physical and mental development of the children were evaluated and compared over a 2-yr period. There were four congenital malformations in the study group and three in the control group (2.1% vs. 1.4%, respectively, P > 0.05). Over the 2-yr follow-up period, there were no statistically significant differences between the two groups with respect to children's weight, height, head circumference, and intelligence scores, and the values of all parameters of both groups were similar to those of the national standards. In summary, LNG-EC has no effect on the physical growth, mental development, or occurrence of birth defects in children born from pregnancies in which EC failed. © 2014 by the Society for the Study of Reproduction, Inc.

  13. Cohort Profile: the 'children of the 90s'--the index offspring of the Avon Longitudinal Study of Parents and Children.

    PubMed

    Boyd, Andy; Golding, Jean; Macleod, John; Lawlor, Debbie A; Fraser, Abigail; Henderson, John; Molloy, Lynn; Ness, Andy; Ring, Susan; Davey Smith, George

    2013-02-01

    The Avon Longitudinal Study of Parents and Children (ALSPAC) is a transgenerational prospective observational study investigating influences on health and development across the life course. It considers multiple genetic, epigenetic, biological, psychological, social and other environmental exposures in relation to a similarly diverse range of health, social and developmental outcomes. Recruitment sought to enroll pregnant women in the Bristol area of the UK during 1990-92; this was extended to include additional children eligible using the original enrollment definition up to the age of 18 years. The children from 14541 pregnancies were recruited in 1990-92, increasing to 15247 pregnancies by the age of 18 years. This cohort profile describes the index children of these pregnancies. Follow-up includes 59 questionnaires (4 weeks-18 years of age) and 9 clinical assessment visits (7-17 years of age). The resource comprises a wide range of phenotypic and environmental measures in addition to biological samples, genetic (DNA on 11343 children, genome-wide data on 8365 children, complete genome sequencing on 2000 children) and epigenetic (methylation sampling on 1000 children) information and linkage to health and administrative records. Data access is described in this article and is currently set up as a supported access resource. To date, over 700 peer-reviewed articles have been published using ALSPAC data.

  14. Cohort Profile: The ‘Children of the 90s’—the index offspring of the Avon Longitudinal Study of Parents and Children

    PubMed Central

    Boyd, Andy; Golding, Jean; Macleod, John; Lawlor, Debbie A; Fraser, Abigail; Henderson, John; Molloy, Lynn; Ness, Andy; Ring, Susan; Davey Smith, George

    2013-01-01

    The Avon Longitudinal Study of Parents and Children (ALSPAC) is a transgenerational prospective observational study investigating influences on health and development across the life course. It considers multiple genetic, epigenetic, biological, psychological, social and other environmental exposures in relation to a similarly diverse range of health, social and developmental outcomes. Recruitment sought to enrol pregnant women in the Bristol area of the UK during 1990–92; this was extended to include additional children eligible using the original enrolment definition up to the age of 18 years. The children from 14 541 pregnancies were recruited in 1990–92, increasing to 15 247 pregnancies by the age of 18 years. This cohort profile describes the index children of these pregnancies. Follow-up includes 59 questionnaires (4 weeks–18 years of age) and 9 clinical assessment visits (7–17 years of age). The resource comprises a wide range of phenotypic and environmental measures in addition to biological samples, genetic (DNA on 11 343 children, genome-wide data on 8365 children, complete genome sequencing on 2000 children) and epigenetic (methylation sampling on 1000 children) information and linkage to health and administrative records. Data access is described in this article and is currently set up as a supported access resource. To date, over 700 peer-reviewed articles have been published using ALSPAC data. PMID:22507743

  15. Predictive Factors of Postoperative Pain and Postoperative Anxiety in Children Undergoing Elective Circumcision: A Prospective Cohort Study

    PubMed Central

    Tsamoudaki, Stella; Ntomi, Vasileia; Yiannopoulos, Ioannis; Christianakis, Efstratios; Pikoulis, Emmanuel

    2015-01-01

    Background Although circumcision for phimosis in children is a minor surgical procedure, it is followed by pain and carries the risk of increased postoperative anxiety. This study examined predictive factors of postoperative pain and anxiety in children undergoing circumcision. Methods We conducted a prospective cohort study of children scheduled for elective circumcision. Circumcision was performed applying one of the following surgical techniques: sutureless prepuceplasty (SP), preputial plasty technique (PP), and conventional circumcision (CC). Demographics and base-line clinical characteristics were collected, and assessment of the level of preoperative anxiety was performed. Subsequently, a statistical model was designed in order to examine predictive factors of postoperative pain and postoperative anxiety. Assessment of postoperative pain was performed using the Faces Pain Scale (FPS). The Post Hospitalization Behavior Questionnaire study was used to assess negative behavioral manifestations. Results A total of 301 children with a mean age of 7.56 ± 2.61 years were included in the study. Predictive factors of postoperative pain measured with the FPS included a) the type of surgical technique, b) the absence of siblings, and c) the presence of postoperative complications. Predictive factors of postoperative anxiety included a) the type of surgical technique, b) the level of education of mothers, c) the presence of preoperative anxiety, and d) a history of previous surgery. Conclusions Although our study was not without its limitations, it expands current knowledge by adding new predictive factors of postoperative pain and postoperative anxiety. Clearly, further randomized controlled studies are needed to confirm its results. PMID:26495079

  16. Serum Levels of Persistent Organic Pollutants and Insulin Secretion among Children Age 7–9 Years: A Prospective Cohort Study

    PubMed Central

    Park, Su Hyun; Ha, Eunhee; Hong, Young Sun; Park, Hyesook

    2016-01-01

    Background: Persistent organic pollutants (POPs) are endocrine disruptors and have been suggested as possible risk factors for diabetes. Few studies have been performed to investigate this association among children. Objectives: In this study, we prospectively examined the relationship between the serum concentration of POPs and glucose metabolism in children. Methods: Data were collected from the Ewha Birth & Growth Cohort Study, an ongoing birth cohort study initially constructed between 2001 and 2006. In 2010–2012, the POP concentration was measured in serum from a total of 214 children, 7–9 years of age. Using fasting glucose and insulin measurements at both baseline and the second year of follow-up, the homeostatic model assessment of beta-cell function (HOMA-β) and homeostatic model assessment of insulin resistance (HOMA-IR) were calculated. Multiple linear regression analysis and a linear mixed-effects model were used to determine the relationship between POP tertiles and metabolic biomarkers. Results: Compared with the lowest tertile of total marker PCBs, participants in the third tertile had decreased HOMA-β values, after adjustment for age, sex, body mass index z-score, mother’s education, ponderal index, and history of breastfeeding (–18.94%; 95% CI: –32.97%, –1.98%). In a linear mixed model, the HOMA-β values were still lower in subjects in the highest compared with the lowest tertile of total PCBs at the 2-year follow-up period (108.3 vs. 135.0, respectively). Conclusion: The results of the study suggested that exposure to POPs among children might affect insulin secretory function, which could lead to an increased risk of developing diabetes. Citation: Park SH, Ha EH, Hong YS, Park H. 2016. Serum levels of persistent organic pollutants and insulin secretion among children age 7–9 years: a prospective cohort study. Environ Health Perspect 124:1924–1930; http://dx.doi.org/10.1289/EHP147 PMID:27266903

  17. Cognitive development in children up to age 11 years born after ART-a longitudinal cohort study.

    PubMed

    Barbuscia, Anna; Mills, Melinda C

    2017-05-24

    How does the cognitive development of children conceived after ART (IVF and ICSI) - measured as cognitive skills at age 3, 5, 7 and 11 years - differ over time from those born after natural conception (NC)? Improved measures of cognitive development up to age 5 years were recorded in children conceived with ART compared to NC, which attenuates by 11 years, with ART children still scoring slightly better than NC children. Results on the cognitive outcomes of children conceived after ART have been highly contradictory. Some have shown that ART children have an impaired behavioural, socio-emotional and cognitive development and higher risk of mental disorders. Others have reported no increased risk or difference. Cognitive development has not been previously examined using latent growth curve models from ages 3 to 11 years, also including appropriate attention to confounding parental characteristics. Longitudinal data for the first five waves (2000-2012) of the UK Millennium Cohort Study were used, which is a two-stage sample of all infants born in 2000-2001 and resident in the UK at 9 months of age, drawn from the Department of Social Security Child Benefit Registers. A final sample of N = 15 218 children (125 IVF and 61 ICSI), from 14 816 families was used. Information was available for all waves for 8298 children. Four additional follow-up surveys were conducted in 2003, 2005, 2007 and 2012. Our sample includes children born within a union (married or cohabiting parents) and where information on cognitive scores was available for at least two measurement points. Cognitive development was assessed with the British Ability Scales. At age 3 and 5 years (wave 2 and 3), children completed the naming vocabulary component, which measures expressive verbal ability. At age 7 years (wave 4), verbal cognitive abilities were assessed through the word reading test, and at age 11 years (wave 5) through a verbal similarity test. Two-tailed Student's t-tests examined differences

  18. DEVELOPMENT OF DISRUPTIVE BEHAVIORS IN YOUNG CHILDREN: A PROSPECTIVE POPULATION-BASED COHORT STUDY

    PubMed Central

    BAILLARGEON, RAYMOND H.; MORISSET, ALEXANDRE; KEENAN, KATE; NORMAND, CLAUDE L.; SÉGUIN, JEAN R.; JAPEL, CHRISTA; CAO, GUANQIONG

    2013-01-01

    We know relatively little about the development of disruptive behaviors (DBs), and gender differences therein. The objective of this study was to describe the continuity and discontinuity in the degree to which young children in the general population are reported to exhibit specific DBs over time. Data came from the Québec Longitudinal Study of Child Development. First, the results show that relatively few children exhibit DBs on a frequent basis at 41 months of age. Second, the results show that a majority of children who exhibit a particular DB on a frequent basis at 41 months of age did not do so 1 year earlier. In addition, a majority of children who exhibited a particular DB on a frequent basis at 29 months of age no longer do so 1 year later. Third, gender differences in DBs (boys > girls) are either emerging or at least increasing in magnitude between 29 and 41 months of age. Consistent with the canalization of the behavioral development principle, children who exhibited DBs on a frequent basis at 29 months of age are less likely to stop doing so in the following year if they had exhibited the same behaviors at 17 months of age. PMID:28079905

  19. Language ability of children with and without a history of stuttering: a longitudinal cohort study.

    PubMed

    Watts, Amy; Eadie, Patricia; Block, Susan; Mensah, Fiona; Reilly, Sheena

    2015-02-01

    This study aims to determine whether the communication and language skills of children who have a history of stuttering are different from children who do not have a history of stuttering at ages 2-5 years. This study utilizes data from the Early Language in Victoria Study (ELVS), a longitudinal study with a community sample of 1910 children recruited in Melbourne, Australia, as well as a concurrent study examining the onset and progression of stuttering. Participants with a history of stuttering (n = 181) and a control group without a history of stuttering (n = 1438) were identified according to the established protocol of these two existing studies. The stuttering group scored higher than the non-stuttering group on all of the communication and language outcomes measured. The group differences were statistically significant on four of the seven measures and these findings were maintained when potentially confounding factors were controlled for. Importantly, the children with a history of stuttering, as a group, and the control group without a history of stuttering demonstrated developmentally-appropriate early communication and language skills.

  20. Child- and parent-reported quality of life trajectories in children with epilepsy: A prospective cohort study.

    PubMed

    Ferro, Mark A; Avery, Lisa; Fayed, Nora; Streiner, David L; Cunningham, Charles E; Boyle, Michael H; Lach, Lucyna; Glidden, Gina; Rosenbaum, Peter L; Ronen, Gabriel M

    2017-07-01

    To describe the developmental trajectories of quality of life (QoL) in a large cohort of children with epilepsy, and to assess the relative contribution of clinical, psychosocial, and sociodemographic variables on QoL trajectories. Five assessments during a 28-month prospective cohort study were used to model trajectories of QoL. Participants were recruited with their parents from six Canadian tertiary centers. A convenience sample of 506 children aged 8-14 years with epilepsy and without intellectual disability or autism spectrum disorder were enrolled. A total of 894 children were eligible and 330 refused participation. Participating children were, on average, 11.4 years of age, and 49% were female. Nearly one third (32%) had partial seizures. At baseline, 479 and 503 child- and parent-reported questionnaires were completed. In total, 354 children (74%) and 366 parents (73%) completed the 28-month follow-up. QoL was measured using the child- and parent-reported version of the Childhood Epilepsy QoL scale (CHEQOL-25). Child-reported QoL was fitted best by a six-class model and parent-reported QoL by a five-class model. In both models, trajectories remained either stable or improved over 28 months. Of these children, 62% rated their QoL as high or moderately high, defined as at least one standard deviation above the average CHEQOL-25 score. Greater family, classmate, and peer social support, fewer symptoms of child and parent depression, and higher receptive vocabulary were identified as the most robust predictors of better QoL (all p < 0.001). Most children with epilepsy and their parents reported relatively good QoL in this first joint self- and proxy-reported trajectory study. Findings confirm the heterogeneous QoL outcomes for children with epilepsy and the primary importance of psychosocial factors rather than seizure and AED-specific factors in influencing QoL. These predictors that are potentially amenable to change should now be the focus of specific

  1. Is childhood cruelty to animals a marker for physical maltreatment in a prospective cohort study of children?☆

    PubMed Central

    McEwen, Fiona S.; Moffitt, Terrie E.; Arseneault, Louise

    2014-01-01

    Childhood cruelty to animals is thought to indicate that a child may have been maltreated. This study examined: (a) prevalence of cruelty to animals among 5- to 12-year-old children; (b) the association between cruelty to animals, child physical maltreatment, and adult domestic violence; and (c) whether cruelty to animals is a marker of maltreatment taking into account age, persistence of cruelty, and socioeconomic disadvantage. Data were from the Environmental Risk (E-Risk) Longitudinal Twin Study, an epidemiological representative cohort of 2,232 children living in the United Kingdom. Mothers reported on cruelty to animals when children were 5, 7, 10, and 12 years, on child maltreatment up to age 12, and adult domestic violence. Nine percent of children were cruel to animals during the study and 2.6% persistently (≥2 time-points). Children cruel to animals were more likely to have been maltreated than other children (OR = 3.32) although the majority (56.4%) had not been maltreated. Animal cruelty was not associated with domestic violence when maltreatment was controlled for. In disadvantaged families, 6 in 10 children cruel to animals had been maltreated. In other families, the likelihood of maltreatment increased with age (from 3 in 10 5-year-olds to 4.5 in 10 12-year-olds) and persistence (4.5 in 10 of those persistently cruel). Although childhood cruelty to animals is associated with maltreatment, not every child showing cruelty had been maltreated. The usefulness of cruelty to animals as a marker for maltreatment increases with the child's age, persistence of behavior, and poorer social background. PMID:24268376

  2. Port Pirie Cohort Study: environmental exposure to lead and children's abilities at the age of four years

    SciTech Connect

    McMichael, A.J.; Baghurst, P.A.; Wigg, N.R.; Vimpani, G.V.; Robertson, E.F.; Roberts, R.J.

    1988-08-25

    We studied the effect of environmental exposure to lead on children's abilities at the age of four years in a cohort of 537 children born during 1979 to 1982 to women living in a community situated near a lead smelter. Samples for measuring blood lead levels were obtained from the mothers antenatally, at delivery from the mothers and umbilical cords, and at the ages of 6, 15, and 24 months and then annually from the children. Concurrently, the mothers were interviewed about personal, family, medical, and environmental factors. Maternal intelligence, the home environment, and the children's mental development (as evaluated with use of the McCarthy Scales of Children's Abilities) were formally assessed. The mean blood lead concentration varied from 0.44 mumol per liter in midpregnancy to a peak of 1.03 mumol per liter at the age of two years. The blood lead concentration at each age, particularly at two and three years, and the integrated postnatal average concentration were inversely related to development at the age of four. Multivariate analysis incorporating many factors in the children's lives indicated that the subjects with an average postnatal blood lead concentration of 1.50 mumol per liter had a general cognitive score 7.2 points lower (95 percent confidence interval, 0.3 to 13.2; mean score, 107.1) than those with an average concentration of 0.50 mumol per liter. Similar deficits occurred in the perceptual-performance and memory scores. Within the range of exposure studied, no threshold dose for an effect of lead was evident. We conclude that postnatal blood lead concentration is inversely related to cognitive development in children, although one must be circumspect in making causal inferences from studies of this relation, because of the difficulties in defining and controlling confounding effects.

  3. Is childhood cruelty to animals a marker for physical maltreatment in a prospective cohort study of children?

    PubMed

    McEwen, Fiona S; Moffitt, Terrie E; Arseneault, Louise

    2014-03-01

    Childhood cruelty to animals is thought to indicate that a child may have been maltreated. This study examined: (a) prevalence of cruelty to animals among 5- to 12-year-old children; (b) the association between cruelty to animals, child physical maltreatment, and adult domestic violence; and (c) whether cruelty to animals is a marker of maltreatment taking into account age, persistence of cruelty, and socioeconomic disadvantage. Data were from the Environmental Risk (E-Risk) Longitudinal Twin Study, an epidemiological representative cohort of 2,232 children living in the United Kingdom. Mothers reported on cruelty to animals when children were 5, 7, 10, and 12 years, on child maltreatment up to age 12, and adult domestic violence. Nine percent of children were cruel to animals during the study and 2.6% persistently (≥2 time-points). Children cruel to animals were more likely to have been maltreated than other children (OR=3.32) although the majority (56.4%) had not been maltreated. Animal cruelty was not associated with domestic violence when maltreatment was controlled for. In disadvantaged families, 6 in 10 children cruel to animals had been maltreated. In other families, the likelihood of maltreatment increased with age (from 3 in 10 5-year-olds to 4.5 in 10 12-year-olds) and persistence (4.5 in 10 of those persistently cruel). Although childhood cruelty to animals is associated with maltreatment, not every child showing cruelty had been maltreated. The usefulness of cruelty to animals as a marker for maltreatment increases with the child's age, persistence of behavior, and poorer social background. Copyright © 2013 Elsevier Ltd. All rights reserved.

  4. The acceleration of spoken-word processing in children's native-language acquisition: an ERP cohort study.

    PubMed

    Ojima, Shiro; Matsuba-Kurita, Hiroko; Nakamura, Naoko; Hagiwara, Hiroko

    2011-04-01

    Healthy adults can identify spoken words at a remarkable speed, by incrementally analyzing word-onset information. It is currently unknown how this adult-level speed of spoken-word processing emerges during children's native-language acquisition. In a picture-word mismatch paradigm, we manipulated the semantic congruency between picture contexts and spoken words, and recorded event-related potential (ERP) responses to the words. Previous similar studies focused on the N400 response, but we focused instead on the onsets of semantic congruency effects (N200 or Phonological Mismatch Negativity), which contain critical information for incremental spoken-word processing. We analyzed ERPs obtained longitudinally from two age cohorts of 40 primary-school children (total n=80) in a 3-year period. Children first tested at 7 years of age showed earlier onsets of congruency effects (by approximately 70ms) when tested 2 years later (i.e., at age 9). Children first tested at 9 years of age did not show such shortening of onset latencies 2 years later (i.e., at age 11). Overall, children's onset latencies at age 9 appeared similar to those of adults. These data challenge the previous hypothesis that word processing is well established at age 7. Instead they support the view that the acceleration of spoken-word processing continues beyond age 7. Copyright © 2011 Elsevier Ltd. All rights reserved.

  5. Which children and young people are excluded from school? Findings from a large British birth cohort study, the Avon Longitudinal Study of Parents and Children (ALSPAC).

    PubMed

    Paget, A; Parker, C; Heron, J; Logan, S; Henley, W; Emond, A; Ford, T

    2017-09-14

    Exclusion from school is increasingly recognized as pertinent to child health. National educational data reveal that boys, children who are looked-after, living in poverty, have special educational needs, or from certain ethnic minorities, are disproportionately excluded from school. As population-based data on the wider characteristics of excluded children are scarce, we aimed to describe predictors of school exclusion in the Avon Longitudinal Study of Parents and Children. Avon Longitudinal Study of Parents and Children, a prospective U.K. population-based birth cohort study, collected parent reports of permanent school exclusions by 8 years and parent and self-reports of permanent and fixed-term exclusions in the preceding 12 months at 16 years. Potential risk factors were examined for associations with exclusion using logistic regression, with a focus on child mental health and neurodevelopment. Analyses were based on all available data on 53/8,245 (0.6%) pupils excluded from school by 8 years and 390/4,482 (8.7%) at 16 years. Key factors associated with exclusion at both time points included male gender, lower socio-economic status, maternal psychopathology, mental health and behavioural difficulties, psychiatric disorder, social communication difficulties, language difficulties, antisocial activities, bullying/being bulled, lower parental engagement with education, low school engagement, poor relationship with teacher, low educational attainment, and special educational needs (all p < .05). Exclusion from school was associated with child, family and school-related factors identifiable at, or prior to, primary school age. Child health professionals have an important role in the holistic, multidisciplinary assessment of children who are at risk of exclusion from school. Mental health and neurodevelopmental difficulties should be recognized and supported, to improve the health and educational outcomes among this vulnerable group. © 2017 John Wiley & Sons

  6. Ozone exposure, vitamin C intake, and genetic susceptibility of asthmatic children in Mexico City: a cohort study

    PubMed Central

    2013-01-01

    Background We previously reported that asthmatic children with GSTM1 null genotype may be more susceptible to the acute effect of ozone on the small airways and might benefit from antioxidant supplementation. This study aims to assess the acute effect of ozone on lung function (FEF25-75) in asthmatic children according to dietary intake of vitamin C and the number of putative risk alleles in three antioxidant genes: GSTM1, GSTP1 (rs1695), and NQO1 (rs1800566). Methods 257 asthmatic children from two cohort studies conducted in Mexico City were included. Stratified linear mixed models with random intercepts and random slopes on ozone were used. Potential confounding by ethnicity was assessed. Analyses were conducted under single gene and genotype score approaches. Results The change in FEF25-75 per interquartile range (60 ppb) of ozone in persistent asthmatic children with low vitamin C intake and GSTM1 null was −91.2 ml/s (p = 0.06). Persistent asthmatic children with 4 to 6 risk alleles and low vitamin C intake showed an average decrement in FEF25-75 of 97.2 ml/s per 60 ppb of ozone (p = 0.03). In contrast in children with 1 to 3 risk alleles, acute effects of ozone on FEF25-75 did not differ by vitamin C intake. Conclusions Our results provide further evidence that asthmatic children predicted to have compromised antioxidant defense by virtue of genetic susceptibility combined with deficient antioxidant intake may be at increased risk of adverse effects of ozone on pulmonary function. PMID:23379631

  7. Understanding burn injuries in Aboriginal and Torres Strait Islander children: protocol for a prospective cohort study

    PubMed Central

    Ivers, Rebecca Q; Hunter, Kate; Clapham, Kathleen; Coombes, Julieann; Fraser, Sarah; Lo, Serigne; Gabbe, Belinda; Hendrie, Delia; Read, David; Kimble, Roy; Sparnon, Anthony; Stockton, Kellie; Simpson, Renee; Quinn, Linda; Towers, Kurt; Potokar, Tom; Mackean, Tamara; Grant, Julian; Lyons, Ronan A; Jones, Lindsey; Eades, Sandra; Daniels, John; Holland, Andrew J A

    2015-01-01

    Introduction Although Aboriginal and Torres Strait Islander children in Australia have higher risk of burns compared with non-Aboriginal children, their access to burn care, particularly postdischarge care, is poorly understood, including the impact of care on functional outcomes. The objective of this study is to describe the burden of burns, access to care and functional outcomes in Aboriginal and Torres Strait Islander children in Australia, and develop appropriate models of care. Methods and analysis All Aboriginal and Torres Strait Islander children aged under 16 years of age (and their families) presenting with a burn to a tertiary paediatric burn unit in 4 Australian States (New South Wales (NSW), Queensland, Northern Territory (NT), South Australia (SA)) will be invited to participate. Participants and carers will complete a baseline questionnaire; follow-ups will be completed at 3, 6, 12 and 24 months. Data collected will include sociodemographic information; out of pocket costs; functional outcome; and measures of pain, itch and scarring. Health-related quality of life will be measured using the PedsQL, and impact of injury using the family impact scale. Clinical data and treatment will also be recorded. Around 225 participants will be recruited allowing complete data on around 130 children. Qualitative data collected by in-depth interviews with families, healthcare providers and policymakers will explore the impact of burn injury and outcomes on family life, needs of patients and barriers to healthcare; interviews with families will be conducted by experienced Aboriginal research staff using Indigenous methodologies. Health systems mapping will describe the provision of care. Ethics and dissemination The study has been approved by ethics committees in NSW, SA, NT and Queensland. Study results will be distributed to community members by study newsletters, meetings and via the website; to policymakers and clinicians via policy fora, presentations and

  8. Risk of triple-class virological failure in children with HIV: a retrospective cohort study.

    PubMed

    Castro, Hannah; Judd, Ali; Gibb, Diana M; Butler, Karina; Lodwick, Rebecca K; van Sighem, Ard; Ramos, Jose T; Warsawski, Josiane; Thorne, Claire; Noguera-Julian, Antoni; Obel, Niels; Costagliola, Dominique; Tookey, Pat A; Colin, Céline; Kjaer, Jesper; Grarup, Jesper; Chene, Genevieve; Phillips, Andrew

    2011-05-07

    In adults with HIV treated with antiretroviral drug regimens from within the three original drug classes (nucleoside or nucleotide reverse transcriptase inhibitors [NRTIs], non-NRTIs [NNRTIs], and protease inhibitors), virological failure occurs slowly, suggesting that long-term virological suppression can be achieved in most people, even in areas where access is restricted to drugs from these classes. It is unclear whether this is the case for children, the group who will need to maintain viral suppression for longest. We aimed to determine the rate and predictors of triple-class virological failure to the three original drugs classes in children. In the Collaboration of Observational HIV Epidemiological Research Europe, the rate of triple-class virological failure was studied in children infected perinatally with HIV who were aged less than 16 years, starting antiretroviral therapy (ART) with three or more drugs, between 1998 and 2008. We used Kaplan-Meier and Cox regression methods to investigate the risk and predictors of triple-class virological failure after ART initiation. Of 1007 children followed up for a median of 4·2 (IQR 2·4-6·5) years, 237 (24%) were triple-class exposed and 105 (10%) had triple-class virological failure, of whom 29 never had a viral-load measurement less than 500 copies per mL. Incidence of triple-class virological failure after ART initiation increased with time, and risk by 5 years after ART initiation was 12·0% (95% CI 9·4-14·6). In multivariate analysis, older age at ART initiation was associated with increased risk of failure (p=0·02). Of 686 children starting ART with NRTIs and either a NNRTI or ritonavir-boosted protease inhibitor, the rate of failure was higher than in adults with heterosexually transmitted HIV (hazard ratio 2·2 [95% CI 1·6-3·0, p<0·0001]). Findings highlight the challenges of attaining long-term viral suppression in children who will be taking life-long ART. Early identification of children not

  9. Anemia, diet and therapeutic iron among children living with HIV: a prospective cohort study.

    PubMed

    Shet, Anita; Bhavani, P K; Kumarasamy, N; Arumugam, Karthika; Poongulali, S; Elumalai, Suresh; Swaminathan, Soumya

    2015-10-19

    Children living with HIV have higher-than-normal prevalence of anemia. The beneficial effect of therapeutic iron has been questioned in the setting of high prevalence of infections. This study examines anemia prevalence and effect of standard therapeutic iron on HIV disease progression among children. Perinatally-infected children aged 2-12 years were enrolled at three sites in southern India, and were followed for 1 year with clinical assessments, dietary recall and anthropometry. Laboratory parameters included iron markers (ferritin, soluble transferrin receptor) and other micronutrient levels (vitamin A, B12, folate). Iron was given to anemic children based on WHO guidelines. Statistical analyses including frequency distributions, chi square tests and multivariate logistic regression were performed using Stata v13.0. Among 240 children enrolled (mean age 7.7 years, 54.6% males), median CD4 was 25%, 19.2% had advanced disease, 45.5% had malnutrition, and 43.3% were on antiretroviral treatment (ART) at baseline. Anemia was prevalent in 47.1% (113/240) children. Iron deficiency was present in 65.5%; vitamin A and vitamin B12 deficiency in 26.6% and 8.0% respectively; and anemia of inflammation in 58.4%. Independent risk factors for anemia were stunting, CD4 < 25%, detectable viral load ≥ 400 copies/ml and vitamin A deficiency. Inadequate dietary iron was prominent; 77.9% obtained less than two-thirds of recommended daily iron. Among clinically anemic children who took iron, overall adherence to iron therapy was good, and only minor self-limiting adverse events were reported. Median hemoglobin rose from 10.4 g/dl to 10.9 mg/dl among those who took iron for 3 months, and peaked at 11.3 mg/dl with iron taken for up to 6 months. Iron was also associated with a greater fall in clinical severity of HIV stage; however when adjusted for use of ART, was not associated with improvement in growth, inflammatory and CD4 parameters. Children living with HIV in India have a

  10. Resective Epilepsy Surgery for Tuberous Sclerosis in Children: Determining Predictors of Seizure Outcomes in a Multicenter Retrospective Cohort Study.

    PubMed

    Fallah, Aria; Rodgers, Shaun D; Weil, Alexander G; Vadera, Sumeet; Mansouri, Alireza; Connolly, Mary B; Major, Philippe; Ma, Tracy; Devinsky, Orrin; Weiner, Howard L; Gonzalez-Martinez, Jorge A; Bingaman, William E; Najm, Imad; Gupta, Ajay; Ragheb, John; Bhatia, Sanjiv; Steinbok, Paul; Witiw, Christopher D; Widjaja, Elysa; Snead, O Carter; Rutka, James T

    2015-10-01

    There are no established variables that predict the success of curative resective epilepsy surgery in children with tuberous sclerosis complex (TSC). We performed a multicenter observational study to identify preoperative factors associated with seizure outcome in children with TSC undergoing resective epilepsy surgery. A retrospective chart review was performed in eligible children at New York Medical Center, Miami Children's Hospital, Cleveland Clinic Foundation, BC Children's Hospital, Hospital for Sick Children, and Sainte-Justine Hospital between January 2005 and December 2013. A time-to-event analysis was performed. The "event" was defined as seizures after resective epilepsy surgery. Seventy-four patients (41 male) were included. The median age of the patients at the time of surgery was 120 months (range, 3-216 months). The median time to seizure recurrence was 24.0 ± 12.7 months. Engel Class I outcome was achieved in 48 (65%) and 37 (50%) patients at 1- and 2-year follow-up, respectively. On univariate analyses, younger age at seizure onset (hazard ratio [HR]: 2.03, 95% confidence interval [CI]: 1.03-4.00, P = .04), larger size of predominant tuber (HR: 1.03, 95% CI: 0.99-1.06, P = .12), and resection larger than a tuberectomy (HR: 1.86, 95% CI: 0.92-3.74, P = .084) were associated with a longer duration of seizure freedom. In multivariate analyses, resection larger than a tuberectomy (HR: 2.90, 95% CI: 1.17-7.18, P = .022) was independently associated with a longer duration of seizure freedom. In this large consecutive cohort of children with TSC and medically intractable epilepsy, a greater extent of resection (more than just the tuber) is associated with a greater probability of seizure freedom. This suggests that the epileptogenic zone may include the cortex surrounding the presumed offending tuber.

  11. Prescription rates of adrenaline auto-injectors for children in UK general practice: a retrospective cohort study.

    PubMed

    Diwakar, Lavanya; Cummins, Carole; Ryan, Ronan; Marshall, Tom; Roberts, Tracy

    2017-04-01

    Adrenaline auto-injectors (AAI) should be provided to individuals considered to be at high risk of anaphylaxis. There is some evidence that the rate of AAI prescription is increasing, but the true extent has not been previously quantified. To estimate the trends in annual GP-issued prescriptions for AAI among UK children between 2000 and 2012. Retrospective cohort study using data from primary care practices that contributed to The Health Improvement Network (THIN) database. Children and young people aged between 0-17 years of age with a prescription for AAIs were identified, and annual AAI device prescription rates were estimated using Stata (version 12). A total of 1.06 million UK children were identified, providing 5.1 million person years of follow-up data. Overall, 23 837 children were deemed high risk by their GPs, and were prescribed 98 737 AAI devices. This equates to 4.67 children (95% confidence interval [CI] = 4.66 to 4.69), and 19.4 (95% CI = 19.2 to 19.5) devices per 1000 person years. Between 2000 and 2012, there has been a 355% increase in the number of children prescribed devices, and a 506% increase in the total number of AAI devices prescribed per 1000 person years in the UK. The number of devices issued per high-risk child during this period has also increased by 33%. The number of children being prescribed AAI devices and the number of devices being prescribed in UK primary care between 2000 and 2012 has significantly increased. A discussion to promote rational prescribing of AAIs in the NHS is needed. © British Journal of General Practice 2017.

  12. Digit ratio and autism spectrum disorders in the Avon Longitudinal Study of Parents and Children: a birth cohort study.

    PubMed

    Guyatt, Anna Louise; Heron, Jon; Knight, Bernice Le Cornu; Golding, Jean; Rai, Dheeraj

    2015-08-25

    To investigate whether second-to-fourth digit ratio (2D:4D), a measure commonly used as a proxy for fetal testosterone exposure, is associated with autism spectrum disorders (ASDs), as predicted by the extreme male brain theory of autism. A birth cohort study. The Avon Longitudinal Study of Parents and Children (ALSPAC). 6015 ALSPAC children with data on digit ratio, at least 1 outcome measure and information on potential confounding variables (parental occupational class, maternal education and age at digit ratio measurement). Digit ratio was measured by the photocopy and calliper method. ASD diagnosis (cases were identified previously by record linkage or maternal report) and 4 measures that combine optimally within ALSPAC to predict ASD: the Children's Communication Checklist (coherence subscale), the Social and Communication Disorders Checklist, a repetitive behaviour measure, and the Emotionality, Activity and Sociability scale (sociability subscale). These measures were dichotomised, with approximately 10% defined as the 'risk' group. Using logistic regression, we examined the association of 2D:4D with ASDs and 4 dichotomised ASD traits. Covariates were occupational class, maternal education and age at 2D:4D measurement. 2D:4D was not associated with ASDs in males (adjusted OR per 1 SD increase in mean 2D:4D, 0.88 (95% CI 0.65 to 1.21), p=0.435) or females (adjusted OR=1.36 (95% CI 0.81 to 2.28), p=0.245). Similar results were observed after adjustment for IQ. There was 1 weak association between reduced coherence and increased left 2D:4D in males, in the opposite direction to that predicted by the extreme male brain theory (adjusted OR=1.15 (95% CI 1.02 to 1.29), p=0.023). Given multiple comparisons, this is consistent with chance. In this population-based study, there was no strong evidence of an association between 2D:4D and ASD diagnosis or traits, although the CIs were wide. These results are not consistent with the extreme male brain theory. Published

  13. Digit ratio and autism spectrum disorders in the Avon Longitudinal Study of Parents and Children: a birth cohort study

    PubMed Central

    Guyatt, Anna Louise; Heron, Jon; Knight, Bernice Le Cornu; Golding, Jean; Rai, Dheeraj

    2015-01-01

    Objectives To investigate whether second-to-fourth digit ratio (2D:4D), a measure commonly used as a proxy for fetal testosterone exposure, is associated with autism spectrum disorders (ASDs), as predicted by the extreme male brain theory of autism. Design A birth cohort study. Setting The Avon Longitudinal Study of Parents and Children (ALSPAC). Participants 6015 ALSPAC children with data on digit ratio, at least 1 outcome measure and information on potential confounding variables (parental occupational class, maternal education and age at digit ratio measurement). Digit ratio was measured by the photocopy and calliper method. Outcomes ASD diagnosis (cases were identified previously by record linkage or maternal report) and 4 measures that combine optimally within ALSPAC to predict ASD: the Children's Communication Checklist (coherence subscale), the Social and Communication Disorders Checklist, a repetitive behaviour measure, and the Emotionality, Activity and Sociability scale (sociability subscale). These measures were dichotomised, with approximately 10% defined as the ‘risk’ group. Results Using logistic regression, we examined the association of 2D:4D with ASDs and 4 dichotomised ASD traits. Covariates were occupational class, maternal education and age at 2D:4D measurement. 2D:4D was not associated with ASDs in males (adjusted OR per 1 SD increase in mean 2D:4D, 0.88 (95% CI 0.65 to 1.21), p=0.435) or females (adjusted OR=1.36 (95% CI 0.81 to 2.28), p=0.245). Similar results were observed after adjustment for IQ. There was 1 weak association between reduced coherence and increased left 2D:4D in males, in the opposite direction to that predicted by the extreme male brain theory (adjusted OR=1.15 (95% CI 1.02 to 1.29), p=0.023). Given multiple comparisons, this is consistent with chance. Conclusions In this population-based study, there was no strong evidence of an association between 2D:4D and ASD diagnosis or traits, although the CIs were wide. These

  14. Prenatal Exposure to Glycol Ethers and Neurocognitive Abilities in 6-Year-Old Children: The PELAGIE Cohort Study

    PubMed Central

    Béranger, Rémi; Garlantézec, Ronan; Le Maner-Idrissi, Gaïd; Lacroix, Agnès; Rouget, Florence; Trowbridge, Jessica; Warembourg, Charline; Monfort, Christine; Le Gléau, Florent; Jourdin, Marylène; Multigner, Luc; Cordier, Sylvaine; Chevrier, Cécile

    2016-01-01

    Background: Glycol ethers (GE) are widely used organic solvents. Despite the potential neurotoxicity of several families of organic solvents, little is known about the impact of GE on the neurodevelopment of infants and children. Objectives: We investigated the relation between urinary concentrations of GE metabolites in pregnant women and neurocognitive abilities in their 6-year-old children in the PELAGIE mother–child cohort. Methods: Five GE metabolites were measured in first morning void urine samples of 204 French pregnant women in early pregnancy (< 19 weeks of gestation). Psychologists assessed the neurocognitive abilities of their 6-year-old children with the Wechsler Intelligence Scale for Children IV (WISC) and the Developmental Neuropsychological Assessment (NEPSY). We analyzed the results with linear (WISC) and Poisson regression models (NEPSY), adjusted for potential confounders, including child’s stimulation at home. Results: GE metabolites were detected in 90–100% of maternal urine samples. The WISC Verbal Comprehension score was significantly lower for children with the highest tertile of urinary phenoxyacetic acid (PhAA) [β (third vs. first tertile) = –6.53; 95% CI: –11.44, –1.62]. Similarly, the NEPSY Design Copying subtest score was lower in those with the highest tertile of urinary ethoxyacetic acid (EAA) [β (third vs. first tertile) = –0.11; 95% CI: –0.21, 0.00]. The other GE metabolites we studied were not significantly associated with WISC or NEPSY scores. Conclusions: Prenatal urine concentrations of two GE metabolites were associated with lower WISC Verbal Comprehension Index scores and NEPSY Design Copying subscale scores, respectively, at age 6 years. PhAA is the primary metabolite of 2-phenoxyethanol (EGPhE), which is commonly found in cosmetics, and precursors of EAA are frequently used in cleaning agents. Additional research is needed to confirm our findings and further explore potential effects of prenatal GE

  15. Lactase genetic polymorphisms and coeliac disease in children: a cohort study.

    PubMed

    Kuchay, Raja A H; Thapa, Babu R; Mahmood, Akhtar; Anwar, Mumtaz; Mahmood, Safrun

    2015-01-01

    Lactase activity declines during childhood in the majority of human populations leading to adult-type hypolactasia (AtH). C/T-13910 and G/A-22018 single nucleotide polymorphisms (SNPs) have been suggested to be associated with AtH in different human populations. Coeliac disease (CD) is an autoimmune condition characterized by damage to intestinal cells leading to ultimate deterioration. This study investigated the association between coeliac disease (CD) and SNPs leading to AtH in children from North India. Intestinal biopsies and saliva samples were obtained from 52 children with CD diagnosis and 102 control subjects. Biopsies were assayed for disaccharidase activities and samples were genotyped for given SNPs. Prevalence of C/C and G/G genotypes of AtH was almost equal in the CD and control group. The CD group had low lactase activity compared to the control group, irrespective of genotype at C/T -13910 and G/A -22018 SNPs (p < 0.05). For the control group, lactase activity was high in children with C/T + G/A genotypes compared to C/C + G/G (p < 0.05). There appears to be no significant correlation between C/T -13910 or G/A -22018 SNPs of AtH and CD. Children with C/C or G/G genotype of AtH may not be at greater risk of CD.

  16. Parental smoking and post-infancy wheezing in children: a prospective cohort study.

    PubMed Central

    Neuspiel, D R; Rush, D; Butler, N R; Golding, J; Bijur, P E; Kurzon, M

    1989-01-01

    The contribution of parental smoking to wheezing in children was studied in a subset of all British births between April 5 and 11, 1970 (N = 9,670). Children of smoking mothers had an 18.0 per cent cumulative incidence of post-infancy wheezing through 10 years of age, compared with 16.2 per cent among children of nonsmoking mothers (risk ratio 1.11, 95% CI: 1.02, 1.21). This difference was confined to wheezing attributed to wheezy bronchitis, of which children of smokers had 7.4 per cent, and those of nonsmokers had 5.2 per cent (risk ratio 1.44, 95% CI: 1.24, 1.68). The incidence of wheezy bronchitis increased as mothers smoked more cigarettes. After multiple logistic regression analysis was used to control for paternal smoking, social status, sex, family allergy, crowding, breast-feeding, gas cooking and heating, and bedroom dampness, the association of maternal smoking with childhood wheezy bronchitis persisted. Some of this effect was explained by maternal respiratory symptoms and maternal depression, but not by neonatal problems, the child's allergic symptoms, or paternal respiratory symptoms. There was a 14 per cent increase in childhood wheezy bronchitis when mothers smoked over four cigarettes per day, and a 49 per cent increase when mothers smoked over 14 cigarettes daily. PMID:2783639

  17. Iron intakes and status of 2-year-old children in the Cork BASELINE Birth Cohort Study.

    PubMed

    McCarthy, Elaine K; Ní Chaoimh, Carol; O'B Hourihane, Jonathan; Kenny, Louise C; Irvine, Alan D; Murray, Deirdre M; Kiely, Mairead

    2016-08-09

    Young children are at risk of iron deficiency and subsequent anaemia, resulting in long-term consequences for cognitive, motor and behavioural development. This study aimed to describe the iron intakes, status and determinants of status in 2-year-old children. Data were collected prospectively in the mother-child Cork BASELINE Birth Cohort Study from 15 weeks' gestation throughout early childhood. At the 24-month assessment, serum ferritin, haemoglobin and mean corpuscular volume were measured, and food/nutrient intake data were collected using a 2-day weighed food diary. Iron status was assessed in 729 children (median [IQR] age: 2.1 [2.1, 2.2] years) and 468 completed a food diary. From the food diary, mean (SD) iron intakes were 6.8 (2.6) mg/day and 30% had intakes < UK Estimated Average Requirement (5.3 mg/day). Using WHO definitions, iron deficiency was observed in 4.6% (n = 31) and iron deficiency anaemia in five children (1.0%). Following an iron series workup, five more children were diagnosed with iron deficiency anaemia. Twenty-one per cent had ferritin concentrations <15 µg/L. Inadequate iron intakes (OR [95% CI]: 1.94 [1.09, 3.48]) and unmodified cows' milk intakes ≥ 400 mL/day (1.95 [1.07, 3.56]) increased the risk of low iron status. Iron-fortified formula consumption was associated with decreased risk (0.21 [0.11, 0.41] P < 0.05). In this, the largest study in toddlers in Europe, a lower prevalence of low iron status was observed than in previous reports. Compliance with dietary recommendations to limit cows' milk intakes in young children and consumption of iron-fortified products appears to have contributed to improved iron status at two years.

  18. Duration of breast feeding and risk of developmental delay in Taiwanese children: a nationwide birth cohort study.

    PubMed

    Chiu, Wan-Chun; Liao, Hua-Fang; Chang, Pei-Jen; Chen, Pau-Chung; Chen, Yi Chun

    2011-11-01

    The purpose of this study was to examine the relationship between duration of breast feeding and four developmental domains: gross motor, fine motor, language, and personal/social skills. This study included 14,621 infants from birth to 18 months of age. In the Taiwan Birth Cohort Study, four developmental screening items adapted from the Denver Development Screening Test were most appropriate for children aged 15 to 18 months. The proportion of young children who had mastered specific milestones increased consistently with longer duration of breast feeding. The adjusted odds ratios of the risk of developmental delay for the longest duration of breast feeding vs. never breast-fed were 0.69 [95% confidence interval (CI) 0.57, 0.83] for gross motor, 0.64 [95% CI 0.53, 0.77] for fine motor, 0.74 [95% CI 0.60, 0.91] for language, and 0.76 [95% CI 0.64, 0.90] for personal/social skills. Regardless of when the mothers returned to work, duration of breast feeding was found to have an inverse association with developmental delay in young children. The protection against developmental delays remained significant for those children who were breast-fed for more than 6 months. Children who were breast-fed for longer than 6 months had a lower risk of developmental delay than those who were never breast-fed. These data support the hypothesis that duration of breast feeding is positively related to young children's neurodevelopment. © 2011 Blackwell Publishing Ltd.

  19. Growth Patterns of HIV Infected Indian Children in Response to ART: A Clinic Based Cohort Study.

    PubMed

    Parchure, Ritu S; Kulkarni, Vinay V; Darak, Trupti S; Mhaskar, Rahul; Miladinovic, Branko; Emmanuel, Patricia J

    2015-06-01

    To describe catch-up growth after antiretroviral therapy (ART) initiation among children living with human immunodeficiency virus (CLHIV), attending a private clinic in India. This is a retrospective analysis of data of CLHIV attending Prayas clinic, Pune, India. Height and weight z scores (HAZ, WAZ) were calculated using WHO growth charts. Catch-up growth post-ART was assessed using a mixed method model in cases where baseline and at least one subsequent follow-up HAZ/WAZ were available. STATA 12 was used for statistical analysis. During 1998 to 2011, 466 children were enrolled (201 girls and 265 boys; median age = 7 y). A total of 302 children were ever started on ART; of which 73 and 76 children were included for analysis for catch up growth in WAZ and HAZ respectively. Median WAZ and HAZ increased from -2.14 to -1.34 (p = 0.007) and -2.42 to -1.94 (p = 0.34), respectively, 3 y post ART. Multivariable analysis using mixed model (adjusted for gender, guardianship, baseline age, baseline WAZ/HAZ, baseline and time varying WHO clinical stage) showed gains in WAZ (coef = 0.2, 95 % CI: -0.06 to 0.46) and HAZ (coef = 0.49, 95 % CI: 0.21 to 0.77) with time on ART. Lower baseline WAZ/HAZ and older age were associated with impaired catch-up growth. Children staying in institutions and with baseline advanced clinical stage showed higher gain in WAZ. The prevalence of stunting and underweight was high at ART initiation. Sustained catch-up growth was seen with ART. The study highlights the benefit of early ART in achieving normal growth in CLHIV.

  20. Does parental drinking influence children's drinking? A systematic review of prospective cohort studies.

    PubMed

    Rossow, Ingeborg; Keating, Patrick; Felix, Lambert; McCambridge, Jim

    2016-02-01

    To evaluate evidence of the capacity for causal inference in studies of associations between parental and offspring alcohol consumption in the general population. A systematic search for, and narrative analysis of, prospective cohort studies of the consequences of drinking, except where assessed prenatally only, or with clinically derived instruments. Primary outcome measures were alcohol use or related problems in offspring, which were collected at least 3 years after exposure measures of parental drinking. The systematic review included 21 studies comprising 26,354 families or parent-child dyads with quantitative effect measures available for each study. Criteria for capacity of causal inference included (1) theory-driven approach and analysis; (2) analytical rigour; and (3) minimization of sources of bias. Four of the 21 included studies filled several, but not all, criteria and were assessed to have some capacity for causal inference. These four studies found some evidence that parental drinking predicted drinking behaviour in adolescent offspring. The remaining 17 studies had little or no such capacity. There is a fairly large and consistent literature demonstrating that more parental drinking is associated with more drinking in offspring. Despite this, existing evidence is insufficient to warrant causal inferences at this stage. © 2015 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.

  1. Why Are Children in Urban Neighborhoods at Increased Risk for Psychotic Symptoms? Findings From a UK Longitudinal Cohort Study.

    PubMed

    Newbury, Joanne; Arseneault, Louise; Caspi, Avshalom; Moffitt, Terrie E; Odgers, Candice L; Fisher, Helen L

    2016-11-01

    Urban upbringing is associated with a 2-fold adulthood psychosis risk, and this association replicates for childhood psychotic symptoms. No study has investigated whether specific features of urban neighborhoods increase children's risk for psychotic symptoms, despite these early psychotic phenomena elevating risk for schizophrenia and other psychiatric disorders in adulthood. Analyses were conducted on over 2000 children from the Environmental Risk (E-Risk) Longitudinal Twin Study, a nationally-representative cohort of UK-born twins. Neighborhood-level characteristics were assessed for each family via: a geodemographic discriminator indexing neighborhood-level deprivation, postal surveys of over 5000 residents living alongside the children, and in-home interviews with the children's mothers. Children were interviewed about psychotic symptoms at age 12. Analyses were adjusted for important family-level confounders including socioeconomic status (SES), psychiatric history, and maternal psychosis. Urban residency at age-5 (OR = 1.80, 95% CI = 1.16-2.77) and age-12 (OR = 1.76, 95% CI = 1.15-2.69) were both significantly associated with childhood psychotic symptoms, but not with age-12 anxiety, depression, or antisocial behavior. The association was not attributable to family SES, family psychiatric history, or maternal psychosis, each implicated in childhood mental health. Low social cohesion, together with crime victimization in the neighborhood explained nearly a quarter of the association between urbanicity and childhood psychotic symptoms after considering family-level confounders. Low social cohesion and crime victimization in the neighborhood partly explain why children in cities have an elevated risk of developing psychotic symptoms. Greater understanding of the mechanisms leading from neighborhood-level exposures to psychotic symptoms could help target interventions for emerging childhood psychotic symptoms. © The Author 2016. Published by Oxford University

  2. Sleep patterns in children with ADHD: a population-based cohort study from birth to 11 years.

    PubMed

    Scott, Nicola; Blair, Peter S; Emond, Alan M; Fleming, Peter J; Humphreys, Joanna S; Henderson, John; Gringras, Paul

    2013-04-01

    Associations between sleep duration and disturbance in infancy and early childhood and attention deficit hyperactivity disorder diagnoses were investigated. Data from the Avon Longitudinal Study of Parents and Children, a population-based prospective longitudinal birth-cohort study of children born in 1991-1992 in South-West England, were employed. Eight thousand, one hundred and ninety-five children were assessed using the Development and Well-Being Assessment. One hundred and seventy-three cases (2.1%) met criteria for attention deficit hyperactivity disorder. Parental report at eight time points showed children with attention deficit hyperactivity disorder slept less than peers. Absolute differences were small and mainly restricted to night-time sleep, with no strong evidence of differences from controls, except at 69 months [5 years 9 months; 12 min (95% CI: 5-19), P = 0.001], at 81 months [6 years 9 months; 15 min (95% CI: 8-22), P < 0.001] and at 115 months [9 years 7 months; 11 min (95% CI: 4-18), P = 0.001]. The attention deficit hyperactivity disorder group had more night-waking at every age, significant from about 5 years. When tracking children's sleep along a normative centiles chart, a shift in sleep duration from one centile to a lower centile was a useful predictor of attention deficit hyperactivity disorder. Age-specific decreases of >1SD in sleep duration across adjacent time points was a significant predictor of attention deficit hyperactivity disorder at 3-5 years (P = 0.047). In children with attention deficit hyperactivity disorder, shorter sleep duration and sleep disturbances appear early and predate the usual age of clinical diagnosis. The rate of change of sleep duration relative to an individual, rather than absolute sleep duration at any stage, may prove beneficial in identifying increased risk of attention deficit hyperactivity disorder.

  3. Risk of subsequent asthma in children with febrile seizures: a nationwide population-based retrospective cohort study.

    PubMed

    Lin, Wen-Ya; Muo, Chih-Hsin; Ku, Yi-Chia; Sung, Fung-Chang; Kao, Chia-Hung

    2014-12-01

    No study has reported a relationship between febrile seizures and asthma; thus, we examined the association between these two disorders. We identified 991 cases of children with febrile seizures as the case cohort, and the control group was matched according to age, sex, urbanization level, and their parents' occupation at a 1:4 ratio. We applied the Cox proportional hazards regression model to estimate the hazard ratios and 95% confidence intervals for asthma among the children with febrile seizures. After 11 years of follow-up, the asthma incidence in the febrile seizure group was approximately 5% higher than that in the control group (log-rank test, P < 0.0001). The risk of asthma in the febrile seizure group was 1.41 times higher than that in the control group (95% confidence interval, 1.21-1.65; P < 0.001). Furthermore, the risk of asthma development increased (0.96 vs 3.62) in conjunction with the frequency of febrile seizure-related medical visits (one to two visits vs more than four visits; P < 0.0001). Febrile seizures may be associated with an increase in the risk of future asthma occurrence in children. We observed a significantly higher cumulative incidence of asthma occurrence in children with more febrile seizure-related medical visits. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. Motor unit number estimations are smaller in children with type 1 diabetes mellitus: A case-cohort study.

    PubMed

    Toth, Cory; Hebert, Valerie; Gougeon, Claire; Virtanen, Heidi; Mah, Jean K; Pacaud, Daniele

    2014-10-01

    We studied the potential for motor unit number estimation (MUNE) to detect subclinical changes in motor unit numbers in children with type 1 diabetes mellitus (DM). Blinded observers performed clinical assessment, electrophysiology, and multipoint MUNE of the extensor digitorum brevis muscle in children with DM for ≥ 5 years and age-matched healthy controls. For 51 DM subjects, the disease duration was 9.1 ± 2.6 years. Subjects with DM and healthy controls (n=21) had similar demographics. There were no clinical symptoms or signs of peripheral neuropathy in any subject, nor differences in standard electrophysiology between cohorts. Estimated motor unit numbers were decreased significantly in children with DM (224 ± 87 vs. 274 ± 101, P=0.036). Despite the absence of clinical or standard electrophysiological differences from normal control subjects, MUNE can detect a small significant difference in children with DM, suggesting that motor unit loss begins early and subclinically in the disease. Copyright © 2014 Wiley Periodicals, Inc.

  5. Maternal smoking during pregnancy is associated with childhood bone fractures in offspring - A birth-cohort study of 6718 children.

    PubMed

    Parviainen, Roope; Auvinen, Juha; Pokka, Tytti; Serlo, Willy; Sinikumpu, Juha-Jaakko

    2017-08-01

    In children there is limited understanding about the biological and environmental risk factors of fractures. Therefore, we aimed to study the effect of maternal smoking on preschool children's fractures hypothesizing that the fracture risk might be programmed during intrauterine growth in means of disturbed bone formation. A prospective birth cohort included women living in Northern Finland with an expected date of delivery between July 1st, 1985 and June 30th, 1986 (N=9362), and their offspring (N=9432). Smoking was inquired during pregnancy and when the offspring reached seven years of age. Information on in-hospital-treated fractures among the children was collected from the National Hospital Discharge Register (NHDR). The cases who declined to participate or suffered from any bone dysplasia such as osteogenesis imperfecta or any malignancy were excluded, thus 6718 subjects (71.2%) were finally included. Poisson regression analysis with adjustment for gender, asthma, rheumatoid arthritis, socioeconomic status of the family, maternal age and body mass index (BMI) of the children was used to determine the association between maternal smoking during pregnancy and bone fractures. Maternal smoking during pregnancy was associated with a 1.83-fold (95% CI 1.06-3.02, p=0.022) increased risk of in-hospital-treated fractures at pre-school age. The fracture risk in childhood is perhaps increased as a result of modified bone development of the fetus due to maternal smoking. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Does parental drinking influence children's drinking? A systematic review of prospective cohort studies

    PubMed Central

    Keating, Patrick; Felix, Lambert; McCambridge, Jim

    2015-01-01

    Abstract Aims To evaluate evidence of the capacity for causal inference in studies of associations between parental and offspring alcohol consumption in the general population. Methods A systematic search for, and narrative analysis of, prospective cohort studies of the consequences of drinking, except where assessed prenatally only, or with clinically derived instruments. Primary outcome measures were alcohol use or related problems in offspring, which were collected at least 3 years after exposure measures of parental drinking. The systematic review included 21 studies comprising 26 354 families or parent–child dyads with quantitative effect measures available for each study. Criteria for capacity of causal inference included (1) theory‐driven approach and analysis; (2) analytical rigour; and (3) minimization of sources of bias. Results Four of the 21 included studies filled several, but not all, criteria and were assessed to have some capacity for causal inference. These four studies found some evidence that parental drinking predicted drinking behaviour in adolescent offspring. The remaining 17 studies had little or no such capacity. Conclusions There is a fairly large and consistent literature demonstrating that more parental drinking is associated with more drinking in offspring. Despite this, existing evidence is insufficient to warrant causal inferences at this stage. PMID:26283063

  7. Early childhood feeding practices and dental caries in preschool children: a multi-centre birth cohort study

    PubMed Central

    2011-01-01

    Background Dental caries (decay) is an international public health challenge, especially amongst young children. Early Childhood Caries is a rapidly progressing disease leading to severe pain, anxiety, sepsis and sleep loss, and is a major health problem particularly for disadvantaged populations. There is currently a lack of research exploring the interactions between risk and protective factors in the development of early childhood caries, in particular the effects of infant feeding practises. Methods/Design This is an observational cohort study and involves the recruitment of a birth cohort from disadvantaged communities in South Western Sydney. Mothers will be invited to join the study soon after the birth of their child at the time of the first home visit by Child and Family Health Nurses. Data on feeding practices and dental health behaviours will be gathered utilizing a telephone interview at 4, 8 and 12 months, and thereafter at 6 monthly intervals until the child is aged 5 years. Information collected will include a) initiation and duration of breastfeeding, b) introduction of solid food, c) intake of cariogenic and non-cariogenic foods, d) fluoride exposure, and e) oral hygiene practices. Children will have a dental and anthropometric examination at 2 and 5 years of age and the main outcome measures will be oral health quality of life, caries prevalence and caries incidence. Discussion This study will provide evidence of the association of early childhood feeding practices and the oral health of preschool children. In addition, information will be collected on breastfeeding practices and the oral health concerns of mothers living in disadvantaged areas in South Western Sydney. PMID:21223601

  8. Early childhood feeding practices and dental caries in preschool children: a multi-centre birth cohort study.

    PubMed

    Arora, Amit; Scott, Jane A; Bhole, Sameer; Do, Loc; Schwarz, Eli; Blinkhorn, Anthony S

    2011-01-12

    Dental caries (decay) is an international public health challenge, especially amongst young children. Early Childhood Caries is a rapidly progressing disease leading to severe pain, anxiety, sepsis and sleep loss, and is a major health problem particularly for disadvantaged populations. There is currently a lack of research exploring the interactions between risk and protective factors in the development of early childhood caries, in particular the effects of infant feeding practises. This is an observational cohort study and involves the recruitment of a birth cohort from disadvantaged communities in South Western Sydney. Mothers will be invited to join the study soon after the birth of their child at the time of the first home visit by Child and Family Health Nurses. Data on feeding practices and dental health behaviours will be gathered utilizing a telephone interview at 4, 8 and 12 months, and thereafter at 6 monthly intervals until the child is aged 5 years. Information collected will include a) initiation and duration of breastfeeding, b) introduction of solid food, c) intake of cariogenic and non-cariogenic foods, d) fluoride exposure, and e) oral hygiene practices. Children will have a dental and anthropometric examination at 2 and 5 years of age and the main outcome measures will be oral health quality of life, caries prevalence and caries incidence. This study will provide evidence of the association of early childhood feeding practices and the oral health of preschool children. In addition, information will be collected on breastfeeding practices and the oral health concerns of mothers living in disadvantaged areas in South Western Sydney.

  9. Fruit and vegetable consumption and BMI change in primary school-age children: a cohort study.

    PubMed

    Bayer, O; Nehring, I; Bolte, G; von Kries, R

    2014-02-01

    Healthy eating behaviours, such as increasing fruit and vegetable consumption (FVC), are frequently used as a target or outcome measure in obesity prevention interventions. The goal of this study was to demonstrate replacement of high-caloric foods/drinks by FVC and changes in body mass index (BMI) z-score associated with FVC. Anthropometric measurements of 1252 children (51.0% girls) were taken before school entrance (age 6 years) and repeated in the fourth grade (age 10 years). At the same time, parents were asked about their children's diet using a questionnaire. In longitudinal analysis, changes in FVC were not significantly correlated with changes of other nutritional habits, such as consumption of sweets and high-caloric drinks. BMI gain tended to be lower (nonsignificant) in children with increasing fruit consumption compared to those with decreasing fruit consumption. An opposite (nonsignificant) tendency was observed for vegetable consumption and BMI gain. Although beneficial for other health outcomes, the evidence for FVC replacing high-energy foods and thereby reducing BMI gain is weak and could not be substantiated in this study. This might be partially due to the limitation in dietary assessment.

  10. Methadone conversion in infants and children: Retrospective cohort study of 199 pediatric inpatients.

    PubMed

    Fife, Alexandra; Postier, Andrea; Flood, Andrew; Friedrichsdorf, Stefan J

    2016-01-01

    Methadone administration has increased in pediatric clinical settings. This review is an attempt to ascertain an equianalgesic dose ratio for methadone in the pediatric population using standard adult dose conversion guidelines. US tertiary children's hospital. Hospitalized pediatric patients, 0-18 years of age. A retrospective chart review was conducted for patients who were converted from their initial opioid therapy regimen (morphine, hydromorphone, and/or fentanyl) to methadone. The primary endpoint was whether or not a dose correction was needed for methadone in the 6 days following conversion using standard dose conversion charts for adults. Documented clinical signs of withdrawal, unrelieved pain, or oversedation were examined. The majority (53.7 percent) of the 199 children were converted to methadone on intensive care units prior extubation or postextubation. The mean conversion ratio was 23.7 mg of oral morphine to 1 mg of oral methadone (median, 18.8 mg:1 mg, SD=25.7). Most patients experienced an adequate conversion (n=115, 57.8 percent), while 83 (41.7 percent) appeared undermedicated, and one child was oversedated. There were no associations found with conversion ratios for initial morphine dose, days to conversion, or effect of withdrawal of concomitant agents with potential for withdrawal. Opioid conversion to methadone is commonly practiced at our institution; however, dosing was significantly lower compared to adult conversion ratios, and more than 40 percent of children were undermedicated. The majority of children in this study received opioids for sedation while intubated and ventilated; therefore, safe and efficacious pediatric methadone conversion rates remain unclear. Prospective studies are needed.

  11. Assessment of dental caries predictors in 6-year-old school children - results from 5-year retrospective cohort study

    PubMed Central

    2012-01-01

    Background This was a retrospective cohort study undertaken to assess the rate and pattern of dental caries development in 6-year-old school children followed-up for a period of 5 years, and to identify baseline risk factors that were associated with 5 years caries experience in Malaysian children. Methods This 5-years retrospective cohort study comprised primary school children initially aged 6 years in 2004. Caries experience of each child was recorded annually using World Health Organization criteria. The rates of dental caries were recorded in prevalence and incidence density of carious lesions from baseline to final examination. Risk assessment was done to assess relative risk for caries after 5 years in children with baseline caries status. Simple and multiple logistic regression analysis were performed to identify significant independent risk factors for caries. Results The sample consisted of 1830 school children. All components of DMFT showed significant differences between baseline and final examination. Filled teeth (FT) component of the DMFT showed the greatest increases. Results revealed the initial baseline caries level in permanent dentition was a strong predictor for future caries after 5 years (RR=3.78, 95% CI=3.48-4.10, P<0.001). Logistic regression analysis showed significant association between caries occurrence and residence (urban/rural) (OR=1.80, P<0.001). However, it was not significantly associated with gender and ethnicity. The incidence density of caries, affected persons (IDp) observed from baseline and after 5 years was 5.80 persons/100 person-year of observation. The rate of new caries-affected tooth (IDt) in the period from baseline and after 5-years was 0.76 teeth/100 teeth-year of observation. Conclusion The majority of 12-year-old school children (70%) were caries-free and most of the caries were concentrated in only a small proportion (30%) of them. We found that the presence of caries in permanent teeth at the age of 6 years was

  12. Understanding burn injuries in Aboriginal and Torres Strait Islander children: protocol for a prospective cohort study.

    PubMed

    Ivers, Rebecca Q; Hunter, Kate; Clapham, Kathleen; Coombes, Julieann; Fraser, Sarah; Lo, Serigne; Gabbe, Belinda; Hendrie, Delia; Read, David; Kimble, Roy; Sparnon, Anthony; Stockton, Kellie; Simpson, Renee; Quinn, Linda; Towers, Kurt; Potokar, Tom; Mackean, Tamara; Grant, Julian; Lyons, Ronan A; Jones, Lindsey; Eades, Sandra; Daniels, John; Holland, Andrew J A

    2015-10-13

    Although Aboriginal and Torres Strait Islander children in Australia have higher risk of burns compared with non-Aboriginal children, their access to burn care, particularly postdischarge care, is poorly understood, including the impact of care on functional outcomes. The objective of this study is to describe the burden of burns, access to care and functional outcomes in Aboriginal and Torres Strait Islander children in Australia, and develop appropriate models of care. All Aboriginal and Torres Strait Islander children aged under 16 years of age (and their families) presenting with a burn to a tertiary paediatric burn unit in 4 Australian States (New South Wales (NSW), Queensland, Northern Territory (NT), South Australia (SA)) will be invited to participate. Participants and carers will complete a baseline questionnaire; follow-ups will be completed at 3, 6, 12 and 24 months. Data collected will include sociodemographic information; out of pocket costs; functional outcome; and measures of pain, itch and scarring. Health-related quality of life will be measured using the PedsQL, and impact of injury using the family impact scale. Clinical data and treatment will also be recorded. Around 225 participants will be recruited allowing complete data on around 130 children. Qualitative data collected by in-depth interviews with families, healthcare providers and policymakers will explore the impact of burn injury and outcomes on family life, needs of patients and barriers to healthcare; interviews with families will be conducted by experienced Aboriginal research staff using Indigenous methodologies. Health systems mapping will describe the provision of care. The study has been approved by ethics committees in NSW, SA, NT and Queensland. Study results will be distributed to community members by study newsletters, meetings and via the website; to policymakers and clinicians via policy fora, presentations and publication in peer-reviewed journals. Published by the BMJ

  13. Prenatal Exposure to Glycol Ethers and Neurocognitive Abilities in 6-Year-Old Children: The PELAGIE Cohort Study.

    PubMed

    Béranger, Rémi; Garlantézec, Ronan; Le Maner-Idrissi, Gaïd; Lacroix, Agnès; Rouget, Florence; Trowbridge, Jessica; Warembourg, Charline; Monfort, Christine; Le Gléau, Florent; Jourdin, Marylène; Multigner, Luc; Cordier, Sylvaine; Chevrier, Cécile

    2017-04-01

    Glycol ethers (GE) are widely used organic solvents. Despite the potential neurotoxicity of several families of organic solvents, little is known about the impact of GE on the neurodevelopment of infants and children. We investigated the relation between urinary concentrations of GE metabolites in pregnant women and neurocognitive abilities in their 6-year-old children in the PELAGIE mother-child cohort. Five GE metabolites were measured in first morning void urine samples of 204 French pregnant women in early pregnancy (< 19 weeks of gestation). Psychologists assessed the neurocognitive abilities of their 6-year-old children with the Wechsler Intelligence Scale for Children IV (WISC) and the Developmental Neuropsychological Assessment (NEPSY). We analyzed the results with linear (WISC) and Poisson regression models (NEPSY), adjusted for potential confounders, including child's stimulation at home. GE metabolites were detected in 90-100% of maternal urine samples. The WISC Verbal Comprehension score was significantly lower for children with the highest tertile of urinary phenoxyacetic acid (PhAA) [β (third vs. first tertile) = -6.53; 95% CI: -11.44, -1.62]. Similarly, the NEPSY Design Copying subtest score was lower in those with the highest tertile of urinary ethoxyacetic acid (EAA) [β (third vs. first tertile) = -0.11; 95% CI: -0.21, 0.00]. The other GE metabolites we studied were not significantly associated with WISC or NEPSY scores. Prenatal urine concentrations of two GE metabolites were associated with lower WISC Verbal Comprehension Index scores and NEPSY Design Copying subscale scores, respectively, at age 6 years. PhAA is the primary metabolite of 2-phenoxyethanol (EGPhE), which is commonly found in cosmetics, and precursors of EAA are frequently used in cleaning agents. Additional research is needed to confirm our findings and further explore potential effects of prenatal GE exposures on neurocognitive performance in children.

  14. Predicting time to emergency department return for anxiety disorders and acute stress reactions in children and adolescents: a cohort study.

    PubMed

    Newton, Amanda S; Rosychuk, Rhonda J; Niu, Xiaoqing; Radomski, Ashley D; McGrath, Patrick J

    2015-08-01

    While studies indicate that few children with anxiety disorders receive specialized mental health care, significant knowledge gaps exist for the mental health care trajectory outside of specialized care. We examined whether physician-based care after an emergency department (ED) visit for mental health care predicted time to ED return. We conducted a retrospective cohort study using administrative data from Alberta, Canada. Included in the cohort were 8075 children <18 years discharged from an ED (104 EDs in total), April 2002-September 2010, following a visit for an anxiety disorder or acute stress reaction. We used a multivariable Cox proportional hazards model to estimate time to ED return for mental health care (censored at 90 days). The variables of interest were: number and type of physician visits 30 days after index visit. We adjusted for sociodemographics, clinical acuity, comorbidity, and recent history of ED mental health care in the model. Within 30 days of ED discharge, multiple physician follow-up visits were associated with shorter return time (adjusted HR 1.24, 95 % CI 1.08-1.43). A single physician follow-up visit was associated with longer return time (adjusted HR 0.68, 95 % CI 0.58-0.79). Physician follow-up visits for mental health care were associated with shorter return time (adjusted HR 2.5, 95 % CI 2.21-2.83). Following an index visit, ED return by children with anxiety disorders or acute stress reactions is associated with specific characteristics of subsequent physician visits. Improving physician use of evidence-based treatment and family access to coordinated services may reduce costly hospital-based care.

  15. Maternal cancer and congenital anomalies in children – a Danish nationwide cohort study

    PubMed Central

    Momen, Natalie C.; Ernst, Andreas; Arendt, Linn Håkonsen; Olsen, Jørn; Li, Jiong; Gissler, Mika; Rasmussen, Finn; Ramlau-Hansen, Cecilia Høst

    2017-01-01

    Several studies on pregnancy-associated cancers have suggested an association with congenital anomalies in offspring. Previous studies have included maternal cancers diagnosed up to 2 years after pregnancy; however, long latency periods of some cancers mean that cancers diagnosed many years postpartum might have been present during pregnancy in a preclinical state. This paper considers the association between maternal cancers diagnosed from 2 years prior to pregnancy until the mother reaches 50 years of age, and congenital anomalies, as diagnosed at birth or within the first year of life. The current population-based study looks at associations of cancers in mothers with congenital anomalies in their children. Children were followed up from birth to diagnosis of a congenital anomaly, death, emigration or end of follow-up (whichever occurred first). A total of 56,016 children (2.6%) were considered exposed to a maternal cancer of any type; and they had a hazard ratio (HR) of 1.04 (95% confidence interval [CI]: 1.00, 1.09) compared with unexposed children. The greatest HR was seen among children whose mothers had been diagnosed with cancers before or during pregnancy (HR: 1.37, 95% CI: 1.07, 1.75). Similar results were seen when paternal cancers were used as a ‘negative control’. Statistically significant associations were seen for some specific congenital anomalies of organ systems (congenital anomalies of the musculoskeletal system [HR: 1.13, 95% CI: 1.02, 1.25]) and for some specific types of maternal cancer (leukaemia [HR: 1.31, 95% CI: 1.01, 1.61], The results of the main analyses suggest a small increase in risk of congenital anomalies in offspring of mothers diagnosed with cancer from 2 years before pregnancy, until the mother reaches 50 years of age; with the greatest increase seen for exposure in the pre-pregnancy and pregnancy period. These results may reflect shared causes for some cancers and some congenital anomalies. The similar results seen for

  16. Acute disseminated encephalomyelitis: a 10-year cohort study in Thai children.

    PubMed

    Visudtibhan, Anannit; Tuntiyathorn, Lochana; Vaewpanich, Jarin; Sukjit, Prapasri; Khongkatithum, Chaiyos; Thampratankul, Lunliya; Chiemchanya, Surang; Visudhiphan, Pongsakdi

    2010-11-01

    Childhood acute disseminated encephalomyelitis (ADEM) is a demyelinating disease with variable clinical courses and outcomes. Its evolution to multiple sclerosis in Asian children is yet to be determined. Medical records, investigation results and magnetic resonance imaging of brain of Thai children aged less than 15 years with initial diagnosis of ADEM at a referral university hospital in Thailand from January 1997 to December 2006 were reviewed. Clinical course and the outcome were finalized by telephone interview, self-report questionnaire, and/or neurological examination by December 2008. Modified Rankin Score was applied for determination of disability. MRI findings were categorized along with the locations and number of areas of abnormalities shown by T2-weight and FLAIR. 16 patients consisting of 5 boys and 11 girls (age-range 1-14 years, mean 6.9 ± 3.6 years, median 6 years) were identified. Nine patients had cranial nerve dysfunctions including one child with optic neuropathy. One patient died with confirmed pathological diagnosis of ADEM. Among the remaining 15, who were followed from 2 to 10 years (mean 5.8 years), 13 and 3 patients were classified into monophasic ADEM and multiple sclerosis, respectively. Ten of 13 with final diagnosis of ADEM had complete recovery. There was no association between number of lesions or location in the initial MRI and the outcome and final diagnosis. ADEM in Thai children had similar clinical presentation and outcome to previous studies in Western countries. ADEM can occasionally evolve to multiple sclerosis in Thai children as being shown in previous reports from other Asian countries.

  17. Apgar-score in children prenatally exposed to antiepileptic drugs: a population-based cohort study

    PubMed Central

    Christensen, Jakob; Pedersen, Henrik Søndergaard; Kjaersgaard, Maiken Ina Siegismund; Parner, Erik Thorlund; Vestergaard, Mogens; Sørensen, Merete Juul; Olsen, Jørn; Bech, Bodil Hammer; Pedersen, Lars Henning

    2015-01-01

    Objectives It is unknown if prenatal exposure to antiepileptic drugs (AEDs) increases the risk of low Apgar score in offspring. Setting Population-based study using health registers in Denmark. Participants We identified all 677 021 singletons born in Denmark from 1997 to 2008 and linked the Apgar score from the Medical Birth Register with information on the women's prescriptions for AEDs during pregnancy from the Danish Register of Medicinal Product Statistics. We used the Danish National Hospital Registry to identify mothers diagnosed with epilepsy before birth of the child. Results were adjusted for smoking and maternal age. Results Among 2906 children exposed to AEDs, 55 (1.9%) were born with an Apgar score ≤7 as compared with 8797 (1.3%) children among 674 115 pregnancies unexposed to AEDs (adjusted relative risk (aRR)=1.41 (95% CI 1.07 to 1.85). When analyses were restricted to the 2215 children born of mothers with epilepsy, the aRR of having a low Apgar score associated with AED exposure was 1.34 (95% CI 0.90 to 2.01) When assessing individual AEDs, we found increased, unadjusted RR for exposure to carbamazepine (RR=1.86 (95% CI 1.01 to 3.42)), valproic acid (RR=1.85 (95% CI 1.04 to 3.30)) and topiramate (RR=2.97 (95% CI 1.26 to 7.01)) when compared to unexposed children. Conclusions Prenatal exposure to AEDs was associated with increased risk of being born with a low Apgar score, but the absolute risk of a low Apgar score was <2%. Risk associated with individual AEDs indicate that the increased risk is not a class effect, but that there may be particularly high risks of a low Apgar score associated with certain AEDs. PMID:26359281

  18. Atopic dermatitis and association of risk for primary immune thrombocytopenia and autoimmune diseases among children: A nationwide population-based cohort study.

    PubMed

    Wei, Chang-Ching; Lin, Cheng-Li; Shen, Te-Chun; Tsai, Jeng-Dau

    2016-07-01

    Primary immune thrombocytopenia (ITP) is currently defined as an acquired autoimmune disorder with persistent thrombocytopenia. However, the temporal interaction between T helper type 2 cell (Th2)-mediated allergic diseases and T helper type 1 cell (Th1)-mediated ITP remains unknown. Atopic dermatitis (AD) is considered one of the first steps in the atopic march. Herein, we conducted a population-based cohort analysis to investigate the risk of ITP in children with AD in comparison with non-AD controls. We subsequently compared the occurrence of other autoimmune diseases in ITP children in both AD and non-AD cohorts. From 2000 to 2007, 120,704 children with newly diagnosed AD and 241,408 randomly selected non-AD controls were included in the study. By the end of 2008, incidences of ITP in both cohorts and the AD cohort to non-AD cohort hazard ratios (HRs) and confidence intervals (CIs) were measured. Comparison of the occurrence of other autoimmune diseases in ITP between children with and without AD was analyzed. The incidence of ITP during the study period was 1.72-fold greater (95% CI: 1.13-2.62) in the AD cohort than in the non-AD cohort (6.96 vs 4.00 per 100,000 person-years). The risk was greatest among male children, children >2 years, those in densely populated areas, and those with white-collar parents. The HR of ITP in AD children increased significantly with the number of AD-related clinical visits (P < 0.001). The risk of developing ITP in the AD cohort was highest within the first 3 years after the diagnosis of AD (HR: 1.78; CI: 1.14-2.78). The AD cohort with ITP had a higher occurrence rate of other autoimmune diseases than the non-AD cohort with ITP. AD children had a greater risk of developing ITP and other autoimmune diseases. Further research is needed to clarify the role of allergy in the pathogenesis of ITP and autoimmune diseases.

  19. Using Participant Event Monitoring in a Cohort Study of Unintentional Injuries Among Children and Adolescents

    PubMed Central

    Wilkins, J.R.; Crawford, J. Mac; Stallones, Lorann; Koechlin, Kathleen M.; Shen, Lei; Hayes, John; Bean, Thomas L.

    2007-01-01

    Objectives. We conducted a 3-year cohort study of 407 youths aged 9 to 18 years to develop multivariable risk prediction models of agriculture-related injuries. Methods. Data were obtained via participant event monitoring, with youths self-reporting injuries and exposures in daily diaries over a 13-week period. We evaluated data quality by comparing injury self-reports with other injury data. Results. Semilogarithmic plots of rates of all unintentional injuries combined (US data from 2000) as well as of agriculture-related injuries (US and Canadian data from 19 previous studies) graphed as a function of injury severity exhibited linearity, as did plots based on the present results. Severity-specific unintentional injury rates were 1.4- to 4.3-times higher than national rates, suggesting that our methodology can significantly reduce injury underreporting. In addition, at each severity level, estimated agriculture-related injury rates were 5.8- to 9.3-times higher than rates from previous national, regional, and state-based studies. Conclusions. Our approach to participant event monitoring can be implemented with youths aged 9 to 18 years and will yield reliable daily data on unintentional injuries. PMID:17194864

  20. Secondary cancers among children with acute lymphoblastic leukaemia treated by the Tokyo Children's Cancer Study Group protocols: a retrospective cohort study.

    PubMed

    Ishida, Yasushi; Maeda, Miho; Urayama, Kevin Y; Kiyotani, Chikako; Aoki, Yuki; Kato, Yoko; Goto, Shoko; Sakaguchi, Sachi; Sugita, Kenichi; Tokuyama, Mika; Nakadate, Naoya; Ishii, Eizaburo; Tsuchida, Masahiro; Ohara, Akira

    2014-01-01

    With improvement in survival, it is important to evaluate the impact of treatment on secondary cancers in acute lymphoblastic leukaemia (ALL) survivors. A retrospective cohort study comprising 2918 children diagnosed with ALL and enrolled on Tokyo Children's Cancer Study Group (TCCSG) protocols between 1984 and 2005 was conducted to evaluate the incidence of secondary cancers and associated factors including treatment protocol, cranial irradiation and other characteristics of the primary ALL. Thirty-seven patients developed secondary cancers, including acute myeloid leukaemia (n = 11), myelodysplastic syndrome (n = 5), non-Hodgkin lymphoma (n = 2), brain tumours (n = 13) and other solid carcinomas (n = 6) within a median follow-up duration of 9·5 years. The cumulative incidence of any secondary cancers was 1·0% (95% confidence interval (CI), 0·7-1·4%) at 10 years and 2·4% (95% CI, 1·5-3·7%) at 20 years, respectively. Standardized incidence rate ratio of secondary cancers was 9·3 (95% CI, 6·5-12·8). Multivariate analyses showed an increased risk of secondary cancers associated with the recent treatment protocol and cranial irradiation. There was no evidence of a reduction in secondary cancer incidence despite marked decreases in cranial irradiation use in the recent protocols.

  1. Cohort study of neurocognitive functioning and adaptive behavior in children and adolescents with NPC1

    PubMed Central

    THURM, AUDREY; FARMER, CRISTAN; FARHAT, NICOLE YANJANIN; WIGGS, EDYTHE; BLACK, DAVID; PORTER, FORBES D

    2015-01-01

    AIM To describe the neurocognitive and adaptive behavior profile of children and adolescents with Niemann–Pick Disease type C1 (NPC1), a rare genetic disease that frequently presents in childhood, with variable onset and symptom complex involving neurodegeneration. METHOD Thirty-eight participants (20 males, 18 females; mean age 8y 10mo, SD 4y 8mo, range 1–18y) with NPC1 were evaluated through a natural history protocol. RESULTS NPC1 severity was in the mild to moderate range for most participants. Cognitive scores (n=32) ranged from very low to above average; about half of the participants exhibited a clinically significant advantage of Verbal IQ over Non-verbal IQ. Adaptive behavior scores (n=21) were generally in the borderline to impaired range. Longitudinal cognitive data (n=19) suggested a pattern of decreasing scores over time. However, most participants remained at the same general level of functioning throughout the study. INTERPRETATION This study begins to systematically describe the neurocognitive phenotype of children and adolescents with NPC1, identifying heterogeneity and decline, aiding in understanding the natural history of the disease to plan treatment studies. PMID:26586413

  2. Why some children with externalising problems develop internalising symptoms: testing two pathways in a genetically sensitive cohort study.

    PubMed

    Wertz, Jasmin; Zavos, Helena; Matthews, Timothy; Harvey, Kirsten; Hunt, Alice; Pariante, Carmine M; Arseneault, Louise

    2015-07-01

    Children with externalising problems are at risk of developing internalising problems as they grow older. The pathways underlying this developmental association remain to be elucidated. We tested two processes that could explain why some children with externalising problems develop internalising symptoms in preadolescence: a mediation model whereby the association between early externalising and later new internalising symptoms is explained by negative experiences; and a genetic model, whereby genes influence both problems. We used data from the Environmental Risk (E-Risk) Study, a 1994-1995 birth cohort of 2,232 twins born in England and Wales. We assessed externalising and internalising problems using combined mothers' and teachers' ratings at age 5 and 12. We measured bullying victimisation, maternal dissatisfaction and academic difficulties between age 7 and 10 and used linear regression analyses to test the effects of these negative experiences on the association between early externalising and later internalising problems. We employed a Cholesky decomposition to examine the genetic influences on the association. Children with externalising problems at age 5 showed increased rates of new internalising problems at age 12 (r = .24, p < .001). Negative experiences accounted for some of the association between early externalising and later internalising problems. Behavioural-genetic analyses indicated that genes influencing early externalising problems also affected later internalising problems. Our findings highlight the role of genetic influences in explaining why some children with externalising problems develop internalising symptoms in preadolescence. Negative experiences also contribute to the association, possibly through gene-environment interplay. Mental health professionals should monitor the development of internalising symptoms in young children with externalising problems. © 2014 Association for Child and Adolescent Mental Health.

  3. Does Giardia lamblia cause villous atrophy in children?: A retrospective cohort study of the histological abnormalities in giardiasis.

    PubMed

    Koot, Bart G P; ten Kate, Fiebo J W; Juffrie, Mohammad; Rosalina, Ina; Taminiau, Jan J A M; Benninga, Marc A

    2009-09-01

    To determine the prevalence and type of histological abnormalities in duodenal mucosa associated with Giardia lamblia in children who undergo esophago-gastroduodenoscopy. Duodenal biopsies containing G lamblia were retrieved from all paediatric patients who had undergone endoscopy in our centre in the last 20 years. These biopsies were scored for histological abnormalities by a single pathologist using a semiquantative scale and staged according to the Marsh criteria. In those with a Marsh stage above 0, the presence of coeliac disease was investigated. After excluding all patients with concomitant coeliac disease, 4 out of 32 (13%) patients had a biopsy showing crypt hyperplasia and 1 out of 32 (3%) had partial villous atrophy. No intraepithelial lymphocytosis was found. In our cohort, 2 patients with giardiasis and mild histological abnormalities were diagnosed with coeliac disease only after a repeated endoscopy and serology were performed; in 1 of them after a delay of 5 years. Other histological abnormalities frequently observed were increased eosinophilic infiltration of the lamina propria (35%) and lymph follicle formation (35%). Infiltration of neutrophilic and eosinophilic granulocytes in the epithelial layer was observed less frequently (16% and 9%, respectively). Villous atrophy, intraepithelial lymphocytosis and/or crypt hyperplasia are rare in children with giardiasis who undergo esophagogastroduodenoscopy. Therefore, other causes, particularly coeliac disease, should always be suspected. This study, however, suggests that giardiasis can cause chronic mucosal inflammation, often of an eosinophilic nature, in these children.

  4. Correlates of Mental Illness and Wellbeing in Children: Are They the Same? Results From the UK Millennium Cohort Study.

    PubMed

    Patalay, Praveetha; Fitzsimons, Emla

    2016-09-01

    To investigate a framework of correlates of both mental illness and wellbeing in a large, current, and nationally representative sample of children in the United Kingdom. An ecologic framework of correlates including individual (sociodemographic and human capital), family, social, and wider environmental factors were examined in 12,347 children aged 11 years old from the UK Millennium Cohort Study. Mental illness and wellbeing scores were standardized to allow comparisons, and the variance explained by the different predictors was estimated. Mental illness and wellbeing were weakly correlated in children (r = 0.2), and their correlates were similar in some instances (e.g., family structure, sibling bullying, peer problems) but differed in others (e.g., family income, perceived socioeconomic status, cognitive ability, health status, neighborhood safety). The predictors included in the study explained 47% of the variance in symptoms of mental illness, with social relationships, home environment, parent health, cognitive ability, socioeconomic status, and health factors predicting large amounts of variance. A comparatively lower 26% of the variance in wellbeing was explained by the study variables, with wider environment, social relationships, perceived socioeconomic status, and home environment predicting the most variance. Correlates of children's mental illness and wellbeing are largely distinct, stressing the importance of considering these concepts separately and avoiding their conflation. This study highlights the relevance of these findings for understanding social gradients in mental health through the life course and the conceptualization and development of mental illness and wellbeing in childhood as precursors to lifelong development in these domains. Copyright © 2016 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

  5. [Birth cohort studies in China: a review].

    PubMed

    Wang, L; Sun, L; He, X Y; Wang, Y X; Yu, W P

    2017-04-10

    With longer than 100-year experience of development, methods used on birth cohort study have been viewed as having important roles in exploring the probable effects of health and environment exposure both prior to and during the pregnancy in the life circle as infants, children, adolescents, adults, and the elderly. However in China, birth cohort studies started late but with rapid development. Recently, some well-known methods on birth cohort studies were established in mainland China, Hong Kong and Taiwan area. This paper presented an overall review on the progress about birth cohort studies and their prospects, in China.

  6. Characteristics Associated with Utilization of Asthma-Related Traditional Chinese Medicine Services among Asthma Children in Taiwan: A Nationwide Cohort Study

    PubMed Central

    Tsai, Tung-Hu; Chou, Yiing-Jenq

    2015-01-01

    Introduction. Previous studies have demonstrated the advantages of TCM use among asthmatic children. However, there is a paucity of epidemiologic reports on features of TCM users among asthmatic children. This cohort study aimed to investigate child's, parent's, and provider's characteristics associated with the use of asthma-related TCM services among newly diagnosed asthmatic children. Materials and Methods. A nationally representative cohort of one million National Health Insurance beneficiaries was used. The newly diagnosed asthma children who received asthma medication from western medicine providers from 2005 to 2010 were selected as our sample for analysis. Generalized estimating equation was applied to identify the child's, parents', and provider's characteristics associated with the use of asthma-related TCM among the newly diagnosed asthmatic children. Results. Of 20,080 children who were enrolled and followed up for one year, 4,034 children used TCM for asthma-related treatment. Children with prior experience of TCM, pre-school and school aged children, boys, those with more severe asthma or poorer health, with higher income parents were more likely to use asthma-related TCM. Herbal medicine was the most common modality among asthmatic children. Conclusions. There were only 20% newly diagnosed asthmatic children using TCM. The findings may shed light on possible integration of TCM with western medicine services. PMID:25972906

  7. Prevalence and Persistence of Sleep Disordered Breathing Symptoms in Young Children: A 6-Year Population-Based Cohort Study

    PubMed Central

    Bonuck, Karen A.; Chervin, Ronald D.; Cole, Timothy J.; Emond, Alan; Henderson, John; Xu, Linzhi; Freeman, Katherine

    2011-01-01

    Study Objectives: To describe the prevalence, persistence, and characteristics associated with sleep disordered breathing (SDB) symptoms in a population-based cohort followed from 6 months to 6.75 years. Design: Avon Longitudinal Study of Parents and Children (ALSPAC). Setting: England, 1991-1999. Participants: 12,447 children in ALSPAC with parental report of apnea, snoring, or mouth-breathing frequency on any one of 7 questionnaires. Measurements: Symptom prevalence rates—assessed as “Always” and “Habitually”—are reported at 0.5, 1.5, 2.5, 3.5, 4.75, 5.75, and 6.75 years of age. The proportion of children in whom symptoms develop, persist or abate between observation points is reported. Exploratory multivariate analyses identified SDB risk factors at 1.5, 4.75, and 6.75 years. Results: The prevalence of apnea (“Always”) is 1%-2% at all ages assessed. In contrast, snoring “Always” ranges from 3.6% to 7.7%, and snoring “Habitually” ranges from 9.6% to 21.2%, with a notable increase from 1.5- 2.5 years. At 6 years old, 25% are habitual mouth-breathers. The “Always” and “Habitual” incidence of each symptom between time points is 1%-5% and 5%-10%, respectively. In multivariate analyses of combined symptoms, socioeconomic factors have stronger, more persistent effects upon increased SDB risk than gestational age, gender, or race (aside from 1.5 years); adenoidectomy decreases risk by 40%-50%. Conclusions: This is the first natural history study of the primary symptoms of SDB across a key 6-year period in the development of SDB symptoms. Snoring rates are higher and spike earlier than previously reported. Symptoms are dynamic, suggesting the need for early and continued vigilance in early childhood. Citation: Bonuck KA; Chervin RD; Cole TJ; Emond A; Henderson J; Xu L; Freeman K. Prevalence and persistence of sleep disordered breathing symptoms in young children: a 6-year population-based cohort study. SLEEP 2011;34(7):875-884. PMID

  8. Tonsillectomy among children with low baseline acute throat infection consultation rates in UK general practices: a cohort study.

    PubMed

    Koshy, Elizabeth; Watt, Hilary; Curcin, Vasa; Bottle, Alex; Sharland, Mike; Saxena, Sonia

    2015-02-03

    To investigate the effectiveness of tonsillectomy in reducing acute throat infection (ATI) consultation rates over 6 years' follow-up among children with low baseline ATI consultation rates. Retrospective cohort study. UK general practices from the Clinical Practice Research Datalink. Children aged 4-15 years with ≤3 ATI consultations during the 3 years prior to 2001 (baseline). 450 children who underwent tonsillectomy (tonsillectomy group) and 13 442 other children with an ATI consultation (comparison group) in 2001. Mean differences in ATI consultation rates over the first 3 years' and subsequent 3 years' follow-up compared with 3 years prior to 2001 (baseline); odds of ≥3 ATI consultations at the same time points. Among children in the tonsillectomy group, the 3-year mean ATI consultation rate decreased from 1.31 to 0.66 over the first 3 years' follow-up and further declined to 0.60 over the subsequent 3 years' follow-up period. Compared with children who had no operation, those who underwent tonsillectomy experienced a reduction in 3-year mean ATI consultations per child of 2.5 (95% CI 2.3 to 2.6, p<0.001) over the first 3 years' follow-up, but only 1.2 (95% CI 1.0 to 1.4, p<0.001) over the subsequent 3 years' follow-up compared with baseline, respectively. This equates to a mean reduction of 3.7 ATI consultations over a 6-year period and approximates to a mean annual reduction of 0.6 ATI consultations per child, per year, over 6 years' follow-up. Children who underwent tonsillectomy were also much less likely to experience ≥3 ATI consultations during the first 3 years' follow-up (adjusted OR=0.12, 95% CI 0.08 to 0.17) and the subsequent 3 years' follow-up (adjusted OR=0.24, 95% CI 0.14 to 0.41). Among children with low baseline ATI rates, there was a statistically significant reduction in ATI consultation rates over 6 years' follow-up. However, the relatively modest clinical benefit needs to be weighed against the potential

  9. Cohort Profile Update: The GAZEL Cohort Study.

    PubMed

    Goldberg, Marcel; Leclerc, Annette; Zins, Marie

    2015-02-01

    The original GAZEL cohort was composed of 20 625 employees of the French national gas and electricity companies (15 011 male employees then aged 40 to 50 years and 5614 women between 35 and 50 years old) at its inception in 1989. A Cohort Profile article was published in 2007. By the end of 2013, participants were aged 60-75, and almost all of them retired during follow-up. Accordingly, the main focus of research in the past decade was devoted to the study of the persistent, long-term effects of occupational exposures after retirement; of the transition between professionally active life and retirement; and on determinants of early ageing. Accordingly, in addition to the health, behavioural and social data collected yearly since the beginning of the follow-up, new data were thus collected on cognitive complaints, cognitive and physical functioning, limitations in daily activities, time use and social relationships of retirees. This update presents the main findings of research within the GAZEL Cohort Study during the past 7 years. Any research group, in France or elsewhere, can submit a research proposal to work on the GAZEL cohort. To do this, interested researchers should contact one of the principal investigators of the GAZEL Cohort Study.

  10. Longitudinal association of neighborhood variables with Body Mass Index in Dutch school-age children: The KOALA Birth Cohort Study.

    PubMed

    Schmidt, Swantje C; Sleddens, Ester F C; de Vries, Sanne I; Gubbels, Jessica; Thijs, Carel

    2015-06-01

    Changes in the neighborhood environment may explain part of the rapid increase in childhood overweight and obesity during the last decades. To date few theory-driven rather than data-driven studies have explored longitudinal associations between multiple neighborhood characteristics and child body weight development. We aimed to assess the relationship between physical, social and perceived safety related characteristics of the neighborhood and Body Mass Index (BMI) development in children during early school age, using a longitudinal design. We included an examination of moderating and confounding factors based on a conceptual model adapted from the EnRG framework (Environmental Research framework for weight Gain prevention) and empirical research. Analyses included 1887 children from the KOALA Birth Cohort Study followed from baseline age 4-5 years until 8-9 years. For children age 4-5 years, parents completed a questionnaire measuring characteristics of the neighborhood. Reliability and factor analyses were used to identify constructs for neighborhood characteristics. Linear regression analysis was performed to assess the relationship between neighborhood constructs and BMI z-scores cross-sectionally at age 4-5 years and longitudinally using Generalized Estimating Equations with BMI z-scores over 5 repeated measurements until age 8-9 years. Fourteen constructs were identified and grouped in three domains including perceived physical, social, or safety related characteristics of the neighborhood. Cross-sectionally, a lower BMI z-score was associated with higher perceived physical attractiveness of the neighborhood environment (standardized regression coefficient (β) -0.078, 95% CI -0.123 to -0.034) and a higher level of social capital (β -0.142, -0.264 to -0.019). Longitudinally, similar associations were observed with potentially even stronger regression coefficients. This study suggests that BMI in children is mainly related to the modifiable physical

  11. Breast feeding, parental allergy and asthma in children followed for 8 years. The PIAMA birth cohort study.

    PubMed

    Scholtens, S; Wijga, A H; Brunekreef, B; Kerkhof, M; Hoekstra, M O; Gerritsen, J; Aalberse, R; de Jongste, J C; Smit, H A

    2009-07-01

    It is unclear how the association between breast feeding and asthma develops with age of the child and how this association over time is influenced by maternal or paternal allergy. These factors--the age of the child and maternal or paternal allergy--might partly explain the conflicting results observed in cross-sectional studies. The study population consisted of 3115 Dutch children born in 1996/1997 who participated in the PIAMA (Prevention and Incidence of Asthma and Mite Allergy) birth cohort study. Data on breast feeding and asthma (based on wheeze, dyspnoea and prescription of inhaled steroids) were collected by yearly questionnaires. At 8 years, specific immunoglobulin E (IgE) to airborne allergens and bronchial responsiveness were measured. Data were analysed by logistic regression and generalised estimating equations (GEEs), and stratified by maternal and paternal allergic status. 35% (n = 1081) of the children were breast fed for >16 weeks. At 8 years of age, 12.6% (n = 392) had asthma. Breast feeding (>16 weeks vs no breast feeding) was significantly associated with a lower asthma prevalence from 3 to 8 years of age, in children of both non-allergic and allergic mothers. The inverse association between breast feeding and sensitisation to airborne allergens at 8 years was non-significant. Breast feeding was not associated with bronchial hyper-responsiveness. No interaction between breast feeding and gender, maternal allergy or paternal allergy was observed in any of the associations. Breast feeding is associated with a lower asthma risk in children until 8 years of age without evidence of attenuation and regardless of the family history of allergy.

  12. Long-Term Effects of Otitis Media a Ten-Year Cohort Study of Alaskan Eskimo Children

    ERIC Educational Resources Information Center

    Kaplan, Gary J.; And Others

    1973-01-01

    Histories of ear disease, otoscopic examinations, and audiologic, intelligence, and achievement tests were obtained from a cohort of 489 Alaskan Eskimo children, followed through the first 10 years of life, to determine whether otitis media (middle ear inflammation) deleteriously affected intellectual functioning and achievement in school.…

  13. Long-Term Effects of Otitis Media a Ten-Year Cohort Study of Alaskan Eskimo Children

    ERIC Educational Resources Information Center

    Kaplan, Gary J.; And Others

    1973-01-01

    Histories of ear disease, otoscopic examinations, and audiologic, intelligence, and achievement tests were obtained from a cohort of 489 Alaskan Eskimo children, followed through the first 10 years of life, to determine whether otitis media (middle ear inflammation) deleteriously affected intellectual functioning and achievement in school.…

  14. Development assessment of HIV exposed children aged 6-18 months: a cohort study from North India.

    PubMed

    Rajan, Remya; Seth, Anju; Mukherjee, Sharmila B; Chandra, Jagdish

    2017-03-05

    HIV exposed children are vulnerable to developmental delay irrespective of their HIV status due to combined effect of risk factors like poverty, prenatal drug exposure, stress and chronic illness in family and malnutrition. This cohort study assessed the development of 50 HIV exposed children aged 6-18 months at a Pediatric Centre of Excellence in HIV care in India. The development was assessed using Development Assessment Scale for Indian Infants (DASII) at enrolment, 3 and 6 months later. The development quotient (DQ) scores and proportion of children with developmental delay (DQ ≤ 70) were compared among two sub-groups, HIV infected (HI) and HIV exposed uninfected (HEU) children. The various social and clinical factors affecting development were studied by univariate and multivariate analysis. Prevalence of developmental delay was 2.4% in the HEU (n = 41), and 33.3% in HI (n = 9). The DQ of HI was significantly lower than that of HEU at all three assessments. The DQ of HI were also significantly lower compared to the HEU at ages 12.1-18 months (83.37 ± 20.73 vs 94.68 ± 5.13, p = 0.005) and 18.1-24 months (84.55 ± 15.35 vs 94.63 ± 5.86, p = 0.006) respectively. The development of HEU was adversely affected by lower socioeconomic status and presence of wasting. In addition, development of HI was also adversely influenced by presence of stunting and opportunistic infections, advanced disease stage and shorter ART duration. We conclude that with optimum care, HEU can have a normal development, while a considerable proportion of HI may continue to have delayed development.

  15. Why Are Children in Urban Neighborhoods at Increased Risk for Psychotic Symptoms? Findings From a UK Longitudinal Cohort Study

    PubMed Central

    Newbury, Joanne; Arseneault, Louise; Caspi, Avshalom; Moffitt, Terrie E.; Odgers, Candice L.; Fisher, Helen L.

    2016-01-01

    Background: Urban upbringing is associated with a 2-fold adulthood psychosis risk, and this association replicates for childhood psychotic symptoms. No study has investigated whether specific features of urban neighborhoods increase children’s risk for psychotic symptoms, despite these early psychotic phenomena elevating risk for schizophrenia and other psychiatric disorders in adulthood. Methods: Analyses were conducted on over 2000 children from the Environmental Risk (E-Risk) Longitudinal Twin Study, a nationally-representative cohort of UK-born twins. Neighborhood-level characteristics were assessed for each family via: a geodemographic discriminator indexing neighborhood-level deprivation, postal surveys of over 5000 residents living alongside the children, and in-home interviews with the children’s mothers. Children were interviewed about psychotic symptoms at age 12. Analyses were adjusted for important family-level confounders including socioeconomic status (SES), psychiatric history, and maternal psychosis. Results: Urban residency at age-5 (OR = 1.80, 95% CI = 1.16–2.77) and age-12 (OR = 1.76, 95% CI = 1.15–2.69) were both significantly associated with childhood psychotic symptoms, but not with age-12 anxiety, depression, or antisocial behavior. The association was not attributable to family SES, family psychiatric history, or maternal psychosis, each implicated in childhood mental health. Low social cohesion, together with crime victimization in the neighborhood explained nearly a quarter of the association between urbanicity and childhood psychotic symptoms after considering family-level confounders. Conclusions: Low social cohesion and crime victimization in the neighborhood partly explain why children in cities have an elevated risk of developing psychotic symptoms. Greater understanding of the mechanisms leading from neighborhood-level exposures to psychotic symptoms could help target interventions for emerging childhood psychotic symptoms

  16. Mortality in Children with Human Immunodeficiency Virus Initiating Treatment: A Six-Cohort Study in Latin America.

    PubMed

    Luque, Marco T; Jenkins, Cathy A; Shepherd, Bryan E; Padgett, Denis; Rouzier, Vanessa; Succi, Regina Célia M; Machado, Daisy M; McGowan, Catherine C; Vermund, Sten H; Pinto, Jorge A

    2017-03-01

    To assess the risks of and factors associated with mortality, loss to follow-up, and changing regimens after children with HIV infected perinatally initiate combination antiretroviral therapy (cART) in Latin America and the Caribbean. This 1997-2013 retrospective cohort study included 1174 antiretroviral therapy-naïve, perinatally infected children who started cART age when they were younger than 18 years of age (median 4.7 years; IQR 1.7-8.8) at 1 of 6 cohorts from Argentina, Brazil, Haiti, and Honduras, within the Caribbean, Central and South America Network for HIV Epidemiology. Median follow-up was 5.6 years (IQR 2.3-9.3). Study outcomes were all-cause mortality, loss to follow-up, and major changes in cART. We used Cox proportional hazards models stratified by site to examine the association between predictors and times to death or changing regimens. Only 52% started cART at younger than 5 years of age; 19% began a protease inhibitor. At cART initiation, median CD4 count was 472 cells/mm(3) (IQR 201-902); median CD4% was 16% (IQR 10-23). Probability of death was high in the first year of cART: 0.06 (95% CI 0.04-0.07). Five years after cART initiation, the cumulative mortality incidence was 0.12 (95% CI 0.10-0.14). Cumulative incidences for loss to follow-up and regimen change after 5 years were 0.16 (95% 0.14-0.18) and 0.30 (95% 0.26-0.34), respectively. Younger children had the greatest risk of mortality, whereas older children had the greatest risk of being lost to follow-up or changing regimens. Innovative clinical and community approaches are needed for quality improvement in the pediatric care of HIV in the Americas. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Validation of the Children's Eating Behavior Questionnaire in 3 year old children of a multi-ethnic Asian population: The GUSTO cohort study.

    PubMed

    Quah, Phaik Ling; Cheung, Yin Bun; Pang, Wei Wei; Toh, Jia Ying; Saw, Seang-Mei; Godfrey, Keith M; Yap, Fabian; Chong, Yap Seng; Mary, Chong Foong-Fong

    2017-02-20

    The Children's Eating Behaviour Questionnaire (CEBQ) was developed to measure eating behaviors related to obesity risk in children. However, this questionnaire has not been validated for use in South East Asia, where parenting practices are different from those in western countries and child obesity rates are increasing. The aim of this study was to examine the validity of the CEBQ administered to mothers of children aged 3 years in Singapore. Confirmatory factor analysis (CFA) was used to examine if the original 35-item, 8-factor model was supported in our cohort. Participants were 636 mother-child dyads (mean (SD) child age = 36.7 (1.6) months), from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) birth cohort in which the mothers were characterized in pregnancy and children were followed up to age 3 years. The CFA showed a poor model fit; RMSEA = 0.072 (PCLOSE<0.001), SRMR = 0.094, CFI = 0.826, and TLI = 0.805. Exploratory factor analysis revealed a 35 item, 7-factor structure (factor loadings ≥ 0.35): enjoyment of food, food fussiness, emotional overeating, desire to drink, emotional under eating, satiety responsiveness and slowness in eating. Cronbach's alpha estimates ranged from 0.70 to 0.88 for the 7 subscales. Convergent validity tests via correlation analysis revealed that emotional under eating (r = -0.14), slowness in eating (r = -0.16) and satiety responsiveness (r = -0.11) were negatively correlated with BMI z-score at 3 years, while enjoyment of food (r = 0.12) was positively correlated, p < 0.05. In conclusion, we found a revised 7-factor structure of the CEBQ more appropriate for examining eating behavior in 3 year old children in the Singapore setting. Further replication studies in a separate cohort study are warranted before further use of these factor structures generated.

  18. Outcome of Guillain - Barré Syndrome in Children: A prospective cohort study in a tertiary hospital in Upper Egypt

    PubMed Central

    Sadek, Abdelrahim Abdrabou; Abou-Taleb, Ashraf; Ali, Wafaa Ahmed

    2016-01-01

    Introduction Guillain-Barré syndrome is the most common cause of acute flaccid paralysis in children, and defined as an acute inflammatory polyneuropathy. The objective of this study was to assess the clinico-laboratory profile, and outcome of Guillain-Barré syndrome in children at Sohag University Hospital. Methods This prospective cohort observational study was conducted in 2014–2015. The included children were subjected to through medical history and detailed systemic and neurological examination. Nerve conduction studies and cerebrospinal fluid analysis were done for all patients. Follow up was done at three and six months both clinically and by nerve conduction studies. Results This study included 50 patients (27 males/23 females) with median age of 2.92 years. Upper respiratory tract infections were the most common antecedent infections (50%) and the neurological findings were weakness of both lower limbs and pain in all patients (100%) followed by sphincteric dysfunction (26%) while cranial neuropathies were found in 4%. Nerve conduction study revealed that acute inflammatory demyelinating polyradiculoneuropathy was found in 52% of cases, acute motor axonal neuropathy in 36% of cases, whereas acute motor-sensory axonal neuropathy was found in 6% of cases. The outcome was good in about 78% of cases, Hughes motor scale revealed that 58% were healthy, 18% had minor signs or symptoms, 12% walked without support, 6% walked with support, and 6% were bed ridden. Conclusion The outcome was favorable, although a minority of patients suffered neurological deficit. Immediate administration of intravenous immunoglobulin reduced mortality and disability. PMID:28163843

  19. Obesity in British children with and without intellectual disability: cohort study.

    PubMed

    Emerson, Eric; Robertson, Janet; Baines, Susannah; Hatton, Chris

    2016-07-27

    Reducing the prevalence of and inequities in the distribution of child obesity will require developing interventions that are sensitive to the situation of 'high risk' groups of children. Children with intellectual disability appear to be one such group. We aimed to estimate the prevalence of obesity in children with and without intellectual disability in a longitudinal representative sample of British children and identify risk factors associated with obesity at age 11. Information was collected on a nationally representative sample of over 18,000 at ages 9 months, 3, 5, 7 and 11 years. We used UK 1990 gender-specific growth reference charts and the LMS Growth programme to identify age and gender-specific overweight and obesity BMI thresholds for each child at ages 5, 7 and 11 years. Children with intellectual disabilities were significantly more likely than other children to be obese at ages five (OR = 1.32[1.03-1.68]), seven (OR = 1.39[1.05-1.83]) and eleven (OR = 1.68[1.39-2.03]). At ages five and seven increased risk of obesity among children with intellectual disabilities was only apparent among boys. Among children with intellectual disability risk of obesity at age eleven was associated with persistent maternal obesity, maternal education, child ethnicity and being bullied at age five. Children with intellectual disability are a high-risk group for the development of obesity, accounting for 5-6 % of all obese children. Interventions to reduce the prevalence and inequities in the distribution of child obesity will need to take account of the specific situation of this group of children.

  20. Early life microbial exposure and fractional exhaled nitric oxide in school-age children: a prospective birth cohort study

    PubMed Central

    2013-01-01

    Background Inflammation is a key factor in the pathogenesis of respiratory diseases. Early life exposure to microbial agents may have an effect on the development of the immune system and on respiratory health later in life. In the present work we aimed to evaluate the associations between early life microbial exposures, and fractional exhaled nitric oxide (FeNO) at school age. Methods Endotoxin, extracellular polysaccharides (EPS) and β(1,3)-D-glucan were measured in living room dust collected at 2–3 months of age in homes of participants of three prospective European birth cohorts (LISA, n = 182; PIAMA, n = 244; and INMA, n = 355). Home dampness and pet ownership were periodically reported by the parents through questionnaires. FeNO was measured at age 8 for PIAMA and at age 10/11 for LISA and INMA. Cohort-specific associations between the indoor microbial exposures and FeNO were evaluated using multivariable regression analyses. Estimates were combined using random-effects meta-analyses. Results FeNO at school age was lower in children exposed to endotoxin at age 2–3 months (β -0.05, 95% confidence interval (CI) -0.10;-0.01) and in children with reported dog ownership during the first two years of life (GM ratio 0.82, CI 0.70-0.96). FeNO was not significantly associated with early life exposure to EPS, β(1,3)-D-glucan, indoor dampness and cat ownership. Conclusion Early life exposure to bacterial endotoxin and early life dog ownership are associated with lower FeNO at school age. Further studies are needed to confirm our results and to unravel the underlying mechanisms and possible clinical relevance of this finding. PMID:24295277

  1. Origin of cardiovascular risk in overweight preschool children: a cohort study of cardiometabolic risk factors at the onset of obesity.

    PubMed

    Shashaj, Blegina; Bedogni, Giorgio; Graziani, Maria P; Tozzi, Alberto E; DiCorpo, Maria L; Morano, Donatella; Tacconi, Ludovica; Veronelli, Patrizio; Contoli, Benedetta; Manco, Melania

    2014-10-01

    To date, the relationship among adiposity, insulin resistance, and cardiovascular risk factors at the onset of overweight or obesity has been unexplored. To assess whether insulin resistance and metabolic abnormalities are detectable at the onset of obesity and to unravel the interplay among adiposity, insulin resistance, and other such abnormalities. The Origin of Cardiovascular Risk in Overweight Preschool Children cohort study aimed to evaluate at the onset of obesity in preschool children the prevalence of metabolic abnormalities, including hypertension, dyslipidemia, impaired carbohydrate metabolism, and nonalcoholic fatty liver disease. Between July 1, 2011, and July 30, 2012, in the Rome municipality, 13 family pediatricians enrolled healthy children (age range, 2.0-5.8 years) in the study during their routine practice of growth monitoring. Clinical medical records of 5729 children were reviewed; 597 children manifested new-onset overweight or obesity as their body mass index changed from normal weight to overweight or obesity in the previous 12 months according to the International Obesity Task Force classification. Of them, 219 were studied. Patients with new-onset overweight or obesity underwent clinical laboratory testing, including oral glucose tolerance test, and ultrasonographic investigations of fatty liver and intimal medial thickness of the common carotid arteries, subcutaneous adipose tissue, and visceral adipose tissue. The homeostatic assessment model algorithm-insulin resistance was calculated. Among the entire population (n = 5729), overweight increased from 7.0% at 2.0 years to 16.9% at 5.8 years, with corresponding figures of 1.1% to 2.9% for obesity. In total, 597 overweight or obese children (10.4%) were identified, and 219 of them (36.7%) were studied. Among the latter, 86 patients (39.3%) had at least 1 metabolic abnormality. Hypertension was diagnosed in 29 patients (13.2%), dyslipidemia in 55 patients (25.1%), impaired fasting

  2. Similar bleeding phenotype in young children with haemophilia A or B: a cohort study.

    PubMed

    Clausen, N; Petrini, P; Claeyssens-Donadel, S; Gouw, S C; Liesner, R

    2014-11-01

    The bleeding phenotype has been suggested to differ between haemophilia A and B. More knowledge on the bleeding phenotype at initiation of treatment is important to optimize patient care. The aim of this study was to investigate the severity of the bleeding phenotype and the variation in bleeding in children with severe or moderate haemophilia A and B. Consecutive, previously untreated patients with severe or moderate haemophilia A and B (factor VIII or IX activity <0.01 or 0.01-0.05 IU mL(-1) respectively) born between January 1st 2000 and January 1st 2010 were included. Primary outcome was severity of bleeding tendency. Secondary outcome was variation in bleeding pattern. A total of 582 patients with severe haemophilia A and 76 with severe haemophilia B did not differ in age at first exposure to clotting factor (0.81 vs. 0.88 years, P = 0.20), age at first bleed (0.82 vs. 0.88 years, P = 0.36), and age at first joint bleed (1.18 vs. 1.20 years, P = 0.59). Patients with moderate haemophilia were older compared to patients with severe haemophilia. In patients with moderate haemophilia there were no clear differences between haemophilia A and B. Severity and variation in bleeding phenotype are similar during the early stage of treatment in patients with severe and moderate haemophilia A and B respectively. The findings imply that children with haemophilia B should be observed and treated as vigilantly as those with haemophilia A.

  3. Follow-up results of children with melamine induced urolithiasis: a prospective observational cohort study.

    PubMed

    Gao, Jian; Xu, Hong; Kuang, Xin-Yu; Huang, Wen-Yan; Zhao, Nai-Qing; Rao, Jia; Qian, Qiang-Ying; Cheng, Xian-Ying; Feng, Zhi-Min; Xu, Jing; Zhang, Xin; Wang, Xiang

    2011-08-01

    Melamine-contaminated milk powder was the cause of the 2008 outbreak of urolithiasis in young children and infants in China, but the prognosis of these children remains unknown. We hypothesized that urolithiasis induced by melamine-contaminated milk powder may be associated with secondary renal injury. A total of 8335 children (≤6 years old) with a history of consuming melamine-contaminated milk powder were screened. Urine analysis and urinary system ultrasonography were performed. For children with urolithiasis, the basic information and the results of examination were recorded, and effective therapy was given. They were followed up for 6 months after the original diagnosis, and urinary microprotein profiles were measured. Of the 8335 children, 105 (1.26%) were diagnosed with melamine-contaminated milk powder-associated urolithiasis. The size of the stone was correlated with the duration of exposure to melamine. Six months later, 69.8% (67) of the children with urolithiasis passed stones (follow-up rate: 91.4%). Of the 67 children, 28 passed stones within 2 months. The higher possibility of passing a stone was correlated with the smaller diameter of the stone (P<0.001). The detection rate of abnormal urinary microprotein excretion (microalbumin, immunoglobulin G, and N-acetyl-β-D-glucosidase) was 52.4% in children with persistent stones and 38.2% in those who passed their stones. The detection rate was lower in children who passed stones within 2 months (31.8%) than in those who passed stones in 2 to 6 months (50.0%). The levels of microalbumin/creatinine and immunoglobulin G/creatinine were significantly higher in children with persistent stones than in those who passed their stones. Early passage of a stone may reduce the renal injury induced by melamine-contaminated milk powder-associated urolithiasis.

  4. Playgroup Participation and Social Support Outcomes for Mothers of Young Children: A Longitudinal Cohort Study

    PubMed Central

    Hancock, Kirsten J.; Cunningham, Nadia K.; Lawrence, David; Zarb, David; Zubrick, Stephen R.

    2015-01-01

    Objective This study aimed to examine friendship networks and social support outcomes for mothers according to patterns of playgroup participation. Methods Data from the Longitudinal Study of Australian Children were used to examine the extent to which patterns of playgroup participation across the ages of 3–19 months (Wave 1) and 2–3 years (Wave 2) were associated with social support outcomes for mothers at Wave 3 (4–5 years) and four years later at Wave 5 (8–9 years). Analyses were adjusted for initial friendship attachments at Wave 1 and other socio-demographic characteristics. Results Log-binomial regression models estimating relative risks showed that mothers who never participated in a playgroup, or who participated at either Wave 1 or Wave 2 only, were 1.7 and 1.8 times as likely to report having no support from friends when the child was 4–5 years, and 2.0 times as likely to have no support at age 8–9 years, compared with mothers who persistently participated in playgroup at both Wave 1 and Wave 2. Conclusion These results provide evidence that persistent playgroup participation may acts as a protective factor against poor social support outcomes. Socially isolated parents may find playgroups a useful resource to build their social support networks. PMID:26181426

  5. Increase the risk of intellectual disability in children with scabies: A nationwide population-based cohort study.

    PubMed

    Liu, Jui-Ming; Hsu, Ren-Jun; Chang, Fung-Wei; Yeh, Chia-Lun; Huang, Chun-Fa; Chang, Shu-Ting; Chiu, Nan-Chang; Chang, Hung-Yang; Chi, Hsin; Lin, Chien-Yu

    2017-06-01

    Scabies is a common and distressing disease caused by the mite Sarcoptes scabiei var. hominis. Psychiatric disorder in childhood is an important disease and easily neglected. There are several similarities in scabies and psychiatric disorders in childhood (PDC). Both of them may present with pruritus. They are relatively common in patients with lower socioeconomic status and crowded environment. Furthermore, immune-mediated inflammatory processes play a role in the pathophysiology in both diseases. An association between scabies and psychiatric disorders may exist. This nationwide population-based cohort study utilized data from the National Health Insurance Research Database to investigate the relationship between scabies and PDC. A total of 2137 children with scabies were identified as the study group and 8548 age- and sex-matched children were selected as the control group. A total of 607 (5.68%) children developed PDC during the 7-year follow-up period. The overall incidences of PDC are similar but patients with scabies had a higher risk of developing intellectual disability (ID) (scabies group vs control group: 1.3% vs 0.6%, adjusted hazard ratio: 2.04 and 95% confidence interval: 1.25-3.32). The immune-mediated inflammatory processes of both diseases were reviewed and may contribute to the 104% increased risk of interleukin in patients with scabies. We suggest a more comprehensive management in treating patients with scabies or ID. Early and comprehensive treatment of scabies and other risk factors may decrease the risk of subsequent ID. When we approach patients with ID, concurrent evaluation of scabies and other risk factors may contribute to successful management.

  6. Prenatal Concentrations of Polychlorinated Biphenyls, DDE, and DDT and Overweight in Children: A Prospective Birth Cohort Study

    PubMed Central

    Mendez, Michelle A.; Martinez, David; Grimalt, Joan O.; Torrent, Maties; Sunyer, Jordi; Vrijheid, Martine

    2011-01-01

    Background: Recent experimental evidence suggests that prenatal exposure to endocrine-disrupting chemicals (EDCs) may increase postnatal obesity risk and that these effects may be sex or diet dependent. Objectives: We explored whether prenatal organochlorine compound (OC) concentrations [polychlorinated biphenyls (PCBs), dichlorodiphenyldichloroethylene (DDE), and dichlorodiphenyltrichloroethane (DDT)] were associated with overweight at 6.5 years of age and whether child sex or fat intakes modified these associations. Methods: We studied 344 children from a Spanish birth cohort established in 1997–1998. Overweight at 6.5 years was defined as a body mass index (BMI) z-score ≥ 85th percentile of the World Health Organization reference. Cord blood OC concentrations were measured and treated as categorical variables (tertiles). Children’s diet was assessed by food frequency questionnaire. Relative risks (RRs) were estimated using generalized linear models. Results: After multivariable adjustment, we found an increased RR of overweight in the third tertile of PCB exposure [RR = 1.70; 95% confidence interval (CI): 1.09, 2.64] and the second tertile of DDE exposure (RR = 1.67; 95% CI: 1.10, 2.55), but no association with DDT exposure in the population overall. Associations between overweight and PCB and DDE concentrations were strongest in girls (p-interaction between 0.01 and 0.28); DDT was associated with overweight only in boys. For DDT we observed stronger associations in children with fat intakes at or above compared with below the median, but this interaction was not significant (p-interaction > 0.05). Conclusions: This study suggests that prenatal OC exposures may be associated with overweight in children and that sex and high-fat intake may influence susceptibility. PMID:22027556

  7. Associations of plasma uric acid and purine metabolites with blood pressure in children: the KOALA Birth Cohort Study.

    PubMed

    Scheepers, Lieke E J M; Boonen, Annelies; Pijnenburg, Wieke; Bierau, Jörgen; Staessen, Jan A; Stehouwer, Coen D A; Thijs, Carel; Arts, Ilja C W

    2017-05-01

    Elevated serum uric acid concentration has been associated with high blood pressure (BP) and hypertension. A putative underlying mechanism is the accumulation of reactive oxygen species when uric acid is generated by an increased enzyme activity of xanthine oxidase (XO). The aims of the present study were to investigate the associations between plasma uric acid concentration, purine metabolite ratios, as proxies for increased XO activity, and SBP and DBP in school-age children. Cross-sectional analyses were performed in 246 children (46% boys; mean age 7.1 years) from the Dutch KOALA Birth Cohort Study. Purine metabolites were determined with ultra-performance liquid chromatography-tandem mass spectrometry. During a home visit, a nurse collected a blood sample and measured BP three times; in addition, parents measured their child's BP on three consecutive days, in the morning and evening. Generalized estimating equations were used for analyses while controlling for variables such as sex, age, BMI, physical activity, and dietary intake. In multivariable analysis, uric acid (per SD of 38 μmol/l) was associated with DBP z-scores [sβ 0.07; confidence interval (CI), 0.01-1.14], but not with SBP z-scores. Higher ratios of uric acid/xanthine (per SD of 138) (sβ 0.09; CI, 0.01-0.17) and xanthine/hypoxanthine (per SD of 321) (sβ 0.08; CI, 0.02-0.17) were associated with higher DBP z-scores, but not with SBP z-scores. In school-age children, uric acid and the ratios of uric acid/xanthine and xanthine/hypoxanthine were significantly associated with DBP z-scores. Suggesting that, both uric acid concentration and increased XO activity are associated with BP.

  8. Maternal depressive symptoms not associated with reduced height in young children in a US prospective cohort study.

    PubMed

    Ertel, Karen A; Koenen, Karestan C; Rich-Edwards, Janet W; Gillman, Matthew W

    2010-10-27

    Shorter stature is associated with greater all cause and heart disease mortality, but taller stature with increased risk of cancer mortality. Though childhood environment is important in determining height, limited data address how maternal depression affects linear growth in children. We examined the relationships between antenatal and postpartum depressive symptoms and child height and linear growth from birth to age 3 years in a U.S. sample. Subjects were 872 mother-child pairs in Project Viva, a prospective pre-birth cohort study. The study population is relatively advantaged with high levels of income and education and low risk of food insecurity. We assessed maternal depression at mid-pregnancy (mean 28 weeks' gestation) and 6 months postpartum with the Edinburgh Postnatal Depression Scale (score > = 13 on 0-30 scale indicating probable depression). Child outcomes at age 3 were height-for-age z-score (HAZ) and leg length. HAZ was also available at birth and ages 6 months, 1, 2, and 3 years. Seventy (8.0%) women experienced antenatal depression and 64 (7.3%) experienced postpartum depression. The mean (SD) height for children age 3 was 97.2 cm (4.2), with leg length of 41.6 cm (2.6). In multivariable linear regression models, exposure to postpartum depression was associated with greater HAZ (0.37 [95% confidence interval: 0.16, 0.58]) and longer leg length (0.88 cm [0.35, 1.41]). The relationship between postpartum depression and greater HAZ was evident starting at 6 months and continued to age 3. We found minimal relationships between antenatal depression and child height outcomes. Our findings do not support the hypothesis that maternal depression is associated with reduced height in children in this relatively advantaged sample in a high-income country.

  9. Parental educational level and injury incidence and mortality among foreign-born children: a cohort study with 46 years follow-up.

    PubMed

    Beiki, Omid; Karimi, Najmeh; Mohammadi, Reza

    2014-01-01

    Injury risk during childhood and adolescence vary depending on socio-economic factors. The aim of this study was to study if the risk of fatal and non-fatal unintentional injuries among foreign-born children was similar across parental educational level or not. In this retrospective cohort study we followed 907,335 children between 1961 and 2007 in Sweden. We established the cohort by linkage between Swedish national registers including cause of death register and in-patient register, through unique Personal Identification Numbers. The main exposure variable was parental (maternal and paternal) educational level. The cohorts was followed from start date of follow-up period, or date of birth whichever occurred last, until exit date from the cohort, which was date of hospitalization or death due to unintentional injury, first emigration, death due to other causes than injury or end of follow-up, whichever came first. We calculated hazard ratios (HR) with 95% confidence intervals (95% CI) by Cox proportional hazards regression models. Overall, we found 705 and 78,182 cases of death and hospitalization due to unintentional injuries, respectively. Risk of death and hospitalization due to unintentional injuries was statistically significantly 1.48 (95% CI: 1.24-1.78) and 1.10 (95% CI: 1.08-1.12) times higher among children with lowest parental educational level (9 years and shorter years of study) compared to children with highest parental educational level (+13 years of study). We found similar results when stratified our study group by sex of children, by maternal and paternal educational level separately, and injury type (traffic-related, fall, poisoning, burn and drowning). It seems injury prevention work against unintentional injuries is less effective among children with low parental education compared with those with higher parental education. We recommend designing specific preventive interventions aiming at children with low parental education. © 2014 KUMS, All

  10. Risk of death among children of atomic bomb survivors after 62 years of follow-up: a cohort study.

    PubMed

    Grant, Eric J; Furukawa, Kyoji; Sakata, Ritsu; Sugiyama, Hiromi; Sadakane, Atsuko; Takahashi, Ikuno; Utada, Mai; Shimizu, Yukiko; Ozasa, Kotaro

    2015-10-01

    No clear epidemiological hereditary effects of radiation exposure in human beings have been reported. However, no previous studies have investigated mortality into middle age in a population whose parents were exposed to substantial amounts of radiation before conception. We assessed mortality in children of the atomic bomb survivors after 62 years of follow-up. In this prospective cohort study, we assessed 75 327 singleton children of atomic bomb survivors in Hiroshima and Nagasaki and unexposed controls, born between 1946 and 1984, and followed up to Dec 31, 2009. Parental gonadal doses of radiation from the atomic bombings were the primary exposures. The primary endpoint was death due to cancer or non-cancer disease, based on death certificates. Median follow-up was 54·3 years (IQR 45·4-59·3). 5183 participants died from disease. The mean age of the 68 689 surviving children at the end of follow-up was 53·1 years (SD 7·9) with 15 623 (23%) older than age 60 years. For parents who were exposed to a non-zero gonadal dose of radiation, the mean dose was 264 mGy (SD 463). We detected no association between maternal gonadal radiation exposure and risk of death caused by cancer (hazard ratio [HR] for 1 Gy change in exposure 0·891 [95% CI 0·693-1·145]; p=0·36) or risk of death caused by non-cancer diseases (0·973 [0·849-1·115]; p=0·69). Likewise, paternal exposure had no effect on deaths caused by cancer (0·815 [0·614-1·083]; p=0·14) or deaths caused by non-cancer disease (1·103 [0·979-1·241]; p=0·12). Age or time between parental exposure and delivery had no effect on risk of death. Late effects of ionising radiation exposure include increased mortality risks, and models of the transgenerational effects of radiation exposure predict more genetic disease in the children of people exposed to radiation. However, children of people exposed to the atomic bombs in Hiroshima and Nagasaki had no indications of deleterious health effects after 62

  11. Seasonal variation of diseases in children: a 6-year prospective cohort study in a general hospital.

    PubMed

    Schrijver, Tessa V; Brand, Paul L P; Bekhof, Jolita

    2016-04-01

    Seasonal variation in pediatrics has been well described in some infectious diseases, asthma, and diabetes, but data on seasonality for other diseases in children are sparse. To explore the extent of seasonal variation of the entire pediatric field, we analyzed diagnostic codes of all newly referred patients (n = 51,054) to our pediatric department of a large teaching hospital in the Netherlands over a 6-year period (2008-2013). Seasonality was analyzed using simple moving averages, the standard error of the mean (SEM) and the percentage monthly variation. We defined seasonal variation as a visually recognizable periodic pattern in every year in combination with a standard error of the mean > 0.20. Four diseases fulfilled our definition of seasonality: respiratory tract infections (peak in January, +107.0 %), gastroenteritis (peak in February-March, +95.8 % and +112.9 %, respectively), functional complaints (peak in March, +34.0 %, and November, +13.4 %), and asthma (peak in March, +27.8 %, and October, +17.5 %). Together, these four categories comprised 21.2 % of all newly referred patients. Seasonal variation occurs in more than one fifth of all patients with pediatric disease. We demonstrated not only seasonal variation for respiratory tract infections, gastroenteritis, and asthma, but also for functional complaints. • Seasonal variation has been described for pediatric diseases such as bronchiolitis, gastroenteritis, asthma, and diabetes. • Information on seasonality in other pediatric fields is sparse but may be helpful in understanding pathophysiology and workforce planning. What is new: • This study confirmed seasonal variation in respiratory infection diseases gastroenteritis and asthma. • Moreover, it showed seasonal variation for functional complaints for example (abdominal pain and headache), which has not been described previously.

  12. Antibiotic Prophylaxis to Prevent Surgical Site Infections in Children: A Prospective Cohort Study.

    PubMed

    Khoshbin, Amir; So, Jeannette P; Aleem, Ilyas S; Stephens, Derek; Matlow, Anne G; Wright, James G

    2015-08-01

    To investigate the association between antibiotic prophylaxis (AP) and surgical-site infection in pediatric patients. Surgical-site infections (SSIs) are a major cause of postoperative morbidity and mortality. Despite numerous studies in adults, benefit of AP in preventing SSIs in children is uncertain. Patients aged 0 to 21 years who underwent surgical procedures at a pediatric acute care hospital from April 1, 2009, to December 31, 2010, were assessed. Antibiotic prophylaxis indication and administration according to an evidence-based guideline were recorded. Complete compliance was defined as AP given, when indicated, within 60 minutes before incision. Surgical-site infections were identified using the Centers for Disease Control and Prevention criteria and documented in the medical records using the International Classification of Diseases, Tenth Revision. Multiple logistic regressions adjusting for age, sex, American Society of Anesthesiologists status, wound classification, admission status, surgical discipline, and surgical duration evaluated association of AP compliance and SSI. Of 5309 patients for whom antibiotics were indicated, 3901 (73.5%) with complete compliance had an infection rate of 3.0%, whereas 1408 (26.5%) who were not compliant had an infection rate of 4.3% (adjusted relative risk: 0.7; 95% confidence interval: 0.5-0.9; P = 0.02). Of 4156 patients for whom antibiotics were not indicated, the 895 (21.5%) who received antibiotics had an infection rate of 1.7% compared with 0.7% in the 3261 (78.5%) who did not receive antibiotics (adjusted relative risk: 1.6; 95% confidence interval: 0.8-3.1; P = 0.18). In pediatric surgery, complete compliance with AP was associated with 30% decreased risk of SSI.

  13. Neuropsychological outcome of children with traumatic brain injury and its association with late magnetic resonance imaging findings: A cohort study.

    PubMed

    Volpe, Daniele S J; Oliveira, Nátali C A C; Santos, A Carlos; Linhares, Maria B M; Carlotti, Ana P C P

    2017-09-05

    To evaluate neuropsychological outcome after traumatic brain injury (TBI) and its association with trauma severity and late magnetic resonance imaging (MRI) findings. Prospective cohort study of patients with TBI admitted to the paediatric intensive care unit over 5 years. Trauma severity was determined by Glasgow Coma Scale (GCS), neurological outcome by King's Outcome Scale for Childhood Head Injury (KOSCHI) and neuropsychological outcome by Wechsler Intelligence Scale for Children - Fourth Edition. Twenty-five children (median age 6 years at trauma) were included. Patients were divided into Disability (DIS)(n = 10) and Good Recovery (GR)(n = 15) groups. Initial GCS score was not significantly different in both groups (median 6 vs. 10; p = 0.34). DIS group had lower values ​​of working memory index (WMI)(median 74 vs. 94; p = 0.004), perceptual reasoning index (PRI)(75 vs. 96; p = 0.03), verbal comprehension index (VCI)(65 vs. 84; p = 0.02), processing speed index (PSI)(74 vs. 97; p = 0.01) and full-scale intelligence quotient (FSIQ)(65 vs. 87; p = 0.008). In the GR group, 60% of patients had normal or minimally altered MRI versus 10% of patients in the DIS group (p = 0.018). Fractional anisotropy positively correlated with WMI(r = 0.65; p = 0.005), PRI(r = 0.52; p = 0.03) and FSIQ(r = 0.50; p = 0.04). Neuropsychological impairment was observed in 40% of children who suffered a TBI and was associated with late MRI abnormalities.

  14. Traffic-related air pollution and noise and children's blood pressure: results from the PIAMA birth cohort study.

    PubMed

    Bilenko, Natalya; van Rossem, Lenie; Brunekreef, Bert; Beelen, Rob; Eeftens, Marloes; Hoek, Gerard; Houthuijs, Danny; de Jongste, Johan C; van Kempen, Elise; Koppelman, Gerard H; Meliefste, Kees; Oldenwening, Marieke; Smit, Henriette A; Wijga, Alet H; Gehring, Ulrike

    2015-01-01

    Elevation of a child's blood pressure may cause possible health risks in later life. There is evidence for adverse effects of exposure to air pollution and noise on blood pressure in adults. Little is known about these associations in children. We investigated the associations of air pollution and noise exposure with blood pressure in 12-year-olds. Blood pressure was measured at age 12 years in 1432 participants of the PIAMA birth cohort study. Annual average exposure to traffic-related air pollution [NO2, mass concentrations of particulate matter with diameters of less than 2.5 µm (PM2.5) and less than 10 µm (PM10), and PM2.5 absorbance] at the participants' home and school addresses at the time of blood pressure measurements was estimated by land-use regression models. Air pollution exposure on the days preceding blood pressure measurements was estimated from routine air monitoring data. Long-term noise exposure was assessed by linking addresses to modelled equivalent road traffic noise levels. Associations of exposures with blood pressure were analysed by linear regression. Effects are presented for an interquartile range increase in exposure. Long-term exposure to NO2 and PM2.5 absorbance were associated with increased diastolic blood pressure, in children who lived at the same address since birth [adjusted mean difference (95% confidence interval) [mmHg] 0.83 (0.06 to 1.61) and 0.75 (-0.08 to 1.58), respectively], but not with systolic blood pressure. We found no association of blood pressure with short-term air pollution or noise exposure. Long-term exposure to traffic-related air pollution may increase diastolic blood pressure in children. © The European Society of Cardiology 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  15. Anthroposophic therapy for children with chronic disease: a two-year prospective cohort study in routine outpatient settings

    PubMed Central

    Hamre, Harald J; Witt, Claudia M; Kienle, Gunver S; Meinecke, Christoph; Glockmann, Anja; Willich, Stefan N; Kiene, Helmut

    2009-01-01

    Background Many children with chronic disease use complementary therapies. Anthroposophic treatment for paediatric chronic disease is provided by physicians and differs from conventional treatment in the use of special therapies (art therapy, eurythmy movement exercises, rhythmical massage therapy) and special medications. We studied clinical outcomes in children with chronic diseases under anthroposophic treatment in routine outpatient settings. Methods In conjunction with a health benefit program, consecutive outpatients starting anthroposophic treatment for any chronic disease participated in a prospective cohort study. Main outcome was disease severity (Disease and Symptom Scores, physicians' and caregivers' assessment on numerical rating scales 0–10). Disease Score was documented after 0, 6, and 12 months, Symptom Score after 0, 3, 6, 12, 18, and 24 months. Results A total of 435 patients were included. Mean age was 8.2 years (standard deviation 3.3, range 1.0–16.9 years). Most common indications were mental disorders (46.2% of patients; primarily hyperkinetic, emotional, and developmental disorders), respiratory disorders (14.0%), and neurological disorders (5.7%). Median disease duration at baseline was 3.0 years (interquartile range 1.0–5.0 years). The anthroposophic treatment modalities used were medications (69.2% of patients), eurythmy therapy (54.7%), art therapy (11.3%), and rhythmical massage therapy (6.7%). Median number of eurythmy/art/massage therapy sessions was 12 (interquartile range 10–20), median therapy duration was 118 days (interquartile range 78–189 days). From baseline to six-month follow-up, Disease Score improved by average 3.00 points (95% confidence interval 2.76–3.24 points, p < 0.001) and Symptom Score improved by 2.41 points (95% confidence interval 2.16–2.66 points, p < 0.001). These improvements were maintained until the last follow-up. Symptom Score improved similarly in patients not using adjunctive non

  16. Anthroposophic therapy for children with chronic disease: a two-year prospective cohort study in routine outpatient settings.

    PubMed

    Hamre, Harald J; Witt, Claudia M; Kienle, Gunver S; Meinecke, Christoph; Glockmann, Anja; Willich, Stefan N; Kiene, Helmut

    2009-06-19

    Many children with chronic disease use complementary therapies. Anthroposophic treatment for paediatric chronic disease is provided by physicians and differs from conventional treatment in the use of special therapies (art therapy, eurythmy movement exercises, rhythmical massage therapy) and special medications. We studied clinical outcomes in children with chronic diseases under anthroposophic treatment in routine outpatient settings. In conjunction with a health benefit program, consecutive outpatients starting anthroposophic treatment for any chronic disease participated in a prospective cohort study. Main outcome was disease severity (Disease and Symptom Scores, physicians' and caregivers' assessment on numerical rating scales 0-10). Disease Score was documented after 0, 6, and 12 months, Symptom Score after 0, 3, 6, 12, 18, and 24 months. A total of 435 patients were included. Mean age was 8.2 years (standard deviation 3.3, range 1.0-16.9 years). Most common indications were mental disorders (46.2% of patients; primarily hyperkinetic, emotional, and developmental disorders), respiratory disorders (14.0%), and neurological disorders (5.7%). Median disease duration at baseline was 3.0 years (interquartile range 1.0-5.0 years). The anthroposophic treatment modalities used were medications (69.2% of patients), eurythmy therapy (54.7%), art therapy (11.3%), and rhythmical massage therapy (6.7%). Median number of eurythmy/art/massage therapy sessions was 12 (interquartile range 10-20), median therapy duration was 118 days (interquartile range 78-189 days).From baseline to six-month follow-up, Disease Score improved by average 3.00 points (95% confidence interval 2.76-3.24 points, p < 0.001) and Symptom Score improved by 2.41 points (95% confidence interval 2.16-2.66 points, p < 0.001). These improvements were maintained until the last follow-up. Symptom Score improved similarly in patients not using adjunctive non-anthroposophic therapies within the first six study

  17. Evaluating the Predictive Impact of an Emergent Literacy Model on Dyslexia in Italian Children: A Four-Year Prospective Cohort Study.

    PubMed

    Bigozzi, Lucia; Tarchi, Christian; Pezzica, Sara; Pinto, Giuliana

    2016-01-01

    The strong differences in manifestation, prevalence, and incidence in dyslexia across languages invite studies in specific writing systems. In particular, the question of the role played by emergent literacy in opaque and transparent writing systems remains a fraught one. This research project tested, through a 4-year prospective cohort study, an emergent literacy model for the analysis of the characteristics of future dyslexic children and normally reading peers in Italian, a transparent writing system. A cohort of 450 children was followed from the last year of kindergarten to the third grade in their reading acquisition process. Dyslexic children were individuated (Grade 3), and their performances in kindergarten in textual competence, phonological awareness, and conceptual knowledge of the writing system were compared with a matched group of normally reading peers. Results showed the predictive relevance of the conceptual knowledge of the writing system. The study's implications are discussed. © Hammill Institute on Disabilities 2014.

  18. Trends in Depression and Antidepressant Prescribing in Children and Adolescents: A Cohort Study in The Health Improvement Network (THIN)

    PubMed Central

    Wijlaars, Linda P. M. M.; Nazareth, Irwin; Petersen, Irene

    2012-01-01

    Background In 2003, the Committee on Safety of Medicines (CSM) advised against treatment with selective serotonin reuptake inhibitors (SSRIs) other than fluoxetine in children, due to a possible increased risk of suicidal behaviour. This study examined the effects of this safety warning on general practitioners' depression diagnosing and prescription behaviour in children. Methods and Findings We identified a cohort of 1,502,753 children (<18 y; registered with GP for >6 m) in The Health Improvement Network (THIN) UK primary care database. Trends in incidence of depression diagnoses, symptoms and antidepressant prescribing were examined 1995–2009, accounting for deprivation, age and gender. We used segmented regression analysis to assess changes in prescription rates. Overall, 45,723 (3%) children had ≥1 depression-related entry in their clinical records. SSRIs were prescribed to 16,925 (1%) of children. SSRI prescription rates decreased from 3.2 (95%CI:3.0,3.3) per 1,000 person-years at risk (PYAR) in 2002 to 1.7 (95%CI:1.7,1.8) per 1,000 PYAR in 2005, but have since risen to 2.7 (95%CI:2.6,2.8) per 1,000 PYAR in 2009. Prescription rates for CSM-contraindicated SSRIs citalopram, sertraline and especially paroxetine dropped dramatically after 2002, while rates for fluoxetine and amitriptyline remained stable. After 2005 rates for all antidepressants, except paroxetine and imipramine, started to rise again. Rates for depression diagnoses dropped from 3.0 (95%CI:2.8,3.1) per 1,000 PYAR in 2002 to 2.0 (95%CI:1.9,2.1) per 1,000 PYAR in 2005 and have been stable since. Recording of symptoms saw a steady increase from 1.0 (95%CI:0.8,1.2) per 1,000 PYAR in 1995 to 4.7 (95%CI:4.5,4.8) per 1,000 PYAR in 2009. Conclusions The rates of depression diagnoses and SSRI prescriptions showed a significant drop around the time of the CSM advice, which was not present in the recording of symptoms. This could indicate caution on the part of GPs in making depression diagnoses and

  19. Psychosocial adjustment in perinatally human immunodeficiency virus infected or exposed children – a Retrospective Cohort Study

    PubMed Central

    Zalwango, Sarah K; Kizza, Florence N; Nkwata, Allan K; Sekandi, Juliet N; Kakaire, Robert; Kiwanuka, Noah; Whalen, Christopher C; Ezeamama, Amara E

    2016-01-01

    Objective To determine whether perinatal HIV infection and exposure adversely affected psychosocial adjustment (PA) between 6 and 18 years of life (i.e. during school-age and adolescence). Methods We enrolled 58 perinatally HIV-infected, 56 HIV-exposed uninfected and 54 unexposed controls from Kampala, Uganda. Perinatal HIV status was determined by 18 months of age using a DNA-polymerase chain-reaction test and was confirmed via HIV rapid diagnostic test at psychosocial testing when the children were 6 to 18 years old. Five indicators of PA (depressive symptoms, distress, hopelessness, positive future orientation and esteem) were measured using validated, culturally adapted and translated instruments. Multivariable linear regression analyses estimated HIV-status-related percent differences (β) in PA indicators and corresponding 95% confidence intervals (CIs). Results During school-age and adolescence, positive outlook (β=−3.8, 95% CI: −7.2, −0.1) and self-esteem (β=−4.3, 95% CI: −6.7, −1.8) scores were significantly lower, whereas depressive (β=11.4, 95% CI: 3.3, 19.5) and distress (β=12.3, 95% CI: 5.9, 18.7) symptoms were elevated for perinatally HIV-infected, compared to unexposed controls and exposed uninfected children. Similarly, positive outlook (β=−4.3, 95% CI: −7.3, −1.2) and self-esteem were lower for exposed controls versus HIV-unexposed children. Hopelessness was similar by perinatal HIV status. Likewise, the distress and depressive symptom levels were comparable for HIV-exposed uninfected and HIV-unexposed children. Conclusions Perinatal HIV infection predicted higher distress and depressive symptoms, while HIV-affected status (infection/exposure) predicted low self-esteem and diminished positive outlook in the long term. However, HIV-affected status had no impact on hopelessness, suggesting that psychosocial interventions as an integral component of HIV care for infected children or primary care exposed uninfected children may

  20. Effect of long-term Helicobacter pylori infection on growth of children: a cohort study.

    PubMed

    Kocaoglu, Celebi; Ozel, Ahmet; Cayci, Mustafa; Solak, Ece Selma

    2016-05-01

    The effects of Helicobacter pylori (H. pylori) infection on growth are a controversial issue. We investigated the effects of long-term H. pylori infection on height and weight in children. A total of 200 children of 7-18 years old suffering from dyspeptic complaints were classified into two groups: H. pylori positive and negative groups, respectively. Whether the infection was impoved was followed up while performing urea breath test, and according to exposure time to the infection, the children were further divided into group 1 (≤1.5 months), group 2 (>1.5-≤6 months) and group 3 (>6 months). Antropometric measurements were obtained and repeated every six months. Mean growth velocity scores in the H. pylori positive and negative groups were 0.49±3.85 [95% confidence interval (CI): -0.21-1.18] and 1.98±4.42 (95% CI: 1-2.96), respectively. The difference between both groups was statistically significant (P=0.012). Mean growth velocity scores in groups 1, 2 and 3 were 0.96±3.84, 0.16±4.51 and -0.85±3.09, respectively. Mean growth velocity scores of group 3 were significantly lower than those of groups 0 and 1 (P=0.005 and P=0.041). The mean weight scores in group 3 were similar to those in group 2, but the scores in group 3 were significantly lower than those in group 1 (-1.75±1.05, -1.21±1.37 and -0.88±1.49, respectively). As the duration of exposure is prolonged in children with H. pylori infection, the negative effect of the infection on both height and weight is evident.

  1. Caesarean delivery, caesarean delivery on maternal request and childhood overweight: a Chinese birth cohort study of 181 380 children.

    PubMed

    Li, H; Ye, R; Pei, L; Ren, A; Zheng, X; Liu, J

    2014-02-01

    What is already known about this subject Both rates of caesarean section and childhood overweight have been steadily increasing over the past decade in many parts of the world. Caesarean delivery on maternal request contributes remarkably to the rising trend of caesarean births. A few small-scale studies suggest that caesarean section may be associated with later overweight and obesity, whereas little is known about the impact of caesarean delivery on maternal request. What this study adds Caesarean section is associated with an increased risk of childhood overweight. Children born by caesarean delivery on maternal request are also more likely to be overweight. The strength of the caesarean-overweight association is modest. To assess the impact of caesarean delivery including non-medically indicated maternal request caesarean delivery on childhood overweight. We conducted a prospective investigation of a Chinese birth cohort involving 181 380 children, who were born during 1993-1996 to mothers registered in a perinatal care surveillance system and whose weight and height were measured in 2000. Information on delivery mode and covariates was obtained from the surveillance system. Overweight was defined according to the International Obesity Task Force body mass index (BMI) cutoffs. Multivariable logistic regression was used to estimate adjusted odds ratios. Stratified analyses were done to test whether the association between caesarean section and overweight persisted across subgroups. The adjusted odds ratio of overweight for children born by caesarean compared with vaginal delivery was 1.13 [95% confidence interval {CI}: 1.08, 1.18]. The association persisted in subgroups stratified by gender, maternal education, maternal BMI, weight gain during pregnancy and child birthweight (all P values for interaction test ≥0.30). The adjusted odds ratio of overweight for children born by non-medically indicated caesarean delivery compared with vaginal delivery was 1

  2. State of personal hygiene among primary school children: A community based cohort study.

    PubMed

    Ahmadu, Baba Usman; Rimamchika, Musa; Ibrahim, Ahmad; Nnanubumom, Andy Angela; Godiya, Andrew; Emmanuel, Pembi

    2013-01-01

    Good personal hygiene in primary school children could be effective towards preventing infectious diseases. This work examined personal cleanliness of primary school children in Banki based on the following variables: bathing, state of uniforms, hair, nails and oral hygiene. One hundred and fifty primary school children in Banki community were selected using the cluster random sampling method. Analysis of variance was used to compare means and to test for significance of data, and coefficient of correlation to investigate the relationship between cleanliness and age of subjects. There were 87 (58 %) boys and 63 (42 %) girls in a ratio of 1.4:1. Ninety six (64 %) pupils belong to low socioeconomic class. Whereas, 53 (35.3 %) were found within 11-13 years age group, the overall mean age was 9 years (Standard deviation [SD] was 2.2), 95 CI (7.0 - 11.0) years. Comparing means for the different categories of personal hygiene, there was significant difference (F= 61.47, p < 0.0001). General personal cleanliness in our participants improved with age, and a positive significant correlation was observed between age and personal cleanliness in (r = 0.971, p = 0.026). In conclusion, significant number of primary school pupils in Banki community had good personal hygiene, which was observed to be directly proportional with age. Therefore, all efforts towards quality health education on personal hygiene as a means of primary prevention of illnesses in primary school pupils should be sustained.

  3. Moderators of the longitudinal relationship between the perceived physical environment and outside play in children: the KOALA birth cohort study.

    PubMed

    Remmers, Teun; Van Kann, Dave; Gubbels, Jessica; Schmidt, Swantje; de Vries, Sanne; Ettema, Dick; Kremers, Stef P J; Thijs, Carel

    2014-12-12

    Promoting unstructured outside play is a promising vehicle to increase children's physical activity (PA). This study investigates if factors of the social environment moderate the relationship between the perceived physical environment and outside play. 1875 parents from the KOALA Birth Cohort Study reported on their child's outside play around age five years, and 1516 parents around age seven years. Linear mixed model analyses were performed to evaluate (moderating) relationships among factors of the social environment (parenting influences and social capital), the perceived physical environment, and outside play at age five and seven. Season was entered as a random factor in these analyses. Accessibility of PA facilities, positive parental attitude towards PA and social capital were associated with more outside play, while parental concern and restriction of screen time were related with less outside play. We found two significant interactions; both involving parent perceived responsibility towards child PA participation. Although we found a limited number of interactions, this study demonstrated that the impact of the perceived physical environment may differ across levels of parent responsibility.

  4. Birth cohort study on the effects of desert dust exposure on children's health: protocol of an adjunct study of the Japan Environment & Children’s Study

    PubMed Central

    Kanatani, Kumiko T; Adachi, Yuichi; Sugimoto, Nobuo; Noma, Hisashi; Onishi, Kazunari; Hamazaki, Kei; Takahashi, Yoshimitsu; Ito, Isao; Egawa, Miho; Sato, Keiko; Go, Tohshin; Kurozawa, Youichi; Inadera, Hidekuni; Konishi, Ikuo; Nakayama, Takeo

    2014-01-01

    Introduction Desert dust is estimated to constitute about 35% of aerosol in the troposphere. Desertification, climatic variability and global warming all can contribute to increased dust formation. This study aims to examine possible health effects of desert dust exposure on pregnant women and their children. The purpose of this report was to present the study protocol. Methods and analysis This 4-year birth cohort study began in 2011 as an adjunct study of the Japan Environment & Children’s Study (JECS) involving three regions: Kyoto, Toyama and Tottori. The JECS participants of the three regions above who also agreed to participate in this adjunct study were enrolled prior to delivery. Light Detecting and Ranging (LIDAR) with a polarisation analyser, which can distinguish mineral dust particles from other particles, is used for exposure measurements. Outcomes are allergic symptoms for mothers and development of asthma and other allergic or respiratory diseases for their children. Data are acquired in a timely manner by connecting local LIDAR equipment to an online questionnaire system. Participants answer the online questionnaire using mobile phones or personal computers. Ethics and dissemination The study protocol was approved by the ethics committees of Kyoto University, University of Toyama and Tottori University. All participants provided written informed consent. The results of this study will be published in peer-reviewed journals and disseminated to the scientific community and general public. Trial Registration number UMIN000010826. PMID:24958210

  5. Do positive children become positive adults? Evidence from a longitudinal birth cohort study

    PubMed Central

    Richards, Marcus; Huppert, Felicia A

    2012-01-01

    Background Little is known about the long-term consequences of positive wellbeing in childhood in the general population. We used the MRC National Survey of Health and Development (the British 1946 birth cohort) to test associations between adolescent positive wellbeing and social functioning in midlife. Method Temperament and behaviour at ages 13 and 15 years were rated by school teachers on a range of criteria. These mostly referred to absence or presence of conduct and emotional problems, but four items allowed positive ratings: ‘very popular with other children’, ‘unusually happy and contented’, ‘makes friends extremely easily’ and ‘extremely energetic, never tired’. In addition, at age 16 years survey members self-completed the Maudsley Personality Inventory, from which a summary measure of extraversion was derived, as this was previously found to be associated with midlife positive wellbeing in this cohort. Results Being a happy child, defined as receiving at least two of the above teacher ratings, was positively associated with midlife functioning and wellbeing, specifically a low probability of lifetime emotional problems, a high frequency of contact with friends or relatives, engagement in social activities, and to a lesser extent feeling satisfied with accomplishments in working life. These associations were independent of father’s social class, childhood cognition, educational attainment, and midlife occupational social class. There were no independent associations between being a happy child and educational or occupational attainment, being married, engagement in prosocial activities, taking leadership in community activities, and with life satisfaction in general or with family life. Extraversion was associated with a low probability of lifetime emotional problems, high engagement in social activities, being married, general midlife life satisfaction, and satisfaction with family life, but not with social contact, prosocial activity

  6. Cesarean section and increased body mass index in school children: two cohort studies from distinct socioeconomic background areas in Brazil

    PubMed Central

    2013-01-01

    Background Recent studies have raised controversy regarding the association between cesarean section and later obesity in the offspring. The purpose of this study was to assess the association of cesarean section with increased body mass index (BMI) and obesity in school children from two Brazilian cities with distinct socioeconomic backgrounds. Methods Two birth cohorts respectively born in 1994 in Ribeirao Preto, a wealthy city in Southeast, and in 1997/98 in Sao Luis, a less wealthy city in Northeast of Brasil, were evaluated. After birth, 2,846 pairs of mothers-newborns were evaluated in Ribeirao Preto and 2,542 in Sao Luis. In 2004/05, 790 children aged 10/11 years were randomly reassessed in Ribeirao Preto and 673 at 7/9 years in Sao Luis. Information on type of delivery, maternal and child characteristics, socioeconomic position and anthropometric measurements were collected after birth and at school age. Obesity was defined as BMI ≥ 95th percentile at school age. Results Obesity rate was 13.0% in Ribeirao Preto and 2.1% in Sao Luis. Cesarean section was associated with obesity and remained significant after adjustment only in Ribeirao Preto [OR = 1.74 (95% CI: 1.04; 2.92)]. The association between cesarean section and BMI remained significant after adjustment for maternal schooling, maternal smoking during pregnancy, duration of breastfeeding, gender, birth weight and gestational age, type of school and, only in Sao Luis, pre-pregnancy maternal weight. In Ribeirao Preto children born by cesarean section had BMI 0.31 kg/m2 (95%CI: 0.11; 0.51) higher than those born by vaginal delivery. In Sao Luis BMI of children born by cesarean section was 0.28 kg/m2 higher (95%CI: 0.08; 0.49) than those born by vaginal delivery. Conclusion A positive association between cesarean section and increased BMI z-score was demonstrated in areas with different socioeconomic status in a middle-income country. PMID:23886115

  7. Assessment of cardiometabolic risk in children in population studies: underpinning developmental origins of health and disease mother-offspring cohort studies.

    PubMed

    Huang, R-C; Prescott, Susan L; Godfrey, Keith M; Davis, Elizabeth A

    2015-01-01

    Pregnancy and birth cohorts have been utilised extensively to investigate the developmental origins of health and disease, particularly in relation to understanding the aetiology of obesity and related cardiometabolic disorders. Birth and pregnancy cohorts have been utilised extensively to investigate this area of research. The aim of the present review was twofold: first to outline the necessity of measuring cardiometabolic risk in children; and second to outline how it can be assessed. The major outcomes thought to have an important developmental component are CVD, insulin resistance and related metabolic outcomes. Conditions such as the metabolic syndrome, type 2 diabetes and CHD all tend to have peak prevalence in middle-aged and older individuals but assessments of cardiometabolic risk in childhood and adolescence are important to define early causal factors and characterise preventive measures. Typically, researchers investigating prospective cohort studies have relied on the thesis that cardiovascular risk factors, such as dyslipidaemia, hypertension and obesity, track from childhood into adult life. The present review summarises some of the evidence that these factors, when measured in childhood, may be of value in assessing the risk of adult cardiometabolic disease, and as such proceeds to describe some of the methods for assessing cardiometabolic risk in children.

  8. The TARGET cohort study protocol: a prospective primary care cohort study to derive and validate a clinical prediction rule to improve the targeting of antibiotics in children with respiratory tract illnesses

    PubMed Central

    2013-01-01

    Background Children with respiratory tract infections are the single most frequent patient group to make use of primary care health care resources. The use of antibiotics remains highly prevalent in young children, but can lead to antimicrobial resistance as well as reinforcing the idea that parents should re-consult for similar symptoms. One of the main drivers of indiscriminate antimicrobial use is the lack of evidence for, and therefore uncertainty regarding, which children are at risk of poor outcome. This paper describes the protocol for the TARGET cohort study, which aims to derive and validate a clinical prediction rule to identify children presenting to primary care with respiratory tract infections who are at risk of hospitalisation. Methods/design The TARGET cohort study is a large, multicentre prospective observational study aiming to recruit 8,300 children aged ≥3 months and <16 years presenting to primary care with a cough and respiratory tract infection symptoms from 4 study centres (Bristol, London, Oxford and Southampton). Following informed consent, symptoms, signs and demographics will be measured. In around a quarter of children from the Bristol centre, a single sweep, dual bacterial-viral throat swab will be taken and parents asked to complete a symptom diary until the child is completely well or for 28 days, whichever is sooner. A review of medical notes including clinical history, re-consultation and hospitalisations will be undertaken. Multivariable logistic regression will be used to identify the independent clinical predictors of hospitalisation as well as the prognostic significance of upper respiratory tract microbes. The clinical prediction rule will be internally validated using various methods including bootstrapping. Discussion The clinical prediction rule for hospitalisation has the potential to help identify a small group of children for hospitalisation and a much larger group where hospitalisation is very unlikely and antibiotic

  9. Risk of psychological distress in parents of preterm children in the first year: evidence from the UK Millennium Cohort Study

    PubMed Central

    Carson, Claire; Redshaw, Maggie; Gray, Ron; Quigley, Maria A

    2015-01-01

    Objective To assess whether the parents of babies born preterm (PT; <37 weeks completed gestation) are at excess risk of psychological distress (PD) at 9 months postpartum, and to explore the influence of the degree of prematurity. Design and participants Data were drawn from the UK Millennium Cohort Study, a nationally representative prospective cohort of babies born in 2000–2002. 12 100 families with complete data available for both parents at recruitment (9 months postpartum) are included. Exposure and outcome Mothers report of gestational age at birth (in weeks) was grouped into: very PT (<32 weeks), moderately PT (32–33 weeks), late PT (34–36 weeks), early term (37–38 weeks), full-term (39–41 weeks), post-term (42 weeks). PD was assessed using a modified Rutter Malaise Inventory, a validated instrument that has been used in both men and women to assess levels of anxiety and distress. Results Overall, 7% of families reported a PT birth; 12.1% of mothers and 8.9% of fathers showed signs of PD at 9 months postpartum. The mothers of very PT infants had an increased risk of PD, compared with the mothers of full-term babies (unadjusted OR 2.10 (1.30 to 3.39; adjusted OR 1.66 (1.02 to 2.69)). Mothers of moderate or late PT babies had no apparent increased risk of PD. However, mothers of early term babies also showed a small excess risk of PD (adjusted OR 1.16 (0.99 to 1.36)). Unadjusted analysis suggested a doubling in the risk of PD in fathers of very and moderately PT babies, compared with fathers of full-term babies, which remains statistically significant after adjustment in the moderately PT group (adjusted OR1.98 (1.20 to 3.29)). Conclusions The parents of very PT children are at an increased risk of PD at 9 months postpartum, and mothers of children born at early term also see an elevated risk compared with mothers of full-term babies. PMID:26685019

  10. Pain management following major intracranial surgery in pediatric patients: a prospective cohort study in three academic children's hospitals.

    PubMed

    Maxwell, Lynne G; Buckley, George M; Kudchadkar, Sapna R; Ely, Elizabeth; Stebbins, Emily L; Dube, Christine; Morad, Athir; Jastaniah, Ebaa A; Sethna, Navil F; Yaster, Myron

    2014-11-01

    Pain management following major intracranial surgery is often limited by a presumed lack of need and a concern that opioids will adversely affect postoperative outcome and interfere with the neurologic examination. Nevertheless, evidence in adults is accumulating that these patients suffer moderate to severe pain, and this pain is often under-treated. The purpose of this prospective, clinical observational cohort study was to assess the incidence of pain, prescribed analgesics, methods of analgesic delivery, and patient/parent satisfaction in pediatric patients undergoing cranial surgery at three major university children's hospitals. After obtaining IRB and parental consent (and when applicable, patient assent), children who underwent cranial surgery for cancer, epilepsy, vascular malformations, and craniofacial reconstruction were studied. Neither intraoperative anesthetic management nor postoperative pain management was standardized, but were based on institutional routine. Patients were evaluated daily by a study investigator and by chart review for pain scores using age appropriate, validated tools (FLACC, Faces Pain Scale-Revised, Wong-Baker Faces Scale or Self-Report on a 0-10 scale), for patient/parent satisfaction using a subset of the NRC Picker satisfaction tool and in adolescents a modified QoR-40, and for the frequency, mode of administration, and type of analgesic provided. Finally, the incidence of opioid-induced side effects, specifically nausea, vomiting, pruritus, altered level of consciousness, and need for emergency diagnostic radiologic studies for altered neurologic examination were recorded. Data are provided as mean ± SD. Two hundred children (98:102 M:F), averaging 7.8 ± 5.8 years old (range 2 months-18.5 years) and 32.2 ± 23.0 kg (range 4.5-111.6 kg) undergoing craniectomy (51), craniotomy (96), and craniofacial reconstruction (53) were studied. Despite considerable variation in mode and route of analgesic administration, there were no

  11. Mortality associated with gastrointestinal bleeding in children: A retrospective cohort study

    PubMed Central

    Attard, Thomas M; Miller, Mikaela; Pant, Chaitanya; Kumar, Ashwath; Thomson, Mike

    2017-01-01

    AIM To determine the clinical characteristics of children with gastrointestinal bleeding (GIB) who died during the course of their admission. METHODS We interrogated the Pediatric Hospital Information System database, including International Classification of Diseases, Current Procedural Terminology and Clinical Transaction Classification coding from 47 pediatric tertiary centers extracting the population of patients (1-21 years of age) admitted (inpatient or observation) with acute, upper or indeterminate GIB (1/2007-9/2015). Descriptive statistics, unadjusted univariate and adjusted multivariate analysis of the associations between patient characteristics and treatment course with mortality was performed with mortality as primary and endoscopy a secondary outcome of interest. All analyses were performed using the R statistical package, v.3.2.3. RESULTS The population with GIB was 19528; 54.6% were male, overall mortality was 2.07%; (0.37% in patients with the principal diagnosis of GIB). When considering only the mortalities in which GIB was the principal diagnosis, 48% (12 of 25 principal diagnosis GIB mortalities) died within the first 3 d of admission, whereas 19.8% of secondary diagnosis GIB patients died with 3 d of admission. Patients who died were more likely to have received octreotide (19.8% c.f. 4.04%) but tended to have not received proton pump inhibitor therapy in the first 48 h, and far less likely to have undergone endoscopy during their admission (OR = 0.489, P < 0.0001). Chronic liver disease associated with a greater likelihood of endoscopy. Mortalities were significantly more likely to have multiple complex chronic conditions. CONCLUSION GIB associated mortality in children is highest within 7 d of admission. Multiple comorbidities are a risk factor whereas early endoscopy during the admission is protective. PMID:28321162

  12. Clinically meaningful reduction in pain severity in children treated by paramedics: a retrospective cohort study.

    PubMed

    Jennings, Paul A; Lord, Bill; Smith, Karen

    2015-11-01

    Pediatric pain is a common presenting symptom in the prehospital setting; however, there is a lack of data identifying factors associated with effective pain management in this population. We sought to identify the factors associated with clinically meaningful pain reduction in children. An analysis of electronic patient care records of all patients younger than 15 years presenting with pain to the emergency medical service of Victoria, Australia, over a 4-year period (2008-2011). Data were analyzed using descriptive statistics and multivariate regression to assess predictors of clinically meaningful pain reduction. Clinically meaningful pain reduction was defined as a reduction of 2 or more points on an 11-point scale. A total of 92378 children were transported, of whom 15016 (16.3%) met the inclusion criteria. The median age was 11 (interquartile range, 9-13) years, and 59.2% were male. Patients older than 9 years were less likely (adjusted odds ratio [AOR], 0.5; 95% confidence interval [CI], 0.4-0.6) and boys were more likely (adjusted odds ratio, 1.1; 95% CI, 1.0-1.3) to have a clinically meaningful reduction in pain. Patients with pain classified as musculoskeletal were more likely to achieve a reduction in pain score of 2 or more when compared with pain due to other medical causes (AOR, 1.7; 95% CI, 1.5-1.9). Factors other than the type of analgesia are important determinants of prehospital pain relief and are likely to impact on clinical care and research. Clinical audit and research projects should stratify patients according to patient as well as management factors to maximize service improvement. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Influence of sleep-onset time on the development of 18-month-old infants: Japan Children's cohort study.

    PubMed

    Iemura, Akiko; Iwasaki, Mizue; Yamakawa, Noriko; Tomiwa, Kiyotaka; Anji, Yoko; Sakakihara, Yoichi; Kakuma, Tatsuyuki; Nagamitsu, Shinichiro; Matsuishi, Toyojiro

    2016-04-01

    We report here the influence of sleep patterns on the development of infants in Japan. A total of 479 infants were registered in two different Japanese cities. Direct neurological observations were performed by licensed pediatric neurologists. We designed a prospective cohort study and identified the sleep factors of children showing atypical development. The Kinder Infant Developmental Scale (KIDS) was used to evaluate the infant developmental quotient (DQ); we also applied a neurobehavioral screening battery. Neurobehavioral observations in 18-month-old infants were designed to check all developmental categories within the three areas of motor function, language, and social function. Based on the observations, each infant was classified as having "atypical development" or "typical development". We found that later sleep onset time (>22:00 h), and longer naps during the day each had significant positive correlations with atypical development patterns in 18-month-old infants. For each hour the infant sleep-onset time extended past 22:00 h, the infants showed worse neurodevelopmental outcomes, at an odds ratio increase of 2.944. Although our results may be confounded by sleep problems resulting from pre-existing developmental disabilities, we can safely conclude that appropriate sleeping habits are important for healthy development in 18-month-old infants. Copyright © 2015 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

  14. Polish Mother and Child Cohort Study (REPRO_PL) - Methodology of the follow-up of the children at the age of 7.

    PubMed

    Polańska, Kinga; Hanke, Wojciech; Król, Anna; Potocka, Adrianna; Waszkowska, Małgorzata; Jacukowicz, Aleksandra; Gromadzińska, Jolanta; Wąsowicz, Wojciech; Jerzyńska, Joanna; Stelmach, Włodzimierz; Stelmach, Iwona

    2016-11-18

    Effects of environmental exposures in utero and in the first years of life on early life health and development is a growing research area with major public health implications. The main aim of this work has been to provide an overview of the next step of the Polish Mother and Child Cohort Study (REPRO_PL) covering exposure, health and neurodevelopment assessments of children at 7 years of age. Details regarding methodology of the follow-up of the children are crucial for cross-cohort collaboration and a full understanding of the future research questions. Phase III of the REPRO_PL cohort covers a follow-up of 900 children at the age of 7 years old. The questionnaire filled in by the mothers is composed of: socio-demographic, child exposure and home environment information, nutritional status and health data. In the case of 400 children, environmental (including collection of urine, saliva and buccal cells), health status and psychomotor assessments are performed. Health and development check consists of physical measurements, child health status assessment (including lung function tests, skin prick testing, an interview/examination by an allergist) and psychomotor development tests (the Strength and Difficulties Questionnaire and the Intelligence and Development Scales). The results of the study will become available within the next few years. Extension of the REPRO_PL cohort with examinations of children at the age of 7 years old may provide a better understanding of the relationship between environmental and lifestyle-related factors and children's health and neurodevelopment; and may further strengthen scientific base for policies and interventions promoting healthy lifestyle. Int J Occup Med Environ Health 2016;29(6):883-893.

  15. Association between breast feeding and asthma in 6 year old children: findings of a prospective birth cohort study

    PubMed Central

    Oddy, W H; Holt, P G; Sly, P D; Read, A W; Landau, L I; Stanley, F J; Kendall, G E; Burton, P R

    1999-01-01

    Objectives To investigate the association between the duration of exclusive breast feeding and the development of asthma related outcomes in children at age 6 years. Design Prospective cohort study. Setting Western Australia. Subjects 2187 children ascertained through antenatal clinics at the major tertiary obstetric hospital in Perth and followed to age 6 years. Main outcome measures Unconditional logistic regression to model the association between duration of exclusive breast feeding and outcomes related to asthma or atopy at 6 years of age, allowing for several important confounders: sex, gestational age, smoking in the household, and early childcare. Results After adjustment for confounders, the introduction of milk other than breast milk before 4 months of age was a significant risk factor for all asthma and atopy related outcomes in children aged 6 years: asthma diagnosed by a doctor (odds ratio 1.25, 95% confidence interval 1.02 to 1.52); wheeze three or more times since 1 year of age (1.41, 1.14 to 1.76); wheeze in the past year (1.31, 1.05 to 1.64); sleep disturbance due to wheeze within the past year (1.42, 1.07 to 1.89); age when doctor diagnosed asthma (hazard ratio 1.22, 1.03 to 1.43); age at first wheeze (1.36, 1.17 to 1.59); and positive skin prick test reaction to at least one common aeroallergen (1.30, 1.04 to 1.61). Conclusion A significant reduction in the risk of childhood asthma at age 6 years occurs if exclusive breast feeding is continued for at least the 4 months after birth. These findings are important for our understanding of the cause of childhood asthma and suggest that public health interventions to optimise breast feeding may help to reduce the community burden of childhood asthma and its associated traits. Key messagesAsthma is the leading cause of admission to hospital in Australian children and its prevalence is increasingWhether breast feeding protects against asthma or atopy, or both, is controversialAsthma is a complex disease

  16. Five-minute Apgar score and educational outcomes: retrospective cohort study of 751,369 children.

    PubMed

    Tweed, Emily J; Mackay, Daniel F; Nelson, Scott M; Cooper, Sally-Ann; Pell, Jill P

    2016-03-01

    The Apgar score is used worldwide for assessing the clinical condition and short-term prognosis of newborn infants. Evidence for a relationship with long-term educational outcomes is conflicting. We investigated whether Apgar score at 5 min after birth was associated with additional support needs (ASN) and educational attainment. Data on pregnancy, delivery and later educational outcomes for children attending Scottish schools between 2006 and 2011 were collated by linking individual-level data from national educational and maternity databases. The relationship between Apgar score and overall ASN, type-specific ASN and educational attainment was assessed using binary, multinomial and generalised ordinal logistic regression models, respectively. Missing covariate data were imputed. Of the 751,369 children eligible, 9741 (1.3%) had a low or intermediate Apgar score and 49,962 (6.6%) had ASN. Low Apgar score was independently associated with overall ASN status (adjusted OR for Apgar ≤3, OR 1.52 95% CI 1.35 to 1.70), as well as ASN due to cognitive (OR 1.26, 95% CI 1.09 to 1.47), sensory (OR 2.49 95% CI 1.66 to 3.73) and motor (OR 3.57, 95% CI 2.86 to 4.47) impairments. There was a dose-response relationship between Apgar score and overall ASN status: of those scoring 0-3, 10.1% had ASN, compared with 9.1% of those scoring 4-7 and 6.6% of those scoring 7-10. A low Apgar score was associated with lower educational attainment, but this was not robust to adjustment for confounders. Apgar scores are associated with long-term as well as short-term prognoses, and with educational as well as clinical outcomes at the population level. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  17. Preschoolers' parent-rated health disparities are strongly associated with measures of adiposity in the Lifeways cohort study children.

    PubMed

    Shrivastava, Aakash; Murrin, Celine; Kelleher, Cecily C

    2014-07-21

    To examine the relationship between lifecourse factors from preschoolers' microecosystem and their parent-reported (mother-reported) health (PRH), following them prospectively from preconception to age 5 years. To investigate if preschoolers' body mass index (BMI) and waist circumference were associated with preschoolers' PRH when controlled for lifecourse predictors. Lifeways cross-generation cohort study. Ireland. Of 1082 families, 62% mothers responded on a health and lifestyle questionnaire at follow-up. Food frequency, BMI and waist circumference were measured. There were 547 family data sets available for analysis of children's PRH. Mother-reported children's PRH at age 5. Associations with child's individual and familial exposures from preconception to age 5 years examined using logistic regression. In univariate analysis, relatively positive rating of children's PRH were associated with children's lower intake of fats (OR (95% CI) 2.2 (1.1 to 4.3)), higher intake of fruits/vegetables (OR (95% CI) 2.2 (1.1 to 4.3)); as well as familial socioeconomic characteristics {higher household income (OR (95% CI) 3.0 (1.6 to 5.9)), non-entitlement to means-tested healthcare (OR (95% CI) 2.1 (1.0 to 4.3)), mothers' higher education (OR (95% CI) 1.9 (1.0 to 3.6))}, psychosocial characteristics {father's participation in study (OR (95% CI) 2.1 (1.0 to 4.3)), mothers' perceiving better support from partner (OR (95% CI) 2.3 (1.2 to 4.3)), children (OR (95% CI) 1.9 (1.0 to 3.7)) or relatives (OR (95% CI) 2.2 (1.1 to 4.1))}, parents' lifestyle {mothers' lower intake of energy (OR (95% CI) 2.2 (1.1 to 4.3)), fathers' non-smoking status (OR (95% CI) 2.2 (1.1 to 4.4))} and parents' health {mothers' self-rated health relatively positive (OR (95% CI) 5.1 (2.6 to 9.9)), fathers' self-rated health relatively positive (OR (95% CI) 3.0 (1.5 to 6.0))}. In multivariable analysis (χ(2)=34.2, df=21, N=303, R(2 )= 0.26, p<0.05), one of the two strong predictors of children

  18. Brain-Science Based Cohort Studies

    ERIC Educational Resources Information Center

    Koizumi, Hideaki

    2011-01-01

    This article describes a number of human cohort studies based on the concept of brain-science and education. These studies assess the potential effects of new technologies on babies, children and adolescents, and test hypotheses drawn from animal and genetic case studies to see if they apply to people. A flood of information, virtual media,…

  19. Brain-Science Based Cohort Studies

    ERIC Educational Resources Information Center

    Koizumi, Hideaki

    2011-01-01

    This article describes a number of human cohort studies based on the concept of brain-science and education. These studies assess the potential effects of new technologies on babies, children and adolescents, and test hypotheses drawn from animal and genetic case studies to see if they apply to people. A flood of information, virtual media,…

  20. Choroidal thickness in relation to birth parameters in 11- to 12-year-old children: the Copenhagen Child Cohort 2000 Eye Study.

    PubMed

    Li, Xiao Q; Munkholm, Anja; Larsen, Michael; Munch, Inger C

    2014-10-30

    To examine choroidal thickness in a population-based child cohort in relation to birth parameters. The Copenhagen Child Cohort 2000 Eye Study examined 1406 children aged 11 to 12 years using enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT), ocular biometry and measurement of height, weight, refraction, and self-reported pubertal development status. Birth parameters were obtained from the Danish Medical Birth Registry. The subfoveal choroid in low birth weight children (<2500 g, n = 51, mean 324 ± 76 μm) was thinner than in normal birth weight children (2500-4500 g, n = 1194, mean 361 ± 78 μm), the difference being -37 (CI95 -60 to -15) μm, P = 0.001 after adjusting for age, sex, height, Tanner stage by sex, axial length, anterior chamber depth, and spherical equivalent refractive error. The subfoveal choroid in high birth weight children (>4500 g, n = 48, mean 351 ± 63 μm) was comparable with normal birth weight children, P = 0.44. The subfoveal choroid was thinner in preterm children, however the difference was not significant (-18 [-37 to 2] μm, P = 0.08). Small for gestation children had thinner subfoveal choroid (-19 [-37 to -1] μm, P = 0.04) compared with appropriate for gestation children. Longer birth length was associated with a thicker subfoveal choroid (2 [1-4] μm/cm, P = 0.005). Macular choroidal thickness at 16 extrafoveal locations was measured in a subset of children and found to have the same associations with birth weight as the subfoveal choroidal thickness. In 11- to 12-year-old children, thinner choroids were associated with lower birth weight, lower birth length, and being small for the gestational age. Copyright 2015 The Association for Research in Vision and Ophthalmology, Inc.

  1. Factors associated with early outcomes following standardised therapy in children with ulcerative colitis (PROTECT): a multicentre inception cohort study.

    PubMed

    Hyams, Jeffrey S; Davis, Sonia; Mack, David R; Boyle, Brendan; Griffiths, Anne M; LeLeiko, Neal S; Sauer, Cary G; Keljo, David J; Markowitz, James; Baker, Susan S; Rosh, Joel; Baldassano, Robert N; Patel, Ashish; Pfefferkorn, Marian; Otley, Anthony; Heyman, Melvin; Noe, Joshua; Oliva-Hemker, Maria; Rufo, Paul; Strople, Jennifer; Ziring, David; Guthery, Stephen L; Sudel, Boris; Benkov, Keith; Wali, Prateek; Moulton, Dedrick; Evans, Jonathan; Kappelman, Michael D; Marquis, Alison; Sylvester, Francisco A; Collins, Margaret H; Venkateswaran, Suresh; Dubinsky, Marla; Tangpricha, Vin; Spada, Krista L; Britt, Ashley; Saul, Bradley; Gotman, Nathan; Wang, Jessie; Serrano, Jose; Kugathasan, Subra; Walters, Thomas; Denson, Lee A

    2017-09-19

    Previous retrospective studies of paediatric ulcerative colitis have had limited ability to describe disease progression and identify predictors of treatment response. In this study, we aimed to identify characteristics associated with outcomes following standardised therapy after initial diagnosis. The PROTECT multicentre inception cohort study was based at 29 centres in the USA and Canada and included paediatric patients aged 4-17 years who were newly diagnosed with ulcerative colitis. Guided by the Pediatric Ulcerative Colitis Activity Index (PUCAI), patients received initial standardised treatment with mesalazine (PUCAI 10-30) oral corticosteroids (PUCAI 35-60), or intravenous corticosteroids (PUCAI ≥65). The key outcomes for this analysis were week 12 corticosteroid-free remission, defined as PUCAI less than 10 and taking only mesalazine, and treatment escalation during the 12 study weeks to anti-tumour necrosis factor α (TNFα) agents, immunomodulators, or colectomy among those initially treated with intravenous corticosteroids. We identified independent predictors of outcome through multivariable logistic regression using a per-protocol approach. This study is registered with ClinicalTrials.gov, number NCT01536535. Patients were recruited between July 10, 2012, and April 21, 2015. 428 children initiated mesalazine (n=136), oral corticosteroids (n=144), or intravenous corticosteroids (n=148). Initial mean PUCAI was 31·1 (SD 13·3) in children initiating with mesalazine, 50·4 (13·8) in those initiating oral corticosteroids, and 66·9 (13·7) in those initiating intravenous corticosteroids (p<0·0001 for between-group comparison). Week 12 outcome data were available for 132 patients who initiated with mesalazine, 141 with oral corticosteroids, and 143 with intravenous corticosteroids. Corticosteroid-free remission with the patient receiving mesalazine treatment only at 12 weeks was achieved by 64 (48%) patients in the mesalazine group, 47 (33%) in the

  2. Relationships of physical fitness and obesity with metabolic risk factors in children and adolescents: Chungju city cohort study.

    PubMed

    Kim, Hyo Jin; Lee, Kyu-Jin; Jeon, Yeon Jin; Ahn, Moon Bae; Jung, In Ah; Kim, Shin Hee; Cho, Won-Kyoung; Cho, Kyoung Soon; Park, So Hyun; Jung, Min Ho; Lee, Jin-Hee; Suh, Byung-Kyu

    2016-03-01

    The purpose of this study was to investigate the relationships of physical fitness and obesity with metabolic risk factors in children and adolescents. This cohort study was conducted in Chungju city, South Korea. Total 843 subjects were enrolled, including 193 elementary school 4th grade male (E4M), 189 elementary school 4th grade female (E4F) and 461 male-middle school students (M1M). The subjects were also classified into 2 groups by body mass index; normal weight (NW) group and overweight included obesity (OW/OB) group. Physical fitness was measured by shuttle run (cardiorespiratory fitness, CRF), sit and reach (flexibility), handgrip strength (muscular strength) and stand long jump (agility). The prevalence of OW/OB was respectively 33.7% (65 of 193) among E4M, 28.6% (54 of 189) among E4F, and 28.0% (129 of 461) among M1M. Hematocrit, white blood cell, triglyceride, low-density lipoprotein, insulin, homeostasis model assessment of insulin resistance, systolic and diastolic blood pressure were higher, while high-density lipoprotein were lower in the OW/OB group than in the NW group. The OW/OB group presented significantly lower CRF (P<0.01) and lower agility, but higher muscular strength compared with NW group. CRF was negatively correlated with obesity indices and metabolic risk factors. After adjustments for potential confounders, odds ratios for 4th-5th grade CRF of OW/OB compared NW in the E4M, E4F, M1M, were 7.38 (95 % CI, 3.24-16.83), 4.10 (95% CI, 1.83-9.18), 16.06 (95% CI, 8.23-31.00) (P<0.01). Our study has shown that CRF has negative correlation with OW/OB in children and adolescents of Chungju city. We suggest that improvement of CRF through regular physical activity would be an important method for reducing the metabolic risks of childhood obesity.

  3. Relationships of physical fitness and obesity with metabolic risk factors in children and adolescents: Chungju city cohort study

    PubMed Central

    Kim, Hyo Jin; Lee, Kyu-Jin; Jeon, Yeon Jin; Ahn, Moon Bae; Jung, In Ah; Kim, Shin Hee; Cho, Won-Kyoung; Cho, Kyoung Soon; Park, So Hyun; Jung, Min Ho

    2016-01-01

    Purpose The purpose of this study was to investigate the relationships of physical fitness and obesity with metabolic risk factors in children and adolescents. Methods This cohort study was conducted in Chungju city, South Korea. Total 843 subjects were enrolled, including 193 elementary school 4th grade male (E4M), 189 elementary school 4th grade female (E4F) and 461 male-middle school students (M1M). The subjects were also classified into 2 groups by body mass index; normal weight (NW) group and overweight included obesity (OW/OB) group. Physical fitness was measured by shuttle run (cardiorespiratory fitness, CRF), sit and reach (flexibility), handgrip strength (muscular strength) and stand long jump (agility). Results The prevalence of OW/OB was respectively 33.7% (65 of 193) among E4M, 28.6% (54 of 189) among E4F, and 28.0% (129 of 461) among M1M. Hematocrit, white blood cell, triglyceride, low-density lipoprotein, insulin, homeostasis model assessment of insulin resistance, systolic and diastolic blood pressure were higher, while high-density lipoprotein were lower in the OW/OB group than in the NW group. The OW/OB group presented significantly lower CRF (P<0.01) and lower agility, but higher muscular strength compared with NW group. CRF was negatively correlated with obesity indices and metabolic risk factors. After adjustments for potential confounders, odds ratios for 4th–5th grade CRF of OW/OB compared NW in the E4M, E4F, M1M, were 7.38 (95 % CI, 3.24–16.83), 4.10 (95% CI, 1.83–9.18), 16.06 (95% CI, 8.23–31.00) (P<0.01). Conclusion Our study has shown that CRF has negative correlation with OW/OB in children and adolescents of Chungju city. We suggest that improvement of CRF through regular physical activity would be an important method for reducing the metabolic risks of childhood obesity. PMID:27104177

  4. Circulating phthalates during critical illness in children are associated with long-term attention deficit: a study of a development and a validation cohort.

    PubMed

    Verstraete, S; Vanhorebeek, I; Covaci, A; Güiza, F; Malarvannan, G; Jorens, P G; Van den Berghe, G

    2016-03-01

    Environmental phthalate exposure has been associated with attention deficit disorders in children. We hypothesized that in children treated in the pediatric intensive care unit (PICU), circulating phthalates leaching from indwelling medical devices contribute to their long-term attention deficit. Circulating plasma concentrations of di(2-ethylhexyl)phthalate (DEHP) metabolites were quantified in 100 healthy children and 449 children who had been treated in PICU and were neurocognitively tested 4 years later. In a development patient cohort (N = 228), a multivariable bootstrap study identified stable thresholds of exposure to circulating DEHP metabolites above which there was an independent association with worse neurocognitive outcome. Subsequently, in a second patient cohort (N = 221), the observed independent associations were validated. Plasma concentrations of DEHP metabolites, which were virtually undetectable [0.029 (0.027-0.031) µmol/l] in healthy children, were 4.41 (3.76-5.06) µmol/l in critically ill children upon PICU admission (P < 0.001). Plasma DEHP metabolite concentrations decreased rapidly but remained 18 times higher until PICU discharge (P < 0.001). After adjusting for baseline risk factors and duration of PICU stay, and further for PICU complications and treatments, exceeding the potentially harmful threshold for exposure to circulating DEHP metabolites was independently associated with the attention deficit (all P ≤ 0.008) and impaired motor coordination (all P ≤ 0.02). The association with the attention deficit was confirmed in the validation cohort (all P ≤ 0.01). This phthalate exposure effect explained half of the attention deficit in post-PICU patients. Iatrogenic exposure to DEHP metabolites during intensive care was independently and robustly associated with the important attention deficit observed in children 4 years after critical illness. Clinicaltrials.gov identifier: NCT00214916.

  5. Factors related to progression of thoracolumbar kyphosis in children with achondroplasia: a retrospective cohort study of forty-eight children treated in a comprehensive orthopaedic center.

    PubMed

    Borkhuu, Battugs; Nagaraju, Durga K; Chan, Gilbert; Holmes, Larry; Mackenzie, William G

    2009-07-15

    Retrospective cohort. To assess the period prevalence and predisposing factors in thoracolumbar kyphosis progression (TLK). TLK is a common presentation in children with achondroplasia. This condition occurs very early in life; it is observed during the first attempts to sit, and has multifactorial etiology. Studies are limited on the radiologic assessment of the angle of wedging of the deformed vertebra, but none to our knowledge on TLK progression in achondroplasia. The records of 48 of 103 children with achondroplasia seen between 1997 and 2005 were examined. Developmental motor delay (DMD) and other potential predictors of TLK were assessed. The criteria for DMD were a child's inability to sit without support by 6 months and an inability to walk independently by 15 months. Lateral radiographs were examined for the magnitude of TLK, thoracic kyphosis, lumbar lordosis, percentage of apical vertebral wedging for the height and width of the vertebra, and apical vertebral translation. The association between TLK progression and potential predisposing factors were assessed using chi test, Fisher exact, t test, and binomial regression model for predictor identification. The period prevalence of TLK progression in children with achondroplasia was 35.4%. TLK progression was significantly related to DMD, risk ratio = 2.40, 95% confidence interval = 1.10 to 5.58, apical vertebral translation (P = 0.01), and percentage apical vertebral wedging for height (P = 0.01). After adjustment for relevant covariates, the relationship between DMD and TLK progression persisted, risk ratio = 2.65, 95% confidence interval, 1.20 to 5.91. DMD was significantly associated with TLK progression and other radiologic parameters namely, initial TLK of >25 degrees , percentage of apical vertebral wedging for the height of the vertebra, and apical vertebral translation.

  6. Secondhand smoke and incidence of dental caries in deciduous teeth among children in Japan: population based retrospective cohort study.

    PubMed

    Tanaka, Shiro; Shinzawa, Maki; Tokumasu, Hironobu; Seto, Kahori; Tanaka, Sachiko; Kawakami, Koji

    2015-10-21

    Does maternal smoking during pregnancy and exposure of infants to tobacco smoke at age 4 months increase the risk of caries in deciduous teeth? Population based retrospective cohort study of 76 920 children born between 2004 and 2010 in Kobe City, Japan who received municipal health check-ups at birth, 4, 9, and 18 months, and 3 years and had information on household smoking status at age 4 months and records of dental examinations at age 18 months and 3 years. Smoking during pregnancy and exposure of infants to secondhand smoke at age 4 months was assessed by standardised parent reported questionnaires. The main outcome measure was the incidence of caries in deciduous teeth, defined as at least one decayed, missing, or filled tooth assessed by qualified dentists without radiographs. Cox regression was used to estimate hazard ratios of exposure to secondhand smoke compared with having no smoker in the family after propensity score adjustment for clinical and lifestyle characteristics. Prevalence of household smoking among the 76 920 children was 55.3% (n=42 525), and 6.8% (n=5268) had evidence of exposure to tobacco smoke. A total of 12 729 incidents of dental caries were observed and most were decayed teeth (3 year follow-up rate 91.9%). The risk of caries at age 3 years was 14.0% (no smoker in family), 20.0% (smoking in household but without evidence of exposure to tobacco smoke), and 27.6% (exposure to tobacco smoke). The propensity score adjusted hazard ratios of the two exposure groups compared with having no smoker in the family were 1.46 (95% confidence interval 1.40 to 1.52) and 2.14 (1.99 to 2.29), respectively. The propensity score adjusted hazard ratio between maternal smoking during pregnancy and having no smoker in the family was 1.10 (0.97 to 1.25). Exposure to tobacco smoke at 4 months of age was associated with an approximately twofold increased risk of caries, and the risk of caries was also increased among those exposed to household

  7. Gender Differences of Children's Developmental Trajectory from 6 to 60 Months in the Taiwan Birth Cohort Pilot Study

    ERIC Educational Resources Information Center

    Lung, For-Wey; Chiang, Tung-Liang; Lin, Shio-Jean; Feng, Jui-Ying; Chen, Po-Fei; Shu, Bih-Ching

    2011-01-01

    The parental report instrument is the most efficient developmental detection method and has shown high validity with professional assessment instruments. The reliability and validity of the Taiwan Birth Cohort Study (TBCS) 6-, 18- and 36-month scales have already been established. In this study, the reliability and validity of the 60-month scale…

  8. Ultrastructural characterization of genetic diffuse lung diseases in infants and children: a cohort study and review.

    PubMed

    Citti, Arianna; Peca, Donatella; Petrini, Stefania; Cutrera, Renato; Biban, Paolo; Haass, Cristina; Boldrini, Renata; Danhaive, Olivier

    2013-10-01

    Pediatric diffuse lung diseases are rare disorders with an onset in the neonatal period or in infancy, characterized by chronic respiratory symptoms and diffuse interstitial changes on imaging studies. Genetic disorders of surfactant homeostasis represent the main etiology. Surfactant protein B and ABCA3 deficiencies typically cause neonatal respiratory failure, which is often lethal within a few weeks or months. Although heterozygous ABCA3 mutation carriers are mostly asymptomatic, there is growing evidence that monoallelic mutations may affect surfactant homeostasis. Surfactant protein C mutations are dominant or sporadic disorders leading to a broad spectrum of manifestations from neonatal respiratory distress syndrome to adult pulmonary fibrosis. The authors performed pathology and ultrastructural studies in 12 infants who underwent clinical lung biopsy. One carried a heterozygous SP-B mutation, 3 carried SP-C mutations, and 7 carried ABCA3 mutations (5 biallelic and 2 monoallelic). Optical microscopy made it possible to distinguish between surfactant-related disorders and other forms. One of the ABCA3 monoallelic carriers had morphological features of alveolar capillary dysplasia, a genetic disorder of lung alveolar, and vascular development. One patient showed no surfactant-related anomalies but had pulmonary interstitial glycogenosis, a developmental disorder of unknown origin. Electron microscopy revealed specific lamellar bodies anomalies in all SP-B, SP-C, and ABCA3 deficiency cases. In addition, the authors showed that heterozygous ABCA3 mutation carriers have an intermediate ultrastructural phenotype between homozygous carriers and normal subjects. Lung biopsy is an essential diagnostic procedure in unexplained diffuse lung disorders, and electron microscopy should be performed systematically, since it may reveal specific alterations in genetic disorders of surfactant homeostasis.

  9. Trajectory of Material Hardship and Income Poverty in Families of Children Undergoing Chemotherapy: A Prospective Cohort Study.

    PubMed

    Bona, Kira; London, Wendy B; Guo, Dongjing; Frank, Deborah A; Wolfe, Joanne

    2016-01-01

    Poverty is correlated with negative health outcomes in pediatric primary care, and is emerging as a negative prognostic indicator in pediatric oncology. However, measures of poverty amenable to targeted intervention, such as household material hardship (HMH)--including food, energy, and housing insecurity--have not been described in pediatric oncology. We describe the trajectory of family reported HMH and income poverty at a pediatric oncology referral center in New England with high psychosocial supports. Single site, prospective cohort study including 99 English-speaking families of children receiving chemotherapy for primary cancer. Families completed face-to-face surveys at two time-points: (1) Within 30 days of child's diagnosis (T1) (N = 99, response rate 88%); (2) 6-months following diagnosis (T2) (N = 93, response rate 94%). HMH was assessed in three domains: food, energy, and housing insecurity. Twenty percent of families reported low-income (≤200% Federal Poverty Level) and at least one HMH prior to their child's diagnosis. At T2, 25% of families lost >40% annual household income secondary to treatment-related work disruptions, and 29% of families reported HMH despite utilization of psychosocial supports. Low-income and HMH are prevalent in a significant proportion of newly diagnosed pediatric oncology families at a large referral center. Despite psychosocial supports, the proportion of families experiencing unmet basic needs increases during chemotherapy to nearly one in three families. HMH provides a quantifiable and remediable measure of poverty in pediatric oncology. Interventions to ameliorate this concrete component of poverty could benefit a significant proportion of pediatric oncology families. © 2015 Wiley Periodicals, Inc.

  10. Internal living environment and respiratory disease in children: findings from the Growing Up in New Zealand longitudinal child cohort study.

    PubMed

    Tin Tin, Sandar; Woodward, Alistair; Saraf, Rajneeta; Berry, Sarah; Atatoa Carr, Polly; Morton, Susan M B; Grant, Cameron C

    2016-12-08

    The incidence of early childhood acute respiratory infections (ARIs) has been associated with aspects of the indoor environment. In recent years, public awareness about some of these environmental issues has increased, including new laws and subsequent changes in occupant behaviours. This New Zealand study investigated current exposures to specific risk factors in the home during the first five years of life and provided updated evidence on the links between the home environment and childhood ARI hospitalisation. Pregnant women (n = 6822) were recruited in 2009 and 2010, and their 6853 children created a child cohort that was representative of New Zealand births from 2007-10. Longitudinal data were collected through face-to-face interviews and linkage to routinely collected national datasets. Incidence rates with Poisson distribution confidence intervals were computed and Cox regression modelling for repeated events was performed. Living in a rented dwelling (48%), household crowding (22%) or dampness (20%); and, in the child's room, heavy condensation (20%) or mould or mildew on walls or ceilings (13%) were prevalent. In 14% of the households, the mother smoked cigarettes and in 30%, other household members smoked. Electric heaters were commonly used, followed by wood, flued gas and unflued portable gas heaters. The incidence of ARI hospitalisation before age five years was 33/1000 person-years. The risk of ARI hospitalisation was higher for children living in households where there was a gas heater in the child's bedroom: hazard ratio for flued gas heater 1.69 (95% CI: 1.21-2.36); and for unflued gas heater 1.68 (95% CI: 1.12-2.53); and where a gas heater was the sole type of household heating (hazard ratio: 1.64 (95% CI: 1.29-2.09)). The risk was reduced in households that used electric heaters (Hazard ratio: 0.74 (95% CI: 0.61-0.89)) or wood burners (hazard ratio: 0.79 (95% CI: 0.66-0.93)) as a form of household heating. The associations with other risk

  11. Iron-Folic Acid Supplementation During Pregnancy Reduces the Risk of Stunting in Children Less Than 2 Years of Age: A Retrospective Cohort Study from Nepal

    PubMed Central

    Nisar, Yasir Bin; Dibley, Michael J.; Aguayo, Victor M.

    2016-01-01

    The aim of the study was to investigate the effect of antenatal iron-folic acid (IFA) supplementation on child stunting in Nepalese children age <2 years. A retrospective cohort study design was used, in which a pooled cohort of 5235 most recent live births 2 years prior to interview from three Nepal Demographic and Health Surveys (2001, 2006 and 2011) was analysed. The primary outcome was stunting in children age <2 years. The main exposure variable was antenatal IFA supplementation. Multivariate Poisson regression analysis was performed. In our sample, 31% and 10% of Nepalese children age <2 years were stunted and severely stunted, respectively. The adjusted relative risk of being stunted was 14% lower in children whose mothers used IFA supplements compared to those whose mothers did not use (aRR = 0.86, 95% CI = 0.77–0.97). Additionally, the adjusted relative risk of being stunted was significantly reduced by 23% when antenatal IFA supplementation was started ≤6 months with ≥90 IFA supplements used during pregnancy (aRR = 0.77, 95% CI = 0.64–0.92). Antenatal IFA supplementation significantly reduced the risk of stunting in Nepalese children age <2 years. The greatest impact on the risk reduction of child stunting was when IFA supplements were started ≤6 months with ≥90 supplements were used. PMID:26828515

  12. Iron-Folic Acid Supplementation During Pregnancy Reduces the Risk of Stunting in Children Less Than 2 Years of Age: A Retrospective Cohort Study from Nepal.

    PubMed

    Nisar, Yasir Bin; Dibley, Michael J; Aguayo, Victor M

    2016-01-27

    The aim of the study was to investigate the effect of antenatal iron-folic acid (IFA) supplementation on child stunting in Nepalese children age <2 years. A retrospective cohort study design was used, in which a pooled cohort of 5235 most recent live births 2 years prior to interview from three Nepal Demographic and Health Surveys (2001, 2006 and 2011) was analysed. The primary outcome was stunting in children age <2 years. The main exposure variable was antenatal IFA supplementation. Multivariate Poisson regression analysis was performed. In our sample, 31% and 10% of Nepalese children age <2 years were stunted and severely stunted, respectively. The adjusted relative risk of being stunted was 14% lower in children whose mothers used IFA supplements compared to those whose mothers did not use (aRR = 0.86, 95% CI = 0.77-0.97). Additionally, the adjusted relative risk of being stunted was significantly reduced by 23% when antenatal IFA supplementation was started ≤6 months with ≥90 IFA supplements used during pregnancy (aRR = 0.77, 95% CI = 0.64-0.92). Antenatal IFA supplementation significantly reduced the risk of stunting in Nepalese children age <2 years. The greatest impact on the risk reduction of child stunting was when IFA supplements were started ≤6 months with ≥90 supplements were used.

  13. Perceptions of health risk among parents of overweight children: a cross-sectional study within a cohort.

    PubMed

    Park, Min Hae; Falconer, Catherine L; Saxena, Sonia; Kessel, Anthony S; Croker, Helen; Skow, Aine; Viner, Russell M; Kinra, Sanjay

    2013-07-01

    To identify the socio-demographic and behavioural characteristics associated with perceptions of weight-related health risk among the parents of overweight children. Baseline data from a cohort of parents of children aged 4-11 years in five areas in England in 2010-2011 were analysed; the sample was restricted to parents of overweight children (body mass index ≥ 91(st) centile of UK 1990 reference; n=579). Associations between respondent characteristics and parental perception of health risk associated with their child's weight were examined using logistic regression analyses. Most parents (79%) did not perceive their child's weight to be a health risk. Perception of a health risk was associated with recognition of the child's overweight status (OR 10.59, 95% CI 5.51 to 20.34), having an obese child (OR 4.21, 95% CI 2.28 to 7.77), and having an older child (OR 2.67, 95% CI 1.32 to 5.41). However, 41% of parents who considered their child to be overweight did not perceive a health risk. Parents that recognise their child's overweight status, and the parents of obese and older children, are more likely to perceive a risk. However, many parents that acknowledge their child is overweight do not perceive a related health risk. Copyright © 2013 Elsevier Inc. All rights reserved.

  14. Cancer risks in children with congenital malformations in the nervous and circulatory system-A population based cohort study.

    PubMed

    Sun, Yuelian; Overvad, Kim; Olsen, Jørn

    2014-08-01

    We estimated the age and organ-specific cancer risk for children with a congenital malformation (CM) in the nervous or in the circulatory system. We identified 1,709,456 live born singletons in Denmark between 1 January 1977 and 31 December 2007 and excluded children with chromosomal birth defects. Information on CMs was obtained from the Danish National Hospital Register. Information on cancer occurrence was obtained from the Danish Cancer Registry. We applied Cox proportional hazards regression model to estimate hazard ratios (HR) for cancer. Children entered into the CM cohort on the day of birth regardless of when the CM was diagnosed or on the day of CM diagnosis in an alternative analysis. Overall, 4484 (0.26%) and 24,643 (1.44%) children were diagnosed with a CM in the nervous and in the circulatory system, respectively. Compared with children without any CM, children with a CM in the nervous system had a 5.97 fold (95%CI [confidence interval]: 4.66-7.64) higher risk of cancer, including cancer in the central nervous system (HR=18.84, 95%CI: 12.67-28.01), in the mesothelial and soft tissue (HR=15.64, 95%CI: 7.99-30.60), in the skin (HR=4.91, 95%CI: 2.19-11.0). The associations were stronger early in life. Children with a CM in the circulatory system had a 2.64 fold (95%CI: 2.21-3.16) higher risk of cancer, including cancer in the lymphatic and haematopoietic tissues (HR=3.22, 95%CI: 2.43-4.27) and cancer in the CNS (HR=2.40, 95%CI: 1.43-4.02). Some of these associations were weaker in the alternative analysis. Children with subtypes of CM in the two systems showed a higher cancer risk. Children who were diagnosed with a CM in the nervous system had a substantially higher cancer risk especially early in life. Children diagnosed with a CM in the circulatory system had a moderately higher cancer risk. Copyright © 2014 Elsevier Ltd. All rights reserved.

  15. In utero exposure to atrazine analytes and early menarche in the Avon Longitudinal Study of Parents and Children Cohort.

    PubMed

    Namulanda, Gonza; Taylor, Ethel; Maisonet, Mildred; Boyd Barr, Dana; Flanders, W Dana; Olson, David; Qualters, Judith R; Vena, John; Northstone, Kate; Naeher, Luke

    2017-07-01

    Evidence from experimental studies suggests that atrazine and its analytes alter the timing of puberty in laboratory animals. Such associations have not been investigated in humans. To determine the association between in utero exposure to atrazine analytes and earlier menarche attainment in a nested case-control study of the population-based Avon Longitudinal Study of Parents and Children. Cases were girls who reported menarche before 11.5 years while controls were girls who reported menarche at or after 11.5 years. Seven atrazine analyte concentrations were measured in maternal gestational urine samples (sample gestation week median (IQR): 12 (8-17)) during the period 1991-1992, for 174 cases and 195 controls using high performance liquid chromatography-tandem mass spectrometry. We evaluated the study association using multivariate logistic regression, adjusting for potential confounders. We used multiple imputation to impute missing confounder data for 29% of the study participants. Diaminochlorotriazine (DACT) was the most frequently detected analyte (58%>limit of detection [LOD]) followed by desethyl atrazine (6%), desethyl atrazine mercapturate (3%), atrazine mercapturate (1%), hydroxyl atrazine (1%), atrazine (1%) and desisopropyl atrazine (0.5%). Because of low detection of other analytes, only DACT was included in the exposure-outcome analyses. The adjusted odds of early menarche for girls with DACT exposures≥median was 1.13 (95% Confidence Interval [95% CI]:0.82, 1.55) and exposurestudy is the first to examine the association between timing of menarche and atrazine analytes. We found a weak, non-significant association between in

  16. Children Born in 2001: First Results from the Base Year of the Early Childhood Longitudinal Study, Birth Cohort (ECLS?B). E.D. TAB. NCES 2005-036.

    ERIC Educational Resources Information Center

    Flanagan, Kristin Denton; West, Jerry

    2004-01-01

    This E.D. TAB provides descriptive information about children born in the United States in 2001. It is the first publication based on the Early Childhood Longitudinal Study, Birth Cohort (ECLS?B), and it presents information on certain child and family characteristics, on children's mental and physical skills, on children's first experiences in…

  17. Dengue Infection in Children in Ratchaburi, Thailand: A Cohort Study. I. Epidemiology of Symptomatic Acute Dengue Infection in Children, 2006–2009

    PubMed Central

    Sabchareon, Arunee; Sirivichayakul, Chukiat; Limkittikul, Kriengsak; Chanthavanich, Pornthep; Suvannadabba, Saravudh; Jiwariyavej, Vithaya; Dulyachai, Wut; Pengsaa, Krisana; Margolis, Harold S.; Letson, G. William

    2012-01-01

    Background There is an urgent need to field test dengue vaccines to determine their role in the control of the disease. Our aims were to study dengue epidemiology and prepare the site for a dengue vaccine efficacy trial. Methods and Findings We performed a prospective cohort study of children in primary schools in central Thailand from 2006 through 2009. We assessed the epidemiology of dengue by active fever surveillance for acute febrile illness as detected by school absenteeism and telephone contact of parents, and dengue diagnostic testing. Dengue accounted for 394 (6.74%) of the 5,842 febrile cases identified in 2882, 3104, 2717 and 2312 student person-years over the four years, respectively. Dengue incidence was 1.77% in 2006, 3.58% in 2007, 5.74% in 2008 and 3.29% in 2009. Mean dengue incidence over the 4 years was 3.6%. Dengue virus (DENV) types were determined in 333 (84.5%) of positive specimens; DENV serotype 1 (DENV-1) was the most common (43%), followed by DENV-2 (29%), DENV-3 (20%) and DENV-4 (8%). Disease severity ranged from dengue hemorrhagic fever (DHF) in 42 (10.5%) cases, dengue fever (DF) in 142 (35.5%) cases and undifferentiated fever (UF) in 210 (52.5%) cases. All four DENV serotypes were involved in all disease severity. A majority of cases had secondary DENV infection, 95% in DHF, 88.7% in DF and 81.9% in UF. Two DHF (0.5%) cases had primary DENV-3 infection. Conclusion The results illustrate the high incidence of dengue with all four DENV serotypes in primary school children, with approximately 50% of disease manifesting as mild clinical symptoms of UF, not meeting the 1997 WHO criteria for dengue. Severe disease (DHF) occurred in one tenth of cases. Data of this type are required for clinical trials to evaluate the efficacy of dengue vaccines in large scale clinical trials. PMID:22860141

  18. The relationship of height and body fat to gender-assortative weight gain in children. A longitudinal cohort study (EarlyBird 44).

    PubMed

    Ajala, Olubukola; Fr Meaux, Alissa E; Hosking, Joanne; Metcalf, Brad S; Jeffery, Alison N; Voss, Linda D; Wilkin, Terence J

    2011-08-01

    Height, body fat and body mass index (BMI) are correlated in children, so we hypothesized that the gender-assortative associations in BMI recently reported in contemporary children might extend to their height and body fat. Prospective longitudinal cohort study. A total of 226 healthy trios (mother, father and child) from a 1995?1996 birth cohort randomly recruited in the city of Plymouth, UK. Height, weight, and BMI (kg/m(2)) were measured in each of the parents and, in addition, sum of five skin-folds (SF) in their children at 5, 6, 7 and 8 y. BMI and SF were strongly height-dependent in the children by 8 y (r = 0.41-0.56). SF was gender-assortative insofar as the mean SF was significantly greater in the daughters (but not the sons) of obese mothers (obese vs. normal weight: +2.5 cm p < 0.001) and in the sons (but not the daughters) of obese fathers (obese vs. normal: +1.3 cm p < 0.001). As expected, offspring height correlated with that of their parents, but overweight/obese children were systematically taller than normal weight children (boys: +1.02 SDS, girls: +1.14 SDS, p < 0.01), and this difference was independent of parental height or BMI. Height is transmitted by both parents, and the body fat of overweight/obese children largely by the same-sex parent, but the extra height associated with more fat in the child is unrelated to the height or weight of either parent. The secular trend in height among contemporary children may simply reflect their rising body fat. Excess fat is unhealthy, so the trend in height may not be healthy either.

  19. Fermented Food Consumption and Psychological Distress in Pregnant Women: A Nationwide Birth Cohort Study of the Japan Environment and Children's Study.

    PubMed

    Takahashi, Fumiaki; Nishigori, Hidekazu; Nishigori, Toshie; Mizuno, Satoshi; Obara, Taku; Metoki, Hirohito; Sakurai, Kasumi; Ishikuro, Mami; Iwama, Noriyuki; Tatsuta, Nozomi; Nishijima, Ichiko; Fujiwara, Ikuma; Arima, Takahiro; Nakai, Kunihiko; Sugiyama, Takashi; Kuriyama, Shinichi; Yaegashi, Nobuo

    2016-12-01

    Health benefits of fermented foods are attracting attention worldwide, and they have been traditionally eaten in Japan. Moreover, a recent study showed the association between the higher intake of yogurt and lower prevalence of depressive symptoms during pregnancy. Psychological problems, such as anxiety and depression, during pregnancy are serious health concerns and may increase the risk of adverse outcomes in children. In this study, we explored the association between fermented food consumption and psychological distress in 10,129 pregnant Japanese women, using the fixed data of the Japan Environment and Children's Study (JECS), an ongoing nation-wide birth cohort study. Food consumption was assessed with a semi-quantitative food frequency questionnaire (FFQ), and the Kessler 6-item psychological distress scale (K6) was administered to eligible women during their second or third trimester to eliminate overlap with the period of hyperemesis gravidarum. The mean median gestation in the subjects was 24.8 weeks. In total, 9,030 subjects completed the K6 questionnaire and FFQ. Importantly, the prevalence of the K6 score of ≥ 13 was 3.1% (280 subjects). This value was lower compared to precedent studies, which may reflect that cooperative and health conscious subject participated in the survey. The multivariate logistic regression analysis indicates that the intake of yogurt, lactic acid beverages, cheese, Japanese pickles, miso soup, or fermented soybeans was not significantly associated with a K6 score of ≥ 13. In conclusion, the present cohort study shows no association between fermented food consumption and psychological distress symptoms during the second or third trimester of pregnancy.

  20. Selection factors in cohort studies

    SciTech Connect

    Nicholson, W.J.

    1985-05-01

    Cohort studies play an important role in the quantitation of cancer risk among occupationally exposed individuals. Properly conducted cohort studies can develop important data on the age, time, and exposure dependence of cancer risk. Such information allows identification of possible selection effects which may be present and allows generalization of risk estimates to other exposure circumstances.

  1. Cohort profile: Shahroud Eye Cohort Study.

    PubMed

    Fotouhi, Akbar; Hashemi, Hassan; Shariati, Mohammad; Emamian, Mohammad Hassan; Yazdani, Kamran; Jafarzadehpur, Ebrahim; Koohian, Hassan; Khademi, Mohammad Reza; Hodjatjalali, Kamran; Kheirkhah, Ahmad; Chaman, Reza; Malihi, Sarvenaz; Mirzaii, Mehdi; Khabazkhoob, Mehdi

    2013-10-01

    The Shahroud Eye Cohort Study was set up to determine the prevalence and incidence of visual impairment and major eye conditions in the 40-64-year-old population of Shahroud as a Middle Eastern population. The first phase of the study was conducted in 2009-10. Using random cluster sampling, 6311 Shahroud inhabitants were invited for ophthalmologic examinations; of these, 5190 participants completed phase 1 (participation rate of 82.2%). All participants were interviewed to collect data on participants' demographics, occupation status, socioeconomic status, history of smoking, and medical and ophthalmic history, as well as history of medication, and the quality and duration of their insurance. DNA and plasma samples, as well as four dots of whole blood were collected from participants. Extensive optometric and ophthalmologic examinations were performed for each participant, including lensometry of current glasses, testing near and far visual acuity; determining objective and subjective refraction; eye motility; cycloplegic refraction; colour vision test; slit-lamp biomicroscopy and intraocular pressure measurement; direct and indirect fundoscopy; perimetry test; ocular biometry; corneal topography; lens and fundus photography; and the Schirmer's (1008 participants) and tear breakup time tests (1013 participants). The study data are available for collaborative research at Noor Ophthalmology Research Center, Tehran, Iran.

  2. Cancer in children and young adults born after assisted reproductive technology: a Nordic cohort study from the Committee of Nordic ART and Safety (CoNARTaS).

    PubMed

    Sundh, Karin Jerhamre; Henningsen, Anna-Karina A; Källen, Karin; Bergh, Christina; Romundstad, Liv Bente; Gissler, Mika; Pinborg, Anja; Skjaerven, Rolv; Tiitinen, Aila; Vassard, Ditte; Lannering, Birgitta; Wennerholm, Ulla-Britt

    2014-09-01

    Do children and young adults born after assisted reproductive technology (ART) have an increased risk of cancer? Children born after ART showed no overall increase in the rate of cancer when compared with children born as a result of spontaneous conception. Children born after ART have more adverse perinatal outcomes, i.e. preterm births, low birthweights and birth defects. Previous studies have shown divergent results regarding the risk of cancer among children born after ART. A retrospective Nordic population-based cohort study was performed, comprising all children born after ART in Sweden, Denmark, Finland and Norway between 1982 and 2007. The mean (±standard deviation) follow-up time was 9.5 (4.8) years. Children born after ART (n = 91 796) were compared with a control group of children born after spontaneous conception. This control group was almost 4-fold the size of the ART group (n = 358 419) and matched for parity, year of birth and country. Data on perinatal outcomes and cancer were obtained from the National Medical Birth Registries, the Cancer Registries, the Patient Registries and the Cause of Death Registries. The cancer diagnoses were divided into 12 main groups. Hazard ratios (HRs) and adjusted HR were calculated. Adjustments were carried out for country, maternal age, parity, sex, gestational age and birth defects. There was no significant increase in overall cancer rates among children born after ART when compared with children born after spontaneous conception (adjusted HR 1.08; 95% CI 0.91-1.27). Cancer, of any form, was found among 181 children born after ART (2.0/1000 children, 21.0/100 000 person-years) compared with 638 children born after spontaneous conception (1.8/1000 children, 18.8/100 000 person-years). Leukaemia was the most common type of cancer (n = 278, 0.62/1000 children) but no significantly increased incidence was found among children born after ART. An increased risk was observed for 2 of 12 cancer groups. They were central

  3. Self-Reported Health Experiences of Children Living with Congenital Heart Defects: Including Patient-Reported Outcomes in a National Cohort Study.

    PubMed

    Knowles, Rachel Louise; Tadic, Valerija; Hogan, Ailbhe; Bull, Catherine; Rahi, Jugnoo Sangeeta; Dezateux, Carol

    2016-01-01

    Understanding children's views about living with congenital heart defects (CHDs) is fundamental to supporting their successful participation in daily life, school and peer relationships. As an adjunct to a health and quality of life outcomes questionnaire, we asked school-age children who survived infant heart procedures to describe their experiences of living with CHDs. In a UK-wide cohort study, children aged 10 to 14 years with CHDs self-completed postal questionnaires that included an open question about having a 'heart problem'. We compared the characteristics of children with more and less severe cardiac diagnoses and, through collaborative inductive content analysis, investigated the subjective experiences and coping strategies described by children in both clinical severity groups. Text and/or drawings were returned by 436 children (246 boys [56%], mean age 12.1 years [SD 1.0; range 10-14]); 313 had less severe (LS) and 123 more severe (MS) cardiac diagnoses. At the most recent hospital visit, a higher proportion of the MS group were underweight (more than two standard deviations below the mean for age) or cyanosed (underweight: MS 20.0%, LS 9.9%; cyanosed: MS 26.2%, LS 3.5%). Children in the MS group described concerns about social isolation and feeling 'different', whereas children with less severe diagnoses often characterised their CHD as 'not a big thing'. Some coping strategies were common to both severity groups, including managing health information to avoid social exclusion, however only children in the LS group considered their CHD 'in the past' or experienced a sense of survivorship. Children's reported experiences were not dependent on their cardiac diagnosis, although there were clear qualitative differences by clinical severity group. Children's concerns emphasised social participation and our findings imply a need to shift the clinical focus from monitoring cardiac function to optimising participation. We highlight the potential for informing

  4. Scaling-Up Access to Antiretroviral Therapy for Children: A Cohort Study Evaluating Care and Treatment at Mobile and Hospital-Affiliated HIV Clinics in Rural Zambia

    PubMed Central

    van Dijk, Janneke H.; Moss, William J.; Hamangaba, Francis; Munsanje, Bornface; Sutcliffe, Catherine G.

    2014-01-01

    Background Travel time and distance are barriers to care for HIV-infected children in rural sub-Saharan Africa. Decentralization of care is one strategy to scale-up access to antiretroviral therapy (ART), but few programs have been evaluated. We compared outcomes for children receiving care in mobile and hospital-affiliated HIV clinics in rural Zambia. Methods Outcomes were measured within an ongoing cohort study of HIV-infected children seeking care at Macha Hospital, Zambia from 2007 to 2012. Children in the outreach clinic group received care from the Macha HIV clinic and transferred to one of three outreach clinics. Children in the hospital-affiliated clinic group received care at Macha HIV clinic and reported Macha Hospital as the nearest healthcare facility. Results Seventy-seven children transferred to the outreach clinics and were included in the analysis. Travel time to the outreach clinics was significantly shorter and fewer caretakers used public transportation, resulting in lower transportation costs and fewer obstacles accessing the clinic. Some caretakers and health care providers reported inferior quality of service provision at the outreach clinics. Sixty-eight children received ART at the outreach clinics and were compared to 41 children in the hospital-affiliated clinic group. At ART initiation, median age, weight-for-age z-scores (WAZ) and CD4+ T-cell percentages were similar for children in the hospital-affiliated and outreach clinic groups. Children in both groups experienced similar increases in WAZ and CD4+ T-cell percentages. Conclusions HIV care and treatment can be effectively delivered to HIV-infected children at rural health centers through mobile ART teams, removing potential barriers to uptake and retention. Outreach teams should be supported to increase access to HIV care and treatment in rural areas. PMID:25122213

  5. Maternal Pre-Pregnancy BMI and Intelligence Quotient (IQ) in 5-Year-Old Children: A Cohort Based Study

    PubMed Central

    Bliddal, Mette; Olsen, Jørn; Støvring, Henrik; Eriksen, Hanne-Lise F.; Kesmodel, Ulrik S.; Sørensen, Thorkild I. A.; Nøhr, Ellen A.

    2014-01-01

    Background An association between maternal pre-pregnancy BMI and childhood intelligence quotient (IQ) has repeatedly been found but it is unknown if this association is causal or due to confounding caused by genetic or social factors. Methods We used a cohort of 1,783 mothers and their 5-year-old children sampled from the Danish National Birth Cohort. The children participated between 2003 and 2008 in a neuropsychological assessment of cognitive ability including IQ tests taken by both the mother and the child. Linear regression analyses were used to estimate the associations between parental BMI and child IQ adjusted for a comprehensive set of potential confounders. Child IQ was assessed with the Wechsler Primary and Preschool Scales of Intelligence – Revised (WPPSI-R). Results The crude association between maternal BMI and child IQ showed that BMI was adversely associated with child IQ with a reduction in IQ of −0.40 point for each one unit increase in BMI. This association was attenuated after adjustment for social factors and maternal IQ to a value of −0.27 (−0.50 to −0.03). After mutual adjustment for the father's BMI and all other factors except maternal IQ, the association between paternal BMI and child IQ yielded a regression coefficient of −0.26 (−0.59 to 0.07), which was comparable to that seen for maternal BMI (−0.20 (−0.44 to 0.04)). Conclusion Although maternal pre-pregnancy BMI was inversely associated with the IQ of her child, the similar association with paternal BMI suggests that it is not a specific pregnancy related adiposity effect. PMID:24727836

  6. Interruptions of antiretroviral therapy in children and adolescents with HIV infection in clinical practice: a retrospective cohort study in the USA

    PubMed Central

    Rakhmanina, Natella; Lam, Kam S; Hern, Jaclyn; Young, Heather A; Walters, Alex; Castel, Amanda D

    2016-01-01

    Introduction Changes in combination antiretroviral therapy (cART) throughout childhood challenge the continuity of paediatric HIV treatment. This study aimed to evaluate the prevalence of treatment interruption (TI), including lamivudine (3TC) monotherapy, and the relationship of TI to virologic and immunologic parameters in HIV-infected paediatric patients. Methods Nested within a prospective observational study of a city-wide cohort of HIV-infected persons in the District of Columbia, this sub-study collected retrospective data on antiretroviral therapy, enrolment (endpoint) and historic (lifelong) CD4 counts and HIV RNA viral load (VL) of the paediatric cohort. TI was defined as interruption of cART ≥4 consecutive weeks. Data on TI, including 3TC monotherapy TI (MTI), were collected. Descriptive statistics and univariate testing were used to compare children with TI and MTI to children on continuous treatment (CT). Results Thirty-eight (28%) out of 136 enrolled children (median age=12.9 years) experienced TI, with 14 (37%) of those placed on 3TC MTI. Significantly lower endpoint median CD4 counts (598 cells/mm3 vs. 815 cells/mm3; p=0.003) and CD4% (27.5% vs. 33%; p=0.006) were observed in the TI cohort as compared to the CT cohort. The median endpoint VL in the overall TI cohort was ~4 times higher than among the CT cohort (1427 copies/mL vs. 5581 copies/mL; p<0.0001). After a median TI duration of one year, a majority (n=31; 82%) of patients with TI restarted cART, including 100% of those with total TI and 53% of those on MTI, respectively. Conclusions In our study, we observed high frequency of the TI in HIV in paediatric HIV clinical practice. All TIs, including 3TC MTI, were associated with significantly lower endpoint median CD4 counts and higher median VLs, as compared to CT in paediatric patients. The high frequency of TI and associated poor outcomes suggest a need for a better strategy in managing the course of the paediatric and adolescent cART. PMID

  7. [Implementation of a French cohort of children or adolescents with autism spectrum disorders: ELENA cohort].

    PubMed

    Baghdadli, A; Loubersac, J; Soussana, M; Rattaz, C; Michelon, C

    2014-10-01

    Multidisciplinary cohort studies of children with autism spectrum disorders (ASD) followed from childhood to adulthood exist abroad but not in France. The objective of the ELENA French cohort is to study the developmental trajectories of children and adolescents with ASD and their risk or protective associated factors. This is an open, prospective and multicenter cohort study, including children and adolescents under 16 years of age with ASD recruited from services specialized in the assessment of developmental disorders. The patients will be monitored every 18 months for at least 36 months and during a maximum of 10 years. Clinical, social, environmental, and genetic data, as well as data relating to the parental quality of life will be collected. The primary endpoint will be the adaptive level in three domains of the Vineland II (communication, socialization and daily living skills). The secondary endpoints will be parental quality of life, comorbidities, interventions and severity of ASD. The inclusion of 1600 patients over a 10-year period is expected. This cohort should contribute to a better knowledge of the child developing an ASD, taking into account the physical, social and familial environment, the type of interventions and some genetic components. It should also lay the foundations for a national network of professionals working in the field of autism research by offering them a common tool for promoting translational studies. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  8. Impact of family-friendly prison policies on health, justice and child protection outcomes for incarcerated mothers and their dependent children: a cohort study protocol.

    PubMed

    Myers, Helen; Segal, Leonie; Lopez, Derrick; Li, Ian W; Preen, David B

    2017-08-23

    Female imprisonment has numerous health and social sequelae for both women prisoners and their children. Examples of comprehensive family-friendly prison policies that seek to improve the health and social functioning of women prisoners and their children exist but have not been evaluated. This study will determine the impact of exposure to a family-friendly prison environment on health, child protection and justice outcomes for incarcerated mothers and their dependent children. A longitudinal retrospective cohort design will be used to compare outcomes for mothers incarcerated at Boronia Pre-release Centre, a women's prison with a dedicated family-friendly environment, and their dependent children, with outcomes for mothers incarcerated at other prisons in Western Australia (that do not offer this environment) and their dependent children. Routinely collected administrative data from 1985 to 2013 will be used to determine child and mother outcomes such as hospital admissions, emergency department presentations, custodial sentences, community service orders and placement in out-of home care. The sample consists of all children born in Western Australia between 1 January 1985 and 31 December 2011 who had a mother in a West Australian prison between 1990 and 2012 and their mothers. Children are included if they were alive and aged less than 18 years at the time of their mother's incarceration. The sample comprises an exposed group of 665 women incarcerated at Boronia and their 1714 dependent children and a non-exposed comparison sample of 2976 women incarcerated at other West Australian prisons and their 7186 dependent children, creating a total study sample of 3641 women and 8900 children. This project received ethics approval from the Western Australian Department of Health Human Research Ethics Committee, the Western Australian Aboriginal Health Ethics Committee and the University of Western Australia Human Research Ethics Committee. © Article author(s) (or their

  9. Whooping cough in school age children presenting with persistent cough in UK primary care after introduction of the preschool pertussis booster vaccination: prospective cohort study.

    PubMed

    Wang, Kay; Fry, Norman K; Campbell, Helen; Amirthalingam, Gayatri; Harrison, Timothy G; Mant, David; Harnden, Anthony

    2014-06-24

    To estimate the prevalence and clinical severity of whooping cough (pertussis) in school age children presenting with persistent cough in primary care since the introduction and implementation of the preschool pertussis booster vaccination. Prospective cohort study (November 2010 to December 2012). General practices in Thames Valley, UK. 279 children aged 5 to 15 years who presented in primary care with a persistent cough of two to eight weeks' duration. Exclusion criteria were cough likely to be caused by a serious underlying medical condition, known immunodeficiency or immunocompromise, participation in another clinical research study, and preschool pertussis booster vaccination received less than one year previously. Evidence of recent pertussis infection based on an oral fluid anti-pertussis toxin IgG titre of at least 70 arbitrary units. Cough frequency was measured in six children with laboratory confirmed pertussis. 56 (20%, 95% confidence interval 16% to 25%) children had evidence of recent pertussis infection, including 39 (18%, 13% to 24%) of 215 children who had been fully vaccinated. The risk of pertussis was more than three times higher (21/53; 40%, 26% to 54%) in children who had received the preschool pertussis booster vaccination seven years or more previously than in those who had received it less than seven years previously (20/171; 12%, 7% to 17%). The risk of pertussis was similar between children who received five and three component preschool pertussis booster vaccines (risk ratio for five component vaccine 1.14, 0.64 to 2.03). Four of six children in whom cough frequency was measured coughed more than 400 times in 24 hours. Pertussis can still be found in a fifth of school age children who present in primary care with persistent cough and can cause clinically significant cough in fully vaccinated children. These findings will help to inform consideration of the need for an adolescent pertussis booster vaccination in the United Kingdom. UK

  10. Electrocardiographic Abnormalities and Treatment with Benznidazole among Children with Chronic Infection by Trypanosoma cruzi: A Retrospective Cohort Study

    PubMed Central

    Colantonio, Lisandro D.; Prado, Nilda; Segura, Elsa L.; Sosa-Estani, Sergio

    2016-01-01

    Background Chronic infection by Trypanosoma cruzi could cause heart conduction disturbances. We sought to analyze electrocardiographic abnormalities among children with chronic T. cruzi infection with and without trypanocidal treatment with benznidazole. Methodology/Principal Findings We studied 111 children 6–16 years of age with asymptomatic chronic T. cruzi infection who were recruited in 1991–1992 in Salta, Argentina. Most children were randomly assigned to benznidazole 5 mg/Kg/day (n = 47) or matching placebo (n = 48) for 60 days. Remaining children (n = 16) received treatment with benznidazole 5 mg/Kg/day open-label. Electrocardiograms were obtained at baseline and in 1995–1996, 1998, 2000 and 2005, and were analyzed using the Buenos Aires method. Among the 94 children with an electrocardiogram at baseline, 8 (8.5%) had electrocardiographic abnormalities, including 4 (4.7%) children with right bundle branch block. Proportion of abnormal electrocardiograms in the full population (n = 111) remained constant over time (media follow-up 8.6 years). Multivariable adjusted prevalence ratios (95% confidence interval [95%CI]) for electrocardiographic abnormalities in 1995–1996, 1998, 2000 and 2005 comparing children treated with benznidazole versus those not treated were 2.76 (0.66, 11.60), 2.33 (0.44, 12.31), 3.06 (0.48, 19.56), and 1.94 (0.33, 11.25), respectively. Among the 86 children with a normal electrocardiogram at baseline, 16 (18.6%) developed electrocardiographic abnormalities during follow-up. The multivariable adjusted hazard ratio for incident electrocardiographic abnormalities comparing children treated with benznidazole versus those not treated was 0.68 (95%CI: 0.25, 1.88). Conclusions/Significance Electrocardiographic abnormalities are frequent among children with chronic T. cruzi infection. Treatment with benznidazole for 60 days may not be associated with less electrocardiographic abnormalities. PMID:27158908

  11. Searching the optimal PTH target range in children undergoing peritoneal dialysis: new insights from international cohort studies.

    PubMed

    Haffner, Dieter; Schaefer, Franz

    2013-04-01

    The treatment of the mineral and bone disorder associated with chronic kidney disease (CKD-MBD) remains a major challenge in pediatric patients. The principal aims of therapeutic measures are not only to prevent the debilitating skeletal complications and to achieve normal growth but also to preserve long-term cardiovascular health. Serum parathyroid hormone (PTH) levels are used as a surrogate parameter of bone turnover. Whereas it is generally accepted that serum calcium and phosphate levels should be kept within the range for age, current pediatric consensus guidelines differ markedly with respect to the optimal PTH target range and operate on a limited evidence base. Recently, the International Pediatric Dialysis Network (IPPN) established a global registry collecting detailed clinical and biochemical information, including data relevant to CKD-MBD in children on chronic peritoneal dialysis (PD). This review highlights the current evidence basis regarding the optimal PTH target range in pediatric CKD patients, and re-assesses the current guidelines in view of the outcome data collected by the IPPN registry. Based on a comprehensive evaluation of CKD-MBD outcome measures in this global patient cohort, a PTH target range of 1.7-3 times the upper limit of normal (i.e. 100-200 pg/ml) appears reasonable in children undergoing chronic PD.

  12. Prenatal exposure to loratadine in children with hypospadias: a nested case-control study within the Danish National Birth Cohort.

    PubMed

    Pedersen, Lars; Nørgaard, Mette; Skriver, Mette Vinther; Olsen, Jørn; Sørensen, Henrik Toft

    2006-01-01

    The aim of this study was to examine the risk of hypospadias after reported exposure to loratadine and other antihistamines during pregnancy, based on data from the Danish National Birth Cohort. We examined the risk of hypospadias in a nested case-control design based on women enrolled in the Danish National Birth Cohort from 1998 to 2002 ( approximately 95,000 pregnant women). Data on maternal use of medicine in pregnancy were retrieved from questionnaires and telephone interviews, and data on birth outcomes were obtained from the Hospital Discharge Registry (HDR). Within the Danish National Birth Cohort, we identified cases with a diagnosis of hypospadias and randomly selected 10 controls per case without such a diagnosis (matched by date of birth). We identified 203 cases of hypospadias recorded in the HDR within 1 year postpartum and 2030 controls. One case (0.5%) and 25 (1.2%) controls reported exposure to loratadine in the first trimester or up to 30 days before the time of conception. The adjusted odds ratio (OR) for hypospadias among users of loratadine relative to nonusers was 0.9 (95% CI: 0.1-6.9) and the corresponding OR for other antihistamines was 0.5 (95% CI: 0.1-1.9). These data do not indicate an increased risk of hypospadias associated with maternal exposure to loratadine. In addition, this study does not suggest any risk differential between maternal exposure to loratadine and other antihistamines. However, the statistical precision of the risk estimates was low.

  13. The prevalence of children affected by parental cancer and their use of specialized psychiatric services: the 1987 Finnish Birth Cohort study.

    PubMed

    Niemelä, Mika; Paananen, Reija; Hakko, Helinä; Merikukka, Marko; Gissler, Mika; Räsänen, Sami

    2012-11-01

    The studies reporting population-based estimates of the proportion of children with a parent suffering from cancer are very few. These children have been shown to suffer from psychological symptoms, but it is not known whether their use of psychiatric services is increased. Our study examined the prevalence of children affected by parental cancer at national level and whether these children use specialized psychiatric services more than their peers. The study is a retrospective population-based registry study. All 60,069 children born in Finland in 1987 were followed up with various health and social registers from 1987 to 2008. The associations of parental cancer treatments with children's psychiatric service use were analyzed with logistic regressions. During the 21-year follow-up 3,909 (6.6%) of the children had a parent suffering from cancer. The children of the cancer patients used more specialized psychiatric care than their peers and the service use depended on parent's gender, as well as cohort members' gender and the age at occurrence. The combination of parental cancer and psychiatric disorder, whether the ill parent or spouse, increased the children's psychiatric service use even more. Children affected by parental cancer comprise a substantial part of the population in society using increased level of psychiatric services. Parental cancer is clearly an illness which has to be taken into account in planning child- and parenting-focused prevention and promotion actions in adult health care. "Parent's cancer is like a tsunami which rolls over the whole family. If it struck a thousand families at the same time the whole healthcare system would be mobilized. But when it strikes one family at a time you are left alone with your children" (quote from a father during a family intervention). Weaver et al.1 have reported that 14% of all cancer survivors in the USA have minor dependent children, representing a population of about 1.58 million survivors and 2

  14. APOL1-associated glomerular disease among African-American children: a collaboration of the Chronic Kidney Disease in Children (CKiD) and Nephrotic Syndrome Study Network (NEPTUNE) cohorts.

    PubMed

    Ng, Derek K; Robertson, Catherine C; Woroniecki, Robert P; Limou, Sophie; Gillies, Christopher E; Reidy, Kimberly J; Winkler, Cheryl A; Hingorani, Sangeeta; Gibson, Keisha L; Hjorten, Rebecca; Sethna, Christine B; Kopp, Jeffrey B; Moxey-Mims, Marva; Furth, Susan L; Warady, Bradley A; Kretzler, Matthias; Sedor, John R; Kaskel, Frederick J; Sampson, Matthew G

    2017-06-01

    Individuals of African ancestry harboring two variant alleles within apolipoprotein L1 ( APOL1 ) are classified with a high-risk (HR) genotype. Adults with an HR genotype have increased risk of focal segmental glomerulosclerosis and chronic kidney disease compared with those with a low-risk (LR) genotype (0 or 1 variants). The role of APOL1 risk genotypes in children with glomerular disease is less well known. This study characterized 104 African-American children with a glomerular disease by APOL1 genotype in two cohorts: the Chronic Kidney Disease in Children (CKiD) and Nephrotic Syndrome Study Network (NEPTUNE). Among these subjects, 46% had an HR genotype with a similar age at cohort enrollment. For APOL1 HR children, the median age of disease onset was older (CKiD: 4.5 versus 11.5 years for LR versus HR; NEPTUNE: 11 versus 14 years for LR versus HR, respectively) and preterm birth was more common [CKiD: 27 versus 4%; NEPTUNE: 26 versus 12%; combined odds ratio 4.6 (95% confidence interval: 1.4, 15.5)]. Within studies, HR children had lower initial estimated glomerular filtration rate (eGFR) (CKiD: 53 versus 69 mL/min/1.73 m 2 ; NEPTUNE: 74 versus 94 mL/min/1.73 m 2 ). Longitudinal eGFR decline was faster among HR children versus LR (CKiD: -18 versus -8% per year; NEPTUNE: -13 versus -3% per year). Children with an HR genotype in CKiD and NEPTUNE seem to have a more aggressive form of glomerular disease, in part due to a higher prevalence of focal segmental glomerulosclerosis. These consistent findings across independent cohorts suggest a common natural history for children with APOL1 -associated glomerular disease. Further study is needed to determine the generalizability of these findings.

  15. Morphea in Adults and Children Cohort III

    PubMed Central

    Dharamsi, Jennifer Warner; Victor, Sandra; Aguwa, Nancy; Ahn, Chul; Arnett, Frank; Mayes, Maureen D.; Jacobe, Heidi

    2014-01-01

    IMPORTANCE Small studies have implicated the association of specific autoantibodies with morphea subtype or severity, but no large-scale studies have been conducted. This prospective case-control study confirmed the presence of antinuclear antibodies (ANAs) and other autoantibodies in morphea but found they are of limited significance. OBJECTIVE To determine the prevalence of ANAs, extractable nuclear antigens such as antihistone antibodies (AHAs), and anti–single-stranded DNA antibodies (ssDNA abs) in patients with morphea vs a healthy control population and their association with clinical measures of morphea severity. DESIGN, SETTING, AND PARTICIPANTS Nested case-control study, conducted at the University of Texas Southwestern Medical Center, Dallas, and University of Texas Health Science Center, Houston. Study participants included individuals enrolled in the Morphea in Adults and Children (MAC) cohort and Scleroderma Family Registry and DNA Repository. MAIN OUTCOMES AND MEASURES Prevalence of ANAs, AHAs, ssDNA abs in patients with morphea vs matched controls and association of the presence of autoantibodies with clinical indicators of morphea severity. RESULTS The prevalence of ANAs, AHAs, and ssDNA abs in patients with morphea was 34%, 12%, and 8%, respectively. Antinuclear antibodies and AHAs, but not ssDNA abs, were present more frequently in cases than in controls. There was no difference in ANA prevalence among morphea subtypes. Among patients with linear morphea, the presence of autoantibodies was associated with clinical indicators of severe morphea including functional limitation (ssDNA ab, P = .005; and AHA, P = .006), extensive body surface area involvement (ssDNA ab, P = .01; and ANA, P = .005), and higher skin scores (ANA, P = .004). The presence of autoantibodies was not associated with clinical measures of morphea activity. CONCLUSIONS AND RELEVANCE Our results demonstrate that ANAs and AHAs are more prevalent among patients with morphea but are

  16. Determinants of plasma PCB, brominated flame retardants, and organochlorine pesticides in pregnant women and 3 year old children in The Norwegian Mother and Child Cohort Study.

    PubMed

    Caspersen, Ida Henriette; Kvalem, Helen Engelstad; Haugen, Margaretha; Brantsæter, Anne Lise; Meltzer, Helle Margrete; Alexander, Jan; Thomsen, Cathrine; Frøshaug, May; Bremnes, Nanna Margrethe Bruun; Broadwell, Sharon Lynn; Granum, Berit; Kogevinas, Manolis; Knutsen, Helle Katrine

    2016-04-01

    Exposure to persistent organic pollutants (POPs) during prenatal and postnatal life has been extensively studied in relation to adverse health effects in children. The aim was to identify determinants of the concentrations of polychlorinated biphenyls (PCBs), brominated flame retardants (polybrominated diphenyl ethers, PBDEs; polybrominated biphenyl, PBB), and organochlorine pesticides (OCPs) in blood samples from pregnant women and children in The Norwegian Mother and Child Cohort Study (MoBa). Blood samples were collected from two independent subsamples within MoBa; a group of women (n=96) enrolled in mid-pregnancy during the years 2002-2008 and a group of 3 year old children (n=99) participating during 2010-2011. PCB congeners (74, 99, 138, 153, 180, 170, 194, 209, 105, 114, 118, 156, 157, 167, and 189), brominated flame retardants (PBDE-28, 47, 99, 100, 153, 154, and PBB-153), as well as the OCPs hexachlorobenzene (HCB), oxychlordane, 4,4'dichlorodiphenyltrichloroethane (DDT), and 4,4'dichlorodiphenyldichloroethylene (DDE) were measured in both pregnant women and children. Age, low parity, and low pre-pregnant BMI were the most important determinants of increased plasma concentrations of POPs in pregnant women. In 3 year old children, prolonged breastfeeding duration was a major determinant of increased POP concentrations. Estimated dietary exposure to PCBs during pregnancy was positively associated with plasma concentrations in 3 year old children, but not in pregnant women. Plasma concentrations were approximately 40% higher in children compared to pregnant women. Several factors associated with exposure and toxicokinetics, i.e. accumulation, excretion and transfer via breastmilk of POPs were the main predictors of POP levels in pregnant women and children. Diet, which is the main exposure source for these compounds in the general population, was found to predict PCB levels only among children. For the PBDEs, for which non-dietary sources are more important

  17. Health care for children with diabetes mellitus from low-income families in Ontario and California: a population-based cohort study.

    PubMed

    Kaiser, Sunitha V; Sundaram, Vandana; Cohen, Eyal; Shulman, Rayzel; Guan, Jun; Sanders, Lee; Guttmann, Astrid

    2016-01-01

    Children with diabetes mellitus in low-income families have poor outcomes, but little is known as to how this relates to healthcare system structure. Our objective was to gain insight into how best to structure health systems to serve these children by describing their health care use in 2 health system models: a Canadian model, with an organized diabetes care network that includes generalists, and an American model, with targeted support services for children from low-income families. We performed a population-based retrospective cohort study involving children aged 1-17 years with type 1 diabetes mellitus. We used administrative data from between 2009 and 2012 from the California Children's Services program and Ontario. We used Ontario Drug Benefit Program enrolment to identify children from low-income families. Proportions of children receiving 2 or more routine diabetes visits per year were compared using χ2 tests, and diabetes-complication hospital admission rates were compared using direct standardization. More California children from low-income families (n = 4922) received routine care for diabetes from pediatric endocrinologists (63.9% v. 26.9%, p < 0.001) and used insulin pumps (22.8% v. 16.4%, p < 0.001) than Ontario children (n = 2050).California children from low-income families were less likely than Ontario children to receive 2 visits for routine diabetes care per year (64.7% v. 75.7%, p < 0.001), and had slightly higher per-patient year hospital admission rates for diabetes complications (absolute differences 0.02, 95% confidence interval [CI] 0.02-0.02, for boys; 0.03, 95% CI 0.03-0.03, for girls). Ontario children from low-income families received more routine diabetes care than did California children from low-income families. Both groups of children had clinically comparable rates of hospital admission for diabetes complications. Diabetes care networks that integrate generalists may play a role in improving access and outcomes for the growing

  18. Health care for children with diabetes mellitus from low-income families in Ontario and California: a population-based cohort study

    PubMed Central

    Kaiser, Sunitha V.; Sundaram, Vandana; Cohen, Eyal; Shulman, Rayzel; Guan, Jun; Sanders, Lee; Guttmann, Astrid

    2016-01-01

    Background: Children with diabetes mellitus in low-income families have poor outcomes, but little is known as to how this relates to healthcare system structure. Our objective was to gain insight into how best to structure health systems to serve these children by describing their health care use in 2 health system models: a Canadian model, with an organized diabetes care network that includes generalists, and an American model, with targeted support services for children from low-income families. Methods: We performed a population-based retrospective cohort study involving children aged 1-17 years with type 1 diabetes mellitus. We used administrative data from between 2009 and 2012 from the California Children's Services program and Ontario. We used Ontario Drug Benefit Program enrolment to identify children from low-income families. Proportions of children receiving 2 or more routine diabetes visits per year were compared using χ2 tests, and diabetes-complication hospital admission rates were compared using direct standardization. Results: More California children from low-income families (n = 4922) received routine care for diabetes from pediatric endocrinologists (63.9% v. 26.9%, p < 0.001) and used insulin pumps (22.8% v. 16.4%, p < 0.001) than Ontario children (n = 2050).California children from low-income families were less likely than Ontario children to receive 2 visits for routine diabetes care per year (64.7% v. 75.7%, p < 0.001), and had slightly higher per-patient year hospital admission rates for diabetes complications (absolute differences 0.02, 95% confidence interval [CI] 0.02-0.02, for boys; 0.03, 95% CI 0.03-0.03, for girls). Interpretation: Ontario children from low-income families received more routine diabetes care than did California children from low-income families. Both groups of children had clinically comparable rates of hospital admission for diabetes complications. Diabetes care networks that integrate generalists may play a role in

  19. Adiposity and glucose intolerance exacerbate components of metabolic syndrome in children consuming sugar-sweetened beverages: QUALITY cohort study.

    PubMed

    Wang, J W; Mark, S; Henderson, M; O'Loughlin, J; Tremblay, A; Wortman, J; Paradis, G; Gray-Donald, K

    2013-08-01

    Sugar-sweetened beverage (SSB) consumption is linked to weight gain and metabolic syndrome (MetS) components in children, but whether these associations are modified by excess weight and glucose tolerance status in children is not known. The objective of this study was to examine the cross-sectional associations between SSB intake and MetS components among children above and below the 85th body mass index (BMI) percentile and those with and without impaired glucose tolerance (IGT). Data were from the QUébec Adiposity and Lifestyle InvesTigation in Youth study (2005-2008). Caucasian children aged 8-10 years (n = 632) were recruited from 1040 primary schools in Québec, Canada. SSB consumption was assessed by three 24-h dietary recalls, body fat mass by dual-energy absorptiometry, physical activity by 7-d accelerometer. Multivariate linear regressions were used, with age, sex, fat mass index and physical activity as covariates, including waist circumference (WC), systolic blood pressure (SBP), concentrations of triglyceride and high-density lipoprotein cholesterol and homeostasis model assessment of insulin resistance (HOMA-IR) as outcome variables. Among overweight children, a 100-mL higher SSB consumption was associated with a 0.1-unit higher HOMA-IR (P = 0.009) and a 1.1-mm Hg higher SBP (P = 0.001). In children with IGT, a 100-mL higher SSB consumption was associated with a 1.4-mm Hg higher SBP and a 4.0-cm higher WC (P < 0.001). These associations were not observed among children <85th BMI percentile. Our results suggest that the association between higher SSB consumption and MetS components is more evident in overweight/obese and glucose-intolerant children. © 2012 The Authors. Pediatric Obesity © 2012 International Association for the Study of Obesity.

  20. Use of prescription stimulant for Attention Deficit Hyperactivity Disorder in Aboriginal children and adolescents: a linked data cohort study.

    PubMed

    Ghosh, Manonita; Holman, C D'Arcy J; Preen, David B

    2015-12-09

    Increasing recognition of Attention Deficit Hyperactivity Disorder (ADHD) among Aboriginal children, adolescents and young adults is a public health challenge. We investigated the pattern of prescription stimulants for ADHD among Aboriginal individuals in Western Australia (WA). Using a whole-population-based linked data we followed a cohort of individuals born in WA from 1980-2005, and their parents were born in Australia, to identify stimulant prescription for ADHD derived from statutory WA stimulant prescription dispensing between 2003 and 2007. Parental link was ascertained through WA Family Connections Genealogical Linkage System. Cox proportional hazards regression (HR) models were performed to determine the association between stimulant use and Aboriginal and non-Aboriginal status. Of the total cohort of 186,468, around 2% (n = 3677) had prescription stimulants for ADHD. Individuals with both Aboriginal parents were two-thirds (HR 0.33, 95 % CI 0.26-0.42), and with only Aboriginal mother were one-third (HR 0.69, 95% CI 0.53-0.90) less likely to have stimulants, compared to individuals with non-Aboriginal parents. HR in Aboriginals was 62% lower (HR 0.35, 95% CI 0.25-0.49) in metropolitan areas, and 72% lower (HR 0.28, 95% CI 0.20-0.38) in non-metropolitan areas, than non-Aboriginals. The risk for simulant use was four times higher among Aboriginal boys than Aboriginal girls (HR 4.08, 95% CI, 2.92-5.69). Aboriginal cultural understanding of ADHD and attitude towards stimulant medication serve as a determinant of their access to health services. Any ADHD intervention and policy framework must take into account a holistic approach to Aboriginal culture, beliefs and individual experience to provide optimal care they need.

  1. Prevalence of dental caries among a cohort of preschool children living in Gampaha district, Sri Lanka: a descriptive cross sectional study.

    PubMed

    Perera, Priyantha J; Abeyweera, Nishadhi T; Fernando, Meranthi P; Warnakulasuriya, Tania D; Ranathunga, Nayomi

    2012-11-13

    Dental caries among young children are a global problem. Scant attention is paid towards primary teeth, leading to high prevalence of dental caries. There are only few studies done in Sri Lanka, addressing oral hygiene among preschool children. Scientific evidence is in need to persuade authorities to establish a programme promoting oral hygiene among preschool children. A descriptive cross sectional study was conducted in Ragama Medical officer of Health area. Consecutive children between 2 - 5 years of age, attending child welfare clinics were recruited for the study. Practices related to dental hygiene and socio-economic characteristics were obtained using an interviewer administered questionnaire. Mouth was examined for evidence of dental caries. Data collection and examination were done by two doctors who were trained for this purpose. The data were analysed using SSPS version 16. Total of 410 children were included. None had a routine visits to a dentist. Practices related to tooth brushing were satisfactory. Prevalence of dental caries gradually increased with age to reach 68.8% by 5 years. Mean total decayed-extracted-filled (deft) score for the whole sample was 1.41 and Significant caries index (SIC) was 4.09. Decayed tooth were the main contributor for the deft score and Care index was only 1.55. Girls had a significantly higher prevalence of caries than boys. Dental care provided for Sri Lankan preschool children appears to be unsatisfactory as prevalence of dental caries among this cohort of preschool children was very high. There is an urgent need to improve dental care facilities for Sri Lankan preschool children.

  2. Depression and chronic health conditions in parents of children with and without developmental disabilities: the growing up in Ireland cohort study.

    PubMed

    Gallagher, Stephen; Hannigan, Ailish

    2014-02-01

    Epidemiological evidence suggests that poor physical health and depression are highly co-morbid. To date, however, no study has considered whether depression in parents caring for children with developmental disabilities is partly driven by poor physical health. Using data from the Growing Up in Ireland national cohort study (2006 to date), 627 parents of children with developmental disabilities were compared with 7941 parents of typically developing children on scores from the Centre for Epidemiological Depression Scale, chronic health conditions, socio-demographic and child behavioural characteristics. Having a child with disabilities was associated with a higher risk of depression (odds ratio (OR)=1.83, 95% confidence interval (CI): 1.43, 2.35) compared to parents of typically developing children. Adjusting for the presence of chronic health conditions accounted for some of this excess risk (OR=1.77, 95% CI: 1.38, 2.27). The association between having a child with disabilities and increased risk of depression was explained, however, by adjusting for the child problem behaviours (OR=1.07, 95% CI: 0.81, 1.43). This study has confirmed, in a population-based sample, the high risk of depression in parents caring for children with developmental disabilities after adjusting for the presence of a chronic health condition. Importantly, given that poor mental health in these parents is associated with a battery of negative health and social family outcomes, it is imperative that health professionals pay attention to the mental health needs of these parents.

  3. Measures of adiposity in two cohorts of Hawaiian school children.

    PubMed

    Brown, Daniel E; Gotshalk, Lincoln A; Katzmarzyk, Peter T; Allen, Lenard

    2011-07-01

    Native Hawaiians have high rates of obesity and obesity-related diseases compared with non-Hawaiians in Hawaii, and the relation between this ethnic disparity in adiposity and socioeconomic status (SES) in children is unclear. The present study compared measures of adiposity in two cohorts of school children residing in the Hilo area of Hawaii and related these measures to parental reports of ethnicity, household income and parent educational attainment. All children in either Kindergarten (mean age 5.6 years) or third grade (mean age 8.7 years) in eight elementary schools in the Hilo area were invited to participate. A total of 125 children had anthropometric, bioelectric impedance and air displacement plethysmography measurements taken and their parents answered questions about household income, parental educational attainment and genealogical background that included ethnicity of ancestors. Boys and girls in both cohorts had stature approximately at the 50(th) percentile (Z-score = 0) of national samples (CDC data). Z-scores of BMI were elevated compared to the CDC reference curves, but were significantly higher in male Native Hawaiian children in the older cohort among whom nearly 50% had a BMI above the 95(th) percentile for age. In the younger cohort, there was no significant ethnic difference in adiposity measures. In the older cohort, Native Hawaiian boys had significantly higher adiposity measures than their classmates. Adiposity in third grade girls was significantly and inversely related to their father's educational attainment. Percentage of Hawaiian ancestry was not significantly related to adiposity measures. Ethnic disparity in adiposity among Native Hawaiians compared with non-Hawaiian age mates occurs after the age of 6 years, and is confined to males in this sample. For older girls, father's, but not mother's, educational attainment was inversely related to adiposity.

  4. Palatoplasty decreases the re-insertion rate of middle ear ventilation tube in cleft palate children - A population-based birth cohort study.

    PubMed

    Huang, Chii-Yuan; Wu, Chuan-Song; Tang, Chao-Hsiun; Wang, Mao-Che; Kuo, Ting-Yu; Tu, Tzong-Yang

    2016-08-01

    Palatoplasty can significantly decrease their middle ear re-intubation rate with a relatively lower hazard ratio compared to children who underwent VTI only. In children with cleft palate, questions remain about the overall effect of ventilation tube insertion (VTI) and palatoplasty for their OME. A large-scale study might offer more evidence for the roles of palatal surgery. This was a retrospective birth cohort study based upon a national database. We analyzed children born between 1999-2004 and diagnosed as cleft palate and/or lips. These children, according to their surgeries, were separated into two groups: (1) VTI only, and (2) VTI and palatoplasty. Kaplan-Meier analysis and log-rank test were used to calculate their cumulative tube re-insertion rates. Their hazard ratios of tube re-insertion were also analyzed. In total, 1205 cleft children were collected, with 151 in the VTI only group and 1054 in the VTI + palatoplasty group. Ventilation tube re-insertion rates were significantly lower in the VTI + palatoplasty group (p = 0.002). The cumulative re-insertion rates also showed a significant difference (p = 0.001). When compared to the VTI only group, the adjusted hazard ratio was 0.528 in the VTI + palatoplasty group (p = 0.001).

  5. Lifestyles and socio-cultural factors among children aged 6-8 years from five Italian towns: the MAPEC_LIFE study cohort.

    PubMed

    Bagordo, Francesco; De Donno, Antonella; Grassi, Tiziana; Guido, Marcello; Devoti, Gabriele; Ceretti, Elisabetta; Zani, Claudia; Feretti, Donatella; Villarini, Milena; Moretti, Massimo; Salvatori, Tania; Carducci, Annalaura; Verani, Marco; Casini, Beatrice; Bonetta, Sara; Carraro, Elisabetta; Schilirò, Tiziana; Bonizzoni, Silvia; Bonetti, Alberto; Gelatti, Umberto

    2017-03-07

    Lifestyles profoundly determine the quality of an individual's health and life since his childhood. Many diseases in adulthood are avoidable if health-risk behaviors are identified and improved at an early stage of life. The aim of the present research was to characterize a cohort of children aged 6-8 years selected in order to perform an epidemiological molecular study (the MAPEC_LIFE study), investigate lifestyles of the children that could have effect on their health status, and assess possible association between lifestyles and socio-cultural factors. A questionnaire composed of 148 questions was administered in two different seasons to parents of children attending 18 primary schools in five Italian cities (Torino, Brescia, Pisa, Perugia and Lecce) to obtain information regarding the criteria for exclusion from the study, demographic, anthropometric and health information on the children, as well as some aspects on their lifestyles and parental characteristics. The results were analyzed in order to assess the frequency of specific conditions among the different seasons and cities and the association between lifestyles and socio-economic factors. The final cohort was composed of 1,164 children (50.9 boys, 95.4% born in Italy). Frequency of some factors appeared different in terms of the survey season (physical activity in the open air, the ways of cooking certain foods) and among the various cities (parents' level of education and rate of employment, sport, traffic near the home, type of heating, exposure to passive smoking, ways of cooking certain foods). Exposure to passive smoking and cooking fumes, obesity, residence in areas with heavy traffic, frequency of outdoor play and consumption of barbecued and fried foods were higher among children living in families with low educational and/or occupational level while children doing sports and consuming toasted bread were more frequent in families with high socio-economic level. The socio-economic level seems to

  6. Pathways to Care for Critically Ill or Injured Children: A Cohort Study from First Presentation to Healthcare Services through to Admission to Intensive Care or Death

    PubMed Central

    Hodkinson, Peter; Argent, Andrew; Wallis, Lee; Reid, Steve; Perera, Rafael; Harrison, Sian; Thompson, Matthew; English, Mike; Maconochie, Ian; Ward, Alison

    2016-01-01

    Purpose Critically ill or injured children require prompt identification, rapid referral and quality emergency management. We undertook a study to evaluate the care pathway of critically ill or injured children to identify preventable failures in the care provided. Methods A year-long cohort study of critically ill and injured children was performed in Cape Town, South Africa, from first presentation to healthcare services until paediatric intensive care unit (PICU) admission or emergency department death, using expert panel review of medical records and caregiver interview. Main outcomes were expert assessment of overall quality of care; avoidability of severity of illness and PICU admission or death and the identification of modifiable factors. Results The study enrolled 282 children, 252 emergency PICU admissions, and 30 deaths. Global quality of care was graded good in 10% of cases, with half having at least one major impact modifiable factor. Key modifiable factors related to access to care and identification of the critically ill, assessment of severity, inadequate resuscitation, and delays in decision making and referral. Children were transferred with median time from first presentation to PICU admission of 12.3 hours. There was potentially avoidable severity of illness in 185 (74%) of children, and death prior to PICU admission was avoidable in 17/30 (56.7%) of children. Conclusions The study presents a novel methodology, examining quality of care across an entire system, and highlighting the complexity of the pathway and the modifiable events amenable to interventions, that could reduce mortality and morbidity, and optimize utilization of scarce critical care resources; as well as demonstrating the importance of continuity and quality of care. PMID:26731245

  7. Time until first dental caries for young children first seen in Federally Qualified Health Centers: a retrospective cohort study

    PubMed Central

    Kuthy, RA; Jones, M; Kavand, G; Momany, E; Askelson, N; Chi, D; Wehby, G; Damiano, P

    2014-01-01

    Objective The study assessed the time until first dental caries for young children seen at 5 Federally Qualified Health Centers (FQHC) in Iowa and the relationship with the frequency and gaps (in months) of dental episodes, the number of topical fluoride treatments, and the number of dentists caring for the subject. Methods Forty children were randomly selected at each FQHC (n=200). All children were continuously enrolled in the Medicaid program and had their first dental visit prior to age 6. Dental chart findings, claims data for the child and family, and birth certificate information were merged into one dataset. Dental visits were followed for a minimum of 36 months, including dental visits external to the FQHCs. Using time until first caries as the dependent variable, the data were subject to left, interval, and right censoring and were analyzed via Weibull regression. Results Slightly more than half of the 200 children experienced caries. Regression analysis indicated that the hazard rate of first dental caries increased by approximately 2% with each additional month that transpired between preventive recall examinations. In addition, children with older siblings who had a dental visit at the same center during the previous year prior to the subject’s first visit were more likely to have a longer time until first dental caries. Conclusions Timing of dental care episodes was associated with caries experience in young children from low income families. Dental professionals should focus on regularity of dental care in order to prevent or delay caries experience in young children. PMID:24483730

  8. Maternal and paternal indoor or outdoor smoking and the risk of asthma in their children: a nationwide prospective birth cohort study.

    PubMed

    Tabuchi, Takahiro; Fujiwara, Takeo; Nakayama, Tomio; Miyashiro, Isao; Tsukuma, Hideaki; Ozaki, Koken; Kondo, Naoki

    2015-02-01

    Little is known about the differential impact of combinations of parental smoking behavior (indoor or outdoor smoking, or not smoking) on preventing childhood asthma. Our objective was to examine the association between parental smoking behavior and children's asthma. A nationally representative population-based birth cohort of 40,580 babies, aged 0.5 years in 2001 (response rate, 87.8%), was studied to estimate adjusted odds ratios of combinations of maternal and paternal indoor or outdoor smoking at home for physician visits and hospitalization for childhood asthma up to 8-years-old, and population attributable fractions. Odds of hospitalization for asthma among children whose father alone smokes indoors at home did not largely increase (up to 20%). However, if the mother also smokes indoors at home, the odds strongly increased. After adjusting for demographic, perinatal and socioeconomic factors, the increase in odds for children whose father and mother both smoke indoors compared to children with non-smoking parents was 54% (95% confidence interval: 21-96%), 43% (8-90%) and 72% (22-143%) for children aged 0.5<-2.5, 2.5<-4.5 and 4.5<-8 years-old, respectively. The odds ratios of smoking outdoors did not largely differ from those of smoking indoors. Our estimation of population attributable fractions revealed that if all parents in Japan quit smoking, hospitalization of children for asthma could be reduced by 8.3% (2.2-14.3%), 9.3% (0.9-17.6%) and 18.2% (7.7-28.8%), respectively. Parental indoor smoking at home increased and exacerbated children's asthma. Smoking at home, whether it is indoors or outdoors, may increase the risks for asthma attacks of their children. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  9. Prenatal and postnatal tobacco exposure and behavioral problems in 10-year-old children: results from the GINI-plus prospective birth cohort study.

    PubMed

    Rückinger, Simon; Rzehak, Peter; Chen, Chih-Mei; Sausenthaler, Stefanie; Koletzko, Sibylle; Bauer, Carl-Peter; Hoffmann, Ute; Kramer, Ursula; Berdel, Dietrich; von Berg, Andrea; Bayer, Otmar; Wichmann, H-Erich; von Kries, Rüdiger; Heinrich, Joachim

    2010-01-01

    Prenatal and postnatal tobacco exposure have been reported to be associated with behavioral problems. However, the magnitude of the association with tobacco exposure at specific periods of exposure is unclear. We assessed the relative risk of behavioral problems in children who had been exposed to tobacco smoke in utero and postnatally. We analyzed data from a prospective birth cohort study in two cities in Germany: the German Infant Nutrition Intervention. Our sample included 5,991 children born between 1995 and 1998 as well as their parents. We measured behavioral problems using the Strength and Difficulties Questionnaire (SDQ) at follow-up 10 years after birth. According to prespecified SDQ cutoff values, children were classified as "normal," "borderline," or "abnormal" according to the subscales "emotional symptoms," "conduct problems," "hyperactivity/inattention," "peer-relationship problems," and a total difficulties score. Smoke exposure and further covariates were assessed using parent questionnaires. Compared with children not exposed to tobacco smoke, children exposed both pre- and postnatally to tobacco smoke had twice the estimated risk [95% confidence interval (CI), 1.4-3.1] of being classified as abnormal according to the total difficulties score of the SDQ at 10 years of age. Children who were only prenatally exposed had a 90% higher relative risk (95% CI, 0.9-4.0), whereas children who were only postnatally exposed had a 30% higher relative risk (95% CI, 0.9-1.9). These results could not be explained by confounding by parental education, father's employment, child's time spent in front of computer or television screen, being a single father or mother, or mother's age. Prenatal exposure to tobacco smoke is associated with behavioral problems in school-age children. Although our findings do not preclude the influence of postnatal exposure, prenatal exposure seems to be more important.

  10. Impact of Food Assistance Programs on Obesity in Mothers and Children: A Prospective Cohort Study in Peru

    PubMed Central

    Miranda, J. Jaime; Bernabé-Ortiz, Antonio

    2016-01-01

    Objectives. To assess obesity risk among mothers participating in Community Kitchens and children participating in Glass of Milk (Peru food assistance programs). Methods. We analyzed prospective data from the Young Lives study. The exposure consisted in varying degrees of benefit from any of the programs (no participation in any of the programs, program participation for some months, or program participation nearly every month) at baseline (2006–2007). The outcome was overweight and obesity in mothers and children at follow-up (2009–2010). Results. Prevalence of childhood overweight and obesity was 15.5% and 5.1%, respectively; the corresponding figures for mothers were 40.5% and 14.6%. Children exposed nearly every month to the Glass of Milk program had a 65% lower risk of becoming obese compared with children not participating in the program (relative risk [RR] = 0.35; 95% confidence interval [CI] = 0.18, 0.66). Mothers participating frequently in the Community Kitchens program had almost twice the risk of becoming obese compared with those who did not participate (RR = 1.93; 95% CI = 1.18, 3.15). Conclusions. Participating in food assistance programs in Peru was associated with a lower risk of obesity in children and greater risk of obesity in mothers. PMID:27196644

  11. Impact of Food Assistance Programs on Obesity in Mothers and Children: A Prospective Cohort Study in Peru.

    PubMed

    Carrillo-Larco, Rodrigo M; Miranda, J Jaime; Bernabé-Ortiz, Antonio

    2016-07-01

    To assess obesity risk among mothers participating in Community Kitchens and children participating in Glass of Milk (Peru food assistance programs). We analyzed prospective data from the Young Lives study. The exposure consisted in varying degrees of benefit from any of the programs (no participation in any of the programs, program participation for some months, or program participation nearly every month) at baseline (2006-2007). The outcome was overweight and obesity in mothers and children at follow-up (2009-2010). Prevalence of childhood overweight and obesity was 15.5% and 5.1%, respectively; the corresponding figures for mothers were 40.5% and 14.6%. Children exposed nearly every month to the Glass of Milk program had a 65% lower risk of becoming obese compared with children not participating in the program (relative risk [RR] = 0.35; 95% confidence interval [CI] = 0.18, 0.66). Mothers participating frequently in the Community Kitchens program had almost twice the risk of becoming obese compared with those who did not participate (RR = 1.93; 95% CI = 1.18, 3.15). Participating in food assistance programs in Peru was associated with a lower risk of obesity in children and greater risk of obesity in mothers.

  12. A prospective observational cohort study to assess the incidence of acute otitis media among children 0-5 years of age in Southern Brazil.

    PubMed

    Lanzieri, Tatiana M; Cunha, Clóvis Arns da; Cunha, Rejane B; Arguello, D Fermin; Devadiga, Raghavendra; Sanchez, Nervo; Barria, Eduardo Ortega

    To estimate acute otitis media incidence among young children and impact on quality of life of parents/caregivers in a southern Brazilian city. Prospective cohort study including children 0-5 years of age registered at a private pediatric practice. Acute otitis media episodes diagnosed by a pediatrician and impact on quality of life of parents/caregivers were assessed during a 12-month follow-up. During September 2008-March 2010, of 1,136 children enrolled in the study, 1074 (95%) were followed: 55.0% were ≤2 years of age, 52.3% males, 94.7% white, and 69.2% had previously received pneumococcal vaccine in private clinics. Acute otitis media incidence per 1000 person-years was 95.7 (95% confidence interval: 77.2-117.4) overall, 105.5 (95% confidence interval: 78.3-139.0) in children ≤2 years of age and 63.6 (95% confidence interval: 43.2-90.3) in children 3-5 years of age. Acute otitis media incidence per 1000 person-years was 86.3 (95% confidence interval: 65.5-111.5) and 117.1 (95% confidence interval: 80.1-165.3) among vaccinated and unvaccinated children, respectively. Nearly 68.9% of parents reported worsening of their overall quality of life. Acute otitis media incidence among unvaccinated children in our study may be useful as baseline data to assess impact of pneumococcal vaccine introduction in the Brazilian National Immunization Program in April 2010. Copyright © 2017 Sociedade Brasileira de Infectologia. Published by Elsevier Editora Ltda. All rights reserved.

  13. Automobile Traffic around the Home and Attained Body Mass Index: A Longitudinal Cohort Study of Children aged 10–18 Years

    PubMed Central

    Jerrett, Michael; McConnell, Rob; Chang, C.C. Roger; Wolch, Jennifer; Reynolds, Kim; Lurmann, Frederick; Gilliland, Frank; Berhane, Kiros

    2009-01-01

    Objectives The objective of this study is to examine the relationship between measured traffic density near the homes of children and attained body mass index (BMI) over an eight-year follow up. Methods Children aged 9–10 years were enrolled across multiple communities in Southern California in 1993 and 1996 (n = 3318). Children were followed until age 18 or high school graduation to collect longitudinal information, including annual height and weight measurements. Multilevel growth curve models were used to assess the association between BMI levels at age 18 and traffic around the home. Results For traffic within 150 m around the child’s home, there were significant positive associations with attained BMI for both sexes at age 18. With the 300 m traffic buffer, associations for both male and female growth in BMI were positive, but significantly elevated only in females. These associations persisted even after controlling for numerous potential confounding variables. Conclusions This analysis yields the first evidence of significant effects from traffic density on BMI levels at age 18 in a large cohort of children. Traffic is a pervasive exposure in most cities, and our results identify traffic as a major risk factor for the development of obesity in children. PMID:19850068

  14. The role of polyclonal intravenous immunoglobulin in treating HIV-infected children with severe bacterial infections: A retrospective cohort study

    PubMed Central

    Huang, Lyen C; Myer, Landon; Jaspan, Heather B

    2008-01-01

    Background Mortality among HIV-infected children in developing countries remains high after serious bacterial infections despite the use of antibiotics. Intravenous immunoglobulin (IVIG) has been used as an adjuvant therapy to treat these infections, but little data exists regarding its efficacy, and previous studies have focused on IVIG as a prophylactic agent. We examined the impact of IVIG as an adjuvant therapy in reducing mortality and length of hospital stay in HIV-infected children with serious bacterial infections. Methods This retrospective study focused on pediatric admissions at a large urban hospital between 2002 and 2006. Children between the ages of one month and nine years of age with laboratory confirmed HIV-status, serious bacterial infection, no prior exposure to IVIG, and a hospital length of stay of 5 days or more, were eligible for inclusion. Results A total of 140 children (median age 1.2 years) met inclusion criteria; lower respiratory tract infection was diagnosed in 94 (67%) of the children, while 74 (53%) had bacterial sepsis. Fifty-four (39%) children were receiving antiretroviral therapy and 39 (28%) were receiving tuberculosis treatment. Overall 73 (52%) were treated with IVIG, with the majority (74%) of children receiving a single dose. Thirteen (9%) died during their hospital admission. In crude analysis IVIG was significantly associated with increased mortality was (Odds Ratio (OR): 5.8; 95% Confidence Interval (CI): 1.2–27.1) and this association was weakened by adjustment for other predictors of mortality (OR 4.3, 95% CI 0.7–27.9, p = 0.123). IVIG use was also associated with longer hospital stays. Conclusion Administration of one to three doses of IVIG during the acute phase of illness does not appear to reduce mortality or the length of hospital stays in HIV-infected children with serious bacterial infections. However, the retrospective nature of this study makes confounding by indication difficult to control and further

  15. A cohort study to define the age-specific incidence and risk factors of Shigella diarrhoeal infections in Vietnamese children: a study protocol.

    PubMed

    Thompson, Corinne N; Anders, Katherine L; Nhi, Le Thi Quynh; Tuyen, Ha Thanh; Van Minh, Pham; Tu, Le Thi Phuong; Nhu, Tran Do Hoang; Nhan, Nguyen Thi Thanh; Ly, Tran Thi Thao; Duong, Vu Thuy; Vi, Lu Lan; Van Thuy, Nguyen Thi; Hieu, Nguyen Trong; Van Chau, Nguyen Vinh; Campbell, James I; Thwaites, Guy; Simmons, Cameron; Baker, Stephen

    2014-12-17

    Shigella spp. are one of the most common causes of paediatric dysentery globally, responsible for a substantial proportion of diarrhoeal disease morbidity and mortality, particularly in industrialising regions. Alarming levels of antimicrobial resistance are now reported in S. flexneri and S. sonnei, hampering treatment options. Little is known, however, about the burden of infection and disease due to Shigella spp. in the community. In order to estimate the incidence of this bacterial infection in the community in Ho Chi Minh City, Vietnam we have designed a longitudinal cohort to follow up approximately 700 children aged 12-60 months for two years with active and passive surveillance for diarrhoeal disease. Children will be seen at 6 month intervals for health checks where blood and stool samples will be collected. Families will also be contacted every two weeks for information on presence of diarrhoea in the child. Upon report of a diarrhoeal disease episode, study nurses will either travel to the family home to perform an evaluation or the family will attend a study hospital at a reduced cost, where a stool sample will also be collected. Case report forms collected at this time will detail information regarding disease history, risk factors and presence of disease in the household.Outcomes will include (i) age-specific incidence of Shigella spp. and other agents of diarrhoeal disease in the community, (ii) risk factors for identified aetiologies, (iii) rates of seroconversion to a host of gastrointestinal pathogens in the first few years of life. Further work regarding the longitudinal immune response to a variety of Shigella antigens, host genetics and candidate vaccine/diagnostic proteins will also be conducted. This is the largest longitudinal cohort with active surveillance designed specifically to investigate Shigella infection and disease. The study is strengthened by the active surveillance component, which will likely capture a substantial proportion of

  16. Cohort profile: The Isle of Man Birth Cohort Study.

    PubMed

    Goodfellow, Stephanie A; Rolfe, Edna M; Golding, Jean

    2013-10-01

    The Isle of Man is a self-governing British Crown Dependency situated equidistantly from England, Scotland and Ireland. In 1991, its population of ∼75,000 comprised ∼50% indigenous Manx and 50% immigrants, mainly from the surrounding countries. It was invited to join the European Longitudinal Study of Pregnancy and Childhood. The aim of the study was to enrol all pregnant women resident on the Island with an expected date of delivery in the 18-month period of January 1991-June 1992. A total of 1314 livebirths formed the eligible cohort. Questionnaires were completed by mothers and their partners during pregnancy and subsequently at 6 weeks, 6 months, 18 months, 3, 5, 7 and 15/16 years. Hands-on examination of the children occurred at age 7 years, when biological samples were collected. Teachers completed questionnaires at 7 and 15 years; medical records were extracted for the obstetric and childhood periods. Response rates varied from >80% from teachers and children at 15 years to only 23% from partners when their children were aged 7 years. Selected data sets are available to collaborators, although many of the data need funds for further collaboration.

  17. Circulating angiopoietin-like protein 8 (ANGPTL8) and ANGPTL3 concentrations in relation to anthropometric and metabolic profiles in Korean children: a prospective cohort study.

    PubMed

    Chung, Hye Soo; Lee, Min Jung; Hwang, Soon Young; Lee, Hyun Jung; Yoo, Hye Jin; Seo, Ji-A; Kim, Sin Gon; Kim, Nan Hee; Baik, Sei Hyun; Choi, Dong Seop; Kim, Seon Mi; Choi, Kyung Mook

    2016-01-06

    Previous studies have shown that angiopoietin-like protein 8 (ANGPTL8), also called as betatrophin, acts together with ANGPTL3 to regulate lipid metabolism, glucose metabolism, and energy homeostasis. Moreover, ANGPTL8 promotes proliferation of pancreatic β-cells and induces insulin secretion. However, there are no previous longitudinal studies in humans. We analyzed the age- and sex-matched data of 240 normal weight and overweight Korean children from the Korean Metabolic disorders and Obesity Study in Elementary School children (K-MOSES), a prospective observational cohort study. At baseline, ANGPTL8 concentrations were positively associated with triglycerides (TG) (r = 0.168, P = 0.010), whereas ANGPTL3 levels were associated with fasting insulin (r = 0.248, P < 0.001) and the homeostasis model assessment of insulin resistance (HOMA-IR) (r = 0.197, P = 0.002). Although both ANGPTL8 and ANGPTL3 levels did not differ between children with normal weight and children with overweight, ANGPTL8 levels were increased in males compared to females (341.2 [267.4-436.5] vs. 270.2 [213.9-378.8] pg/ml, P = 0.001). In particular, there was no significant inter-relationship between circulating ANGPTL8 and ANGPTL3 concentrations in Korean boys and girls (r = -0.073, P = 0.265). Multivariate analysis showed that baseline ANGPTL8 concentrations were independently associated with future changes of serum TG levels in Korean children after adjusting for confounding factors after a 3 year follow-up period (r = -0.165, P = 0.016). This longitudinal study demonstrated for the first time that baseline ANGPTL8 levels were associated with baseline and future changes in TG levels in Korean children.

  18. High-flow nasal cannula therapy versus non-invasive ventilation in children with severe acute asthma exacerbation: An observational cohort study.

    PubMed

    Pilar, J; Modesto I Alapont, V; Lopez-Fernandez, Y M; Lopez-Macias, O; Garcia-Urabayen, D; Amores-Hernandez, I

    2017-10-01

    The present study describes our experience with the high-flow humidified nasal cannula (HFNC) versus non-invasive ventilation (NIV) in children with severe acute asthma exacerbation (SA). An observational study of a retrospective cohort of 42 children with SA admitted to a Pediatric Intensive Care Unit (PICU) for non-invasive respiratory support was made. The primary outcome measure was failure of initial respiratory support (need to escalate from HFNC to NIV or from NIV to invasive ventilation). Secondary outcome measures were the duration of respiratory support and PICU length of stay (LOS). Forty-two children met the inclusion criteria. Twenty (47.6%) received HFNC and 22 (52.3%) NIV as initial respiratory support. There were no treatment failures in the NIV group. However, 8 children (40%) in the HFNC group required escalation to NIV. The PICU LOS was similar in both the NIV and HFNC groups. However, on considering the HFNC failure subgroup, the median length of respiratory support was 3-fold longer (63h) and the PICU LOS was also longer compared with the rest of subjects exhibiting treatment success. Despite its obvious limitations, this observational study could suggest that HFNC in some subjects with SA may delay NIV support and potentially cause longer respiratory support, and longer PICU LOS. Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  19. Monitoring air pollution effects on children for supporting public health policy: the protocol of the prospective cohort MAPEC study

    PubMed Central

    Feretti, D; Ceretti, E; De Donno, A; Moretti, M; Carducci, A; Bonetta, S; Marrese, M R; Bonetti, A; Covolo, L; Bagordo, F; Villarini, M; Verani, M; Schilirò, T; Limina, R M; Grassi, T; Monarca, S; Casini, B; Carraro, E; Zani, C; Mazzoleni, G; Levaggi, R; Gelatti, U

    2014-01-01

    Introduction Genotoxic biomarkers have been studied largely in adult population, but few studies so far have investigated them in children exposed to air pollution. Children are a high-risk group as regards the health effects of air pollution and some studies suggest that early exposure during childhood can play an important role in the development of chronic diseases in adulthood. The objective of the project is to evaluate the associations between the concentration of urban air pollutants and biomarkers of early biological effect in children, and to propose a model for estimating the global risk of early biological effects due to air pollutants and other factors in children. Methods and analysis Two biomarkers of early biological effects, DNA damage by the comet assay and the micronuclei (MN) test, will be investigated in oral mucosa cells of 6–8-year-old children. Concurrently, some toxic airborne pollutants (polycyclic aromatic hydrocarbon (PAH) and nitro-PAH) and in vitro air mutagenicity and toxicity in ultra-fine air particulates (PM0.5) will be evaluated. Furthermore, demographic and socioeconomic variables, other sources of exposures to air pollutants and lifestyle variables will be assessed by a structured questionnaire. The associations between sociodemographic, environmental and other exposure variables and biomarkers of early biological effect using univariate and multivariate models will be analysed. A tentative model for calculating the global absolute risk of having early biological effects caused by air pollution and other variables will be proposed. Ethics and dissemination The project has been approved by the Ethics Committees of the local Health Authorities. The results will be communicated to local Public Health Agencies, for supporting educational programmes and health policy strategies. LIFE+2012 Environment Policy and Governance. LIFE12 ENV/IT/000614. PMID:25227631

  20. Association between traffic-related air pollution in schools and cognitive development in primary school children: a prospective cohort study.

    PubMed

    Sunyer, Jordi; Esnaola, Mikel; Alvarez-Pedrerol, Mar; Forns, Joan; Rivas, Ioar; López-Vicente, Mònica; Suades-González, Elisabet; Foraster, Maria; Garcia-Esteban, Raquel; Basagaña, Xavier; Viana, Mar; Cirach, Marta; Moreno, Teresa; Alastuey, Andrés; Sebastian-Galles, Núria; Nieuwenhuijsen, Mark; Querol, Xavier

    2015-03-01

    Air pollution is a suspected developmental neurotoxicant. Many schools are located in close proximity to busy roads, and traffic air pollution peaks when children are at school. We aimed to assess whether exposure of children in primary school to traffic-related air pollutants is associated with impaired cognitive development. We conducted a prospective study of children (n = 2,715, aged 7 to 10 y) from 39 schools in Barcelona (Catalonia, Spain) exposed to high and low traffic-related air pollution, paired by school socioeconomic index; children were tested four times (i.e., to assess the 12-mo developmental trajectories) via computerized tests (n = 10,112). Chronic traffic air pollution (elemental carbon [EC], nitrogen dioxide [NO2], and ultrafine particle number [UFP; 10-700 nm]) was measured twice during 1-wk campaigns both in the courtyard (outdoor) and inside the classroom (indoor) simultaneously in each school pair. Cognitive development was assessed with the n-back and the attentional network tests, in particular, working memory (two-back detectability), superior working memory (three-back detectability), and inattentiveness (hit reaction time standard error). Linear mixed effects models were adjusted for age, sex, maternal education, socioeconomic status, and air pollution exposure at home. Children from highly polluted schools had a smaller growth in cognitive development than children from the paired lowly polluted schools, both in crude and adjusted models (e.g., 7.4% [95% CI 5.6%-8.8%] versus 11.5% [95% CI 8.9%-12.5%] improvement in working memory, p = 0.0024). Cogently, children attending schools with higher levels of EC, NO2, and UFP both indoors and outdoors experienced substantially smaller growth in all the cognitive measurements; for example, a change from the first to the fourth quartile in indoor EC reduced the gain in working memory by 13.0% (95% CI 4.2%-23.1%). Residual confounding for social class could not be discarded completely; however

  1. Association between Traffic-Related Air Pollution in Schools and Cognitive Development in Primary School Children: A Prospective Cohort Study

    PubMed Central

    Sunyer, Jordi; Esnaola, Mikel; Alvarez-Pedrerol, Mar; Forns, Joan; Rivas, Ioar; López-Vicente, Mònica; Suades-González, Elisabet; Foraster, Maria; Garcia-Esteban, Raquel; Basagaña, Xavier; Viana, Mar; Cirach, Marta; Moreno, Teresa; Alastuey, Andrés; Sebastian-Galles, Núria; Nieuwenhuijsen, Mark; Querol, Xavier

    2015-01-01

    Background Air pollution is a suspected developmental neurotoxicant. Many schools are located in close proximity to busy roads, and traffic air pollution peaks when children are at school. We aimed to assess whether exposure of children in primary school to traffic-related air pollutants is associated with impaired cognitive development. Methods and Findings We conducted a prospective study of children (n = 2,715, aged 7 to 10 y) from 39 schools in Barcelona (Catalonia, Spain) exposed to high and low traffic-related air pollution, paired by school socioeconomic index; children were tested four times (i.e., to assess the 12-mo developmental trajectories) via computerized tests (n = 10,112). Chronic traffic air pollution (elemental carbon [EC], nitrogen dioxide [NO2], and ultrafine particle number [UFP; 10–700 nm]) was measured twice during 1-wk campaigns both in the courtyard (outdoor) and inside the classroom (indoor) simultaneously in each school pair. Cognitive development was assessed with the n-back and the attentional network tests, in particular, working memory (two-back detectability), superior working memory (three-back detectability), and inattentiveness (hit reaction time standard error). Linear mixed effects models were adjusted for age, sex, maternal education, socioeconomic status, and air pollution exposure at home. Children from highly polluted schools had a smaller growth in cognitive development than children from the paired lowly polluted schools, both in crude and adjusted models (e.g., 7.4% [95% CI 5.6%–8.8%] versus 11.5% [95% CI 8.9%–12.5%] improvement in working memory, p = 0.0024). Cogently, children attending schools with higher levels of EC, NO2, and UFP both indoors and outdoors experienced substantially smaller growth in all the cognitive measurements; for example, a change from the first to the fourth quartile in indoor EC reduced the gain in working memory by 13.0% (95% CI 4.2%–23.1%). Residual confounding for social class could

  2. Association of consumption of products containing milk fat with reduced asthma risk in pre-school children: the PIAMA birth cohort study

    PubMed Central

    Wijga, A; Smit, H; Kerkhof, M; de Jongste, J C; Gerritsen, J; Neijens, H; Boshuizen, H; Brunekreef, B

    2003-01-01

    Background: Environment and lifestyle contribute to the development of asthma in children. Understanding the relevant factors in this relationship may provide methods of prevention. The role of diet in the development of asthma in pre-school children was investigated. Methods: Data from 2978 children participating in a prospective birth cohort study were used. Food frequency data were collected at the age of 2 years and related to asthma symptoms reported at the age of 3 years. Results: The prevalence of recent asthma at age 3 was lower in children who consumed (at age 2) full cream milk daily (3.4%) than in those who did not (5.6%) and in those who consumed butter daily (1.5%) than in those who did not (5.1%). The prevalence of recent wheeze was lower in children who consumed milk products daily (13.7%) than in those who did not (18.4%) and in children who consumed butter daily (7.7%) than in those who did not (15.4%). These effects remained in a logistic regression model including different foods and confounders (adjusted odds ratio (CI) for recent asthma: full cream milk daily v rarely 0.59 (0.40 to 0.88), butter daily v rarely 0.28 (0.09 to 0.88)). Daily consumption of brown bread was also associated with lower rates of asthma and wheeze, whereas no associations were observed with the consumption of fruits, vegetables, margarine, and fish. Conclusions: In pre-school children, frequent consumption of products containing milk fat is associated with a reduced risk of asthma symptoms. PMID:12832666

  3. Respiratory Syncytial Virus Genomic Load and Disease Severity Among Children Hospitalized With Bronchiolitis: Multicenter Cohort Studies in the United States and Finland

    PubMed Central

    Hasegawa, Kohei; Jartti, Tuomas; Mansbach, Jonathan M.; Laham, Federico R.; Jewell, Alan M.; Espinola, Janice A.; Piedra, Pedro A.; Camargo, Carlos A.

    2015-01-01

    Background. We investigated whether children with a higher respiratory syncytial virus (RSV) genomic load are at a higher risk of more-severe bronchiolitis. Methods. Two multicenter prospective cohort studies in the United States and Finland used the same protocol to enroll children aged <2 years hospitalized for bronchiolitis and collect nasopharyngeal aspirates. By using real-time polymerase chain reaction analysis, patients were classified into 3 genomic load status groups: low, intermediate, and high. Outcome measures were a length of hospital stay (LOS) of ≥3 days and intensive care use, defined as admission to the intensive care unit or use of mechanical ventilation. Results. Of 2615 enrolled children, 1764 (67%) had RSV bronchiolitis. Children with a low genomic load had a higher unadjusted risk of having a length of stay of ≥3 days (52%), compared with children with intermediate and those with high genomic loads (42% and 51%, respectively). In a multivariable model, the risk of having a length of stay of ≥3 days remained significantly higher in the groups with intermediate (odds ratio [OR], 1.43; 95% confidence interval [CI], 1.20–1.69) and high (OR, 1.58; 95% CI, 1.29–1.94) genomic loads. Similarly, children with a high genomic load had a higher risk of intensive care use (20%, compared with 15% and 16% in the groups with low and intermediate genomic loads, respectively). In a multivariable model, the risk remained significantly higher in the group with a high genomic load (OR, 1.43; 95% CI, 1.03–1.99). Conclusion. Children with a higher RSV genomic load had a higher risk for more-severe bronchiolitis. PMID:25425699

  4. Respiratory syncytial virus genomic load and disease severity among children hospitalized with bronchiolitis: multicenter cohort studies in the United States and Finland.

    PubMed

    Hasegawa, Kohei; Jartti, Tuomas; Mansbach, Jonathan M; Laham, Federico R; Jewell, Alan M; Espinola, Janice A; Piedra, Pedro A; Camargo, Carlos A

    2015-05-15

    We investigated whether children with a higher respiratory syncytial virus (RSV) genomic load are at a higher risk of more-severe bronchiolitis. Two multicenter prospective cohort studies in the United States and Finland used the same protocol to enroll children aged <2 years hospitalized for bronchiolitis and collect nasopharyngeal aspirates. By using real-time polymerase chain reaction analysis, patients were classified into 3 genomic load status groups: low, intermediate, and high. Outcome measures were a length of hospital stay (LOS) of ≥3 days and intensive care use, defined as admission to the intensive care unit or use of mechanical ventilation. Of 2615 enrolled children, 1764 (67%) had RSV bronchiolitis. Children with a low genomic load had a higher unadjusted risk of having a length of stay of ≥3 days (52%), compared with children with intermediate and those with high genomic loads (42% and 51%, respectively). In a multivariable model, the risk of having a length of stay of ≥3 days remained significantly higher in the groups with intermediate (odds ratio [OR], 1.43; 95% confidence interval [CI], 1.20-1.69) and high (OR, 1.58; 95% CI, 1.29-1.94) genomic loads. Similarly, children with a high genomic load had a higher risk of intensive care use (20%, compared with 15% and 16% in the groups with low and intermediate genomic loads, respectively). In a multivariable model, the risk remained significantly higher in the group with a high genomic load (OR, 1.43; 95% CI, 1.03-1.99). Children with a higher RSV genomic load had a higher risk for more-severe bronchiolitis. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  5. Comparison of Children With Onset of Juvenile Dermatomyositis Symptoms Before or After Their Fifth Birthday in a UK and Ireland Juvenile Dermatomyositis Cohort Study

    PubMed Central

    Martin, N; Krol, P; Smith, S; Beard, L; Pilkington, C A; Davidson, J; Wedderburn, L R

    2012-01-01

    Objective To compare 2 groups of children with juvenile dermatomyositis (DM), those with onset of symptoms before their fifth birthday versus those whose disease begins either on or after their fifth birthday, and to assess whether age at onset is associated with differences in disease presentation, treatments received, or outcomes 2 years after diagnosis. Methods Data were analyzed on children recruited to a UK juvenile DM cohort study with a diagnosis of probable or definite juvenile DM and less than 12 months between diagnosis and recruitment. Results Fifty-five (35%) of 157 children had onset of symptoms before their fifth birthday. At diagnosis, cutaneous ulceration was found in 32.7% of the younger group versus 11.8% of the older group (P = 0.003). Facial or body swelling was reported more often in the younger group, whereas headaches, alopecia, and Raynaud's phenomenon were all more frequently reported in the older group. At followup 2 years later, there were no important differences in outcomes between the groups. More than 90% of patients in both groups received both methotrexate and steroids. Twenty-three percent of both groups remained on steroids 2 years after diagnosis. Conclusion Our study showed that children with juvenile DM with disease onset at age <5 years are more likely to present with ulcerative skin disease and edema. There were no clinically significant differences in outcomes between the 2 groups. PMID:22674907

  6. Epidemiology of otitis media during the first seven years of life in children in greater Boston: a prospective, cohort study.

    PubMed

    Teele, D W; Klein, J O; Rosner, B

    1989-07-01

    To determine the epidemiology of acute otitis media (AOM) and duration of middle ear effusion (MEE), we followed consecutively enrolled children from shortly after birth until 7 y of age. Because some children dropped out of the study, data were analyzed for 877 children observed for at least 1 y; 698 were observed for at least 3 y, and 498 were observed until 7 y of age. By 1 y of age, 62% of the children had greater than or equal to 1 episode of AOM and 17% had greater than or equal to 3 episodes; by 3 y of age, 83% had greater than or equal to 1 episode of AOM and 46% had greater than or equal to 3 episodes. The peak incidence occurred during the second 6-mo period of life. Significantly increased risk (by multivariate analysis) for AOM was associated with male gender, sibling history of recurrent AOM, early occurrence of AOM, and not being breast fed. MEE persisted after onset of AOM for weeks to months; prolonged duration of MEE was associated with male gender, sibling history of ear infection, and not being breast fed.

  7. Do early-life exposures explain why more advantaged children get eczema? Findings from the U.K. Millennium Cohort Study.

    PubMed

    Taylor-Robinson, D C; Williams, H; Pearce, A; Law, C; Hope, S

    2016-03-01

    Atopic dermatitis (eczema) in childhood is socially patterned, with higher incidence in more advantaged populations. However, it is unclear what factors explain the social differences. To identify early-life risk factors for eczema, and to explore how early-life risk factors explain any differences in eczema. We estimated odds ratios (ORs) for ever having had eczema by age 5 years in 14 499 children from the U.K. Millennium Cohort Study (MCS), with a focus on maternal, antenatal and early-life risk factors and socioeconomic circumstances (SECs). Risk factors were explored to assess whether they attenuated associations between SECs and eczema. Overall 35·1% of children had ever had eczema by age 5 years. Children of mothers with degree-level qualifications vs. no educational qualifications were more likely to have eczema (OR 1·52, 95% confidence interval 1·31-1·76), and there was a gradient across the socioeconomic spectrum. Maternal atopy, breastfeeding (1-6 weeks and ≥ 6 months), introduction of solids under 4 months or cow's milk under 9 months, antibiotic exposure in the first year of life and grime exposure were associated with an increased odds of having eczema. Female sex, Pakistani and Bangladeshi ethnicity, smoking during pregnancy, exposure to environmental tobacco smoke and having more siblings were associated with reduced odds for eczema. Controlling for maternal, antenatal and early-life characteristics (particularly maternal smoking during pregnancy, breastfeeding and number of siblings) reduced the OR for eczema to 1·26 (95% confidence interval 1·03-1·50) in the group with the highest educational qualifications compared with the least. In a representative U.K. child cohort, eczema was more common in more advantaged children. This was explained partially by early-life factors including not smoking during pregnancy, breastfeeding and having fewer siblings. © 2015 The Authors. British Journal of Dermatology published by John Wiley & Sons Ltd on

  8. Seasonal variation in musculoskeletal extremity injuries in school children aged 6–12 followed prospectively over 2.5 years: a cohort study

    PubMed Central

    Jespersen, Eva; Holst, René; Franz, Claudia; Rexen, Christina T; Wedderkopp, Niels

    2014-01-01

    Objectives The type and level of physical activity in children vary over seasons and might thus influence the injury patterns. However, very little information is available on the distribution of injuries over the calendar year. This study aims to describe and analyse the seasonal variation in extremity injuries in children. Design Prospective cohort study. Setting 10 public schools in the municipality of Svendborg, Denmark. Participants A total of 1259 school children aged 6–12 years participating in the Childhood Health, Activity, and Motor Performance School Study Denmark. Methods School children were surveyed each week during 2.5 school-years. Musculoskeletal injuries were reported by parents answering automated mobile phone text questions (SMS-Track) on a weekly basis and diagnosed by clinicians. Data were analysed for prevalence and incidence rates over time with adjustments for gender and age. Results Injuries in the lower extremities were reported most frequently (n=1049). There was a significant seasonal variation in incidence and prevalence for lower extremity injuries and for lower and upper extremity injuries combined (n=1229). For the upper extremities (n=180), seasonal variation had a significant effect on the risk of prevalence. Analysis showed a 46% increase in injury incidence and a 32% increase in injury prevalence during summer relative to winter for lower and upper extremity injuries combined. Conclusions There are clear seasonal differences in the occurrence of musculoskeletal extremity injuries among children with almost twice as high injury incidence and prevalence estimates during autumn, summer and spring compared with winter. This suggests further research into the underlying causes for seasonal variation and calls for preventive strategies to be implemented in order to actively prepare and supervise children before and during high-risk periods. PMID:24401728

  9. Whooping cough in school age children presenting with persistent cough in UK primary care after introduction of the preschool pertussis booster vaccination: prospective cohort study

    PubMed Central

    Fry, Norman K; Campbell, Helen; Amirthalingam, Gayatri; Harrison, Timothy G; Mant, David; Harnden, Anthony

    2014-01-01

    Objective To estimate the prevalence and clinical severity of whooping cough (pertussis) in school age children presenting with persistent cough in primary care since the introduction and implementation of the preschool pertussis booster vaccination. Design Prospective cohort study (November 2010 to December 2012). Setting General practices in Thames Valley, UK. Participants 279 children aged 5 to 15 years who presented in primary care with a persistent cough of two to eight weeks’ duration. Exclusion criteria were cough likely to be caused by a serious underlying medical condition, known immunodeficiency or immunocompromise, participation in another clinical research study, and preschool pertussis booster vaccination received less than one year previously. Main outcome measures Evidence of recent pertussis infection based on an oral fluid anti-pertussis toxin IgG titre of at least 70 arbitrary units. Cough frequency was measured in six children with laboratory confirmed pertussis. Results 56 (20%, 95% confidence interval 16% to 25%) children had evidence of recent pertussis infection, including 39 (18%, 13% to 24%) of 215 children who had been fully vaccinated. The risk of pertussis was more than three times higher (21/53; 40%, 26% to 54%) in children who had received the preschool pertussis booster vaccination seven years or more previously than in those who had received it less than seven years previously (20/171; 12%, 7% to 17%). The risk of pertussis was similar between children who received five and three component preschool pertussis booster vaccines (risk ratio for five component vaccine 1.14, 0.64 to 2.03). Four of six children in whom cough frequency was measured coughed more than 400 times in 24 hours. Conclusions Pertussis can still be found in a fifth of school age children who present in primary care with persistent cough and can cause clinically significant cough in fully vaccinated children. These findings will help to inform consideration of the

  10. THYROID CANCER STUDY AMONG UKRAINIAN CHILDREN EXPOSED TO RADIATION AFTER THE CHORNOBYL ACCIDENT: IMPROVED ESTIMATES OF THE THYROID DOSES TO THE COHORT MEMBERS

    PubMed Central

    Likhtarov, Ilya; Kovgan, Lina; Masiuk, Sergii; Talerko, Mykola; Chepurny, Mykola; Ivanova, Olga; Gerasymenko, Valentina; Boyko, Zulfira; Voillequé, Paul; Drozdovitch, Vladimir; Bouville, André

    2013-01-01

    In collaboration with the Ukrainian Research Center for Radiation Medicine, the U.S. National Cancer Institute initiated a cohort study of children and adolescents exposed to Chornobyl fallout in Ukraine to better understand the long-term health effects of exposure to radioactive iodines. All 13,204 cohort members were subjected to at least one direct thyroid measurement between 30 April and 30 June 1986 and resided at the time of the accident in the northern part of Kyiv, Zhytomyr, or Chernihiv Oblasts, which were the most contaminated territories of Ukraine as a result of radioactive fallout from the Chornobyl accident. Thyroid doses for the cohort members, which had been estimated following the first round of interviews, were re-evaluated following the second round of interviews. The revised thyroid doses range from 0.35 mGy to 42 Gy, with 95 percent of the doses between 1 mGy and 4.2 Gy, an arithmetic mean of 0.65 Gy, and a geometric mean of 0.19 Gy. These means are 70% of the previous estimates, mainly because of the use of country-specific thyroid masses. Many of the individual thyroid dose estimates show substantial differences because of the use of an improved questionnaire for the second round of interviews. Limitations of the current set of thyroid dose estimates are discussed. For the epidemiologic study, the most notable improvement is a revised assessment of the uncertainties, as shared and unshared uncertainties in the parameter values were considered in the calculation of the 1,000 stochastic estimates of thyroid dose for each cohort member. This procedure makes it possible to perform a more realistic risk analysis. PMID:25208014

  11. Childhood Socioeconomic Position, Educational Attainment, and Adult Cardiovascular Risk Factors: The Aberdeen Children of the 1950s Cohort Study

    PubMed Central

    Lawlor, Debbie A; Batty, G. David; Morton, Susan M.B.; Clark, Heather; Macintyre, Sally; Leon, David A.

    2005-01-01

    Objectives. We assessed the associations of childhood socioeconomic position with cardiovascular disease risk factors (smoking, binge alcohol drinking, and being overweight) and examined the roles of educational attainment and cognitive functioning in these associations. Methods. Data were derived from a cohort study involving 7184 individuals who were born in Aberdeen, Scotland, between 1950 and 1956; had detailed records on perinatal characteristics, childhood anthropometry, and cognitive functioning; and responded to a mailed questionnaire when they were aged 45 to 52 years. Results. Strong graded associations existed between social class at birth and smoking, binge drinking, and being overweight. Adjustment for educational attainment completely attenuated these associations. However, after control for adult social class, adult income and other potential confounding or mediating factors, some association remained. Conclusions. Educational attainment is an important mediating factor in the relation between socioeconomic adversity in childhood and smoking, binge drinking, and being overweight in adulthood. PMID:15983276

  12. Parental depressive and anxiety symptoms during pregnancy and attention problems in children: a cross-cohort consistency study.

    PubMed

    Van Batenburg-Eddes, T; Brion, M J; Henrichs, J; Jaddoe, V W V; Hofman, A; Verhulst, F C; Lawlor, D A; Davey Smith, G; Tiemeier, H

    2013-05-01

    Maternal depression and anxiety during pregnancy have been associated with offspring-attention deficit problems. We explored possible intrauterine effects by comparing maternal and paternal symptoms during pregnancy, by investigating cross-cohort consistency, and by investigating whether parental symptoms in early childhood may explain any observed intrauterine effect. This study was conducted in two cohorts (Generation R, n = 2,280 and ALSPAC, n = 3,442). Pregnant women and their partners completed questionnaires to assess symptoms of depression and anxiety. Child attention problems were measured in Generation R at age 3 with the Child Behavior Checklist, and in ALSPAC at age 4 with the Strengths and Difficulties Questionnaire. In both cohorts, antenatal maternal symptoms of depression (Generation R: OR 1.23, 95% CI 1.05-1.43; ALSPAC: OR 1.33, 95% CI 1.19-1.48) and anxiety (Generation R: OR 1.24, 95% CI 1.06-1.46; ALSPAC: OR 1.32, 95% CI 1.19-1.47) were associated with a higher risk of child attention problems. In ALSPAC, paternal depression was also associated with a higher risk of child attention problems (OR 1.11, 95% CI 1.00-1.24). After adjusting for maternal symptoms after giving birth, antenatal maternal depression and anxiety were no longer associated with child attention problems in Generation R. Moreover, there was little statistical evidence that antenatal maternal and paternal depression and anxiety had a substantially different effect on attention problems of the child. The apparent intrauterine effect of maternal depression and anxiety on offspring-behavioural problems may be partly explained by residual confounding. There was little evidence of a difference between the strength of associations of maternal and paternal symptoms during pregnancy with offspring-attention problems. That maternal symptoms after childbirth were also associated with offspring-behavioural problems may indicate a contribution of genetic influences to the association. © 2012

  13. Glucose-6-phosphate dehydrogenase deficiency and the risk of malaria and other diseases in children in Kenya: a case-control and a cohort study

    PubMed Central

    Uyoga, Sophie; Ndila, Carolyne M; Macharia, Alex W; Nyutu, Gideon; Shah, Shivang; Peshu, Norbert; Clarke, Geraldine M; Kwiatkowski, Dominic P; Rockett, Kirk A; Williams, Thomas N

    2015-01-01

    Summary Background The global prevalence of X-linked glucose-6-phosphate dehydrogenase (G6PD) deficiency is thought to be a result of selection by malaria, but epidemiological studies have yielded confusing results. We investigated the relationships between G6PD deficiency and both malaria and non-malarial illnesses among children in Kenya. Methods We did this study in Kilifi County, Kenya, where the G6PD c.202T allele is the only significant cause of G6PD deficiency. We tested the associations between G6PD deficiency and severe and complicated Plasmodium falciparum malaria through a case-control study of 2220 case and 3940 control children. Cases were children aged younger than 14 years, who visited the high dependency ward of Kilifi County Hospital with severe malaria between March 1, 1998, and Feb 28, 2010. Controls were children aged between 3–12 months who were born within the same study area between August 2006, and September 2010. We assessed the association between G6PD deficiency and both uncomplicated malaria and other common diseases of childhood in a cohort study of 752 children aged younger than 10 years. Participants of this study were recruited from a representative sample of households within the Ngerenya and Chonyi areas of Kilifi County between Aug 1, 1998, and July 31, 2001. The primary outcome measure for the case-control study was the odds ratio for hospital admission with severe malaria (computed by logistic regression) while for the cohort study it was the incidence rate ratio for uncomplicated malaria and non-malaria illnesses (computed by Poisson regression), by G6PD deficiency category. Findings 2863 (73%) children in the control group versus 1643 (74%) in the case group had the G6PD normal genotype, 639 (16%) versus 306 (14%) were girls heterozygous for G6PD c.202T, and 438 (11%) versus 271 (12%) children were either homozygous girls or hemizygous boys. Compared with boys and girls without G6PD deficiency, we found significant

  14. Glucose-6-phosphate dehydrogenase deficiency and the risk of malaria and other diseases in children in Kenya: a case-control and a cohort study.

    PubMed

    Uyoga, Sophie; Ndila, Carolyne M; Macharia, Alex W; Nyutu, Gideon; Shah, Shivang; Peshu, Norbert; Clarke, Geraldine M; Kwiatkowski, Dominic P; Rockett, Kirk A; Williams, Thomas N

    2015-10-01

    The global prevalence of X-linked glucose-6-phosphate dehydrogenase (G6PD) deficiency is thought to be a result of selection by malaria, but epidemiological studies have yielded confusing results. We investigated the relationships between G6PD deficiency and both malaria and non-malarial illnesses among children in Kenya. We did this study in Kilifi County, Kenya, where the G6PD c.202T allele is the only significant cause of G6PD deficiency. We tested the associations between G6PD deficiency and severe and complicated Plasmodium falciparum malaria through a case-control study of 2220 case and 3940 control children. Cases were children aged younger than 14 years, who visited the high dependency ward of Kilifi County Hospital with severe malaria between March 1, 1998, and Feb 28, 2010. Controls were children aged between 3-12 months who were born within the same study area between August 2006, and September 2010. We assessed the association between G6PD deficiency and both uncomplicated malaria and other common diseases of childhood in a cohort study of 752 children aged younger than 10 years. Participants of this study were recruited from a representative sample of households within the Ngerenya and Chonyi areas of Kilifi County between Aug 1, 1998, and July 31, 2001. The primary outcome measure for the case-control study was the odds ratio for hospital admission with severe malaria (computed by logistic regression) while for the cohort study it was the incidence rate ratio for uncomplicated malaria and non-malaria illnesses (computed by Poisson regression), by G6PD deficiency category. 2863 (73%) children in the control group versus 1643 (74%) in the case group had the G6PD normal genotype, 639 (16%) versus 306 (14%) were girls heterozygous for G6PD c.202T, and 438 (11%) versus 271 (12%) children were either homozygous girls or hemizygous boys. Compared with boys and girls without G6PD deficiency, we found significant protection from severe malaria (odds ratio [OR

  15. Excellent outcomes among HIV+ children on ART, but unacceptably high pre-ART mortality and losses to follow-up: a cohort study from Cambodia.

    PubMed

    Raguenaud, Marie-Eve; Isaakidis, Petros; Zachariah, Rony; Te, Vantha; Soeung, Seithabot; Akao, Kazumi; Kumar, Varun

    2009-08-20

    Although HIV program evaluations focusing on mortality on ART provide important evidence on treatment effectiveness, they do not asses overall HIV program performance because they exclude patients who are eligible but not started on ART for whatever reason. The objective of this study was to measure mortality that occurs both pre-ART and during ART among HIV-positive children enrolled in two HIV-programs in Cambodia. Retrospective cohort study on 1168 HIV-positive children <15 years old registered in two HIV-programs over a four-year period. Mortality rates were calculated for both children on treatment and children not started on ART. Over half (53%) of children were 5 years or above and only 69(6%) were <18 months. Overall, 9% (105/1168) of children died since the set-up of the programs. By the end of the observation period, 66(14.5%) patients not on ART had died compared to 39(5.5%) of those under treatment, and 100(22%) who did not start ART were lost-to-follow-up compared to 13(2%) on ART. 66/105 (62.8%) of all in-program deaths occurred before starting ART, of which 56% (37/66) and 79% (52/66) occurred within 3 and 6 months of enrollment respectively. Mortality rate ratio between children not on ART and children on ART was 4.1 (95%CI: 2.7-6.2) (P < 0.001). The most common contributing cause of death in first 3 months of treatment and in first 3 months of program enrollment was tuberculosis. 41/52 (79%) children who died within 6 months of enrollment had met the ART eligibility criteria before death. HIV-positive children experienced a high mortality and loss-to-follow-up rates before starting ART. These program outcomes may be improved by a more timely ART initiation. Measuring overall in-program mortality as opposed to only mortality on ART is recommended in order to more accurately evaluate pediatric HIV-programs performance.

  16. Factors associated with cognitive achievement in late childhood and adolescence: the Young Lives cohort study of children in Ethiopia, India, Peru, and Vietnam.

    PubMed

    Crookston, Benjamin T; Forste, Renata; McClellan, Christine; Georgiadis, Andreas; Heaton, Tim B

    2014-10-04

    There is a well-established link between various measures of socioeconomic status and the schooling achievement and cognition of children. However, less is known about how cognitive development is impacted by childhood improvements in growth, a common indicator of child nutritional status. This study examines the relationship between socioeconomic status and child growth and changes in cognitive achievement scores in adolescents from resource-poor settings. Using an observational cohort of more than 3000 children from four low- and middle-income countries, this study examines the association between cognitive achievement scores and household economic, educational, and nutritional resources to give a more accurate assessment of the influence of families on cognitive development. A composite measure of cognition when children were approximately 8, 12, and 15 years of age was constructed. Household factors included maternal schooling, wealth, and children's growth. A positive and statistically significant relationship between household factors and child cognition was found for each country. If parents have more schooling, household wealth increases, or child growth improves, then children's cognitive scores improve over time. Results for control variables are less consistent. Our findings suggest there is a consistent and strong association between parental schooling, wealth, and child growth with child cognitive achievement. Further, these findings demonstrate that a household's ability to provide adequate nutrition is as important as economic and education resources even into late childhood and adolescence. Hence, efforts to improve household resources, both early in a child's life and into adolescence, and to continue to promote child growth beyond the first few years of life have the potential to help children over the life course by improving cognition.

  17. Observational Follow-up Study on a Cohort of Children with Severe Pneumonia after Discharge from a Day-care Clinic in Dhaka, Bangladesh

    PubMed Central

    Alam, Nur H.; Chisti, Mohammod J.; Salam, Mohammed A.; Ahmed, Tahmeed; Gyr, Niklaus

    2014-01-01

    ABSTRACT Compliance, morbidity, mortality, and hospitalization during fortnightly follow-up were evaluated by an observational study on a cohort of children with severe and very severe pneumonia after day-care treatment at an urban clinic. The primary outcome measures were proportions of success (compliance) and failure (non-compliance) of follow-up visits at the day-care clinic. In total, 251 children were followed up, with median (IQR) age of 5.0 (3.0-9.0) months, and their compliance dropped from 92% at the first to 85% at the sixth visit. Cough (28%), fever (20%), and rapid breathing (13%) were common morbidities. Successful follow-up visits were possible in 180 (95.2%) and 56 (90.3%) of the children with severe and very severe pneumonia respectively. Eleven (4.4%) needed hospitalization, and four (1.6%) died. Majority (≈90%) of the children could be successfully followed up; some failed to attend their scheduled follow-up visits due to hospitalization and death. The common morbidities indicate the importance of follow-up for detecting medical problems and early treatment, thus reducing risk of death. PMID:25076656

  18. Use of mobile and cordless phones and cognition in Australian primary school children: a prospective cohort study.

    PubMed

    Redmayne, Mary; Smith, Catherine L; Benke, Geza; Croft, Rodney J; Dalecki, Anna; Dimitriadis, Christina; Kaufman, Jordy; Macleod, Skye; Sim, Malcolm R; Wolfe, Rory; Abramson, Michael J

    2016-02-19

    Use of mobile (MP) and cordless phones (CP) is common among young children, but whether the resulting radiofrequency exposure affects development of cognitive skills is not known. Small changes have been found in older children. This study focused on children's exposures to MP and CP and cognitive development. The hypothesis was that children who used these phones would display differences in cognitive function compared to those who did not. We recruited 619 fourth-grade students (8-11 years) from 37 schools around Melbourne and Wollongong, Australia. Participants completed a short questionnaire, a computerised cognitive test battery, and the Stroop colour-word test. Parents completed exposure questionnaires on their child's behalf. Analysis used multiple linear regression. The principal exposure-metrics were the total number of reported MP and CP calls weekly categorised into no use ('None'); use less than or equal to the median amount ('Some'); and use more than the median ('More'). The median number of calls/week was 2.5 for MP and 2.0 for CP. MP and CP use for calls was low; and only 5 of 78 comparisons of phone use with cognitive measures were statistically significant. The reaction time to the response-inhibition task was slower in those who used an MP 'More' compared to the 'Some' use group and non-users. For CP use, the response time to the Stroop interference task was slower in the 'More' group versus the 'Some' group, and accuracy was worse in visual recognition and episodic memory tasks and the identification task. In an additional exploratory analysis, there was some evidence of a gender effect on mean reaction times. The highest users for both phone types were girls. Overall, there was little evidence cognitive function was associated with CP and MP use in this age group. Although there was some evidence that effects of MP and CP use on cognition may differ by gender, this needs further exploration. CP results may be more reliable as parents estimated

  19. [Vaccination coverage and socioeconomic determinants of BCG vaccination in children before 3 months: Results of the Elfe cohort study, 2011].

    PubMed

    Guthmann, J-P; Ragot, M; Ben Boutieb, M; Bois, C; Dufourg, M-N; Lévy-Bruhl, D

    2016-09-01

    In 2007, French authorities changed mandatory BCG vaccination for all children into a strong recommendation to vaccinate only children considered at high risk of tuberculosis. Vaccination coverage (VC) data are insufficient in France. We estimated VC at approximately two months of age and identified socioeconomic factors associated with BCG vaccination. The Elfe study (Étude Longitudinale Française depuis l'Enfance) included a random sample of about 18 000 children born in 2011 selected at birth from 320 maternity wards from mainland France. Information was collected through questionnaires and telephone interviews conducted approximately two months after delivery. Because BCG recommendations are different in the Paris region (Île-de-France [IDF]) and outside this region, VC was estimated separately in these two regions. We estimated VC for different levels of tuberculosis risk, approached by the geographical origin of the parents. Poisson regression was performed to analyze the association between socioeconomic factors and BCG vaccination status, and results expressed by prevalence ratios (PR). CV was higher in IDF (59.5%) compared to at-risk children outside IDF (46.7%) (p<0.001). VC in children with two parents from a tuberculosis highly endemic country was 80.5% in IDF and 60.4% outside IDF. In the multivariable model, having one or two parents from a tuberculosis highly endemic country (PR around 1.40) or consulting a private pediatrician (PR around 1.15) or a maternal and child health (MCH) center (PR around 1.40) after leaving the maternity ward were associated with a higher VC, whereas a university educational level in mothers was associated with a lower VC (PR=0.80). In France, BCG vaccination in infants is performed early after discharge from the maternity ward. A first consultation with a pediatrician or in a MCH center is associated with better vaccination coverage. Children at higher risk are probably well identified by physicians and better

  20. Determinants Of Oral corticosteroid Responsiveness in Wheezing Asthmatic Youth (DOORWAY): protocol for a prospective multicentre cohort study of children with acute moderate-to-severe asthma exacerbations.

    PubMed

    Ducharme, F M; Zemek, R; Gravel, J; Chalut, D; Poonai, N; Laberge, S; Quach, C; Krajinovic, M; Guimont, C; Lemière, C; Guertin, M C

    2014-04-07

    Oral corticosteroids are the cornerstone of acute asthma management in the emergency department. Recent evidence has raised doubts about the efficacy of this treatment in preschool-aged children with viral-induced wheezing and in smoking adults. The aims of the study were to: (1) document the magnitude of response to oral corticosteroids in children presenting to the emergency department with moderate or severe asthma; (2) quantify potential determinants of response to corticosteroids and (3) explore the role of gene polymorphisms associated with the responsiveness to corticosteroids. The design is a prospective cohort study of 1008 children aged 1-17 years meeting a strict definition of asthma and presenting with a clinical score of ≥4 on the validated Pediatric Respiratory Assessment Measure. All children will receive standardised severity-specific treatment with prednisone/prednisolone and cointerventions (salbutamol with/without ipratropium bromide). Determinants, namely viral aetiology, environmental tobacco smoke and single nucleotide polymorphism, will be objectively documented. The primary efficacy endpoint is the failure of emergency department (ED) management within 72 h of the ED visit. Secondary endpoints include other measures of asthma severity and time to recovery within 7 days of the index visit. The study has 80% power for detecting a risk difference of 7.5% associated with each determinant from a baseline risk of 21%, at an α of 0.05. Ethical approval has been obtained from all participating institutions. An impaired response to systemic steroids in certain subgroups will challenge the current standard of practice and call for the immediate search for better approaches. A potential host-environment interaction will broaden our understanding of corticosteroid responsiveness in children. Documentation of similar effectiveness of corticosteroids across determinants will provide the needed reassurance regarding current treatment recommendations

  1. Longitudinal changes in neurodevelopmental outcomes between 18 and 36 months in children with prenatal triptan exposure: findings from the Norwegian Mother and Child Cohort Study

    PubMed Central

    Wood, Mollie E; Frazier, Jean A; Nordeng, Hedvig M E; Lapane, Kate L

    2016-01-01

    Objective This study sought to determine whether changes in neurodevelopmental outcomes between 18 and 36 months of age were associated with prenatal exposure to triptan medications, a class of 5-HT receptor agonists used in the treatment of migraine. Method Using data from the Norwegian Mother and Child Cohort Study, a prospective birth cohort that includes nearly 40% of all pregnancies in Norway from 1999 to 2008, we identified 50 469 mother–child dyads who met inclusion criteria and were present for at least one follow-up assessment at 18 or 36 months postpartum. Neurodevelopment was assessed using the Child Behaviour Checklist, the Emotionality, Activity, and Shyness Questionnaire, and the Ages and Stages Questionnaire. We used generalised estimating equations to evaluate change from 18 to 36 months for children prenatally exposed to triptans, relative to contrast groups, and used marginal structural models with inverse probability of treatment and censoring weights to address time-varying exposure and confounding as well as loss to follow-up. Results Among eligible participants (n=50 469), 1.0% used a triptan during pregnancy, 2.0% used triptans prior to pregnancy only, 8.0% reported migraine without triptan use and 89.0% had no history of migraine. Children with prenatal triptan exposure had greater increases in emotionality (r-RR 2.18, 95% CI 1.03 to 4.53) and activity problems (r-RR 1.70, 95% CI 1.02 to 2.8) compared to children born to mothers who discontinued triptan use prior to pregnancy. Conclusion Prenatal triptan exposure was associated with changes over time in externalising-type behaviours such as emotionality and activity, but not with internalising-type behaviours. PMID:27625061

  2. Risk factors for high-titer inhibitor development in children with hemophilia A: results of a cohort study.

    PubMed

    Halimeh, Susan; Bidlingmaier, Christoph; Heller, Christine; Gutsche, Sven; Holzhauer, Susanne; Kenet, Gili; Kurnik, Karin; Manner, Daniela; Iorio, Alfonso; Nowak-Göttl, Ulrike

    2013-01-01

    Among the discussed risk factors for high-titre inhibitor (HRI) development in patients with hemophilia A (HA) are high dose FVIII replacement therapy and use of recombinant FVIII concentrates (rFVIII). The aim of this study was to evaluate the aforementioned risk factors for HRI development in children with hemophilia A ≤2%. About 288 ascertained PUPs (Israel and Germany) were followed after initial HA diagnosis over 200 exposure days. Inhibitor-free survival, hazard ratios (HR), and 95% confidence intervals (CIs) were calculated. Adjustment was performed for factor VIII concentrates, median single dose over the first three months of treatment, first FVIII administration before the age of three months, presence of risk HA gene mutations, "intensive treatment moments" and "year of birth" (proxy for different treatment periods). HRI occurred in 71/288 children (24.7%). In multivariate analysis adjusted for "year of birth", underlying risk gene mutations (HR/CI: 2.37/1.40-3.99), FVIII dose, measured per one IU increase per kgbw (HR/CI: 1.05/1.04-1.07), and first FVIII administration before the age of three months showed a significant impact on HR development. The risk of HRI development was similar for recombinant or plasmatic FVIII products. Children at risk should be treated with carefully calculated lower dose regimens, adapted to individual bleeding situations.

  3. Comparison of PECARN, CATCH, and CHALICE Rules for Children with Minor Head Injury: A prospective cohort study

    PubMed Central

    Easter, Joshua S.; Bakes, Katherine; Dhaliwal, Jasmeet; Miller, Michael; Caruso, Emily; Haukoos, Jason S.

    2014-01-01

    Objective To evaluate the diagnostic accuracy of clinical decision rules and physician judgment for identifying clinically important traumatic brain injuries (TBIs) in children with minor head injuries presenting to the emergency department (ED). Methods We prospectively enrolled children <18 years of age with minor head injury (Glasgow Coma Scale 13 – 15) presenting within 24 hours of their injuries. We assessed the ability of 3 clinical decision rules (CATCH, CHALICE, PECARN) and 2 measures of physician judgment (estimated of <1% risk of TBI, actual CT ordering practice) to predict clinically important TBI, as defined by death from TBI, need for neurosurgery, intubation >24 hours for TBI, or hospital admission >2 nights for TBI. Results Among the 1,009 children, 21 (2%; 95% CI: 1% to 3%) had clinically important TBIs. Only physician practice and PECARN identified all clinically important TBIs, with ranked sensitivities as follows (95% CI): Physician practice and PECARN each 100% (84% to 100%), physician estimates 95% (76% to 100%), CATCH 91% (70% to 99%), and CHALICE 84% (60% to 97%). Ranked specificities were as follows: CHALICE 85% (82% to 87%), physician estimates 68% (65% to 71%), PECARN 62% (59% to 66%), physician practice 50% (47% to 53%), and CATCH 44% (41% to 47%). Conclusions Of the 5 modalities studied, only physician practice and PECARN identified all clinically important TBIs, with PECARN being slightly more specific. CHALICE was incompletely sensitive but the most specific of all rules. CATCH was incompletely sensitive and had the poorest specificity of all modalities. PMID:24635987

  4. Comparison of PECARN, CATCH, and CHALICE rules for children with minor head injury: a prospective cohort study.

    PubMed

    Easter, Joshua S; Bakes, Katherine; Dhaliwal, Jasmeet; Miller, Michael; Caruso, Emily; Haukoos, Jason S

    2014-08-01

    We evaluate the diagnostic accuracy of clinical decision rules and physician judgment for identifying clinically important traumatic brain injuries in children with minor head injuries presenting to the emergency department. We prospectively enrolled children younger than 18 years and with minor head injury (Glasgow Coma Scale score 13 to 15), presenting within 24 hours of their injuries. We assessed the ability of 3 clinical decision rules (Canadian Assessment of Tomography for Childhood Head Injury [CATCH], Children's Head Injury Algorithm for the Prediction of Important Clinical Events [CHALICE], and Pediatric Emergency Care Applied Research Network [PECARN]) and 2 measures of physician judgment (estimated of <1% risk of traumatic brain injury and actual computed tomography ordering practice) to predict clinically important traumatic brain injury, as defined by death from traumatic brain injury, need for neurosurgery, intubation greater than 24 hours for traumatic brain injury, or hospital admission greater than 2 nights for traumatic brain injury. Among the 1,009 children, 21 (2%; 95% confidence interval [CI] 1% to 3%) had clinically important traumatic brain injuries. Only physician practice and PECARN identified all clinically important traumatic brain injuries, with ranked sensitivities as follows: physician practice and PECARN each 100% (95% CI 84% to 100%), physician estimates 95% (95% CI 76% to 100%), CATCH 91% (95% CI 70% to 99%), and CHALICE 84% (95% CI 60% to 97%). Ranked specificities were as follows: CHALICE 85% (95% CI 82% to 87%), physician estimates 68% (95% CI 65% to 71%), PECARN 62% (95% CI 59% to 66%), physician practice 50% (95% CI 47% to 53%), and CATCH 44% (95% CI 41% to 47%). Of the 5 modalities studied, only physician practice and PECARN identified all clinically important traumatic brain injuries, with PECARN being slightly more specific. CHALICE was incompletely sensitive but the most specific of all rules. CATCH was incompletely

  5. Etiological Role and Repeated Infections of Sapovirus among Children Aged Less than 2 Years in a Cohort Study in a Peri-urban Community of Peru

    PubMed Central

    Liu, Xiaofang; Jahuira, Helena; Gilman, Robert H.; Alva, Alicia; Cabrera, Lilia; Okamoto, Michiko; Xu, Hang; Windle, Henry J.; Kelleher, Dermot; Varela, Marco; Verastegui, Manuela; Calderon, Maritza; Sanchez, Gerardo; Sarabia, Vanessa; Ballard, Sarah B.; Bern, Caryn; Mayta, Holger; Crabtree, Jean E.; Cama, Vitaliano; Oshitani, Hitoshi

    2016-01-01

    Human sapovirus has been shown to be one of the most important etiologies in pediatric patients with acute diarrhea. However, very limited data are available about the causative roles and epidemiology of sapovirus in community settings. A nested matched case-control study within a birth cohort study of acute diarrhea in a peri-urban community in Peru from 2007 to 2010 was conducted to investigate the attributable fraction (AF) and genetic diversity of sapovirus. By quantitative reverse transcription–real-time PCR (qPCR) sapovirus was detected in 12.4% (37/299) of diarrheal and 5.7% (17/300) of nondiarrheal stools (P = 0.004). The sapovirus AF (7.1%) was higher in the second year (13.2%) than in the first year (1.4%) of life of children. Ten known genotypes and one novel cluster (n = 5) within four genogroups (GI, GII, GIV, and GV) were identified by phylogenetic analysis of a partial VP1 gene. Further sequence analysis of the full VP1 gene revealed a possible novel genotype, tentatively named GII.8. Notably, symptomatic reinfections with different genotypes within the same (n = 3) or different (n = 5) genogroups were observed in eight children. Sapovirus exhibited a high attributable burden for acute gastroenteritis, especially in the second year of life, of children in a Peruvian community. Further large-scale studies are needed to understand better the global burden, genetic diversity, and repeated infections of sapovirus. PMID:27076657

  6. Rheumatic Fever Follow-Up Study (RhFFUS) protocol: a cohort study investigating the significance of minor echocardiographic abnormalities in Aboriginal Australian and Torres Strait Islander children

    PubMed Central

    2012-01-01

    Background In Australia, rheumatic heart disease (RHD) is almost exclusively restricted to Aboriginal Australian and Torres Strait Islander people with children being at highest risk. International criteria for echocardiographic diagnosis of RHD have been developed but the significance of minor heart valve abnormalities which do not reach these criteria remains unclear. The Rheumatic Fever Follow-Up Study (RhFFUS) aims to clarify this question in children and adolescents at high risk of RHD. Methods/design RhFFUS is a cohort study of Aboriginal and/or Torres Strait Islander children and adolescents aged 8–17 years residing in 32 remote Australian communities. Cases are people with non-specific heart valve abnormalities detected on prior screening echocardiography. Controls (two per case) are age, gender, community and ethnicity-matched to cases and had a prior normal screening echocardiogram. Participants will have echocardiography about 3 years after initial screening echocardiogram and enhanced surveillance for any history suggestive of acute rheumatic fever (ARF). It will then be determined if cases are at higher risk of (1) ARF or (2) developing progressive echocardiography-detected valve changes consistent with RHD. The occurrence and timing of episodes of ARF will be assessed retrospectively for 5 years from the time of the RhFFUS echocardiogram. Episodes of ARF will be identified through regional surveillance and notification databases, carer/subject interviews, primary healthcare history reviews, and hospital separation diagnoses. Progression of valvular abnormalities will be assessed prospectively using transthoracic echocardiography and standardized operating and reporting procedures. Progression of valve lesions will be determined by specialist cardiologist readers who will assess the initial screening and subsequent RhFFUS screening echocardiogram for each participant. The readers will be blinded to the initial assessment and temporal order of the two

  7. Comparing Presenting Clinical Features in 48 Children With Microscopic Polyangiitis to 183 Children Who Have Granulomatosis With Polyangiitis (Wegener's): An ARChiVe Cohort Study.

    PubMed

    Cabral, David A; Canter, Debra L; Muscal, Eyal; Nanda, Kabita; Wahezi, Dawn M; Spalding, Steven J; Twilt, Marinka; Benseler, Susanne M; Campillo, Sarah; Charuvanij, Sirirat; Dancey, Paul; Eberhard, Barbara A; Elder, Melissa E; Hersh, Aimee; Higgins, Gloria C; Huber, Adam M; Khubchandani, Raju; Kim, Susan; Klein-Gitelman, Marisa; Kostik, Mikhail M; Lawson, Erica F; Lee, Tzielan; Lubieniecka, Joanna M; McCurdy, Deborah; Moorthy, Lakshmi N; Morishita, Kimberly A; Nielsen, Susan M; O'Neil, Kathleen M; Reiff, Andreas; Ristic, Goran; Robinson, Angela B; Sarmiento, Angelyne; Shenoi, Susan; Toth, Mary B; Van Mater, Heather A; Wagner-Weiner, Linda; Weiss, Jennifer E; White, Andrew J; Yeung, Rae S M

    2016-10-01

    To uniquely classify children with microscopic polyangiitis (MPA), to describe their demographic characteristics, presenting clinical features, and initial treatments in comparison to patients with granulomatosis with polyangiitis (Wegener's) (GPA). The European Medicines Agency (EMA) classification algorithm was applied by computation to categorical data from patients recruited to the ARChiVe (A Registry for Childhood Vasculitis: e-entry) cohort, with the data censored to November 2015. The EMA algorithm was used to uniquely distinguish children with MPA from children with GPA, whose diagnoses had been classified according to both adult- and pediatric-specific criteria. Descriptive statistics were used for comparisons. In total, 231 of 440 patients (64% female) fulfilled the classification criteria for either MPA (n = 48) or GPA (n = 183). The median time to diagnosis was 1.6 months in the MPA group and 2.1 months in the GPA group (ranging to 39 and 73 months, respectively). Patients with MPA were significantly younger than those with GPA (median age 11 years versus 14 years). Constitutional features were equally common between the groups. In patients with MPA compared to those with GPA, pulmonary manifestations were less frequent (44% versus 74%) and less severe (primarily, hemorrhage, requirement for supplemental oxygen, and pulmonary failure). Renal pathologic features were frequently found in both groups (75% of patients with MPA versus 83% of patients with GPA) but tended toward greater severity in those with MPA (primarily, nephrotic-range proteinuria, requirement for dialysis, and end-stage renal disease). Airway/eye involvement was absent among patients with MPA, because these GPA-defining features preclude a diagnosis of MPA within the EMA algorithm. Similar proportions of patients with MPA and those with GPA received combination therapy with corticosteroids plus cyclophosphamide (69% and 78%, respectively) or both drugs in combination with

  8. Risk of late effects of treatment in children newly diagnosed with standard-risk acute lymphoblastic leukaemia: a report from the Childhood Cancer Survivor Study cohort.

    PubMed

    Essig, Stefan; Li, Qiaozhi; Chen, Yan; Hitzler, Johann; Leisenring, Wendy; Greenberg, Mark; Sklar, Charles; Hudson, Melissa M; Armstrong, Gregory T; Krull, Kevin R; Neglia, Joseph P; Oeffinger, Kevin C; Robison, Leslie L; Kuehni, Claudia E; Yasui, Yutaka; Nathan, Paul C

    2014-07-01

    Treatment of patients with paediatric acute lymphoblastic leukaemia has evolved such that the risk of late effects in survivors treated in accordance with contemporary protocols could be different from that noted in those treated decades ago. We aimed to estimate the risk of late effects in children with standard-risk acute lymphoblastic leukaemia treated with contemporary protocols. We used data from similarly treated members of the Childhood Cancer Survivor Study cohort. The Childhood Cancer Survivor Study is a multicentre, North American study of 5-year survivors of childhood cancer diagnosed between 1970 and 1986. We included cohort members if they were aged 1·0-9·9 years at the time of diagnosis of acute lymphoblastic leukaemia and had received treatment consistent with contemporary standard-risk protocols for acute lymphoblastic leukaemia. We calculated mortality rates and standardised mortality ratios, stratified by sex and survival time, after diagnosis of acute lymphoblastic leukaemia. We calculated standardised incidence ratios and absolute excess risk for subsequent neoplasms with age-specific, sex-specific, and calendar-year-specific rates from the Surveillance, Epidemiology and End Results Program. Outcomes were compared with a sibling cohort and the general US population. We included 556 (13%) of 4329 cohort members treated for acute lymphoblastic leukaemia. Median follow-up of the survivors from 5 years after diagnosis was 18·4 years (range 0·0-33·0). 28 (5%) of 556 participants had died (standardised mortality ratio 3·5, 95% CI 2·3-5·0). 16 (57%) deaths were due to causes other than recurrence of acute lymphoblastic leukaemia. Six (1%) survivors developed a subsequent malignant neoplasm (standardised incidence ratio 2·6, 95% CI 1·0-5·7). 107 participants (95% CI 81-193) in each group would need to be followed-up for 1 year to observe one extra chronic health disorder in the survivor group compared with the sibling group. 415 participants

  9. Outdoor physical activity and its relation with self-reported health in Japanese children: results from the Toyama birth cohort study.

    PubMed

    Liu, J; Sekine, M; Tatsuse, T; Fujimura, Y; Hamanishi, S; Lu, F; Zheng, X

    2015-11-01

    Few studies have examined trends in engagement in outdoor physical activity as children grow and whether changes in physical activity at different ages affect children's health. This study determined the preference for and frequency of physical activity among Japanese children from ages 6 to 12 years and investigated the effect of physical activity and of change in physical activity on children's self-reported health. Data were from the prospective, longitudinal Toyama Birth Cohort Study, a total of 5238 children were followed at their age of 12 years. Preference for and frequency of outdoor physical activity were from the self-administered questionnaire. Self-reported health was from the Japanese version of Dartmouth Primary Care Co-operative project charts. Reporting liking and participating in outdoor physical activity at both ages 6 and 12 years were associated with higher likelihood of good self-reported health (Odds ratio 1.24 [95% CI: 1.03-1.50] for liking activity and OR = 1.27[1.08, 1.50] for participating in activity) compared with those who did not like or participate in this at only one or at neither age, after adjustment for lifestyle factors and body pain. The adjusted OR was 1.23 (95% CI: 0.97-1.56) for girls whose preference for liking outdoor physical activity was not changed at both ages compared with those whose preference changed. The OR was 1.47 (95% CI: 1.14-1.89) for boys who persisted in participating in the outdoor physical activity than those who did not persist. There is an association between a persistent expression of liking outdoor physical activity and self- reported health. © 2015 John Wiley & Sons Ltd.

  10. Congenital Anomalies in Children Exposed to Antithyroid Drugs In-Utero: A Meta-Analysis of Cohort Studies

    PubMed Central

    Luo, Jiayou; Zeng, Rong; Feng, Na; Zhu, Na; Feng, Qi

    2015-01-01

    Background Hyperthyroidism affects about 0.2%-2.7% of all pregnancies, and is commonly managed with antithyroid drugs (ATDs). However, previous studies about the effects of ATDs on congenital anomalies are controversial. Therefore, the present meta-analysis was performed to explore the risk of congenital anomalies in children exposed to ATDs in-utero. Methods Embase, Pubmed, Web of Knowledge, and BIOSIS Citation Index were searched to find out studies about congenital anomalies in children exposed to ATDs in-utero reported up to May 2014. The references cited by the retrieved articles were also searched. The relative risks (RRs) and confidence intervals (CIs) for the individual studies were pooled by fixed effects models, and heterogeneity was analyzed by chi-square and I2 tests. Results Eight studies met the inclusion criteria. Exposure to propylthiouracil (PTU), methimazole/carbimazole (MMI/CMZ), and PTU & MMI/CMZ was investigated in 7, 7 and 2 studies, respectively. The pooled RR was 1.20 (95%CI: 1.02-1.42), 1.64 (95%CI: 1.39-1.92), and 1.83 (95%CI: 1.30-2.56) for congenital anomalies after exposure to PTU, MMI/CMZ, and PTU & MMI/CMZ, respectively. Conclusions The meta-analysis suggests that exposure to ATDs in-utero increases the risk of congenital anomalies. The use of ATDs in pregnancy should be limited when possible. Further research is needed to delineate the exact teratogenic risk for particular congenital anomaly. PMID:25974033

  11. Risk factors for therapeutic failure to meglumine antimoniate and miltefosine in adults and children with cutaneous leishmaniasis in Colombia: A cohort study.

    PubMed

    Castro, Maria Del Mar; Cossio, Alexandra; Velasco, Carlos; Osorio, Lyda

    2017-04-01

    Reports of therapeutic failure to meglumine antimoniate (MA) and miltefosine in cutaneous leishmaniasis (CL) varies between species, populations and geographic regions. This study aimed to determine the clinical, drug-related factors, and Leishmania species associated with treatment failure in children and adults with cutaneous leishmaniasis. A cohort study was performed with children (2-12 years old) and adults (18-65 years old) with CL, who have participated in clinical studies at CIDEIM Cali, Tumaco and Chaparral. Incidence of therapeutic failure was estimated by treatment and age groups. Descriptive, bivariate, and multiple logistic regression analyses were performed for the complete cohort and pediatric patients. Two hundred and thirty patients were included (miltefosine: 112; MA: 118), of which 60.4% were children and 83.9% were infected with L.V. panamensis. Overall incidence of therapeutic failure was 15.65% (95%CI: 10.92-20.38), and was lower for miltefosine than for MA (8.92%, 95%CI: 3.59-14.26 versus 22.03%, 95%CI:14.48-29.58, p = 0.006). Treatment failure was associated with age ≤8 years (OR: 3.29; 95%CI: 1.37-7.89), disease duration ≤1 month (OR: 3.29; 95%CI: 1.37-7.89), regional lymphadenopathy (OR: 2.72; 95%CI: 1.10-6.70), treatment with MA (OR: 3.98; 95%CI: 1.66-9.50), and adherence <90% (OR: 3.59; 95%CI: 1.06-12.11). In children, higher Z-score of height/age was a protective factor (OR: 0.58; 95%CI: 0.36-0.93), while treatment with MA was a risk factor (OR: 40.82; 95%CI: 2.45-677.85), demonstrating significant interaction with age (p = 0.03). Clinical and drug-related factors determine therapeutic failure in CL. High risk of failure in children treated with MA indicates the need to reconsider this drug as first line treatment in this population. Clinical trial registration: NCT00487253 Clinical trial registration: NCT01462500 Clinical trial registration: NCT01464242.

  12. Risk factors for therapeutic failure to meglumine antimoniate and miltefosine in adults and children with cutaneous leishmaniasis in Colombia: A cohort study

    PubMed Central

    Cossio, Alexandra; Velasco, Carlos; Osorio, Lyda

    2017-01-01

    Introduction Reports of therapeutic failure to meglumine antimoniate (MA) and miltefosine in cutaneous leishmaniasis (CL) varies between species, populations and geographic regions. This study aimed to determine the clinical, drug-related factors, and Leishmania species associated with treatment failure in children and adults with cutaneous leishmaniasis. Methods A cohort study was performed with children (2–12 years old) and adults (18–65 years old) with CL, who have participated in clinical studies at CIDEIM Cali, Tumaco and Chaparral. Incidence of therapeutic failure was estimated by treatment and age groups. Descriptive, bivariate, and multiple logistic regression analyses were performed for the complete cohort and pediatric patients. Results Two hundred and thirty patients were included (miltefosine: 112; MA: 118), of which 60.4% were children and 83.9% were infected with L.V. panamensis. Overall incidence of therapeutic failure was 15.65% (95%CI: 10.92–20.38), and was lower for miltefosine than for MA (8.92%, 95%CI: 3.59–14.26 versus 22.03%, 95%CI:14.48–29.58, p = 0.006). Treatment failure was associated with age ≤8 years (OR: 3.29; 95%CI: 1.37–7.89), disease duration ≤1 month (OR: 3.29; 95%CI: 1.37–7.89), regional lymphadenopathy (OR: 2.72; 95%CI: 1.10–6.70), treatment with MA (OR: 3.98; 95%CI: 1.66–9.50), and adherence <90% (OR: 3.59; 95%CI: 1.06–12.11). In children, higher Z-score of height/age was a protective factor (OR: 0.58; 95%CI: 0.36–0.93), while treatment with MA was a risk factor (OR: 40.82; 95%CI: 2.45–677.85), demonstrating significant interaction with age (p = 0.03). Conclusions Clinical and drug-related factors determine therapeutic failure in CL. High risk of failure in children treated with MA indicates the need to reconsider this drug as first line treatment in this population. Trial registration Clinical trial registration: NCT00487253 Clinical trial registration: NCT01462500 Clinical trial registration: NCT

  13. Risk of leukaemia or cancer in the central nervous system among children living in an area with high indoor radon concentrations: results from a cohort study in Norway.

    PubMed

    Del Risco Kollerud, R; Blaasaas, K G; Claussen, B

    2014-09-23

    Over the past few years, there has been growing interest in assessing the relationship between exposure to radon at home and the risk of childhood cancer. Previous studies have produced conflicting results, probably because of limitations assessing radon exposure, too few cancer cases and poorly documented health statistics. We used a cohort approach of 0-15-year-old children to examine whether residential radon exposure was associated with childhood leukaemia and cancer in the central nervous system in the Oslo region. The study was based on Norwegian population registers and identified cancer cases from The Cancer Registry of Norway. The residence of every child was geo-coded and assigned a radon exposure. In all, 712 674 children were followed from 1967 to 2009 from birth to date of cancer diagnosis, death, emigration or 15 years of age. A total of 864 cancer cases were identified, 437 children got leukaemia and 427 got cancer in the central nervous system.Conclusions or interpretation:No association was found for childhood leukaemia. An elevated nonsignificant risk for cancer in the central nervous system was observed. This association should be interpreted with caution owing to the crude exposure assessment and possibilities of confounding.

  14. Risk of leukaemia or cancer in the central nervous system among children living in an area with high indoor radon concentrations: results from a cohort study in Norway

    PubMed Central

    Del Risco Kollerud, R; Blaasaas, K G; Claussen, B

    2014-01-01

    Background: Over the past few years, there has been growing interest in assessing the relationship between exposure to radon at home and the risk of childhood cancer. Previous studies have produced conflicting results, probably because of limitations assessing radon exposure, too few cancer cases and poorly documented health statistics. Methods: We used a cohort approach of 0–15-year-old children to examine whether residential radon exposure was associated with childhood leukaemia and cancer in the central nervous system in the Oslo region. The study was based on Norwegian population registers and identified cancer cases from The Cancer Registry of Norway. The residence of every child was geo-coded and assigned a radon exposure. Results: In all, 712 674 children were followed from 1967 to 2009 from birth to date of cancer diagnosis, death, emigration or 15 years of age. A total of 864 cancer cases were identified, 437 children got leukaemia and 427 got cancer in the central nervous system. Conclusions or interpretation: No association was found for childhood leukaemia. An elevated nonsignificant risk for cancer in the central nervous system was observed. This association should be interpreted with caution owing to the crude exposure assessment and possibilities of confounding. PMID:25117818

  15. Exploring the impact of early life factors on inequalities in risk of overweight in UK children: findings from the UK Millennium Cohort Study

    PubMed Central

    Massion, Samuel; Wickham, Sophie; Pearce, Anna; Barr, Ben; Law, Catherine; Taylor-Robinson, David

    2016-01-01

    Background Overweight and obesity in childhood are socially patterned, with higher prevalence in more disadvantaged populations, but it is unclear to what extent early life factors attenuate the social inequalities found in childhood overweight/obesity. Methods We estimated relative risks (RRs) for being overweight (combining with obesity) at age 11 in 11 764 children from the UK Millennium Cohort Study (MCS) according to socio-economic circumstances (SEC). Early life risk factors were explored to assess if they attenuated associations between SECs and overweight. Results 28.84% of children were overweight at 11 years. Children of mothers with no academic qualifications were more likely to be overweight (RR 1.72, 95% CI 1.48 to 2.01) compared to children of mothers with degrees and higher degrees. Controlling for prenatal, perinatal, and early life characteristics (particularly maternal pre-pregnancy overweight and maternal smoking during pregnancy) reduced the RR for overweight to 1.44, 95% CI 1.23 to 1.69 in the group with the lowest academic qualifications compared to the highest. Conclusions We observed a clear social gradient in overweight 11-year-old children using a representative UK sample. Moreover, we identified specific early life risk factors, including maternal smoking during pregnancy and maternal pre-pregnancy overweight, that partially account for the social inequalities found in childhood overweight. Policies to support mothers to maintain a healthy weight, breastfeed and abstain from smoking during pregnancy are important to improve maternal and child health outcomes, and our study provides some evidence that they may also help to address the continuing rise in inequalities in childhood overweight. PMID:27162002

  16. Patterns and influences in health-related quality of life in children with immune thrombocytopenia: A study from the Dallas ITP Cohort.

    PubMed

    Flores, Adolfo; Klaassen, Robert J; Buchanan, George R; Neunert, Cindy E

    2017-08-01

    Relationships between clinical/demographic factors and health-related quality of life (HRQoL) in childhood immune thrombocytopenia (ITP) remain poorly understood. Recent studies reveal conflicting information about factors that contribute to HRQoL. This was a prospective, single-institution, cohort study of newly diagnosed children with ITP. Serial evaluations of HRQoL were performed using the Kid's ITP Tools (KIT), scored from 0 (worst) to 100 (best), at enrollment and 1 week, 6 months, and 12 months following diagnosis. All visits included bleeding severity grading. Relationships between HRQoL and platelet count, treatment, bleeding severity, and course of disease were examined. A total of 99 children with newly diagnosed ITP were evaluable for analysis. KIT scores were low at diagnosis for parents (median 26, range 15-43) and children (median 65, range 55-81) and were not influenced by age or platelet count. At diagnosis, children who received treatment had lower platelet counts (P = 0.005), more severe hemorrhage (P < 0.0125), and lower HRQoL by parent, child, and proxy reporting (P < 0.05). Oral bleeding negatively impacted proxy-reported disease burden at diagnosis (P = 0.01). Persistence of disease and lower platelet counts at 6 and 12 month visits were the only factors noted to consistently impact quality of life beyond diagnosis for both parents and children. HRQoL is low at diagnosis but significantly improves over time. Patients with ongoing disease and lower platelet counts continue to have significant disease burden. © 2017 Wiley Periodicals, Inc.

  17. Exploring the impact of early life factors on inequalities in risk of overweight in UK children: findings from the UK Millennium Cohort Study.

    PubMed

    Massion, Samuel; Wickham, Sophie; Pearce, Anna; Barr, Ben; Law, Catherine; Taylor-Robinson, David

    2016-08-01

    Overweight and obesity in childhood are socially patterned, with higher prevalence in more disadvantaged populations, but it is unclear to what extent early life factors attenuate the social inequalities found in childhood overweight/obesity. We estimated relative risks (RRs) for being overweight (combining with obesity) at age 11 in 11 764 children from the UK Millennium Cohort Study (MCS) according to socio-economic circumstances (SEC). Early life risk factors were explored to assess if they attenuated associations between SECs and overweight. 28.84% of children were overweight at 11 years. Children of mothers with no academic qualifications were more likely to be overweight (RR 1.72, 95% CI 1.48 to 2.01) compared to children of mothers with degrees and higher degrees. Controlling for prenatal, perinatal, and early life characteristics (particularly maternal pre-pregnancy overweight and maternal smoking during pregnancy) reduced the RR for overweight to 1.44, 95% CI 1.23 to 1.69 in the group with the lowest academic qualifications compared to the highest. We observed a clear social gradient in overweight 11-year-old children using a representative UK sample. Moreover, we identified specific early life risk factors, including maternal smoking during pregnancy and maternal pre-pregnancy overweight, that partially account for the social inequalities found in childhood overweight. Policies to support mothers to maintain a healthy weight, breastfeed and abstain from smoking during pregnancy are important to improve maternal and child health outcomes, and our study provides some evidence that they may also help to address the continuing rise in inequalities in childhood overweight. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  18. Predictors of loss to follow-up among children registered in an HIV prevention mother-to-child transmission cohort study in Pernambuco, Brazil.

    PubMed

    Gouveia, Pedro Alves da Cruz; da Silva, Gerlane Alves Pontes; de Albuquerque, Maria de Fatima Pessoa Militão

    2014-11-27

    Mother-to-child transmission of HIV (MTCT) is the major form of acquiring the disease among children. The loss to follow-up (LTF) of mothers and their children is a problem that affects the effectiveness of programs for the prevention of mother-to-child transmission (PMTCT). The aim of this study is to identify risk factors associated with the LTF of HIV-exposed children in the state of Pernambuco, Brazil. A retrospective cohort study was carried out with 1200 HIV-exposed children born between 2000 and 2009, registered up to the age of 2 months in a public health PMTCT program. Children were considered LTF if they did not return for scheduled visits to monitor infection status. Univariate and multivariate logistic regression analyses were conducted to identify risk factors for LTF. A total of 185 children (15.4%; CI: 95%: 13.4-17.4%) met the case definition of LTF before the determination of serological HIV status. Risk factors independently associated with LTF were mother-child pairs who reside in rural and remote areas (OR 1.86; 95% CI: 1.30-2.66) and mothers who use illicit drugs (OR 1.8; 95% CI: 1.08-3.0). Initiation of the PMTCT during pregnancy was a protective factor for LTF (OR 0.69; 95% CI: 0.49-0.96). The decentralization of support services for HIV-exposed children to other cities in the state seems to be crucial for the accurate monitoring of outcomes. It is also important to introduce additional measures addressing mothers who are drug users so that they remain in the program: an intensive follow-up program that actively searches for absentee mother-child pairs, support from social services and treatment for drug-dependency. The findings of this study highlight the importance of diagnosing mothers as early as possible in order to conduct a more complete follow-up period of the children. Solving the above-mentioned problems is a challenge, which must be overcome so as to improve the quality of PMTCT.

  19. Back pain in children surveyed with weekly text messages - a 2.5 year prospective school cohort study.

    PubMed

    Franz, Claudia; Wedderkopp, Niels; Jespersen, Eva; Rexen, Christina T; Leboeuf-Yde, Charlotte

    2014-01-01

    Back pain is reported to occur already in childhood, but its development at that age is not well understood. The aims of this study were to describe BP in children aged 6-12 years, and to investigate any sex and age differences. Data on back pain (defined as pain in the neck, mid back and/or lower back) were collected once a week from parents replying to automated text-messages over 2.5 school years from 2008 till 2011. The prevalence estimates were presented as percentages and 95% confidence intervals. Differences between estimates were considered significant if confidence intervals did not overlap. A test for trend, using a multi-level mixed-effects logistic regression extended to the longitudinal and multilevel setting, was performed to see whether back pain reporting increased with age. Depending on the age group, 13-38% children reported back pain at least once per survey year, and 5-23% at least twice per survey year. The average weekly prevalence estimate ranged between 1% and 5%. In the final survey year more girls than boys reported back pain at least twice. The prevalence estimates did not increase monotonically with age but showed a greater increase in children younger than 9/10, after which they remained relatively stable up to the age of 12 years. We found that back pain was not a common problem in this age group and recommend health professionals be vigilant if a child presents with constant or recurring back pain. Our results need to be supplemented by a better understanding of the severity and consequences of back pain in childhood. It would be productive to study the circumstances surrounding the appearance of back pain in childhood, as well as, how various bio-psycho-social factors affect its onset and later recurrence. Knowledge about the causes of back pain in childhood might allow early prevention.

  20. Adiposity Trajectory and Its associations with Plasma Adipokine Levels in Children and Adolescents – A Prospective Cohort Study

    PubMed Central

    Li, Shenghui; Liu, Rong; Arguelles, Lester; Wang, Guoying; Zhang, Jun; Shen, Xiaoming; Wang, Xiaobin

    2015-01-01

    Objective This study aimed to examine the associations of longitudinal adiposity measures with two adipokines, leptin and adiponectin, and their ratio in children and adolescents. Methods A total of 953 children and adolescents participated in a 6-year longitudinal study. Body mass index (BMI), percentage body fat (%BF), and fat mass index (FMI) were used to assess adiposity status. Results After adjusting for possible confounders, our regression models revealed that BMI, %BF, and FMI, in both the baseline and follow-up survey, were independently associated with a higher level of leptin and the leptin/adiponectin ratio at the follow-up survey, whereas the significant association with adiponectin only partly existed in adiposity measures at the follow-up visit. Moreover, the longitudinal change in adiposity measures was found to be a significant predictor for follow-up plasma adipokine levels. Compared with the low→low group, the medium→medium group, up-trend group, and high→high group all showed a significantly increased level of leptin and leptin/adiponectin ratio. The up-trend group and high→high group also had significantly decreased adiponectin levels. Conclusions Our findings highlight the importance of adiposity surveillance and the utility of adipokines as biomarkers for adverse metabolic consequences of childhood adiposity. PMID:26704698

  1. Do Children Who Move Home and School Frequently Have Poorer Educational Outcomes in Their Early Years at School? An Anonymised Cohort Study

    PubMed Central

    Hutchings, Hayley A.; Evans, Annette; Barnes, Peter; Demmler, Joanne; Heaven, Martin; Hyatt, Melanie A.; James-Ellison, Michelle; Lyons, Ronan A.; Maddocks, Alison; Paranjothy, Shantini; Rodgers, Sarah E.; Dunstan, Frank

    2013-01-01

    Frequent mobility has been linked to poorer educational attainment. We investigated the association between moving home and moving school frequently and the early childhood formal educational achievement. We carried out a cohort analysis of 121,422 children with anonymised linked records. Our exposure measures were: 1) the number of residential moves registered with a health care provider, and 2) number of school moves. Our outcome was the formal educational assessment at age 6–7. Binary regression modeling was used to examine residential moves within the three time periods: 0 – <1 year; 1 – <4 years and 4 – <6 years. School moves were examined from age 4 to age 6. We adjusted for demographics, residential moves at different times, school moves and birth related variables. Children who moved home frequently were more likely not to achieve in formal assessments compared with children not moving. Adjusted odds ratios were significant for 3 or more moves within the time period 1 –<4 years and for any number of residential moves within the time period 4–<6 years. There was a dose response relationship, with increased odds ratios with increased frequency of residential moves (2 or more moves at 4–<6 years, adjusted odds ratio 1.16 (1.03, 1.29). The most marked effect was seen with frequent school moves where 2 or more moves resulted in an adjusted odds ratio of 2.33 (1.82, 2.98). This is the first study to examine the relationship between residential and school moves in early childhood and the effect on educational attainment. Children experiencing frequent mobility may be disadvantaged and should be closely monitored. Additional educational support services should be afforded to children, particularly those who frequently change school, in order to help them achieve the expected educational standards. PMID:23940601

  2. Prevalence of non-febrile seizures in children with idiopathic autism spectrum disorder and their unaffected siblings: a retrospective cohort study.

    PubMed

    McCue, Lena M; Flick, Louise H; Twyman, Kimberly A; Xian, Hong; Conturo, Thomas E

    2016-11-28

    Autism spectrum disorder (ASD) is a heterogeneous disorder characterized not only by deficits in communication and social interactions but also a high rate of co-occurring disorders, including metabolic abnormalities, gastrointestinal and sleep disorders, and seizures. Seizures, when present, interfere with cognitive development and are associated with a higher mortality rate in the ASD population. To determine the relative prevalence of non-febrile seizures in children with idiopathic ASD from multiplex and simplex families compared with the unaffected siblings in a cohort of 610 children with idiopathic ASD and their 160 unaffected siblings, participating in the Autism Genetic Resource Exchange project, the secondary analysis was performed comparing the life-time prevalence of non-febrile seizures. Statistical models to account for non-independence of observations, inherent with the data from multiplex families, were used in assessing potential confounding effects of age, gender, and history of febrile seizures on odds of having non-febrile seizures. The life-time prevalence of non-febrile seizures was 8.2% among children with ASD and 2.5% among their unaffected siblings. In a logistic regression analysis that adjusted for familial clustering, children with ASD had 5.27 (95%CI: 1.51-18.35) times higher odds of having non-febrile seizures compared to their unaffected siblings. In this comparison, age, presence of gastrointestinal dysfunction, and history of febrile seizures were significantly associated with the prevalence of non-febrile seizures. Children with idiopathic ASD are significantly more likely to have non-febrile seizures than their unaffected siblings, suggesting that non-febrile seizures may be ASD-specific. Further studies are needed to determine modifiable risk factors for non-febrile seizures in ASD.

  3. Maternal and Early Childhood Risk Factors for Overweight and Obesity among Low-Income Predominantly Black Children at Age Five Years: A Prospective Cohort Study

    PubMed Central

    Janjua, Naveed Zafar; Mahmood, Bushra; Islam, M. Aminul; Goldenberg, Robert L.

    2012-01-01

    Objective. To identify maternal and early childhood risk factors for obesity and overweight among children at age 5 in the state of Alabama. Methods. We recruited 740 mothers during early pregnancy from University of Alabama Prenatal Clinics in a prospective cohort study and followed them throughout pregnancy. We followed their children from birth until 5 years of age. The main outcome measure was obesity (BMI for age and sex ≥ 95th percentile) at 5 years of age. We used poisson regression with robust variance estimation to compute risk ratio (RR). Results. At the 5th year of followup, 71 (9.6%) of the children were obese and 85 (11.5%) were overweight (BMI ≥ 85th–<95th percentile). In multivariable analysis, maternal prepregnancy overweight (RR: 2.30, 95% CI: 1.29–4.11) and obesity (RR: 2.53, 95% CI: 1.49–4.31), and child's birth weight >85th percentile (RR: 2.04, 95% CI: 1.13–3.68) were associated with childhood obesity. Maternal prepregnancy BMI, birth weight, and maternal smoking were associated with the child being overweight 1–12 cigarettes/day versus 0 cigarettes/day (RR: 1.40, 95% CI: 1.02–1.91). Conclusion. Children of overweight and obese mothers, and children with higher birth weight, are more likely to be obese and overweight at age 5. Maternal smoking 1–12 cigarettes per day is associated with the child being overweight. PMID:23056928

  4. Non-treatment of children with community health worker-diagnosed fast-breathing pneumonia in rural Malawi: exploratory subanalysis of a prospective cohort study

    PubMed Central

    Mankhambo, Limangeni; Beard, James; Hay Burgess, Debbie C; Costello, Anthony; Izadnegahdar, Rasa; Lufesi, Norman; Mwansambo, Charles; Nambiar, Bejoy; Johnson, Eric S; Platt, Robert W; Mukanga, David; McCollum, Eric D

    2016-01-01

    Background Despite recent progress, pneumonia remains the largest infectious killer of children globally. This paper describes outcomes of not treating community-diagnosed fast-breathing pneumonia on patient recovery. Methods We conducted an exploratory subanalysis of an observational prospective cohort study in Malawi. We recruited children (2–59 months) diagnosed by community health workers with fast-breathing pneumonia using WHO integrated community case management (iCCM) guidelines. Children were followed at days 5 and 14 with a clinical assessment of recovery. We conducted bivariate and multivariable logistic regression for the association between treatment of fast-breathing pneumonia and recovery, adjusting for potential confounders. Results We followed up 847 children, of whom 78 (9%) had not been given antibiotics (non-treatment). Non-treatment cases had higher baseline rates of diarrhoea, non-severe hypoxaemia and fever. Non-recovery (persistence or worsening of symptoms) was 13% and 23% at day 5 in those who did receive and those who did not receive co-trimoxazole. Non-recovery, when defined as worsening of symptoms only, at day 5 was 7% in treatment and 10% in non-treatment cases. For both definitions, combined co-trimoxazole and lumefantrine-artemether (LA) treatment trended towards protection (adjusted OR (aOR) 0.28; 95% CI 0.12 to 0.68/aOR 0.29; 95% CI 0.08 to 1.01). Conclusion We found that children who did not receive co-trimoxazole treatment had worse clinical outcomes; malaria co-diagnosis and treatment also play a significant role in non-recovery. Further research into non-treatment of fast-breathing pneumonia, using a pragmatic approach with consideration for malaria co-diagnosis and HIV status is needed to guide refinement of community treatment algorithms in this region. PMID:27852705

  5. Endoscopic third ventriculocisternostomy in hydrocephalic children under 2 years of age: appropriate or not? A single-center retrospective cohort study.

    PubMed

    Fani, L; de Jong, T H R; Dammers, R; van Veelen, M L C

    2013-03-01

    Treating hydrocephalus can be difficult in children under the age of 2 years because a high amount of uncertainty exists as to which treatment to perform. In this retrospective cohort study, we analyzed children under the age of 2 years with hydrocephalus undergoing an endoscopic third ventriculocisternostomy (ETV) with respect to ETV outcome. In 59 consecutive patients under the age of 2 years, an ETV was performed between 1999 and 2010 at the Erasmus MC, Sophia Children's Hospital. Demographics, etiology of hydrocephalus, and radiological data were extracted retrospectively from the patients' medical records and operative reports and related to outcome. ETV Success Score (ETVSS) was used to retrospectively calculate the probability of success related to the actual outcome. In this series, 42.4 % of patients had a successful ETV. The only statistically significant finding concerned age. The failed ETV patients appeared to be younger (0.52 ± 0.60 vs. 0.86 ± 0.56 year, p = 0.005), and when using a cutoff age of 6 months only, five out of 32 infants had a successful ETV (p = 0.002). Of the children with an arachnoid cyst, 57.1 % were treated successfully with an ETV. Of the five patients with a high probability of ETV success, four (80 %) were indeed successfully treated with ETV (p = 0.049). Our data confirm the overall ineffectiveness of an ETV in children under the age of 6 months. Nevertheless, using the ETVSS is recommended to aid in the decision-making process even in patients under the age of 6 months.

  6. Impact of Home Environment Interventions on the Risk of Influenza-Associated ARI in Andean Children: Observations from a Prospective Household-Based Cohort Study

    PubMed Central

    Budge, Philip J.; Griffin, Marie R.; Edwards, Kathryn M.; Williams, John V.; Verastegui, Hector; Hartinger, Stella M.; Mäusezahl, Daniel; Johnson, Monika; Klemenc, Jennifer M.; Zhu, Yuwei; Gil, Ana I.; Lanata, Claudio F.; Grigalva, Carlos G.

    2014-01-01

    Background The Respiratory Infections in Andean Peruvian Children (RESPIRA-PERU) study enrolled children who participated in a community-cluster randomized trial of improved stoves, solar water disinfection, and kitchen sinks (IHIP trial) and children from additional Andean households. We quantified the burden of influenza-associated acute respiratory illness (ARI) in this household-based cohort. Methods From May 2009 to September 2011, we conducted active weekly ARI surveillance in 892 children age <3 years, of whom 272 (30.5%) had participated in the IHIP trial. We collected nasal swabs during ARI, tested for influenza and other respiratory viruses by RT-PCR, and determined influenza incidence and risk factors using mixed-effects regression models. Results The overall incidence of influenza-associated ARI was 36.6/100 child-years; incidence of influenza A, B, and C was 20.5, 8.7, and 5.2/100 child-years, respectively. Influenza C was associated with fewer days of subjective fever (median 1 vs. 2) and malaise (median 0 vs. 2) compared to influenza A. Non-influenza ARI also resulted in fewer days of fever and malaise, and fewer healthcare visits than influenza A-associated ARI. Influenza incidence varied by calendar year (80% occurred in the 2010 season) and IHIP trial participation. Among households that participated in the IHIP trial, influenza-associated ARI incidence was significantly lower in intervention than in control households (RR 0.40, 95% CI: 0.20–0.82). Conclusions Influenza burden is high among Andean children. ARI associated with influenza A and B had longer symptom duration and higher healthcare utilization than influenza C-associated ARI or non-influenza ARI. Environmental community interventions may reduce influenza morbidity. PMID:24622044

  7. Impact of home environment interventions on the risk of influenza-associated ARI in Andean children: observations from a prospective household-based cohort study.

    PubMed

    Budge, Philip J; Griffin, Marie R; Edwards, Kathryn M; Williams, John V; Verastegui, Hector; Hartinger, Stella M; Mäusezahl, Daniel; Johnson, Monika; Klemenc, Jennifer M; Zhu, Yuwei; Gil, Ana I; Lanata, Claudio F; Grigalva, Carlos G

    2014-01-01

    The Respiratory Infections in Andean Peruvian Children (RESPIRA-PERU) study enrolled children who participated in a community-cluster randomized trial of improved stoves, solar water disinfection, and kitchen sinks (IHIP trial) and children from additional Andean households. We quantified the burden of influenza-associated acute respiratory illness (ARI) in this household-based cohort. From May 2009 to September 2011, we conducted active weekly ARI surveillance in 892 children age <3 years, of whom 272 (30.5%) had participated in the IHIP trial. We collected nasal swabs during ARI, tested for influenza and other respiratory viruses by RT-PCR, and determined influenza incidence and risk factors using mixed-effects regression models. The overall incidence of influenza-associated ARI was 36.6/100 child-years; incidence of influenza A, B, and C was 20.5, 8.7, and 5.2/100 child-years, respectively. Influenza C was associated with fewer days of subjective fever (median 1 vs. 2) and malaise (median 0 vs. 2) compared to influenza A. Non-influenza ARI also resulted in fewer days of fever and malaise, and fewer healthcare visits than influenza A-associated ARI. Influenza incidence varied by calendar year (80% occurred in the 2010 season) and IHIP trial participation. Among households that participated in the IHIP trial, influenza-associated ARI incidence was significantly lower in intervention than in control households (RR 0.40, 95% CI: 0.20-0.82). Influenza burden is high among Andean children. ARI associated with influenza A and B had longer symptom duration and higher healthcare utilization than influenza C-associated ARI or non-influenza ARI. Environmental community interventions may reduce influenza morbidity.

  8. Survival status and predictors of mortality among severely acute malnourished children <5 years of age admitted to stabilization centers in Gedeo Zone: a retrospective cohort study.

    PubMed

    Girum, Tadele; Kote, Mesfin; Tariku, Befikadu; Bekele, Henok

    2017-01-01

    Despite the existence of standard protocol, many stabilization centers (SCs) continue to experience high mortality of children receiving treatment for severe acute malnutrition. Assessing treatment outcomes and identifying predictors may help to overcome this problem. Therefore, a 30-month retrospective cohort study was conducted among 545 randomly selected medical records of children <5 years of age admitted to SCs in Gedeo Zone. Data was entered by Epi Info version 7 and analyzed by STATA version 11. Cox proportional hazards model was built by forward stepwise procedure and compared by the likelihood ratio test and Harrell's concordance, and fitness was checked by Cox-Snell residual plot. During follow-up, 51 (9.3%) children had died, and 414 (76%) and 26 (4.8%) children had recovered and defaulted (missed follow-up for 2 consecutive days), respectively. The survival rates at the end of the first, second and third weeks were 95.3%, 90% and 85%, respectively, and the overall mean survival time was 79.6 days. Age <24 months (adjusted hazard ratio [AHR] =2.841, 95% confidence interval [CI] =1.101-7.329), altered pulse rate (AHR =3.926, 95% CI =1.579-9.763), altered temperature (AHR =7.173, 95% CI =3.05-16.867), shock (AHR =3.805, 95% CI =1.829-7.919), anemia (AHR =2.618, 95% CI =1.148-5.97), nasogastric tube feeding (AHR =3.181, 95% CI =1.18-8.575), hypoglycemia (AHR =2.74, 95% CI =1.279-5.87) and treatment at hospital stabilization center (AHR =4.772, 95% CI =1.638-13.9) were independent predictors of mortality. The treatment outcomes and incidence of death were in the acceptable ranges of national and international standards. Intervention to further reduce deaths has to focus on young children with comorbidities and altered general conditions.

  9. Adult children's socioeconomic resources and mothers' survival after a breast cancer diagnosis: a Swedish population-based cohort study

    PubMed Central

    Brooke, Hannah L; Ringbäck Weitoft, Gunilla; Talbäck, Mats; Feychting, Maria

    2017-01-01

    Objectives Socioeconomic inequalities in survival after breast cancer persist worldwide. We aim to determine whether adult offspring's socioeconomic resources contribute to inequalities in mothers' survival after breast cancer. Methods 14 231 women, aged 65–79 years, with a child aged ≥30 years and a first primary diagnosis of breast cancer in the National Cancer Register between 2001 and 2010 were followed until death, 10 years after diagnosis, or end of study (December 2015). Relative survival proportions and excess mortality within 10 years of diagnosis by strata of offspring's education level and disposable income were estimated using flexible parametric models accounting for measures of mothers' socioeconomic position and expected mortality in the general population. Results 4292 women died during 102 236 person-years of follow-up. Crude 10-year relative survival proportions for mothers of children with >14, 12–14 and <12 years of education were 0.89 (0.87 to 0.91), 0.87 (0.85 to 0.89) and 0.79 (0.76 to 0.81), respectively. Compared with mothers of children with >14 years of education, mothers of children with <12 or 12–14 years of education had substantially higher excess mortality (excess HR 1.69 (1.38 to 2.07) and 1.22 (1.00 to 1.48), respectively). Higher mortality did not differ between tertiles of offspring's disposable income. Conclusions Adult offspring's education level may contribute to inequalities in mothers' survival after breast cancer. Clinicians should be aware of the educational context beyond the individual and women with less educated offsprings may require extra support. This should be considered in future research, policy frameworks and interventions aimed at reducing survival inequalities. PMID:28363931

  10. Advancing Concussion Assessment in Pediatrics (A-CAP): a prospective, concurrent cohort, longitudinal study of mild traumatic brain injury in children: protocol study.

    PubMed

    Yeates, Keith Owen; Beauchamp, Miriam; Craig, William; Doan, Quynh; Zemek, Roger; Bjornson, Bruce; Gravel, Jocelyn; Mikrogianakis, Angelo; Goodyear, Bradley; Abdeen, Nishard; Beaulieu, Christian; Dehaes, Mathieu; Deschenes, Sylvain; Harris, Ashley; Lebel, Catherine; Lamont, Ryan; Williamson, Tyler; Barlow, Karen Maria; Bernier, Francois; Brooks, Brian L; Emery, Carolyn; Freedman, Stephen B; Kowalski, Kristina; Mrklas, Kelly; Tomfohr-Madsen, Lianne; Schneider, Kathryn J

    2017-07-13

    Paediatric mild traumatic brain injury (mTBI) is a public health burden. Clinicians urgently need evidence-based guidance to manage mTBI, but gold standards for diagnosing and predicting the outcomes of mTBI are lacking. The objective of the Advancing Concussion Assessment in Pediatrics (A-CAP) study is to assess a broad pool of neurobiological and psychosocial markers to examine associations with postinjury outcomes in a large sample of children with either mTBI or orthopaedic injury (OI), with the goal of improving the diagnosis and prognostication of outcomes of paediatric mTBI. A-CAP is a prospective, longitudinal cohort study of children aged 8.00-16.99 years with either mTBI or OI, recruited during acute emergency department (ED) visits at five sites from the Pediatric Emergency Research Canada network. Injury information is collected in the ED; follow-up assessments at 10 days and 3 and 6 months postinjury measure a variety of neurobiological and psychosocial markers, covariates/confounders and outcomes. Weekly postconcussive symptom ratings are obtained electronically. Recruitment began in September 2016 and will occur for approximately 24 months. Analyses will test the major hypotheses that neurobiological and psychosocial markers can: (1) differentiate mTBI from OI and (2) predict outcomes of mTBI. Models initially will focus within domains (eg, genes, imaging biomarkers, psychosocial markers), followed by multivariable modelling across domains. The planned sample size (700 mTBI, 300 OI) provides adequate statistical power and allows for internal cross-validation of some analyses. The ethics boards at all participating institutions have approved the study and all participants and their parents will provide informed consent or assent. Dissemination will follow an integrated knowledge translation plan, with study findings presented at scientific conferences and in multiple manuscripts in peer-reviewed journals. © Article author(s) (or their employer

  11. Children with ADHD symptoms have a higher risk for reading, spelling and math difficulties in the GINIplus and LISAplus cohort studies.

    PubMed

    Czamara, Darina; Tiesler, Carla M T; Kohlböck, Gabriele; Berdel, Dietrich; Hoffmann, Barbara; Bauer, Carl-Peter; Koletzko, Sibylle; Schaaf, Beate; Lehmann, Irina; Herbarth, Olf; von Berg, Andrea; Müller-Myhsok, Bertram; Schulte-Körne, Gerd; Heinrich, Joachim

    2013-01-01

    Attention-deficit/hyperactivity disorder (ADHD) and dyslexia belong to the most common neuro-behavioral childhood disorders with prevalences of around 5% in school-aged children. It is estimated that 20-60% of individuals affected with ADHD also present with learning disorders. We investigated the comorbidity between ADHD symptoms and reading/spelling and math difficulties in two on-going population-based birth cohort studies. Children with ADHD symptoms were at significantly higher risk of also showing reading/spelling difficulties or disorder (Odds Ratio (OR) = 2.80, p = 6.59×10⁻¹³) as compared to children without ADHD symptoms. For math difficulties the association was similar (OR = 2.55, p = 3.63×10⁻⁰⁴). Our results strengthen the hypothesis that ADHD and learning disorders are comorbid and share, at least partially, the same underlying process. Up to date, it is not clear, on which exact functional processes this comorbidity is based.

  12. Behavioral Sexual Dimorphism in School-Age Children and Early Developmental Exposure to Dioxins and PCBs: A Follow-Up Study of the Duisburg Cohort

    PubMed Central

    Ranft, Ulrich; Wittsiepe, Jürgen; Kasper-Sonnenberg, Monika; Fürst, Peter; Krämer, Ursula; Seitner, Gabriele; Wilhelm, Michael

    2013-01-01

    Background: Polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) and polychlorinated biphenyls (PCBs) are persistent organic pollutants that have been characterized as endocrine-disrupting chemicals (EDCs). Objectives: Within the Duisburg birth cohort study, we studied associations of prenatal exposure to PCDD/Fs and PCBs with parent-reported sexually dimorphic behavior in children. Methods: We measured lipid-based and WHO2005-TEQ (toxic equivalents established in 2005 by the World Health Organization)–standardized PCDD/Fs and PCBs in maternal blood samples and in early breast milk using gas chromatography/high-resolution mass spectrometry. At the child’s age of 6–8 years, parents (mostly mothers) reported sex-typical characteristics, preferred toys, and play activities using the Pre-School Activities Inventory (PSAI), which was used to derive feminine, masculine, and difference (feminine – masculine) scores. We estimated exposure–outcome associations using multivariate linear regression. A total of 91–109 children were included in this follow-up. Results: Mean blood levels of summed WHO2005-TEQ–standardized dioxins (ΣPCDD/Fs) were 14.5 ± 6.4 pg/g blood lipids, and ΣPCBs were 6.9 ± 3.8 pg/g blood lipids, with similar values for milk lipids. Regression analyses revealed some highly significant interactions between sex and exposure—such as for ΣPCBs in milk, pronounced positive (boys: β = 3.24; CI = 1.35, 5.14) or negative (girls: β = –3.59; CI = –1.10, –6.08) associations with reported femininity. Less pronounced and mostly insignificant but consistent associations were found for the masculinity score, positive for boys and negative for girls. Conclusions: Given our results and the findings of previous studies, we conclude that there is sufficient evidence that these EDCs modify behavioral sexual dimorphism in children, presumably by interacting with the hypothalamic–pituitary–gonadal axis. Citation: Winneke G, Ranft U

  13. Frequency and Duration of Rhinovirus Infections in Children With Cystic Fibrosis and Healthy Controls: A Longitudinal Cohort Study.

    PubMed

    Dijkema, Jasper S; van Ewijk, Bart E; Wilbrink, Berry; Wolfs, Tom F W; Kimpen, Jan L L; van der Ent, Cornelis K

    2016-04-01

    Respiratory viral infections are an important cause of morbidity in patients with chronic respiratory diseases, such as cystic fibrosis (CF). We hypothesized that patients with CF are more susceptible to human rhinovirus (HRV) infections than healthy controls. In a 6-month winter period, 20 young children with CF (0-7 years) and 18 age-matched healthy controls were sampled biweekly for HRV-polymerase chain reaction using nasopharyngeal swabs, irrespective of respiratory symptoms. Respiratory symptoms were scored twice a week. If any symptom was present, an additional sample was obtained. All HRV-positive samples were genotyped to distinguish HRV subtypes. We analyzed 645 samples, with comparable total numbers of samples in both groups. HRV was detected in 40.8% of all analyzed samples. Children with CF had significantly more HRV-positive samples compared with healthy controls, with a mean number (± standard deviation) of 8.1 ± 2.3 versus 5.7 ± 2.9 positive samples per individual (P < 0.01). Prolonged detection (>2 weeks) with the same HRV subtype occurred more frequently in the CF patients (P < 0.01). The genetic distribution and pattern of phylogenetic diversity of the different HRV subtypes were similar in both groups. This is the first in vivo longitudinal study showing that HRV is detected more frequently and persists for longer periods in CF patients compared with healthy controls. This might indicate increased viral replication and/or decreased antiviral defense in patients with CF.

  14. Adherence to antiretroviral therapy in young children in Cape Town, South Africa, measured by medication return and caregiver self-report: a prospective cohort study

    PubMed Central

    Davies, Mary-Ann; Boulle, Andrew; Fakir, Tanzeem; Nuttall, James; Eley, Brian

    2008-01-01

    Background Antiretroviral therapy (ART) dramatically improves outcomes for children in Africa; however excellent adherence is required for treatment success. This study describes the utility of different measures of adherence in detecting lapses in infants and young children in Cape Town, South Africa. Methods In a prospective cohort of 122 HIV-infected children commenced on ART, adherence was measured monthly during the first year of treatment by medication return (MR) for both syrups and tablets/capsules. A questionnaire was administered to caregivers after 3 months of treatment to assess experience with giving medication and self-reported adherence. Viral and immune response to treatment were assessed at the end of one year and associations with measured adherence determined. Results Medication was returned for 115/122 (94%) children with median age (IQR) of 37 (16 – 61) months. Ninety-one (79%) children achieved annual average MR adherence ≥ 90%. This was an important covariate associated with viral suppression after adjustment for disease severity (OR = 5.5 [95%CI: 0.8–35.6], p = 0.075), however was not associated with immunological response to ART. By 3 months on ART, 13 (10%) children had deceased and 11 (10%) were lost to follow-up. Questionnaires were completed by 87/98 (90%) of caregivers of those who remained in care. Sensitivity of poor reported adherence (missing ≥ 1 dose in the previous 3 days) for MR adherence <90% was only 31.8% (95% CI: 10.7% – 53.0%). Caregivers of 33/87 (38.4%) children reported difficulties with giving medication, most commonly poor palatability (21.8%). Independent socio-demographic predictors of MR adherence ≥ 90% were secondary education of caregivers (OR = 4.49; 95%CI: 1.10 – 18.24) and access to water and electricity (OR = 2.65; 95%CI: 0.93 – 7.55). Taking ritonavir was negatively associated with MR adherence ≥ 90% (OR = 0.37; 95%CI: 0.13 – 1.02). Conclusion Excellent adherence to ART is possible in

  15. Self-Reported Health Experiences of Children Living with Congenital Heart Defects: Including Patient-Reported Outcomes in a National Cohort Study

    PubMed Central

    Tadic, Valerija; Hogan, Ailbhe; Bull, Catherine; Rahi, Jugnoo Sangeeta; Dezateux, Carol

    2016-01-01

    Background Understanding children’s views about living with congenital heart defects (CHDs) is fundamental to supporting their successful participation in daily life, school and peer relationships. As an adjunct to a health and quality of life outcomes questionnaire, we asked school-age children who survived infant heart procedures to describe their experiences of living with CHDs. Methods In a UK-wide cohort study, children aged 10 to 14 years with CHDs self-completed postal questionnaires that included an open question about having a ‘heart problem’. We compared the characteristics of children with more and less severe cardiac diagnoses and, through collaborative inductive content analysis, investigated the subjective experiences and coping strategies described by children in both clinical severity groups. Results Text and/or drawings were returned by 436 children (246 boys [56%], mean age 12.1 years [SD 1.0; range 10–14]); 313 had less severe (LS) and 123 more severe (MS) cardiac diagnoses. At the most recent hospital visit, a higher proportion of the MS group were underweight (more than two standard deviations below the mean for age) or cyanosed (underweight: MS 20.0%, LS 9.9%; cyanosed: MS 26.2%, LS 3.5%). Children in the MS group described concerns about social isolation and feeling ‘different’, whereas children with less severe diagnoses often characterised their CHD as ‘not a big thing’. Some coping strategies were common to both severity groups, including managing health information to avoid social exclusion, however only children in the LS group considered their CHD ‘in the past’ or experienced a sense of survivorship. Conclusions Children’s reported experiences were not dependent on their cardiac diagnosis, although there were clear qualitative differences by clinical severity group. Children’s concerns emphasised social participation and our findings imply a need to shift the clinical focus from monitoring cardiac function to

  16. Fetal and Childhood Exposure to Phthalate Diesters and Cognitive Function in Children Up to 12 Years of Age: Taiwanese Maternal and Infant Cohort Study

    PubMed Central

    Huang, Han-Bin; Chen, Hsin-Yi; Su, Pen-Hua; Huang, Po-Chin; Sun, Chien-Wen; Wang, Chien-Jen; Chen, Hsiao-Yen

    2015-01-01

    Few studies have examined the association between environmental phthalate exposure and children’s neurocognitive development. This longitudinal study examined cognitive function in relation to pre-and postnatal phthalate exposure in children 2–12 years old. We recruited 430 pregnant women in their third trimester in Taichung, Taiwan from 2001–2002. A total of 110, 79, 76, and 73 children were followed up at ages 2, 5, 8, and 11, respectively. We evaluated the children’s cognitive function at four different time points using the Bayley and Wechsler tests for assessing neurocognitive functions and intelligence (IQ). Urine samples were collected from mothers during pregnancy and from children at each follow-up visit. They were analyzed for seven metabolite concentrations of widely used phthalate esters. These esters included monomethyl phthalate, monoethyl phthalate, mono-butyl phthalate, mono-benzyl phthalate, and three metabolites of di(2-ethylhexyl) phthalate, namely, mono-2-ethylhexyl phthalate, mono(2-ethyl-5-hydroxyhexyl) phthalate, and mono(2-ethyl-5-oxohexyl) phthalate. We constructed a linear mixed model to examine the relationships between the phthalate metabolite concentrations and the Bayley and IQ scores. We found significant inverse associations between the children’s levels of urinary mono(2-ethyl-5-oxohexyl) phthalate and the sum of the three metabolites of di(2-ethylhexyl) phthalate and their IQ scores (β = -1.818; 95% CI: -3.061, -0.574, p = 0.004 for mono(2-ethyl-5-oxohexyl) phthalate; β = -1.575; 95% CI: -3.037, -0.113, p = 0.035 for the sum of the three metabolites) after controlling for maternal phthalate levels and potential confounders. We did not observe significant associations between maternal phthalate exposure and the children’s IQ scores. Children’s but not prenatal phthalate exposure was associated with decreased cognitive development in the young children. Large-scale prospective cohort studies are needed to confirm

  17. Mortality among pulmonary tuberculosis and HIV-1 co-infected Nigerian children being treated for pulmonary tuberculosis and on antiretroviral therapy: a retrospective cohort study

    PubMed Central

    Ebonyi, Augustine O.; Oguche, Stephen; Agbaji, Oche O.; Sagay, Atiene S.; Okonkwo, Prosper I.; Idoko, John A.; Kanki, Phyllis J.

    2016-01-01

    Background Mortality data, including the risk factors for mortality in HIV-infected children with pulmonary TB (PTB) being treated for PTB and who are on antiretroviral therapy (ART), are scarce in Nigeria. We determined the mortality rate and risk factors for mortality among such children, at the pediatric HIV clinic of the Jos University Teaching Hospital (JUTH) in Jos, Nigeria. Methods We performed a retrospective cohort study on 260 PTB-HIV-1 co-infected children, aged 2 months to 13 years, being treated for PTB and on ART from July 2005 to March 2013. The mortality rate and associated risk factors were determined using multivariate Cox proportional hazards modelling. Results The mortality rate for the study cohort was 1.4 per 100 child-years of follow-up. Median follow-up time was 5.2 years (IQR, 3.5-6.0 years) with total study time being 1159 child-years. The median age of those who died was lower than that of survivors, 1.9 years (IQR, 0.6-3.6 years) versus 3.8 years (IQR, 1.8-6.0 years), p=0.005). The majority of the deaths occurred in males (13, 81.2%), those <5 years of age (14, 87.4%) and those who had severe immunosuppression (11, 68.8%). Risk factors for death were age (with the risk of dying decreasing by 25% for every 1 year increase in age, adjusted hazard ratio (AHR)=0.75 [0.58-0.98], p=0.032), male gender (AHR=3.80 [1.07-13.5], p=0.039) and severe immunosuppression (AHR=3.35 [1.16-9.66], p=0.025). Conclusion In our clinic setting, mortality among our PTB-HIV co-infected children being treated for PTB and on ART was low. However, those presenting with severe immunosuppression and who are males and very young, should be monitored more closely during follow-up in order to further reduce mortality. PMID:28053917

  18. Maternal use of fertility drugs and risk of cancer in children--a nationwide population-based cohort study in Denmark.

    PubMed

    Hargreave, Marie; Jensen, Allan; Nielsen, Thor Schütt Svane; Colov, Emilie Palmgren; Andersen, Klaus Kaae; Pinborg, Anja; Kjaer, Susanne Krüger

    2015-04-15

    Large population-based studies are needed to examine the effect of maternal use of fertility drugs on the risk of cancer in children, while taking into account the effect of the underlying infertility. A cohort of 123,322 children born in Denmark between 1964 and 2006 to 68,255 women who had been evaluated for infertility was established. We used a case-cohort design and calculated hazard ratios (HRs) for cancer in childhood (0-19 years) and in young adulthood (20-29 years) associated with maternal use of six groups of fertility drugs (clomiphene, gonadotropins [i.e., human menopausal gonadotropins and follicle-stimulating hormone], gonadotropin-releasing hormone analogs, human chorionic gonadotropins, progesterone and other fertility drugs). We found no statistically significant association between maternal use of fertility drugs and risk for overall cancer in childhood or young adulthood. However, with regard to specific cancers in childhood, our results showed that maternal use of progesterone before childbirth markedly increased the risks of their offspring for acute lymphocytic leukemia (any use: HR, 4.95; 95% CI, 1.69-14.54; ≥ three cycles of use: HR, 9.96; 95% CI, 2.63-37.77) and for sympathetic nervous system tumors (any use: HR, 5.79; 95% CI, 1.23-27.24; ≥ three cycles of use: HR, 8.51; 95% CI, 1.72-42.19). These findings show that maternal use of progesterone may increase the risk for specific cancers in the offspring. Additional large epidemiological studies are urgently needed to confirm our finding. © 2014 UICC.

  19. Predictors of survival in children with methymalonic acidemia with homocystinuria in Beijing, China: a prospective cohort study.

    PubMed

    Qiliang, Li; Wenqi, Song; Quan, Wang; Xinying, Yang; Jiuwei, Li; Qiang, Sun; Xiaoxia, Peng; Peichang, Wang

    2015-02-01

    (i) To determine whether clinical features and biochemical parameters help to predict survival of methylmalonic acidemia with homocystinuria; (ii) To find the cutoff values of biochemical parameters for predicting survival of methylmalonic acidemia with homocystinuria. A prospective cohort study. A pediatric tertiary hospital in Beijing; all patients were followed until death or June 2013. 45 pediatric patients diagnosed with methylmalonic acidemia with homocystinuria between 2006 and 2012. The data of clinical characteristics and pretreatment biochemical parameters were collected. The Cox regression analysis was performed to identify independent risk factors for survival of patients with methylmalonic acidemia and homocystinuria. The best cutoff values for these independent factors were determined by the receiver characteristic curve. Newborn onset (OR=6.856, 95%CI=2.241-20.976, P=0.001), high level of methylmalonic acid in urine (OR=1.022, 95%CI=1.011-1.033, P<0.001), and high level of urea in serum (OR=1.083, 95%CI=1.027-1.141, P=0.003) were independent negative risk factors for survival of patients with methylmalonic acidemia and homocystinuria. The cutoff values of maximum predictive accuracy of methylmalonic acid in urine and urea in serum were respectively 5.41 mmol/mmol creatinine and 7.80 mmol/L by receiver operating characteristic curve analysis. The patients of methylmalonic acidemia with homocystinuria tend to have an adverse outcome if they have newborn onsets. Elevated urea and urinary methylmalonic acid are predictors of adverse outcomes for the patients. They show similar effect for predicting severe adverse prognosis. The combination of methylmalonic acid in urine concentration and urea in serum concentration provided the most accurate predictive tool.

  20. Parental Depressive and Anxiety Symptoms during Pregnancy and Attention Problems in Children: A Cross-Cohort Consistency Study

    ERIC Educational Resources Information Center

    Van Batenburg-Eddes, T.; Brion, M. J.; Henrichs, J.; Jaddoe, V. W. V.; Hofman, A.; Verhulst, F. C.; Lawlor, D. A.; Smith, G. Davey; Tiemeier, H.

    2013-01-01

    Background: Maternal depression and anxiety during pregnancy have been associated with offspring-attention deficit problems. Aim: We explored possible intrauterine effects by comparing maternal and paternal symptoms during pregnancy, by investigating cross-cohort consistency, and by investigating whether parental symptoms in early childhood may…

  1. Parental Depressive and Anxiety Symptoms during Pregnancy and Attention Problems in Children: A Cross-Cohort Consistency Study

    ERIC Educational Resources Information Center

    Van Batenburg-Eddes, T.; Brion, M. J.; Henrichs, J.; Jaddoe, V. W. V.; Hofman, A.; Verhulst, F. C.; Lawlor, D. A.; Smith, G. Davey; Tiemeier, H.

    2013-01-01

    Background: Maternal depression and anxiety during pregnancy have been associated with offspring-attention deficit problems. Aim: We explored possible intrauterine effects by comparing maternal and paternal symptoms during pregnancy, by investigating cross-cohort consistency, and by investigating whether parental symptoms in early childhood may…

  2. A longitudinal study of natural antibody development to pneumococcal surface protein A families 1 and 2 in Papua New Guinean Highland children: a cohort study.

    PubMed

    Francis, Jacinta P; Richmond, Peter C; Michael, Audrey; Siba, Peter M; Jacoby, Peter; Hales, Belinda J; Thomas, Wayne R; Lehmann, Deborah; Pomat, William S; van den Biggelaar, Anita H J

    2016-01-01

    Pneumococcal surface protein A (PspA), a conserved virulence factor essential for Streptococcus pneumoniae attachment to upper respiratory tract (URT) epithelia, is a potential vaccine candidate for preventing colonisation. This cohort study was conducted in the Asaro Valley in the Eastern Highlands Province of Papua New Guinea, of which Goroka town is the provincial capital. The children included in the analysis were participants in a neonatal pneumococcal conjugate vaccine trial (ClinicalTrials.gov NCT00219401) that was conducted between 2005 and 2009. We investigated the development of anti-PspA antibodies in the first 18 months of life relative to URT pneumococcal carriage in Papua New Guinean infants who experience one of the earliest and highest colonisation rates in the world. Blood samples and nasopharyngeal swabs were collected from a cohort of 88 children at ages 3, 9, and 18 months to quantify immunoglobulin G (IgG) levels to PspA families 1 and 2 using an enzyme-linked immunosorbent assay and to determine URT carriage. Seventy-three per cent (64/88) of infants carried S. pneumoniae at age 3 months; 85 % (75/88) at 9 months, and 83 % (73/88) at 18 months. PspA-IgG levels declined between ages 3 and 9 months (p < 0.001), then increased between 9 and 18 months (p < 0.001). At age 3 months, pneumococcal carriers showed lower PspA1-IgG levels (geometric mean concentration [GMC] 602 arbitrary units [AU]/ml, 95 % confidence interval [CI] 497-728) than non-carriers (GMC 1058 AU/ml [95 % CI 732-1530]; p = 0.008), while at 9 months, PspA1- and PspA2-IgG levels were significantly higher in carriers (PspA1: 186 AU/ml, 95 % CI 136-256; PspA2: 284 AU/ml, 95 % CI 192-421) than in non-carriers (PspA1 87 AU/ml, 95 % CI 45-169; PspA2 74 AU/ml, 95 % CI 34-159) (PspA1: p = 0.037, PspA2: p = 0.003). Our findings confirm that PspA is immunogenic and indicate that natural anti-PspA immune responses are acquired through exposure and

  3. External validation of the DHAKA score and comparison with the current IMCI algorithm for the assessment of dehydration in children with diarrhoea: a prospective cohort study

    PubMed Central

    Levine, Adam C; Glavis-Bloom, Justin; Modi, Payal; Nasrin, Sabiha; Atika, Bita; Rege, Soham; Robertson, Sarah; Schmid, Christopher H; Alam, Nur H

    2016-01-01

    Summary Background Dehydration due to diarrhoea is a leading cause of child death worldwide, yet no clinical tools for assessing dehydration have been validated in resource-limited settings. The Dehydration: Assessing Kids Accurately (DHAKA) score was derived for assessing dehydration in children with diarrhoea in a low-income country setting. In this study, we aimed to externally validate the DHAKA score in a new population of children and compare its accuracy and reliability to the current Integrated Management of Childhood Illness (IMCI) algorithm. Methods DHAKA was a prospective cohort study done in children younger than 60 months presenting to the International Centre for Diarrhoeal Disease Research, Bangladesh, with acute diarrhoea (defined by WHO as three or more loose stools per day for less than 14 days). Local nurses assessed children and classified their dehydration status using both the DHAKA score and the IMCI algorithm. Serial weights were obtained and dehydration status was established by percentage weight change with rehydration. We did regression analyses to validate the DHAKA score and compared the accuracy and reliability of the DHAKA score and IMCI algorithm with receiver operator characteristic (ROC) curves and the weighted κ statistic. This study was registered with ClinicalTrials.gov, number NCT02007733. Findings Between March 22, 2015, and May 15, 2015, 496 patients were included in our primary analyses. On the basis of our criterion standard, 242 (49%) of 496 children had no dehydration, 184 (37%) of 496 had some dehydration, and 70 (14%) of 496 had severe dehydration. In multivariable regression analyses, each 1-point increase in the DHAKA score predicted an increase of 0·6% in the percentage dehydration of the child and increased the odds of both some and severe dehydration by a factor of 1·4. Both the accuracy and reliability of the DHAKA score were significantly greater than those of the IMCI algorithm. Interpretation The DHAKA score

  4. Response to treatment and adverse events associated with use of recombinant activated factor VII in children: a retrospective cohort study

    PubMed Central

    Cooper, James D.; Ritchey, Arthur K.

    2016-01-01

    Background: Recombinant activated factor VII (rFVIIa) is United States (US) Food and Drug Administration (FDA)-approved for patients with hemophilia with inhibitors or congenital factor VII deficiency. Initial reports of off-label use highlighted its efficacy, though newer reports have not repeated these findings. In both types of publication, though, secondary thromboses have been seen in adult patients. The data in children are less clear. Methods: This study analyzed all rFVIIa use at a large children’s hospital for characteristics and outcomes. Recipients of rFVIIa were identified retrospectively via the electronic medical record. Data on patient diagnosis, lab data, other treatments, adverse events, and outcomes were collected. Results: Over 33 months, 66 patient episodes were treated with a total of 606 doses (median = 2). The most common indication (36.4%) was gastrointestinal bleeding (24/66 patients). Only one patient received a dose for an approved labeled indication. For control of bleeding, 33.3% of courses were unsuccessful (19/57). Bleeding from multiple sites was associated with treatment failure. In 16.7% of patients (11/66), unexpected adverse thromboses developed within 1 week of completing a course of rFVIIa. Thromboses in both intra- and extra-corporeal sites were included if they compromised patient care. Conclusions: In the majority of cases reviewed, rFVIIa was successful in stopping or slowing serious bleeding episodes. It was least effective when a patient had diffuse bleeding at the time of administration. The thrombosis rate of 16.7% was higher than expected, though causality cannot be declared. Further investigation is needed to determine the risk–benefit ratio in children. PMID:28255432

  5. Traffic-related air pollution and respiratory symptoms among asthmatic children, resident in Mexico City: the EVA cohort study

    PubMed Central

    Escamilla-Nuñez, Maria-Consuelo; Barraza-Villarreal, Albino; Hernandez-Cadena, Leticia; Moreno-Macias, Hortensia; Ramirez-Aguilar, Matiana; Sienra-Monge, Juan-Jose; Cortez-Lugo, Marlene; Texcalac, Jose-Luis; del Rio-Navarro, Blanca; Romieu, Isabelle

    2008-01-01

    Background Taffic-related air pollution has been related to adverse respiratory outcomes; however, there is still uncertainty concerning the type of vehicle emission causing most deleterious effects. Methods A panel study was conducted among 147 asthmatic and 50 healthy children, who were followed up for an average of 22 weeks. Incidence density of coughing, wheezing and breathing difficulty was assessed by referring to daily records of symptoms and child's medication. The association between exposure to pollutants and occurrence of symptoms was evaluated using mixed-effect models with binary response and poisson regression. Results Wheezing was found to relate significantly to air pollutants: an increase of 17.4 μg/m3 (IQR) of PM2.5 (24-h average) was associated with an 8.8% increase (95% CI: 2.4% to 15.5%); an increase of 34 ppb (IQR) of NO2 (1-h maximum) was associated with an 9.1% increase (95% CI: 2.3% to16.4%) and an increase of 48 ppb (IQR) in O3 levels (1 hr maximum) to an increase of 10% (95% CI: 3.2% to 17.3%). Diesel-fueled motor vehicles were significantly associated with wheezing and bronchodilator use (IRR = 1.29; 95% CI: 1.03 to 1.62, and IRR = 1.32; 95% CI: 0.99 to 1.77, respectively, for an increase of 130 vehicles hourly, above the 24-hour average). Conclusion Respiratory symptoms in asthmatic children were significantly associated with exposure to traffic exhaust, especially from natural gas and diesel-fueled vehicles. PMID:19014608

  6. Long-term mortality in mothers with perinatal losses and risk modification by surviving children and attained education: a population-based cohort study

    PubMed Central

    Halland, Frode; Morken, Nils-Halvdan; DeRoo, Lisa A; Klungsøyr, Kari; Wilcox, Allen J; Skjærven, Rolv

    2016-01-01

    Objective To assess the association between perinatal losses and mother's long-term mortality and modification by surviving children and attained education. Design A population-based cohort study. Setting Norwegian national registries. Participants We followed 652 320 mothers with a first delivery from 1967 and completed reproduction before 2003, until 2010 or death. We excluded mothers with plural pregnancies, without information on education (0.3%) and women born outside Norway. Main outcome measures Main outcome measures were age-specific (40–69 years) cardiovascular and non-cardiovascular mortality. We calculated mortality in mothers with perinatal losses, compared with mothers without, and in mothers with one loss by number of surviving children in strata of mothers’ attained education (<11 years (low), ≥11 years (high)). Results Mothers with perinatal losses had increased crude mortality compared with mothers without; total: HR 1.3 (95% CI 1.3 to 1.4), cardiovascular: HR 1.8 (1.5 to 2.1), non-cardiovascular: HR 1.3 (1.2 to 1.4). Childless mothers with one perinatal loss had increased mortality compared with mothers with one child and no loss; cardiovascular: low education HR 2.7 (1.7 to 4.3), high education HR 0.91 (0.13 to 6.5); non-cardiovascular: low education HR 1.6 (1.3 to 2.2), high education HR 1.8 (1.1 to 2.9). Mothers with one perinatal loss, surviving children and high education had no increased mortality, whereas corresponding mothers with low education had increased mortality; cardiovascular: two surviving children HR 1.7 (1.2 to 2.4), three or more surviving children HR 1.6 (1.1 to 2.4); non-cardiovascular: one surviving child HR 1.2 (1.0 to 1.5), two surviving children HR 1.2 (1.1 to 1.4). Conclusions Irrespective of education, we find excess mortality in childless mothers with a perinatal loss. Increased mortality in mothers with one perinatal loss and surviving children was limited to mothers with low education. PMID:27884847

  7. Long-term mortality in mothers with perinatal losses and risk modification by surviving children and attained education: a population-based cohort study.

    PubMed

    Halland, Frode; Morken, Nils-Halvdan; DeRoo, Lisa A; Klungsøyr, Kari; Wilcox, Allen J; Skjærven, Rolv

    2016-11-24

    To assess the association between perinatal losses and mother's long-term mortality and modification by surviving children and attained education. A population-based cohort study. Norwegian national registries. We followed 652 320 mothers with a first delivery from 1967 and completed reproduction before 2003, until 2010 or death. We excluded mothers with plural pregnancies, without information on education (0.3%) and women born outside Norway. Main outcome measures were age-specific (40-69 years) cardiovascular and non-cardiovascular mortality. We calculated mortality in mothers with perinatal losses, compared with mothers without, and in mothers with one loss by number of surviving children in strata of mothers' attained education (<11 years (low), ≥11 years (high)). Mothers with perinatal losses had increased crude mortality compared with mothers without; total: HR 1.3 (95% CI 1.3 to 1.4), cardiovascular: HR 1.8 (1.5 to 2.1), non-cardiovascular: HR 1.3 (1.2 to 1.4). Childless mothers with one perinatal loss had increased mortality compared with mothers with one child and no loss; cardiovascular: low education HR 2.7 (1.7 to 4.3), high education HR 0.91 (0.13 to 6.5); non-cardiovascular: low education HR 1.6 (1.3 to 2.2), high education HR 1.8 (1.1 to 2.9). Mothers with one perinatal loss, surviving children and high education had no increased mortality, whereas corresponding mothers with low education had increased mortality; cardiovascular: two surviving children HR 1.7 (1.2 to 2.4), three or more surviving children HR 1.6 (1.1 to 2.4); non-cardiovascular: one surviving child HR 1.2 (1.0 to 1.5), two surviving children HR 1.2 (1.1 to 1.4). Irrespective of education, we find excess mortality in childless mothers with a perinatal loss. Increased mortality in mothers with one perinatal loss and surviving children was limited to mothers with low education. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under

  8. The Effect of Maternal Death on the Health of the Husband and Children in a Rural Area of China: A Prospective Cohort Study.

    PubMed

    Zhou, Hong; Zhang, Long; Ye, Fang; Wang, Hai-Jun; Huntington, Dale; Huang, Yanjie; Wang, Anqi; Liu, Shuiqing; Wang, Yan

    2016-01-01

    To examine the effects of maternal death on the health of the index child, the health and educational attainment of the older children, and the mental health and quality of life of the surviving husband. A cohort study including 183 households that experienced a maternal death matched to 346 households that experienced childbirth but not a maternal death was conducted prospectively between June 2009 and October 2011 in rural China. Data on household sociodemographic characteristics, physical and mental health were collected using a quantitative questionnaire and medical examination at baseline and follow-up surveys. Multivariate linear regression, logistic regression models and difference-in-difference (DID) were used to compare differences of outcomes between two groups. The index children who experienced the loss of a mother had a significantly higher likelihood of dying, abandonment and malnutrition compared to children whose mothers survived at the follow-up survey. The risk of not attending school on time and dropping out of school among older children in the affected group was higher than those in the control group during the follow-up. Husbands whose wife died had significantly lower EQ-5D index and EQ-VAS both at baseline and at follow-up surveys compared to those without experiencing a wife's death, suggesting an immediate and sustained poorer mental health quality of life among the surviving husbands. Also the prevalence of posttraumatic stress disorder (PTSD) was 72.6% at baseline and 56.2% at follow-up among husbands whose wife died. Maternal death has multifaceted and spillover effects on the physical and mental health of family members that are sustained over time. Programmes that reduce maternal mortality will mitigate repercussions on surviving family members are critical and needed.

  9. The Effect of Maternal Death on the Health of the Husband and Children in a Rural Area of China: A Prospective Cohort Study

    PubMed Central

    Zhou, Hong; Zhang, Long; Ye, Fang; Wang, Hai-jun; Huntington, Dale; Huang, Yanjie; Wang, Anqi; Liu, Shuiqing; Wang, Yan

    2016-01-01

    Objective To examine the effects of maternal death on the health of the index child, the health and educational attainment of the older children, and the mental health and quality of life of the surviving husband. Methods A cohort study including 183 households that experienced a maternal death matched to 346 households that experienced childbirth but not a maternal death was conducted prospectively between June 2009 and October 2011 in rural China. Data on household sociodemographic characteristics, physical and mental health were collected using a quantitative questionnaire and medical examination at baseline and follow-up surveys. Multivariate linear regression, logistic regression models and difference-in-difference (DID) were used to compare differences of outcomes between two groups. Findings The index children who experienced the loss of a mother had a significantly higher likelihood of dying, abandonment and malnutrition compared to children whose mothers survived at the follow-up survey. The risk of not attending school on time and dropping out of school among older children in the affected group was higher than those in the control group during the follow-up. Husbands whose wife died had significantly lower EQ-5D index and EQ-VAS both at baseline and at follow-up surveys compared to those without experiencing a wife’s death, suggesting an immediate and sustained poorer mental health quality of life among the surviving husbands. Also the prevalence of posttraumatic stress disorder (PTSD) was 72.6% at baseline and 56.2% at follow-up among husbands whose wife died. Conclusions Maternal death has multifaceted and spillover effects on the physical and mental health of family members that are sustained over time. Programmes that reduce maternal mortality will mitigate repercussions on surviving family members are critical and needed. PMID:27280717

  10. The Swiss Preschoolers' health study (SPLASHY): objectives and design of a prospective multi-site cohort study assessing psychological and physiological health in young children.

    PubMed

    Messerli-Bürgy, Nadine; Kakebeeke, Tanja H; Arhab, Amar; Stülb, Kerstin; Zysset, Annina E; Leeger-Aschmann, Claudia S; Schmutz, Einat A; Fares, Fady; Meyer, Andrea H; Munsch, Simone; Kriemler, Susi; Jenni, Oskar G; Puder, Jardena J

    2016-07-08

    Children's psychological and physiological health can be summarized as the child's thinking, feeling, behaving, eating, growing, and moving. Children's psychological and physiological health conditions are influenced by today's life challenges: Thus, stress exposure and lack of physical activity represent important health challenges in older children. However, corresponding evidence for young children is scarce. The aim of Swiss Preschoolers' Health Study (SPLASHY) is to examine the role of stress and physical activity on children's psychological and physiological health, particularly on cognitive functioning, psychological well-being, adiposity and motor skills in children at an early stage of childhood. We will also assess the role of child and environmental characteristics and aim to define sensitive time points. In a total of 84 child care centers, children at preschool age (2-6 years) are recruited and are assessed immediately and one year later. Assessments include direct measurements of the children in the child care centers and at home as well as assessments of children's behavior and environmental factors through informants (parents and child care educators). SPLASHY is one of the first studies in early childhood aiming to investigate the influence of stress and physical activity on children's psychological and physiological health in a community-based longitudinal design. Current Controlled Trials ISRCTN41045021 (date of registration: 21.03.14).

  11. Non-Medical Risk Factors as Avoidable Determinants of Excess Mortality in Children with Chronic Kidney Disease. A Prospective Cohort Study in Nicaragua, a Model Low Income Country

    PubMed Central

    Edefonti, Alberto; Galán, Yajaira Silva; Sandoval Díaz, Mabel; Medina Manzanarez, Marta; Marra, Giuseppina; Robusto, Fabio; Tognoni, Gianni; Sereni, Fabio

    2016-01-01

    Background The widely recognized clinical and epidemiological relevance of the socioeconomic determinants of health-disease conditions is expected to be specifically critical in terms of chronic diseases in fragile populations in low-income countries. However, in the literature, there is a substantial gap between the attention directed towards the medical components of these problems and the actual adoption of strategies aimed at providing solutions for the associated socioeconomic determinants, especially in pediatric populations. We report a prospective outcome study on the independent contribution and reciprocal interaction of the medical and socioeconomic factors to the hard end-point of mortality in a cohort of children with chronic kidney disease in Nicaragua. Methods and Findings Every child (n = 309) diagnosed with chronic kidney disease (CKD) and referred to the tertiary unit of Pediatric Nephrology in Managua (Nicaragua) from a network of nine hospitals serving 80% of the country’s pediatric population was registered between January 2005 and December 2013. The three main socioeconomic determinants evaluated were family income, living conditions and the family’s level of education. Further potential determinants of the outcomes included duration of exposure to disease, CKD stage at the first visit as suggested by the KDOQI guidelines in children, the time it took the patients to reach the reference centre and rural or urban context of life. Well-defined and systematically collected medical and socioeconomic data were available for 257 children over a mean follow-up period of 2.5±2.5 years. Mortality and lost to follow-up were considered as outcome end-points both independently and in combination, because of the inevitably progressive nature of the disease. A high proportion (55%) of children presented in the advanced stages of CKD (CKD stage IV and V) at the first visit. At the end of follow-up, 145 (57%) of the 257 cohort children were alive, 47 (18

  12. Non-Medical Risk Factors as Avoidable Determinants of Excess Mortality in Children with Chronic Kidney Disease. A Prospective Cohort Study in Nicaragua, a Model Low Income Country.

    PubMed

    Montini, Giovanni; Edefonti, Alberto; Galán, Yajaira Silva; Sandoval Díaz, Mabel; Medina Manzanarez, Marta; Marra, Giuseppina; Robusto, Fabio; Tognoni, Gianni; Sereni, Fabio

    2016-01-01

    The widely recognized clinical and epidemiological relevance of the socioeconomic determinants of health-disease conditions is expected to be specifically critical in terms of chronic diseases in fragile populations in low-income countries. However, in the literature, there is a substantial gap between the attention directed towards the medical components of these problems and the actual adoption of strategies aimed at providing solutions for the associated socioeconomic determinants, especially in pediatric populations. We report a prospective outcome study on the independent contribution and reciprocal interaction of the medical and socioeconomic factors to the hard end-point of mortality in a cohort of children with chronic kidney disease in Nicaragua. Every child (n = 309) diagnosed with chronic kidney disease (CKD) and referred to the tertiary unit of Pediatric Nephrology in Managua (Nicaragua) from a network of nine hospitals serving 80% of the country's pediatric population was registered between January 2005 and December 2013. The three main socioeconomic determinants evaluated were family income, living conditions and the family's level of education. Further potential determinants of the outcomes included duration of exposure to disease, CKD stage at the first visit as suggested by the KDOQI guidelines in children, the time it took the patients to reach the reference centre and rural or urban context of life. Well-defined and systematically collected medical and socioeconomic data were available for 257 children over a mean follow-up period of 2.5±2.5 years. Mortality and lost to follow-up were considered as outcome end-points both independently and in combination, because of the inevitably progressive nature of the disease. A high proportion (55%) of children presented in the advanced stages of CKD (CKD stage IV and V) at the first visit. At the end of follow-up, 145 (57%) of the 257 cohort children were alive, 47 (18%) were lost to follow-up and 65 (25

  13. Reduced Risk of Plasmodium vivax Malaria in Papua New Guinean Children with Southeast Asian Ovalocytosis in Two Cohorts and a Case-Control Study

    PubMed Central

    Manning, Laurens; Rarau, Patricia; Laman, Moses; Senn, Nicolas; Grimberg, Brian T.; Tavul, Livingstone; Stanisic, Danielle I.; Robinson, Leanne J.; Aponte, John J.; Dabod, Elijah; Reeder, John C.; Siba, Peter; Zimmerman, Peter A.; Davis, Timothy M. E.; King, Christopher L.; Michon, Pascal; Mueller, Ivo

    2012-01-01

    Background The erythrocyte polymorphism, Southeast Asian ovalocytosis (SAO) (which results from a 27-base pair deletion in the erythrocyte band 3 gene, SLC4A1Δ27) protects against cerebral malaria caused by Plasmodium falciparum; however, it is unknown whether this polymorphism also protects against P. vivax infection and disease. Methods and Findings The association between SAO and P. vivax infection was examined through genotyping of 1,975 children enrolled in three independent epidemiological studies conducted in the Madang area of Papua New Guinea. SAO was associated with a statistically significant 46% reduction in the incidence of clinical P. vivax episodes (adjusted incidence rate ratio [IRR] = 0.54, 95% CI 0.40–0.72, p<0.0001) in a cohort of infants aged 3–21 months and a significant 52% reduction in P. vivax (blood-stage) reinfection diagnosed by PCR (95% CI 22–71, p = 0.003) and 55% by light microscopy (95% CI 13–77, p = 0.014), respectively, in a cohort of children aged 5–14 years. SAO was also associated with a reduction in risk of P. vivax parasitaemia in children 3–21 months (1,111/µl versus 636/µl, p = 0.011) and prevalence of P. vivax infections in children 15–21 months (odds ratio [OR] = 0.39, 95% CI 0.23–0.67, p = 0.001). In a case-control study of children aged 0.5–10 years, no child with SAO was found among 27 cases with severe P. vivax or mixed P. falciparum/P. vivax malaria (OR = 0, 95% CI 0–1.56, p = 0.11). SAO was associated with protection against severe P. falciparum malaria (OR = 0.38, 95% CI 0.15–0.87, p = 0.014) but no effect was seen on either the risk of acquiring blood-stage infections or uncomplicated episodes with P. falciparum. Although Duffy antigen receptor expression and function were not affected on SAO erythrocytes compared to non-SAO children, high level (>90% binding inhibition) P. vivax Duffy binding protein–specific binding inhibitory antibodies were

  14. Correlation of Insurance, Race, and Ethnicity with Pathologic Risk in a Controlled Retinoblastoma Cohort: A Children's Oncology Group Study.

    PubMed

    Green, Adam L; Chintagumpala, Murali; Krailo, Mark; Langholz, Bryan; Albert, Daniel; Eagle, Ralph; Cockburn, Myles; Chevez-Barrios, Patricia; Rodriguez-Galindo, Carlos

    2016-08-01

    To determine whether insurance status, race, and ethnicity correlate with increased retinoblastoma invasiveness as a marker of both risk and time to diagnosis. Retrospective case-control study. All 203 patients from the United States enrolled in the Children's Oncology Group (COG) trial ARET0332, a study of patients with unilateral retinoblastoma requiring enucleation. All surgical specimens underwent pathologic review to determine the presence of well-defined histopathologic features correlating with a higher risk of disease progression. Insurance status, race, and ethnicity were compiled from the study record for each patient. On institutional pathologic review, nonprivate insurance, nonwhite race, and Hispanic ethnicity all correlated significantly with a greater rate of high-risk pathologic findings. Hispanic ethnicity remained a significant predictor on multivariate analysis. On central pathologic review, these correlations remained but did not reach statistical significance. The differences in results from institutional versus central pathologic reviews appeared to be due to a higher likelihood of patients in minority groups of being misclassified as high risk by institutional pathologists. In this controlled study population of patients with retinoblastoma who had central pathologic review, our findings suggest a higher rate of more advanced disease associated with nonprivate insurance, nonwhite race, and Hispanic ethnicity; these findings may be due to delays in diagnosis for these groups. Future work should use direct methods to study the impact of other variables, including English-language proficiency and socioeconomic status. Further effort also should focus on where in the diagnostic process potential delays exist, so that interventions can be designed to overcome barriers to care for these groups. In addition, potential systematic differences in pathologic reads based on demographic variables deserve further study. Copyright © 2016 American Academy

  15. Gait in 5-year-old children with idiopathic clubfoot: A cohort study of 59 children, focusing on foot involvement and the contralateral foot.

    PubMed

    Lööf, Elin; Andriesse, Hanneke; André, Marie; Böhm, Stephanie; Broström, Eva W

    2016-10-01

    Background and purpose - Idiopathic clubfoot can be bilateral or unilateral; however, most studies of gait have assessed clubfoot cases as one uniform group. The contralateral foot in children with unilateral clubfoot has shown deviations in pedobarographic measurements, but it is seldom included in studies of gait. We evaluated gait in children with idiopathic clubfoot, concentrating on foot involvement. Patients and methods - Three-dimensional gait analyses of 59 children, mean age 5.4 years, with bilateral (n = 30) or unilateral (n = 29) idiopathic clubfoot were stratified into groups of bilateral, unilateral, or contralateral feet. Age-matched controls (n = 28) were evaluated for comparison. Gait assessment included: (1) discrete kinematic and kinetic parameters, and (2) gait deviation index for kinematics (GDI) and kinetics (GDI-k). Results - No differences in gait were found between bilateral and unilateral idiopathic clubfoot, but both groups deviated when compared to controls. Compared to control feet, contralateral feet showed no deviations in discrete gait parameters, but discrepancies were evident in relation to unilateral clubfoot, causing gait asymmetries in children with unilateral involvement. However, all groups deviated significantly from control feet according to GDI and GDI-k. Interpretation - Bilateral and unilateral idiopathic clubfoot cases show the same persistent deviations in gait, mainly regarding reduced plantarflexion. Nevertheless, knowledge of foot involvement is important as children with unilateral clubfoot show gait asymmetries, which might give an impression of poorer deviations. The results of GDI/GDI-k indicate global gait adaptations of the contralateral foot, so the foot should preferably not be used as a reference for gait.