Association of cardiovascular disease risk factors with socioeconomic position during childhood and during adulthood.

OBJECTIVE: To investigate strength of associations between risk factors for cardiovascular disease and socioeconomic position during childhood and adulthood. DESIGN: Cross sectional analysis of status of cardiovascular risk factors and past and present social circumstances. SUBJECTS: 5645 male participants in the west of Scotland collaborative study, a workplace screening study. MAIN OUTCOME MEASURES: Strength of association between each risk factor for cardiovascular disease (diastolic blood pressure, serum cholesterol concentration, level of recreational physical exercise, cigarette smoking, body mass index, and FEV1 score (forced expiratory volume in one second as percentage of expected value) and social class during childhood (based on father''s main occupation) and adulthood (based on own occupation at time of screening). RESULTS: All the measured risk factors were significantly associated with both father''s and own social class (P < 0.05), apart from exercise and smoking (not significantly associated with father''s social class) and body mass index (not significantly associated with own social class). For all risk factors except body mass index, the regression coefficient of own social class was larger than the regression coefficient of father''s social class. The difference between the coefficients was significant for serum cholesterol concentration, cigarette smoking, body mass index, and FEV1 score (all P < 0.001). CONCLUSIONS: Subjects'' status for behavioural risk factors (exercise and smoking) was associated primarily with current socioeconomic circumstances, while status for physiological risk factors (serum cholesterol, blood pressure, body mass index, and FEV1) was associated to varying extents with both past and present socioeconomic circumstances.     

Habitual Snoring in school-aged children: environmental and biological predictors

Background

Habitual snoring, a prominent symptom of sleep-disordered breathing, is an important indicator for a number of health problems in children. Compared to adults, large epidemiological studies on childhood habitual snoring and associated predisposing factors are extremely scarce. The present study aimed to assess the prevalence and associated factors of habitual snoring among Chinese school-aged children.

Methods

A random sample of 20,152 children aged 5.08 to 11.99 years old participated in a cross-sectional survey, which was conducted in eight cities of China. Parent-administrated questionnaires were used to collect information on children''s snoring frequency and the possible correlates.

Results

The prevalence of habitual snoring was 12.0% (14.5% for boys vs. 9.5% for girls) in our sampled children. Following factors were associated with an increased risk for habitual snoring: lower family income (adjusted odds ratio [OR] = 1.46), lower father''s education (OR = 1.38 and 1.14 for middle school or under and high school of educational level, respectively), breastfeeding duration < 6 months (OR = 1.17), pregnancy maternal smoking (OR = 1.51), obesity (OR = 1.50), overweight (OR = 1.35), several respiratory problems associated with atopy and infection, such as chronic/allergic rhinitis (OR = 1.94), asthma (OR = 1.43), adenotonsillar hypertrophy (OR = 2.17), and chronic otitis media (OR = 1.31), and family history of habitual snoring (OR = 1.70).

Conclusion

The prevalence of habitual snoring in Chinese children was similar to that observed in other countries. The potential predisposing factors covered socioeconomic characteristics, environmental exposures, chronic health problems, and family susceptibility. Compared to socioeconomic status and family susceptibility, environmental exposures and chronic health problems had greater impact, indicating childhood habitual snoring could be partly prevented by health promotion and environmental intervention.     

Women's social power, child nutrition and poverty in Mali

While the macro-level association between poverty and child malnutrition is well-established, the concept of 'poverty' and its operationalization in terms of measures of socioeconomic status shed little or no light on the mechanisms through which malnutrition is created and/or prevented. This paper investigates a woman's social power, one such mechanism that may mediate the impact of poverty on childhood nutrition. This micro-level factor is examined using survey data on 402 children 5 years of age and younger and their 261 Fulbe mothers in rural Mali. A conceptual model of social power is developed and used to test the hypothesis that a mother's social power can predict her child's nutritional status.     

Child growth and nutritional status in a high-poverty community in eastern Kentucky

The research reported in this paper examines the relationship between household socioeconomic measures, child growth, and nutritional status in a community in eastern Kentucky with a high rate of poverty. It is based on the premise that child growth and nutritional status reflect the social circumstances in which they occur. 21.6% of the children exhibited low height (<15th percentile of National Center for Health Statistics [NCHS] reference values), with 13% of the girls exhibiting stunting (<5th percentile). Thirty-three percent of the children exhibited overweight, and 13% exhibited obesity (>85th percentile and >95th percentile of National Health and Nutrition Examination Survey [NHANES] reference values, respectively); 21.4% of boys were obese, compared to 8.7% of girls. Analysis of variance indicated that child stature is best explained by the father's education level interacting with employment status, and by the mother's employment status interacting with household poverty level. Weight is best explained by the mother's employment status. However, the relationships among socioeconomic measures and growth outcomes differed by gender of the child. These issues are discussed in light of the anthropology literature and the situation in Bridges County, Kentucky where the research took place. Am J Phys Anthropol 109:129–142, 1999. © 1999 Wiley-Liss, Inc.     

Predictors of Children's Secondhand Smoke Exposure at Home: A Systematic Review and Narrative Synthesis of the Evidence

Background

Children''s exposure to secondhand smoke (SHS) has been causally linked to a number of childhood morbidities and mortalities. Over 50% of UK children whose parents are smokers are regularly exposed to SHS at home. No previous review has identified the factors associated with children''s SHS exposure in the home.

Aim

To identify by systematic review, the factors which are associated with children''s SHS exposure in the home, determined by parent or child reports and/or biochemically validated measures including cotinine, carbon monoxide or home air particulate matter.

Methods

Electronic searches of MEDLINE, EMBASE, PsychINFO, CINAHL and Web of Knowledge to July 2014, and hand searches of reference lists from publications included in the review were conducted.

Findings

Forty one studies were included in the review. Parental smoking, low socioeconomic status and being less educated were all frequently and consistently found to be independently associated with children''s SHS exposure in the home. Children whose parents held more negative attitudes towards SHS were less likely to be exposed. Associations were strongest for parental cigarette smoking status; compared to children of non-smokers, those whose mothers or both parents smoked were between two and 13 times more likely to be exposed to SHS.

Conclusion

Multiple factors are associated with child SHS exposure in the home; the best way to reduce child SHS exposure in the home is for smoking parents to quit. If parents are unable or unwilling to stop smoking, they should instigate smoke-free homes. Interventions targeted towards the socially disadvantaged parents aiming to change attitudes to smoking in the presence of children and providing practical support to help parents smoke outside the home may be beneficial.     

Impact of counselling on careseeking behaviour in families with sick children: cluster randomised trial in rural India

Objective To assess whether training doctors in counselling improves careseeking behaviour in families with sick children.Design Pair matched, community randomised trial conducted in 12 primary health centres (six pairs). Doctors in intervention centres were trained in counselling, communication, and clinical skills, using the integrated management of childhood illness approach.Setting Rural district in Rajasthan, India.Participants Children aged under 5 years presenting for curative care and their mothers were recruited and visited monthly at home for six months. A total of 2460 children were recruited (1248 intervention, 1212 control).Main outcome measures Careseeking behaviour of mothers for sick children; mothers'' knowledge and perceptions of seeking care; counselling performance of doctors.Results For episodes of illness with at least one reported danger sign, 15% of intervention group mothers and 10% of control group mothers reported having sought care from an appropriate provider promptly; this difference was not statistically significant (relative risk reduction 5%, 95% confidence interval -0.4% to 11%; P = 0.07). One month after training, intervention site doctors counselled more effectively than control group doctors, but at six months their performance had declined. A greater proportion of mothers in the intervention group than in the control group recalled having had at least one danger sign explained (45% v 8%; P = 0.02).Conclusions Mothers'' appreciation of the need to seek prompt and appropriate care for severe episodes of childhood illness increased, but their careseeking behaviour did not improve significantly.     

Differences in nutritional status between rural and urban Yucatec Maya children: The importance of early life conditions

Early-life conditions shape childhood growth and are affected by urbanization and the nutritional transition. To investigate how early-life conditions (across the “first” and “second” 1000 days) are associated with rural and urban children's nutritional status, we analyzed anthropometric data from Maya children in Yucatan, Mexico. We collected weight, height and triceps skinfold measures, then computed body mass and fat mass indices (BMI/FMI), in a cross-sectional sample of 6-year-olds (urban n = 72, rural n = 66). Demographic, socioeconomic and early-life variables (birthweight/mode, rural/urban residence, household crowding) were collected by maternal interview. We statistically analyzed rural-urban differences in demographic, socioeconomic, early-life, and anthropometric variables, then created linear mixed models to evaluate associations between early-life variables and child anthropometric outcomes. Two-way interactions were tested between early-life variables and child sex, and between early-life variables and rural-urban residence. Results showed that rural children were shorter-statured, with lower overweight/obesity and cesarean delivery rates, compared to urban children. Household crowding was a negative predictor of anthropometric outcomes; the strongest effect was in boys and in urban children. Birthweight positively predicted anthropometric outcomes, especially weight/BMI. Birth mode was positively (not statistically) associated with any anthropometric outcome. Cesarean delivery was more common in boys than in girls, and predicted increased height in urban boys. In conclusion, urbanization and household crowding were the most powerful predictors of Maya 6-year-old anthropometry. The negative effects of crowding may disproportionately affect Maya boys versus girls and urban versus rural children. Early-life conditions shape Maya children's nutritional status both in the “first” and “second” 1000 days.     

Knowledge,attitudes and determinants of exclusive breastfeeding practice among Ghanaian rural lactating mothers

Background

The practice of exclusive breastfeeding (EBF) is influenced by maternal knowledge and attitudes as well as socio-demographic and cultural factors. This study assessed knowledge, attitudes and practice of EBF among rural lactating mothers with infants aged 0–6 months. Factors associated to the practice of EBF were also investigated.

Methods

This cross-sectional study was conducted among 190 rural lactating mothers with infants aged 0–6 months seeking postnatal care at a health centre in Ghana. All data was collected using a questionnaire that contained both closed and open ended questions.

Results

About 26 % (n?=?50) of the mothers were unable to correctly define EBF. The majority (92.6 %, n?=?176) of the mothers said they felt good to EBF for 6 months, to breastfed on demand (99.5 %, n?=?189) and did not have difficulties EBF (90 %, n?=?171). Despite the generally positive attitude towards EBF, 42 % (n?=?79) of the mothers did not EBF their babies. These mothers did not practice EBF because they misunderstood certain signs of the child to mean wanting to eat food or drink water, regarded breastmilk to be inadequate to meet the nutritional needs of the child and misunderstood healthcare professionals’ EBF advice. Higher maternal education was associated with higher likelihood of EBF (OR 3.5; 95 % CI 1.6, 7.7; p?=?0.002). Mothers whose babies were younger than 3 months were more likely to EBF (OR 12.0; 95 % CI 4.4, 32.5; p?<?0.001) than those having babies aged?≥?3 months. Furthermore, higher knowledge of EBF was associated with the likelihood of EBF (OR 5.9; 95 % CI 2.6, 13.3; p?<?0.001).

Conclusion

Mothers’ knowledge and attitudes towards EBF were favourable but practice of EBF was suboptimal. This study adds additional evidence that knowledge of EBF, child’s age and maternal level of education are important determinants of the practice of EBF. Beyond dissemination of health messages, healthcare professionals should pay more counselling attention to less educated mothers, and also older children’s caregivers.

     

Tall claims: Mortality selection and the height of children in India

Data from three rounds of nationally representative health surveys in India (1992/93, 1998/99 and 2005/06) are used to assess the impact of selective mortality on children's anthropometrics. The nutritional status of the child population was simulated under the counterfactual scenario that all children who died in the first three years of life were alive at the time of measurement. The simulations demonstrate that the difference in anthropometrics due to selective mortality would be large only if there were very large differences in anthropometrics between the children who died and those who survived. Differences of this size are not substantiated by the research on the degree of association between mortality and malnutrition. The study shows that although mortality risk is higher among malnourished children, selective mortality has only a minor impact on the measured nutritional status of children stratified by gender.     

Nutritional status and mortality of highland children in Nepal: Impact of sociocultural factors

This study investigates the nutritional status of native children in the highlands of Nepal (1,700–3,000 m) and explores the relationship between child mortality and surviving children's nutritional status. A random sample of 145 households from 11 villages in the Koshi Hill Zone in east Nepal was surveyed, and the nutritional status of the 438 children <14 years of age living in these households was assessed by means of anthropometry. We found a severe growth retardation in the Nepalese children compared to lowland reference groups as well as to highland children from the Andes. Child mortality and altitude are not significantly different between higher (Brahman and Chetri) and lower (Baisya and Sudra) caste households. A lower caste status and higher altitude of the household is associated with a significantly better nutritional status in offspring. In multiple regression analyses, improved nutritional status in children is significantly associated with lower caste (P = 0.001), higher altitude (P = 0.009), and less crowding (P = 0.001) but not with sibling mortality (P = 0.11). We thus conclude that nutritional status of children in households in the highlands of Nepal is associated with the household's socioeconomic status and altitude but not with mortality among siblings. © 1996 Wiley-Liss, Inc.     

An analysis of childhood malnutrition in Kerala and Goa

Improved child health and survival are considered universal humanitarian goals. In this respect, understanding the nutritional status of children has far-reaching implications for the better development of future generations. The present study assessed, first, the nutritional status of children below 5 years using the three anthropometric measures weight-for-age, height-for-age and weight-for-height in two states of India, Kerala and Goa. Secondly, it examined the confounding factors that influence the nutritional status of children in these states. The NFHS-I data for Kerala and Goa were used. The results showed that the relative prevalence of underweight and wasting was high in Kerala, but the prevalence of stunting was medium. In Goa, on the other hand, the relative prevalence of wasting and underweight was very high, and that of stunting was high. Both socioeconomic and family planning variables were significantly associated with malnutrition in these states, but at varied levels. The study recommends more area-specific policies for the development of nutritional intervention programmes.     

Prevalence and Associated Factors for Dual Form of Malnutrition in Mother-Child Pairs at the Same Household in the Gaza Strip-Palestine

Background

In many developing countries nutritional, and epidemiological transitions are emerging into continuing undernutrition and escalating overnutrition, giving rise to the double burden of the malnutrition phenomenon.

Objectives

This study aims to determine the prevalence of the dual form of malnutrition (overweight mother/underweight child) in the same household and its associated factors in the Gaza Strip.

Methods

A total of 357 mother-child pairs from the same households were surveyed from three different geographical locations in the Gaza Strip, namely, El Remal urban area, Jabalia refugee camp, and Al Qarara rural area. The height and weight of mothers aged 18–50 years were measured, and their body mass index (BMI) was computed. The mothers were categorized according to the criterion of the World Health Organization (WHO) for BMI as overweight if they have a BMI ≥ 25 kg/m². Anthropometric indices were measured for children aged two to five years to classify the underweight children Z-score <-1.

Results

The results showed the prevalence of the dual form of malnutrition in the Gaza Strip was 15.7%, and its associated factors were child’s birth order (OR_adj, 1.50, 95% CL, 1.22, 1.82; p = <0.001), father’s educational (low or medium) levels (OR_adj, 3.19, 95% CL, 1.07, 9.5; p = 0. 036), or (OR_adj, 3.4, 95% CL, 1.12, 10.37; p = 0. 031), high scores of mothers'' nutrition knowledge (OR_adj, 1.23, 95% CL, 1.01, 1.52; p = 0. 048), and low monthly income (OR_adj, 0.28, 95% CL, 0.09, 0.88; p = 0. 030).

Conclusions

The results from this study showed the dual form of malnutrition in the same household was prevalent in the Gaza Strip. This is a public health issue that must be understood and addressed and policy makers must implement an appropriate nutrition action plan to control dual form of malnutrition based on the underlying specific risk factors in the study population. In addition, interventions are needed to help individuals to translate their nutrition knowledge into healthy dietary behaviors.     

Is Economic Growth Associated with Reduction in Child Undernutrition in India?

Background

Economic growth is widely perceived as a major policy instrument in reducing childhood undernutrition in India. We assessed the association between changes in state per capita income and the risk of undernutrition among children in India.

Methods and Findings

Data for this analysis came from three cross-sectional waves of the National Family Health Survey (NFHS) conducted in 1992–93, 1998–99, and 2005–06 in India. The sample sizes in the three waves were 33,816, 30,383, and 28,876 children, respectively. After excluding observations missing on the child anthropometric measures and the independent variables included in the study, the analytic sample size was 28,066, 26,121, and 23,139, respectively, with a pooled sample size of 77,326 children. The proportion of missing data was 12%–20%. The outcomes were underweight, stunting, and wasting, defined as more than two standard deviations below the World Health Organization–determined median scores by age and gender. We also examined severe underweight, severe stunting, and severe wasting. The main exposure of interest was per capita income at the state level at each survey period measured as per capita net state domestic product measured in 2008 prices. We estimated fixed and random effects logistic models that accounted for the clustering of the data. In models that did not account for survey-period effects, there appeared to be an inverse association between state economic growth and risk of undernutrition among children. However, in models accounting for data structure related to repeated cross-sectional design through survey period effects, state economic growth was not associated with the risk of underweight (OR 1.01, 95% CI 0.98, 1.04), stunting (OR 1.02, 95% CI 0.99, 1.05), and wasting (OR 0.99, 95% CI 0.96, 1.02). Adjustment for demographic and socioeconomic covariates did not alter these estimates. Similar patterns were observed for severe undernutrition outcomes.

Conclusions

We failed to find consistent evidence that economic growth leads to reduction in childhood undernutrition in India. Direct investments in appropriate health interventions may be necessary to reduce childhood undernutrition in India. Please see later in the article for the Editors'' Summary     

Maternal BMI and country of birth as indicators of childhood obesity in children of Mexican origin

Objective: The goal of this study was to evaluate the relationship between maternal and childhood BMI at baseline in a group of 5‐ to 18‐year‐old children and their mothers, all of whom were of Mexican origin, low socioeconomic status, and enrolled in a cohort study in Houston, TX. Research Methods and Procedures: Using data from 438 mother‐child dyads residing in the same household, we completed logistic regression analyses to determine maternal factors associated with the child being overweight or at‐risk‐for‐overweight, after adjusting for the child's gender, age, and level of physical activity and other maternal confounders. Results: Almost one‐half of the boys and girls (47% and 44%, respectively) were either overweight or at‐risk‐for‐overweight. Obese mothers were twice as likely to have an overweight and/or at‐risk‐for‐overweight child compared with normal‐weight mothers. Women born in the U.S. were twice as likely to have an overweight and/or at‐risk‐for‐overweight child compared with women born in Mexico. In addition, women with less than a high school education were twice as likely to have an overweight child compared with their more educated peers. Discussion: The high prevalence of overweight or at‐risk‐for‐overweight among Mexican‐origin children of low socioeconomic status suggests a continued need to develop and implement culturally sensitive preventive interventions for this minority population. Our data also suggest a need to tailor such interventions particularly for children of obese mothers and those born in the U.S.     

Beyond Socioeconomics: Explaining Ethnic Group Differences in Parenting Through Cultural and Immigration Processes

This study examined both socioeconomic and cultural factors in explaining ethnic differences in monitoring, behavioral control, and warmth—part of a series of coordinated studies presented in this special issue. Socioeconomic variables included mother's and father's educational levels, employment status, home ownership, number of siblings in the household, and single parent status. Cultural factors included nationality or ethnicity, immigrant status of child, mother's/father's age of arrival in the United States, mother's/father's English language use with the child, child's native fluency, and cultural values for independence and interdependence. The sample consisted of 591 European American, 123 African American, 1,614 Asian American, and 597 Latino students in the ninth grade. All the ethnic minority groups were higher than European Americans on behavioral control, and Latinos were also higher than European Americans on monitoring. However, European Americans were higher on parental warmth than Asian Americans and African Americans. These ethnic group differences primarily remained even after controlling for the socioeconomic factors. Finally, in analyses looking within the Asian and Latino groups, differences in parenting were found within both groups due to nationality or ethnicity, youth's fluency in the native language, and cultural values of interdependence, although values of independence were also related to the parenting of Asian Americans.     

先天性心脏病患儿术前营养不良的危险因素分析及其对术后临床结局、免疫功能和生存质量的影响

摘要 目的：分析先天性心脏病（CHD）患儿术前营养不良的危险因素,并观察术前营养不良对患儿术后临床结局、免疫功能和生存质量的影响。方法：选取2020年1月-2022年6月期间江苏省人民医院收治的65例CHD患儿,采用世界卫生组织（WHO）推荐的美国国家卫生统计中心制订的相关营养诊断标准评估CHD患儿的营养情况,统计CHD患儿术前营养不良发生率,采用单因素和多因素Logistic回归分析CHD患儿术前营养不良的危险因素,并观察术前营养不良对患儿术后临床结局、免疫功能和生存质量的影响。结果：本次研究入选的患儿中,有31例出现术前营养不良,34例无营养不良。根据患儿的营养状况将患儿分为营养不良组（n=31）和非营养不良组（n=34）。多因素Logistic回归分析结果显示：出生时体质量偏低、母亲有焦虑情况、母亲有抑郁情况是CHD患儿术前营养不良的危险因素,母亲主动获取疾病知识则是其保护因素（P<0.05）。两组并发症发生率组间对比无统计学差异（P>0.05）,营养不良组的住院时间长于非营养不良组,住院费高于非营养不良组（P<0.05）。两组术后3个月CD3⁺、CD4⁺、CD4⁺/CD8⁺升高,CD8⁺下降,且非营养不良组的改善效果优于营养不良组（P<0.05）。两组术后3个月术前沟通问题、心脏问题和症状、治疗焦虑、感知身体外貌、认知心理问题评分均升高,且非营养不良组的改善效果均优于营养不良组（P<0.05）。结论：出生时体质量偏低、母亲有焦虑情况、母亲有抑郁情况是CHD患儿术前营养不良的危险因素,而母亲主动获取疾病知识是CHD患儿术前营养不良的保护因素。术前营养不良会导致CHD患儿术后免疫功能下降,生存质量降低,临床结局相对偏差。     

Food Marketing towards Children: Brand Logo Recognition,Food-Related Behavior and BMI among 3–13-Year-Olds in a South Indian Town

Objectives

To assess exposure to marketing of unhealthy food products and its relation to food related behavior and BMI in children aged 3–13, from different socioeconomic backgrounds in a south Indian town.

Methods

Child-parent pairs (n = 306) were recruited at pediatric clinics. Exposure to food marketing was assessed by a digital logo recognition test. Children matched 18 logos of unhealthy food (high in fat/sugar/salt) featured in promotion material from the food industry to pictures of corresponding products. Children''s nutritional knowledge, food preferences, purchase requests, eating behavior and socioeconomic characteristics were assessed by a digital game and parental questionnaires. Anthropometric measurements were recorded.

Results

Recognition rates for the brand logos ranged from 30% to 80%. Logo recognition ability increased with age (p<0.001) and socioeconomic level (p<0.001 comparing children in the highest and lowest of three socioeconomic groups). Adjusted for gender, age and socioeconomic group, logo recognition was associated with higher BMI (p = 0.022) and nutritional knowledge (p<0.001) but not to unhealthy food preferences or purchase requests.

Conclusions

Children from higher socioeconomic groups in the region had higher brand logo recognition ability and are possibly exposed to more food marketing. The study did not lend support to a link between exposure to marketing and poor eating behavior, distorted nutritional knowledge or increased purchase requests. The correlation between logo recognition and BMI warrants further investigation on food marketing towards children and its potential role in the increasing burden of non-communicable diseases in this part of India.     

Familial associations of adiposity: findings from a cross-sectional study of 12,181 parental-offspring trios from Belarus

Background

It is suggested that maternal adiposity has a stronger association with offspring adiposity than does paternal adiposity. Furthermore, a recent small study reported gender assortment in parental-offspring adiposity associations. We aimed to examine these associations in one of the largest studies to date using data from a low-middle income country that has recently undergone a major political and economic transition.

Methods and Principal Findings

In a cross-sectional study of 12,181 parental-offspring trios from Belarus (mean age (SD) of mothers 31.7 (4.9), fathers 34.1 (5.1) and children 6.6 (0.3) at time of assessment), we found positive graded associations of mother''s and father''s BMI with offspring adiposity. There was no evidence that these associations differed between mothers and fathers. For example, the odds ratio of offspring overweight or obesity (based on BMI) comparing obese and overweight mothers to normal weight mothers was 2.03 (95%CI 1.77, 2.31) in fully adjusted models; the equivalent result for father''s overweight/obesity was 1.81 (1.58, 2.07). Equivalent results for offspring being in the top 10% waist circumference were 1.91 (1.67, 2.18) comparing obese/overweight to normal weight mothers and 1.72 (1.53, 1.95) comparing obese/overweight to normal weight fathers. Similarly, results for offspring being in the top 10% of percent fat mass were 1.58 (1.36, 1.84) and 1.76 (1.49, 2.07), for mother''s and father''s obese/overweight exposures respectively. There was no strong or consistent evidence of gender assortment - i.e. associations of maternal adiposity exposures with offspring outcomes were similar in magnitude for their daughters compared to equivalent associations in their sons and paternal associations were also similar in sons and daughters.

Conclusions/Significance

These findings suggest that genetic and/or shared familial environment explain family clustering of adiposity. Interventions aimed at changing overall family lifestyle are likely to be important for population level obesity prevention.     

哮喘儿童父母知识知晓率、用药依从性及影响因素分析

目的:了解哮喘儿童父母的对疾病知识的掌握情况以及儿童的服药依从情况和影响因素,为提高哮喘儿童的控制率提供参考依据。方法:选择2015年1月-2015年12月于上海市第十人民医院儿科门诊诊治的支气管哮喘儿童93例,调查其哮喘控制情况、哮喘服药依从性和父母基本情况与相关知识。依从性与知识知晓率的比较采用双向有序的检验,影响因素采用有序结果的累积优势Logistic回归分析。结果:本次调查93例哮喘儿童中,哮喘完全控制率为23.7%,儿童服药依从性好的比率为25.8%,哮喘儿童父母相关知识知晓率高的比率为25.8%,儿童哮喘控制率与服药依从性之间存在相关性(P=0.029),哮喘儿童服药依从性与哮喘儿童父母相关知识知晓率之间存在相关性(P=0.035)。哮喘儿童的服药依从性受到儿童性别(OR=1.153,95%CI:1.04-1.96)、家族史(OR=1.402,95%CI:1.20-2.33)、知识知晓率(OR=1.828,95%CI:1.05-3.17)和病程(OR=0.758,95%CI:0.35-0.97)等因素的影响(P0.05)。结论:哮喘儿童的服药依从性受到儿童性别、家族史、知识知晓率和病程等因素的影响,要充分发挥儿童父母的作用,从医院内干预逐渐进入家庭干预,通过对父母或者监护人的认知或用药知识的提高,切实提高哮喘儿童的用药依从性和哮喘的控制率。     

Psychological consequences for parents of false negative results on prenatal screening for Down's syndrome: retrospective interview study

ObjectiveTo determine the psychological consequences for parents of children with Down''s syndrome of having received a false negative result on prenatal screening.DesignComparison of adjustment of parents who received a false negative result with that of parents not offered a test and those who declined a test.SettingParents were interviewed in their own homes.ParticipantsParents of 179 children with Down''s syndrome (mean age 4 (range 2-6) years).ResultsOverall, regardless of screening history, parents adjusted well to having a child with Down''s syndrome. Compared with mothers who declined a test, mothers in the false negative group had higher parenting stress (mean score 81.2 v 71.8, P=0.016, 95% confidence interval for the difference 1.8 to 17.0) and more negative attitudes towards their children (124.9 v 134.2, P=0.009, −16.2 to −2.4). Fathers in the false negative group had higher parenting stress test scores (77.8 v 70.0, P=0.046, 1.5 to 14.2) than fathers not offered a test. Mothers in the false negative group were more likely to blame others for the outcome than mothers who had not been offered the test (28% v 13%, P=0.032, 3% to 27%). Mothers and fathers in the false negative group were more likely to blame others for this outcome than parents who had declined a test (mothers 28% v 0%, P=0.001, 19% to 37%; fathers 27% v 0%, P=0.004, 17% to 38%). Blaming others was associated with poorer adjustment for mothers and fathers.ConclusionsA false negative result on prenatal screening seems to have a small adverse effect on parental adjustment evident two to six years after the birth of an affected child.