A decade of diabetes: keeping children out of hospital.

OBJECTIVES--To document the number of children aged less than 15 years who developed diabetes and were managed within one large health district, and to evaluate the outcome of those children managed without hospital admission at diagnosis. DESIGN--A retrospective study over 1979-88, when a paediatrician and a physician with special interests in childhood diabetes initiated joint clinics. Data collected from the district diabetes register and files of consultants and health visitors specialising in diabetes. SETTING--Referral of children to consultants in Leicestershire (total population 863,000). MAIN OUTCOME MEASURES--The proportion of children managed without hospital admission, comparison of readmission rates and glycated haemoglobin concentrations between children admitted and those not admitted. RESULTS--Over 10 years 236 children aged 10-14 years developed diabetes (annual incidence rate 12.8/100,000 child population (95% confidence interval 11.3 to 14.7)). In total 138 were not admitted to hospital but received supervised management based at home. Admitted children were younger or acidotic or their family doctors did not contact the diabetes team. Duration of admission declined from seven days in 1979-80 to three days in 1987-8. Ninety two were not admitted to hospital during the 10 years for any reason. Significantly fewer children who received management at home were readmitted for reasons related to diabetes than the group treated in hospital (30 (22%) v 40 (41%); p = 0.004). Concentrations of glycated haemoglobin were no different between the two groups. CONCLUSIONS--Children with newly diagnosed diabetes may be safely and effectively managed out of hospital. Domiciliary or community based management depends on the commitment of consultants specialising in diabetes working in close cooperation with general practitioners, specialist nurses in diabetes, and dietitians.     

Prenatal substance use in a Western urban community.

To assess the extent of prenatal substance use in a predominantly white population in an urban area of the western United States and to develop a risk profile for this population, a cross-sectional prevalence study was done. Prenatal clinics (10 public and 10 private) anonymously recorded demographic information about and collected aliquots of routinely obtained urine specimens from women during prenatal visits. Urine specimens were screened by enzyme immunoassay for amphetamines, marijuana, cocaine, opiates, and ethanol. Of the 935 women screened, 92 (9.8%) had urine specimens positive for one or more of these substances. Urine screens were positive in 56 (10.0%) of 562 women attending private clinics and 36 (9.6%) of 373 women attending public clinics. Only 7 of the 935 women (0.7%) had screens positive for cocaine. Ethanol was the most frequently detected substance in the private clinic group (6.4%), whereas marijuana was most common among women attending public clinics (5.1%). Although substance use in this group of pregnant women occurs at a lower rate and a different pattern from those found in other more densely populated areas, the rate is high enough to be of concern to all prenatal care professionals, who should incorporate substance use history taking and selective urine drug screening into their routine prenatal practices.     

Developmental evaluation of children born to mothers occupationally exposed to waste anesthetic gases

BACKGROUND: The etiology of developmental delay in children is frequently unknown. Increasing evidence supports the possibility that environmental and occupational factors might be part of the basis for such delays. This study focuses on the development of children born to mothers who were exposed during their pregnancy to waste anesthetic gases. METHODS: The study population included 40 children aged 5-13 years born to female anesthesiologists and nurses working in operating rooms (OpRs) exposed to waste anesthetic gases, and 40 unexposed children born to female nurses and physicians who worked in hospitals during their pregnancy but did not work in OpRs. The unexposed group was matched for children's age and gender and maternal occupation (nurses vs. doctors). By means of standardized developmental tests, the present study population was evaluated for their medical and neurodevelopmental state. Questionnaires were given for the detection of attention and activity levels as perceived by the parents. Additional questionnaires dealt with information concerning developmental milestones, maternal and fetal morbidity, and gynecological history. RESULTS: No differences were noted between the groups as newborns or in developmental milestones at the age of 5-13 years; however, the mean score of gross motor ability was significantly lower in the exposed versus the unexposed group. Additionally, the mean score of the DSM-III-R Parent-Teacher Questionnaire (PTQ) (i.e., measure of inattention/hyperactivity) was higher in the exposed group. The level of exposure, as measured by the number of weekly hours in the OpRs, was significantly and negatively correlated with fine motor ability and the score of IQ performance. CONCLUSIONS: Our study supports the hypothesis that occupational exposure to anesthetic gases might be a risk factor for minor neurological deficits of children born to mothers who work in OpRs and therefore indicates the need for more studies in this area and perhaps more caution among OpR pregnant women and employers.     

Factors affecting acceptability of long-acting contraceptive injections in a rural Egyptian community

This study was carried out in 4 adjacent villages in Lower Eghypt with a combined population of 24,000. A team of social workers and physicians worked together to introduce the injectable contraceptive depomedroxyprogesterone acetate as a post-partum long-acting contraceptive to the community leaders and the villagers at several meetings and individual home visits. Post-partum women who agreed to use the drug were defined as acceptors (591) and those who did not were defined as rejectors (715). The incidence of polygamy was higher among the rejectors, and rejectors' husbands had more children from their other wives. Acceptors had more previous pregnancies and children of both sexes than rejectors. The interval between the last 2 pregnancies was shorter among the rejectors. A greater % of acceptors had previously used another contraceptive. The commonest reasons for rejection were desire for further pregnancy (69%), health problems (11%), and desire for another method of contraception (8%). Religious factors figured in only 3% of cases.     

The Perinatal Risk Index: Early Risks Experienced by Domestic Adoptees in the United States

We aimed to assess comprehensively the prevalence of perinatal risks experienced by a potentially high-risk yet understudied population of children domestically adopted in the United States. Data are from participant report and medical records from mothers (n = 580) who completed a domestic adoption placement with nonrelatives at or near birth (Mean placement age = 7 days). We describe a comprehensive measure of perinatal risks, including divergences from previous assessment tools and the incorporation of multiple reporters, and report the prevalence of various types of perinatal risks. The prevalence of each specific risk factor was generally low, although several risks were more prevalent in this sample than estimates from nationally representative publicly available data. Nearly the entire sample (99%) experienced some type of risk exposure. Birth mothers who placed their children for adoption domestically in the US experience higher levels of perinatal risks than the national average, but not for all specific types of risk. Thus, the developmental trajectories of children adopted domestically may systematically differ from the general population to the extent that these specific perinatal risks impact development.     

Children Domestic Accidents Profile in Jazan Region,a call for new policies to improve safety of home environment

High-frequency home accidents draw more attention to the protection of our home environment. WHO has reported that home deaths were among the first 20 causes of death in the 0–14 age group worldwide in 2012. This innovative research was designed to examine children under 15 years of age at home, in 2018 in the Jazan area of Saudi Arabia. Data were collected retrospectively from 19 hospitals in the Jazan area of southern Saudi Arabia during the period from September to December 2019. Data showed that, for the first time, the incidence rate of child home incidents in the Jazan area was 7.4 per 100 children in 2018. Falling, burning, swallowing foreign bodies, and domestic violence were among the most common types of injuries recorded. Home safety continued to be one of the main public health issues in the area with 29,812 home injuries in 1 year, 36.8% bone fractures, 31.6% body distortions, 9.2% distortion fractures and 5.3% child impairment. This study is a crucial step towards addressing the severity of home accidents in Saudi Arabia; troubling figures need further analysis, regular registry, informed policies and well-planned action to avoid these types of accidents.     

Eye Defects of Mentally Handicapped Children

Among 171 children who received routine ophthalmic and orthoptic examinations as part of their evaluation for suspected or known developmental handicap it was found that there was an unusually high incidence of ocular defects. Especially prevalent were high refractive errors (52%) and squints (40%), but there were also a number of other serious eye defects ranging from nystagmus and cataracts to microphthalmos.Because of this high incidence of eye defects it was considered essential that ophthalmic and orthoptic examinations should be part of the routine evaluation of developmentally handicapped children by the team of workers in an assessment centre.     

Promoting children's home safety.

Home accidents are the main cause of death and morbidity in early childhood. Working-class children are at greatest risk. A study in an inner city area of the effects of a national television campaign about child accident prevention and of a locally designed health education initiative showed that 55% of families with young children in the study area did not watch any of the television programmes. Only 9% of a group specially encouraged to watch the programmes took any action to make their homes safer. In a comparable group who also received a home visit at which specific advice was given 60% took action to make their homes safer. The families studied were well aware before the television campaign of the importance and preventability of children''s accidents. The problems disadvantaged families face are therefore not ones of ignorance or apathy about hazards but practical difficulties in converting their concern into action. Administrative arrangements must be developed for providing health workers--especially health visitors--with detailed local information to pass on to parents.     

Effects of preventive home visits to elderly people.

OBJECTIVES--To assess the effect of preventive home visits by public health nurses on the state of health of and use of services by elderly people living at home. DESIGN--Randomised controlled trial. SETTING--General population of elderly people in one of the southern regions of the Netherlands. SUBJECTS--580 subjects aged between 75 and 84 years randomly allocated to intervention (292) or control (288) group. INTERVENTIONS--Four visits a year over three years in intervention group. Control group received no home visits. MAIN OUTCOME MEASURES--Self rated health, functional state, well being, loneliness, aspects of the mental state (depressive complaints, memory disturbances), and mortality. Use of services and costs. RESULTS--Visits had no effect on the health of the subjects. In the group visited no higher scores were seen on health related measures, fewer died (42 (14%) v 50 (17%)), and community care increased slightly. In the control group more were referred to outpatient clinics (166 (66%) v 132 (55%)), and they had a 40% increased risk of admission (incidence rate ratio 1.4; 90% confidence interval 1.2 to 1.6). No differences were found in long term institutional care, and overall expenditure per person in the intervention group exceeded that in the control group by 4%. Additional analyses showed that visits were effective for subjects who initially rated their health as poor. CONCLUSIONS--Preventive home visits are not beneficial for the general population of elderly people living at home but might be effective when restricted to subjects with poor health.     

Five year prospective survey of risk of booking for a home birth in Essex.

A prospective survey was undertaken in 26 practices in Essex to assess the risks associated with a home birth. The 202 women who were booked for a home confinement were compared with a similar group of 185 women who were booked for hospital delivery under consultant care. The principal difference in outcome was the induction rate of 19% in the hospital group compared with 8% in the group booked for delivery at home. A higher rate of episiotomy and second degree tears and more Apgar scores of 7 or below were found in those who were booked for hospital. There were no perinatal deaths in either group. The results of this study showed no evidence of an increased risk associated with home confinements but indicated that there were fewer problems than were encountered in the deliveries in mothers confined in hospital.     

Chronic exposure to sour gas emissions: meeting a community concern with epidemiologic evidence.

For 25 years residents of a rural area in southwestern Alberta have complained of health problems attributed to sour gas emissions from nearby natural gas refineries. We undertook a large epidemiologic study of the current health status and the selected morbidity rates among 2152 people in the exposed area. We established two comparison groups: one was a demographically similar unexposed population and the other a demographically different group also exposed to sour gas emissions in another region. The methods included a cross-sectional survey of current residents and separate historical cohort studies involving registry linkage to investigate cancer incidence and all-cause mortality. The cross-sectional survey involved a comprehensive health questionnaire, standardized clinical examinations by physicians blinded to the subjects'' symptoms and concerns, and several laboratory tests. We were able to contact just under 60% of the people who we knew had moved from each area since 1958 and found no evidence of selective migration for health reasons. Although the residents of the exposed area reported an excess number of symptoms and health problems there were no significant differences in the mortality rate, incidence of cancer, reproductive problems, major ailments, hair levels of arsenic and certain metals or respiratory function between the groups.     

Facilitating children's contributions in clinic? Findings from an in-depth qualitative study with children with Type 1 diabetes

Diabet. Med. 29, 1303-1310 (2012) ABSTRACT: Aims There is a policy drive for children to contribute more directly in clinic visits. However, this has yet to be routinely achieved in practice and relatively little is known to date about younger children's views of their illness and care. This in-depth qualitative study set out to explore the experiences of children 10?years or younger living with Type?1 diabetes. Methods The sample of 17 children was self-selecting from a population of 140 children under 11?years receiving treatment for Type?1 diabetes at two outpatient clinics in a large, multicultural city. Fieldwork comprised home visits, discussion groups and observation in outpatient clinics. Results Children's strong experiential understandings of their condition, the impact of their social position on experiences of care and their active role in maintenance of the regimen were at odds with how they were positioned, and how the disease was discussed, in clinic. Conclusion Findings have implications for facilitating children's contributions in clinic, understanding how ideas about children are reproduced in clinical settings and supporting clinicians to engage with the capacities and priorities of children living with long-term illness.     

Comparison of immunisation rates in general practice and child health clinics.

OBJECTIVE--To compare immunisation uptake rates in general practice surgeries and community child health clinics. DESIGN--Cohort study using data from a computerised child health system. SETTING--Four health districts of North East Thames Regional Health Authority. SUBJECTS--3616 children born January to March 1990 and resident in the four districts at the end of January 1991. MAIN OUTCOME MEASURES--Immunisation uptake rates at 10-12 months of age, age at immunisation, scheduling performance at the two locations, and odds ratios of outstanding immunisations. RESULTS--80% of children registered at general practices had completed their third dose of pertussis immunisation compared with 68% of those at health clinics. Median ages at the third dose were 24 weeks and 29 weeks at the two locations respectively. Scheduling was more effective at general practice surgeries. Unscheduled immunisations were more likely to be given after the recommended age. Overall, children resident in rural and suburban areas had greater uptakes than those in inner cities. Odds ratios for not being fully immunised among children registered at health clinics were 1.4 times those among children immunised in general practice and 3.0 times greater among children resident in inner cities than among those in rural and suburban districts. Children who moved into a district, however, were no less likely to be fully immunised than children who were born there. CONCLUSIONS--The immunisation uptake rate was better in general practices than in child health clinics in both inner city and rural and suburban areas. Uptake may be increased with additional support to enable general practitioners to undertake immunisations, especially in inner cities.     

All Military Adolescents Are Not the Same: Sexuality and Substance Use among Adolescents in the U.S. Military Healthcare System

Data examining sexuality and substance use among active duty and military-dependent youth is limited; however, these psychosocial factors have military implications. Adolescents and young adults aged 12–23 were recruited from an active-duty trainee clinic (n = 225) and a military pediatric clinic (n = 223). Active duty participants were more likely to be older, male, White, previous tobacco users, and report a history of sexual activity and less contraception use at their most recent intercourse, compared to the dependent group. Over 10% of all participants indicated attraction to members of the same gender or both genders. In logistic regression analysis, non-White participants were less likely to use contraception compared to White participants. Adolescents and young adults seen in military clinics frequently engage in high-risk behavior. Clinicians who care for military youth should assess their patient’s psychosocial history. Further study of this population is warranted to identify factors that may influence risk and resilience.     

The Prevalence of Non-Alcoholic Fatty Liver Disease in Children and Adolescents: A Systematic Review and Meta-Analysis

MethodsWe conducted a systematic review and meta-analysis of all studies reporting a prevalence of NAFLD based on any diagnostic method in participants 1–19 years old, regardless of whether assessing NAFLD prevalence was the main aim of the study.ResultsThe pooled mean prevalence of NAFLD in children from general population studies was 7.6% (95%CI: 5.5% to 10.3%) and 34.2% (95% CI: 27.8% to 41.2%) in studies based on child obesity clinics. In both populations there was marked heterogeneity between studies (I² = 98%). There was evidence that prevalence was generally higher in males compared with females and increased incrementally with greater BMI. There was evidence for differences between regions in clinical population studies, with estimated prevalence being highest in Asia. There was no evidence that prevalence changed over time. Prevalence estimates in studies of children/adolescents attending obesity clinics and in obese children/adolescents from the general population were substantially lower when elevated alanine aminotransferase (ALT) was used to assess NAFLD compared with biopsies, ultrasound scan (USS) or magnetic resonance imaging (MRI).ConclusionsOur review suggests the prevalence of NAFLD in young people is high, particularly in those who are obese and in males.     

CRUSADE评分联合血栓弹力图对急性冠脉综合征患者出血风险的评估

目的:运用CRUSADE评分系统联合血栓弹力图对急性冠脉综合征(acute coronary syndrome,ACS)患者抗栓治疗中的出血风险进行评估。方法:回顾性分析2013年1月至2013年12月在上海交通大学医学院附属新华医院住院的ACS患者病历249例,用CRUSADE评分联合血栓弹力图评估ACS患者30天出血事件的发生。结果:随访的249例ACS患者,共有46例(18.5%)患者发生了出血事件;按照CRUSADE评分进行危险分层,极低危组、低危组、中危组、高危组、极高危组的出血率分别为:15%、7.5%、21.2%、32.5%26.7%;各组间出血率的比较:中危组、高危组及极高危组各组的出血率均高于低危组,差异有统计学意义;而高危组出血率高于极低危组,差异有统计学意义,而极低危组与其他各组比较,差异无统计学意义;低危组以上患者出血率高于低危组以下,差异有统计学意义。低危组以上中危组、高危组及极高危组各组间出血率比较,差异无统计学意义;按照血小板抑制率中位数分组,大于中位数组的出血率高于小于中位数组,差异有统计学意义。经多因素Logistic分析:PAg T抑制率(ADP)是ACS患者抗栓治疗中出血事件的独立影响因素。利用ROC曲线分析CRUSADE评分、血栓弹力图以及两者联合对患者出血事件发生的评估,两者联合的曲线下面积大于单独利用CRUSADE评分。结论:随着CRUSADE评分危险分层的增加出血的发生率亦呈增加趋势;危险分层低危以上的患者,不论中危、高危、极高危发生出血事件风险较低危险以下有明显增加;血栓弹力图监测血小板抑制率可作为CRUSADE评分的补充,提高对ACS患者出血风险的预测。     

Seasonal variations in the level of immunoglobulins and serum proteins of children differing by exposure to air-borne lead

A semicohort of children, initial age about 11.5 years, from an exposure area near a secondary lead smelting plant (E group children) was examined for some humoral immune response parameters in the blood and saliva and compared to a group of control children matched by age living in a relatively unpolluted rural area (Co group children). All examinations were performed every autumn and spring over a period of 2 successive years, and the data included in the final analysis were only from children who had completed at least 3 of the 4 examination series performed. To sum up, children from area E showed a clearcut elevation of mean blood lead (Pb) levels with marked seasonal fluctuations peaking in spring; Pb levels in the blood of Co group children had no such season-related fluctuation patterns and tended to slightly decline over the two years of observation. Delta-aminolevulinic acid dehydratases (ALAD) levels in area E were of distinctly lower mean values than in area Co, but no correlation with mean blood Pb levels could be observed. Levels of IgG were more or less inversely correlative with Pb levels in both sexes, levels of IgM showed a distinct downward trend in E group children at all samplings. Total serum protein (SP) levels of children from area E showed a reverse correlation with plumbemia, secretory IgA (sIgA) concentrations showed a decrease in E group children of both sexes, but the values tended to converge with control values. Levels of alpha 1-antitrypsin (A 1-AT) showed marked season-related fluctuation patterns in Co children, the curves in E group children turned steeply upward from the third examination series on. Ceruloplasmin (CPL) levels in E group children had a clearcut upward trend at three subsequent blood samplings, the curves in Co group children continued to drop. Children from area E showed markedly higher frequency rates of abnormal values than did children from Co area.     

Association and linkage of the dopamine transporter gene and attention-deficit hyperactivity disorder in children: heterogeneity owing to diagnostic subtype and severity.

Attention-deficit hyperactivity disorder (ADHD) affects approximately 3%-5% of children in the United States. In the current psychiatric nomenclature, ADHD comprises three subtypes: inattentive, hyperactive-impulsive, and combined. In this study, we used four analytic strategies to examine the association and linkage of the dopamine transporter gene (DAT1) and ADHD. Our sample included 122 children referred to psychiatric clinics for behavioral and learning problems that included but were not limited to ADHD, as well as their parents and siblings. Within-family analyses of linkage disequilibrium, using the transmission disequilibrium test (TDT), confirmed the 480-bp allele as the high-risk allele. In between-family association analyses, levels of hyperactive-impulsive symptoms but not inattentive symptoms were related to the number of DAT1 high-risk alleles. Siblings discordant for the number of DAT1 high-risk alleles differed markedly in their levels of both hyperactive-impulsive and inattentive symptoms, such that the sibling with the higher number of high-risk alleles had much higher symptom levels. Within-family analyses of linkage disequilibrium, using the TDT, suggested association and linkage of ADHD with DAT1 and that this relation was especially strong with the combined but not the inattentive subtype. The relation of DAT1 to ADHD increased monotonically, from low to medium to high levels of symptom severity. Our results replicate and extend previous findings of the association between the DAT1 gene and childhood ADHD. This represents one of the first replicated relations of a candidate gene and a psychiatric disorder in children.     

Carriage of Neisseria meningitidis and Neisseria lactamica among ethnic Greek school children from Russian immigrant families in Athens

During February and March 1995, a survey of meningococcal carriage in 625 school children was carried out in a suburb of Athens in which there was a large number of ethnic Greeks who had immigrated from Russia beginning in the early 1990s. The objectives of the study were: (1) to determine if factors associated with carriage of meningococci observed in a previous study of Greek school children were similar for the immigrant population; (2) to compare phenotypic characteristics of meningococci from the immigrant population with those isolated from children in Athens. Overall isolation rate for meningococci was 82/625 (13.1%), significantly higher than that found for school children in Athens (5.8%) during the winter of 1990 1991 (5.8%) (chi=25.98, P=0.0000003). By univariate analysis, carriage was not associated with sex, number of individuals per household, blood group, secretor status, socioeconomic level or maternal smoking; however, it was associated with fathers' smoking. The high proportion of men who smoked compared with the low proportion of women smokers might contribute to this finding. The main serogroup of meningococci isolated from this population was A (28%). While serogroup A appears to be more prevalent among Russian and Kurdish immigrants (14%) than among Greek school children or military recruits (4%), there has not been an increase in group A meningococcal disease in Greece. The isolation rate for N. lactamica was high 105/625 (17.3%). A few of these strains bound some of the monoclonal antibodies used for meningococcal serotyping and subtyping, and they are being examined in greater detail.     

HIV infection in patients attending clinics for sexually transmitted diseases in England and Wales. Collaborative Study by Consultants in Genitourinary Medicine and the Public Health Laboratory Service.

A national study of the prevalence of HIV antibody designed to monitor sexual spread of HIV infection in England and Wales was made of homosexual and heterosexual patients attending sexually transmitted disease clinics in four districts in 1985, seven in 1986, and 14 in 1987. Patients were invited to participate and were counselled. Among homosexual men in two clinics in south east England, HIV antibody was found in 92 (12.9%) of 711 in 1985, 65 (15.2%) of 428 in 1986, and 81 (14.6%) of 556 in 1987: corresponding findings in the other regions were 16 (5.0%) of 321, 41 (6.3%) of 654, and 21 (3.1%) of 678. The prevalence of HIV antibody was higher in homosexual than bisexual men, in patients aged 25 years or more, or with one or more specified minor complaints. Among heterosexual patients in the south east in 1986, HIV antibody was found in seven (3.0%) of 230 men and three (1.3%) of 233 women and in 1987 in 10 (1.0%) of 962 men and seven (0.7%) of 949 women. In other areas corresponding findings in 1986 were two (0.2%) of 950 men and three (0.4%) of 752 women and in 1987 were three (0.06%) of 5312 men and one (0.02%) of 4778 women. All but one of the heterosexual patients with the antibody were intravenous drug abusers or had had sexual contacts in or were from an area abroad with a high prevalence of AIDS. Failure to identify a heterosexual patient with HIV antibody not in a risk group (other than that of being an attender at the clinic) or who did not have a sexual partner in a risk group suggests that their prevalence in the patient population of the clinics in the south east is less than one in 700 and in the other regions less than one in 3000. Refusals to participate increased during the study but comparisons of patients who agreed and refused in terms of age, the presence of symptoms suggesting AIDS, travel abroad, and number of sexual partners a month showed little evidence of selective bias.