Current Issue : October - December Volume : 2014 Issue Number : 4 Articles : 8 Articles
Background: Untreated celiac disease is traditionally believed to be associated with malabsorption and\nunderweight. However, studies describing body mass index (BMI) in individuals at the time of diagnosis have\nshown contradictory results. We investigated the differences in weight, height, and BMI in 12- year-old children\nwith screening-detected celiac disease compared to their healthy peers.\nMethods: In a population-based screening study of 12,632 12-year-old children, blood samples were analyzed\nfor markers of celiac disease. Children with elevated markers were referred for a small bowel biopsy. Weight and\nheight were measured in 239 out of 242 children with screening-detected celiac disease (57.3% girls) and in 12,227\nchildren without celiac disease (48.5% girls). BMI was categorized according to the International Obesity Task Force.\nAge- and sex-specific cut-off points for underweight, normal weight, and overweight were used.\nResults: Children with celiac disease weighed less and were shorter than their peers (median weight 45.2 kg,\ninterquartile range (IQR) 40.2ââ?¬â??52.2 kg vs. 47.0 kg, IQR 41.1ââ?¬â??54.4 kg, respectively, p = 0.01; median height 156.5 cm,\nIQR 151.0ââ?¬â??162.0 cm vs. 157.5 cm, IQR 152.0ââ?¬â??163.0 cm, respectively, p = 0.04). In comparing those with celiac\ndisease to their healthy peers, 4.2% vs. 5.2% were underweight, 82.0% vs. 72.8% were normal weight, and 13.8%\nvs. 21.9% were overweight, respectively. There was no association between being underweight and the risk of\nhaving undiagnosed celiac disease (Odds ratio (OR) 1.3, 95% CI 0.7ââ?¬â??2.4), but the risk was significantly lower\namong overweight children (OR 0.56, 95% CI 0.4ââ?¬â??0.8). Median BMI was slightly lower among the children with\nscreening-detected celiac disease compared to their healthy peers (18.6 kg/m2, IQR 17.1ââ?¬â??19.8 kg/m2 vs. 18.8 kg/m2,\nIQR 17.2ââ?¬â??21.1 kg/m2, respectively, p = 0.05), but most of the celiac disease cases had a normal BMI.\nConclusions: At a population level, children with celiac disease weigh less, are shorter, and have a lower BMI\ncompared to their peers without celiac disease, and this emphasizes the importance of early recognition and\ntreatment of the condition. However, at an individual level, growth parameters are not reliable in establishing\nthe diagnosis....
Background: Acute viral respiratory exacerbation is one of the most common conditions encountered in a\npaediatric emergency department (PED) during winter months. We aimed at defining clinical predictors of chest\nradiography prescription and radiographic abnormalities, among infants with bronchiolitis in a paediatric\nemergency department.\nMethods: We conducted a prospective cohort study of children less than 2 years of age with clinical bronchiolitis,\nwho presented for evaluation at the paediatric emergency department of an urban general hospital in France.\nDetailed information regarding historical features, examination findings, and management were collected. Clinical\npredictors of interest were explored in multivariate logistic regression models.\nResults: Among 410 chest radiographs blindly interpreted by two experts, 40 (9.7%) were considered as abnormal.\nClinical predictors of chest radiography achievement were age (under three months), feeding difficulties, fever over\n38�°C, hypoxia under than 95% of oxygen saturation, respiratory distress, crackles, and bronchitis rales. Clinical\npredictors of radiographic abnormalities were fever and close to significance hypoxia and conjunctivitis.\nConclusion: Our study provides arguments for reducing chest radiographs in infants with bronchiolitis. For infants\nwith clinical factors such as age less than three months, feeding difficulties, respiratory distress without hypoxia,\nisolated crackles or bronchitis rales, careful clinical follow-up should be provided instead of chest radiography...
Background: Mental disorders in childhood have a considerable health and societal impact but the associated\nnegative consequences may be ameliorated through early identification of risk and protective factors that can\nguide health promoting and preventive interventions. The objective of this study was to inform health policy and\npractice through identification of demographic, familial and environmental factors associated with emotional or\nbehavioural problems in middle childhood, and the predictors of resilience in the presence of identified risk factors.\nMethods: A cohort of 706 mothers followed from early pregnancy was surveyed at six to eight years post-partum\nby a mail-out questionnaire, which included questions on demographics, children�s health, development, activities,\nmedia and technology, family, friends, community, school life, and mother�s health.\nResults: Although most children do well in middle childhood, of 450 respondents (64% response rate), 29.5% and\n25.6% of children were found to have internalising and externalising behaviour problem scores in the lowest\nquintile on the NSCLY Child Behaviour Scales. Independent predictors for problem behaviours identified through\nmultivariable logistic regression modelling included being male, demographic risk, maternal mental health risk, poor\nparenting interactions, and low parenting morale. Among children at high risk for behaviour problems, protective\nfactors included high maternal and child self-esteem, good maternal emotional health, adequate social support,\ngood academic performance, and adequate quality parenting time.\nConclusions: These findings demonstrate that several individual and social resilience factors can counter the\ninfluence of early adversities on the likelihood of developing problem behaviours in middle childhood, thus\ninforming enhanced public health interventions for this understudied life course phase....
Background: In addition to the benefits on physical and mental health, cardiorespiratory fitness has shown to have\npositive effects on cognition. This study aimed to investigate the relationship between cardiorespiratory fitness and\nbody weight status on academic performance among seventh-grade students.\nMethods: Participants included 1531 grade 7 students (787 male, 744 female), ranging in age from 12 to 14 years\n(Mage = 12.3 �± 0.60), from 3 different cohorts. Academic performance was measured using the marks students had,\nat the end of their academic year, in mathematics, language (Portuguese), foreign language (English), and sciences.\nTo assess cardiorespiratory fitness the Progressive Aerobic Cardiovascular Endurance Run, from Fitnessgram, was\nused as the test battery. The relationship between academic achievement and the independent and combined\nassociation of cardiorespiratory fitness/weight status was analysed, using multinomial logistic regression.\nResults: Cardiorespiratory fitness and weight status were independently related with academic achievement. Fit\nstudents, compared with unfit students had significantly higher odds for having high academic achievement\n(OR = 2.29, 95% CI: 1.48-3.55, p < 0.001). Likewise, having a normal weight status was also related with high\nacademic achievement (OR = 3.65, 95% CI: 1.82-7.34, p < 0.001).\nConclusions: Cardiorespiratory fitness and weight status were independently and combined related to academic\nachievement in seventh-grade students independent of the different cohorts, providing further support that\naerobically fit and normal weight students are more likely to have better performance at school regardless of the\nyear that they were born....
Background: Non-infection caused urticaria is a common ailment in adolescents. Its symptoms (e.g., unusual rash\nappearance, limitation of daily activities, and recurrent itching) may contribute to the development of depressive\nstress in adolescents; the potential link has not been well studied. This study aimed to investigate the risk of major\ndepression after a first-attack and non-infection caused urticaria.\nMethods: This study used the Taiwan Longitudinal Health Insurance Database. A total of 5,755 adolescents hospitalized\nfor a first-attack and non-infection caused urticaria from 2005 to 2009 were recruited as the study group, together with\n17,265 matched non-urticarial enrollees who comprised the control group. Patients who had any history of urticaria or\ndepression prior to the evaluation period were excluded. Each patient was followed for one year to identify the\noccurrence of depression. Cox proportional hazards models were generated to compute the risk of major depression,\nadjusting for the subjects� sociodemographic characteristics. Depression-free survival curves were also analyzed.\nResults: Thirty-four (0.6%) adolescents with non-infection caused urticaria and 59 (0.3%) non-urticarial control subjects\nsuffered a new-onset episode of major depression during the study period. The stratified Cox proportional analysis\nshowed that the crude hazard ratio (HR) of depression among adolescents with urticaria was 1.73 times (95% CI,\n1.13-2.64) than that of the control subjects without urticaria. Moreover, the HR were higher in physical (HR: 3.39, 95% CI\n2.77-11.52) and allergy chronic urticaria (HR: 2.43, 95% CI 3.18-9.78).\nConclusion: Individuals who have a non-infection caused urticaria during adolescence are at a higher risk of developing\nmajor depression....
Background: Long chain polyunsaturated fatty acids (LCPUFAs) may influence the immune system. Our objective\nwas to compare the frequency of common illnesses in infants who received formula with or without added\nLCPUFAs.\nMethods: In this observational, multi-center, prospective study, infants consumed formula with 17 mg DHA and\n34 mg ARA/100 kcal (n = 233) or with no added DHA or ARA (n = 92). Pediatricians recorded respiratory illnesses,\notitis media, eczema, and diarrhea through 1 year of age.\nResults: Infants who consumed formula with DHA/ARA had lower incidence of bronchitis/bronchiolitis (P = 0.004),\ncroup (P = 0.044), nasal congestion (P = 0.001), cough (P = 0.014), and diarrhea requiring medical attention\n(P = 0.034). The odds ratio (OR) of having at least one episode of bronchitis/bronchiolitis (0.41, 95% CI 0.24, 0.70;\nP = 0.001), croup (0.23, 95% CI 0.05, 0.97; P = 0.045), nasal congestion (0.37, 95% CI 0.20, 0.66; P = 0.001), cough\n(0.52, 95% CI 0.32, 0.86; P = 0.011), and diarrhea requiring medical attention (0.51, 95% CI 0.28, 0.92; P = 0.026) was\nlower in infants fed DHA/ARA. The OR of an increased number of episodes of bronchitis/bronchiolitis, croup, nasal\ncongestion, cough, and diarrhea, as well as the hazard ratio for shorter time to first episode of bronchitis/bronchiolitis,\nnasal congestion, cough, and diarrhea were also significantly lower in the DHA/ARA group.\nConclusions: In healthy infants, formula with DHA/ARA was associated with lower incidence of common respiratory\nsymptoms and illnesses, as well as diarrhea....
Background: The beneficial effects of the Mediterranean diet have been amply proven in adults with\ncardiovascular risk factors. The effects of this diet have not been extensively assessed in pediatric populations with\nobesity, insulin resistance (IR) and metabolic syndrome (MetS). The aim of this study was to assess the efficacy of\nthe Mediterranean style diet (MSD) to decrease cardiovascular risk factors in children and adolescents with obesity.\nMethods: Participants were randomly assigned to a MSD rich in polyunsaturated fatty acids, fiber, flavonoids and\nantioxidants (60% of energy from carbohydrate, 25% from fat, and 15% from protein, (n = 24); or a standard diet\n(55% of carbohydrate, 30% from fat and 15% from protein, (n = 25), the caloric ingest was individualized. At baseline\nand 16-week of intervention, the glucose, triglycerides (TG), total cholesterol (TC), HDL-C, LDL-C were measured as\nwell as the body composition and anthropometric data. The diet compliance was determined by the 24-hour\nrecalls.\nPaired Student�s t and Macnemar�s test were used to compare effects in biochemical, body composition,\nanthropometric, and dietary variables.\nResults: The MSD group had a significantly decrease in BMI, lean mass, fat mass, glucose, TC, TG, HDL-C and LDL-C.\n(p < 0.05); the diet compliance increased consumption of omega 9 fatty acids, zinc, vitamin E, selenium, and\ndecreased consumption of saturated fatty acids (p < 0.05). The standard diet group decrease in glucose levels and\nfrequency of glucose >100 mg/dL (p < 0.05).\nConclusion: The MSD improves the BMI, glucose and lipid profile in children and adolescents with obesity and any\nMetS component....
Background: Assessing the ventilatory status of non-intubated infants in the Pediatric Intensive Care Unit (PICU) is\na constant challenge. Methods to evaluate ventilation include arterial blood gas analysis (ABG), which is invasive\nand intermittent, and transcutaneous carbon dioxide monitoring (PtcCO2), which, while non-invasive, is also intermittent.\nA method that is non-invasive and continuous would be of great benefit in this population. We hypothesized that\nnon-invasive capnometry via sidestream monitoring of exhaled carbon dioxide (CO2) would provide an acceptable\nmeasurement of ventilatory status when compared to ABG or PtcCO2.\nMethods: Preliminary prospective study of infants less than one year of age admitted to the PICU in a large urban\nteaching hospital. Infants not intubated and not requiring non-invasive ventilation were eligible. A sidestream CO2\nreading was obtained in a convenience sample of 39 patients. A simultaneous ABG was collected in those with an\narterial catheter, and a PtcCO2 was obtained in those without.\nResults: Correlation of sidestream CO2 with ABG was excellent (r2 = 0.907). Sidestream correlated less well with PtcCO2\n(r2 = 0.649). Results were not significantly altered when weight and respiratory rate were added as independent\nvariables. Bland-Altman analysis revealed a bias of -2.7 with a precision of �±6.5 when comparing sidestream CO2 to\nABG, and a bias of -1.7 with a precision of �±9.9 when comparing sidestream CO2 to PtcCO2.\nConclusions: Performance of sidestream monitoring of exhaled CO2 is acceptable clinical trending to assess the\neffectiveness of ventilation in non-intubated infants in the PICU...
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