non-Caucasian Children Research Articles

Trends in cystic fibrosis survival over 40 years in South Africa: An observational cohort study

Temporal trends in cystic fibrosis (CF) survival from low-middle-income settings is poorly reported. We describe changes in CF survival after diagnosis over 40 years from a South African (SA) CF center. An observational cohort study of people diagnosed with CF from 1974 to 2019. Changes in age-specific mortality rates from 2000 (vs. before 2000) were estimated using multivariable Poisson regression. Data were stratified by current age < or ≥10 years and models controlled for diagnosis age, sex, ethnicity, genotype, and Pseudomonas aeruginosa (PA) infection. A second analysis explored the association of mortality with weight and forced expiratory volume in 1 sreported as z-scores (FEV1z-scores) at age 5-8 years. A total of 288 people (52% male; 57% Caucasian; 44% p.Phe508del homozygous) were included (median diagnosis age 0.5 years: Q1, Q3: 0.2, 2.5); 100 (35%) died and 30 (10%) lost to follow-up. Among age >10 years, age-specific mortality from 2000 was significantly lower (adjusted hazard ratio [aHR]: 0.14; 95% confidence interval [CI]: 0.06, 0.29; p < 0.001), but not among age <10 years (aHR: 0.67; 95% CI: 0.28, 1.64; p = 0.383). In children <10 years, Caucasian ethnicity was associated with lower mortality (aHR 0.17; 95% CI: 0.05, 0.63), and longer times since first PA infection with higher mortality (aHR: 1.31; 95% CI: 1.01, 1.68). Mortality was sevenfold higher if FEV1z was<-2.0 at age 5-8 years (aHR: 7.64; 95% CI: 2.58, 22.59). Overall, CF survival has significantly improved in SA from 2000 in people older than 10 years. However, increased risk of mortality persists in young non-Caucasian children, and with FEV1z<-2.0 at age 5-8 years.

Socioeconomic Status, Race and Parental Initial Response to Children's Mental Illness.

To examine how socioeconomic status (SES) and race affect parents' initial response (IR) to their child's mental illness (MI) including 1. Parental confidant(s); 2. Lag time in professional help-seeking; and 3. Referral source. 70 parents of patients new to a Child Psychiatry clinic completed a survey to assess their IR to their child's MI. SES was determined using the United States Census Bureau median income by zip codes. Summary statistics are frequencies and percentages for categorical data, and medians and quartiles for continuous data. Twenty-five percent of parents reported low SES and 31% Non-Caucasian Children (NCC). Confidants of Caucasian and NCC were Pediatrician (77% vs 50%, p = 0.03), and family (73% vs 32%, p = 0.002). Comparing help-seeking Lag Times 66% reported a delay of 1 year or more (p = 0.040). Overall Pediatricians were the leading confidant. Lag times were one year or more with stronger trends in NCC.

Clinical characteristics and surgical management of spinal cord tumors in non-Caucasian Hispanic children

Clinical characteristics and surgical management of spinal cord tumors in non-Caucasian Hispanic children

Haploidentical Stem Cell Transplant with Post-Transplant Cyclophosphamide with Busulfan, Fludarabine and Thiotepa Conditioning for Children with Thalassemia Major

Introduction Allogeneic stem cell transplant (SCT) is a curative option for children with thalassemia major. For non-Caucasian children lacking a matched donor success of haploidentical SCT with post-transplant cyclophosphamide (PTCy) has widened donor pool. Now the next need is to avoid total body irradiation (TBI) as it is not universally available. Another need is to avoid pre-transplant immune suppression (PTIS) with fludarabine and dexamethasone as it increases the risk of infection prior to HSCT. Starting cyclosporine as early as day-1 has shown to reduce severe cytokine release syndrome (CRS) post haploidentical SCT. Severe CRS can lead to increase morbidity & mortality. Here we describe outcomes of two children with thalassemia who underwent haploidentical SCT with PTCy with TBI free conditioning and had early introduction of cyclosporine. Methods Two children with thalassemia major aged 4 and 5-years respectively who had no matched donor underwent haploidentical SCT after taking informed consent of the parents. Donor for the first patient was her father and for the second patient was his mother. Both patients were Pesaro class II. Both children received PTIS in the form of oral hydroxyurea and MMF for 60 days before starting conditioning. The conditioning was with Rituximab 100 mg/m2 IV on day-8, Thiotepa 10 mg/kg on day-7, Busulfan 3.2 mg/kg/dose daily IV for 4 days(day-6 to -3), Fludarabine 40 mg/m2/dose daily IV for 4 days(day-6 to -3) and Rabbit ATG 1.5 mg/kg/dose daily for 3 days (day-4 to -2). Peripheral blood stem cell dose was 8 and 10 million/kg CD34+ cells respectively for them. Graft vs. host disease(GVHD) prophylaxis was with PTCy 50 mg/kg on day+3 & 4, intravenous cyclosporine from day-1 and MMF from day+5. Results Both children engrafted(neutrophils on day+16, day+17 & platelets on day+13, day+12 respectively). None developed CRS. First patient developed acute GVHD of both eyes on day+30 along with skin involvement. She needed steroids topical and systemic and later Ruxolitinib to control GVHD and amniotic membrane covering of both corneas. Second patient developed late onset acute GVHD grade III on day+132. Managed successfully with steroids, etanercept and MMF. No chronic GVHD was seen in both the cases. Chimerism on day+30, day+100 and 1-year is fully donor for both the patients. Both children are alive and thalassemia free at follow up of 12-months. First patient is off immune suppression and second is on tapering doses of immune suppression. Immune reconstitution on day+128 in Case 1, showed CD4-167/ul, CD8-170/ul and on day+100 in Case 2 showed CD4-204/ul, CD8-592/ul. Conclusion Thiotepa, Busulfan & Fludarabine based conditioning is a radiotherapy free option for children with thalassemia major undergoing haploidentical SCT with PTCy. PTIS with oral MMF and hydroxyurea is feasible. Early introduction of cyclosporine is feasible and can possibly reduce CRS.

The Role of Race in the Stereotyping of a Speaker’s Accent as Native or Non-native

An accent is a distinctive way a language is pronounced in a nation, community, or social class. Everyone has an accent, and we acquire our accents from listening to the people around us. Non-Caucasian children born in the United States most often speak English with a standard American accent, but they are often perceived to speak with a non-native accent. Three studies were done over three years to understand this behavior. In the first study, we hypothesized that the speaker’s race would play a role in the perception of the speaker’s accent. We found that the race of the speaker alone influenced the perception of the speaker’s accent as native or non-native, with native representing the standard American accent. In the second study, we hypothesized that listeners’ exposure to a linguistically diverse environment would help prevent the formation of stereotypes. The results from the second study showed that exposure to a multicultural environment reduced listeners’ stereotyping of a speaker’s accent based on the attributed race of the speaker, and this was independent of the race of the listener. Lastly, the third study explored the effectiveness of a brief intervention program that directly educated participants about speech stereotyping. We hypothesized that children would be more receptive to the educational program on stereotypes than adults. Our study showed that adults were receptive to education on stereotypes; however, the study on children’s receptiveness to education on stereotypes was inconclusive.

Paediatric melanoma.

Paediatric melanoma, although rare, is the most common skin cancer in children. Our current knowledge on paediatric melanoma incidence trends is expanding, as several studies have addressed this issue with conflicting results. Known risk factors for paediatric melanoma include family history of melanoma, a previous history of malignancy, large congenital nevi, numerous melanocytic nevi, sunburns, increased UV exposure and a sun-sensitive phenotype. In younger children, melanoma more often presents with atypical features, such as a changing, amelanotic or uniformly coloured, often bleeding lesion, not fulfilling in most cases the conventional ABCDE criteria. The major differential diagnoses are melanocytic nevi, proliferative nodules in congenital nevi and atypical Spitz tumours. Moreover, in the younger age group non-Caucasian children are over-represented, tumours tend to be thicker and lymph nodes are often involved. Despite the frequent diagnosis at an advanced stage, the overall survival is fair in paediatric melanoma. Specific guidelines for management of melanoma in children do not exist, and most often the disease is treated similarly to melanoma in adults.

The Effect of Socioeconomic Status and Parental Demographics on Activation of Department of Child and Family Services in Pediatric Burn Injury

Burns resulting from child maltreatment are tragic causes of significant morbidity and mortality, most commonly affecting children under 3 years of age. More than one third of nonaccidental burns occur in single-parent homes or have parents with history of mental illness, substance abuse, incarceration, or Department of Children and Family Services (DCFS) involvement. The authors sought to profile pediatric burn injuries associated with DCFS investigations. They performed a retrospective chart review of pediatric burn patients, admitted between January 1, 2011 and December 31, 2014. They analyzed patient and household demographics, family composition, employment, zip code, insurance, etiology, percent TBSA burned, surgical interventions, length of hospital stay, disposition, prior DCFS involvement, and DCFS investigation outcomes. There were 126 DCFS investigations involving patients with average age of 2.6 ± 3.2 years and 5 ± 5.6% TBSA burn. Scalds were the most prevalent etiology at 76%. Parents involved with DCFS were 5 years younger than those without DCFS. Factors associated with increased odds of DCFS investigation were non-Caucasian race, single-parent homes, unemployed primary caretaker, Medicaid utilization, and prior DCFS involvement. A majority of DCFS investigations were initiated at outside hospitals, and they found one third to be substantiated cases of abuse. Non-Caucasian children, under 3 years of age, from lower socioeconomic or single-parent homes, are associated with higher rates of DCFS investigations. The majority of DCFS investigations were unsubstantiated and there were no significant epidemiological differences between unsubstantiated and substantiated cases of abuse. Improved understanding of sociodemographic risk factors for children at higher risk for negligence or intentional abuse warrants focused public health programs on regional prevention and education.

An analysis of outcomes in children with cystic fibrosis in a tertiary African centre: A retrospective study.

&lt;p&gt;&lt;strong&gt;Abstract&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Cystic Fibrosis (CF) is a common genetic disorder in Caucasians that has become increasingly prevalent in populations of African descent. The clinical presentation in African children with CF is commonly related to nutritional and growth abnormalities.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims/Objectives&lt;/strong&gt;: To describe clinical, laboratory and spirometric characteristics of children followed up at the CF Clinic at Inkosi Albert Luthuli Central Hospital, Durban, South Africa.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods&lt;/strong&gt;: A retrospective chart review of clinical, laboratory and spirometric data of patients registered from January 2013 to January 2016.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; The data was reviewed for 15 patients mean age 132 months (range 26- 219 months), with 53% males. 60% of these children were Caucasians, 26,7% of these being of black African descent. Collectively, the mean age of diagnosis was 45 months (0- 156), although this was higher in the non-Caucasians at 104 months (range 48-156) versus 1,3 months (range 0-3) in Caucasians. The Caucasian group had better nutritional status when compared to non-Caucasians with BMI of 17,2kg/m&lt;sup&gt;2&lt;/sup&gt; vs 14,5 kg/m&lt;sup&gt;2&lt;/sup&gt;, respectively. Age at diagnosis had a negative correlation with weight-for-age &lt;em&gt;Z &lt;/em&gt;score (-0,61; p &amp;lt; 0.05) and BMI (-0,54; p&amp;lt;0.05). The mean FEV&lt;sub&gt;1&lt;/sub&gt; % predicted was 70.0 (16,1- 120,2). FEV&lt;sub&gt;1&lt;/sub&gt;% predicted had a positive correlation with both weight z-score (0,83; p &amp;lt; 0.001) and BMI (0.59; p &amp;lt; 0.05). Chronic pseudomonas infection occurred only in 2 patients, both of whom were above the age of 16 years. On mutational analysis 5 of the non-Caucasian patients had no mutations identified on the 30 panel mutation used for testing. phelF508.del was the most commonly identified mutation in Caucasians; with 4 homozygotes and 4 heterozygotes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion&lt;/strong&gt;: Cystic fibrosis is diagnosed late in non-Caucasian children in South Africa impacting their growth and lung functions. There is a need for a genetic panel that includes mutations specific for children of African descent.&lt;/p&gt;

Family history and ethnicity influencing clinical presentation of type 1 diabetes in childhood.

A different clinical presentation of type 1 diabetes (T1DM) could be supposed in children belonging to different ethnicities, with or without family history of autoimmunity. This study investigates the effect of ethnicity and family history of T1DM on clinical characteristics at presentation in a group of T1DM children. One hundred ninety-six T1DM children <18years, consecutively diagnosed during the years 2011-2014, were studied including 91% of Caucasians of Italian ancestry and 9% of non-Caucasian origin. Children with 1st or 2nd degree relatives affected by T1DM were younger at disease onset (p=0.005) and showed lower HbA1C levels (p=0.002), and higher IAA levels (p=0.01). Non-Caucasian children were younger at disease onset (p=0.029), and showed more severe hyperglycemia (p=0.008) and ketoacidosis (pH p<0.001). HbA1C levels were negatively related to positive family history of T1DM (p=0.01), fasting C-peptide levels (p=0.003), IAA levels (p=0.03), and IA-2 levels (p=0.003). The level of pH was positively influenced by fasting C-peptide (p=0.004), and negatively impacted by C-reactive protein (p=0.01) and non-Caucasian ethnicity (p=0.03). The milder metabolic decompensation in children with a positive family history of T1DM is probably explained by the awareness of the families in terms of early symptoms of T1DM, while the younger age at onset and the higher levels of autoantibodies may suggest a stronger genetic susceptibility, associated with a more aggressive autoimmune process. The younger age in non-Caucasian children is probably explained by the higher genetic susceptibility in subjects belonging to ethnic groups with a low T1DM incidence. Social aspects and poor living conditions probably predominate in determining the increased severity of metabolic decompensation at onset in children from non-Caucasian ethnicities.

25-hydroxyvitamin D serum level in children of different ethnicity living in Italy.

Several factors including ethnicity are known to influence 25(OH)D levels. The purpose of our study was to assess 25(OH)D levels among 1374 pediatric subjects of different ethnicity and to determine the prevalence of vitamin D deficiency and insufficiency among different ethnic groups. The prevalence of 25(OH)D ≤ 20 ng/ml was 44.2, 65.2, 69.2, 54.0, and 44.8 % among Caucasians, Africans, North Africans, Indians, and others, respectively (P < 0.001). The median of 25(OH)D was 21.0 ng/ml (IQR = 14.0-29.6 ng/ml) for the cohort. Season of blood sampling, age, ethnicity, gestational age, birth weight, and z-score BMI were associated with 25(OH)D levels. Caucasians had higher median 25(OH)D levels than sub-Saharan Africans (P < 0.001), North Africans (P < 0.001), and Indians (P < 0.001). There were no significant differences in the median 25(OH)D levels between ethnic groups among infants, whereas for children older than 1 year we found significant differences in 25(OH)D levels in the different ethnic groups, compared to Caucasians. Ethnicity was correlated with 25(OH)D levels among children older than 1 year. We found a high prevalence of vitamin D deficiency and insufficiency after the first year of life, and this was more remarkable in non-Caucasian children.

Gender, socioeconomic, and ethnic differences in sleep patterns in school-aged children

ObjectivesAge-related changes in sleep behavior are well described in children, yet the effect of gender, socioeconomic status (SES), and ethnicity is less clear. These factors are important when developing culturally and socially appropriate guidelines for healthy sleep. The objective of our study was to examine the effects of age, gender, SES, and ethnicity on sleep patterns in school-aged children. MethodsA cross-sectional survey was conducted through primary schools in Adelaide, South Australia. Parents reported demographic information and sleep patterns for school and non-school days for 1845 children aged 5 to 10years. Results48% of the cohort were boys (mean age, 7.7±1.7y), 85% were Caucasian, and there was an equal distribution across defined SES bands. Sleep duration reduced with age and was shorter on non-school than school nights as a result of later bedtimes. Boys, children from low SES areas, and non-Caucasian children reported shorter sleep times than girls, children from high SES areas, and Caucasian children, respectively. Non-Caucasian children from low SES areas reported the shortest sleep opportunity. ConclusionsThe results from our study suggest that in addition to biological mechanisms, sleep behaviors are culturally and socially driven and should be considered when developing recommendations for healthy sleep in children.

Phenotypic expression of the 3120+1G&gt;A mutation in non-Caucasian children with cystic fibrosis in South Africa

Cystic fibrosis (CF) is the most common genetic disorder in Caucasians. Presentation of CF in non-Caucasians is less well studied. This audit was undertaken to determine the phenotypic expression of the 3120+1G>A mutation in black and mixed race children in South Africa. A multi-centre retrospective chart review of clinical, laboratory and spirometry data of non-Caucasian CF patients in four CF centres in South Africa was collected. Data was collected at diagnosis and after a five-year follow-up period. Ethical approval was granted for the study. A total of 30 participants were enrolled of whom 14 (47%) were homozygous and 16 (53%) heterozygous for the 3120+1G>A mutation. The mean age of diagnosis was 13 months. Twenty-four (80%) patients had malnutrition (mean weight z-score -3.6) or failure to thrive (77%) at presentation. Twenty (67%) presented with non-specific abdominal symptoms, whilst fifteen (50%) had recurrent respiratory tract infections. Pseudomonas aeruginosa was detected at a mean age of 21 months. The mean FEV1 was 73% predicted (95% CI 54.0-91.1) at study entry and 68% predicted (95% CI 49.74-87.06) at follow-up. Failure to thrive and a diagnosis of protein energy malnutrition (kwashiorkor) are the common presenting features of CF in children with the 3120+1G>A mutation. Meconium ileus is a rare presenting feature of CF in black and mixed race children with this deletion in South Africa.

Response to Gill et al.

To the Editor: We thank Gill et al. (1) for their interest in our recent publication addressing racial and gender differences among patients with eosinophilic esophagitis (EoE) (2). We were not aware of their prior work in this area, but we appreciate the summary of their findings on this topic and look forward to reviewing the full details in their published report when it is available. On the basis of the information they relate in their letter, however, we would make the claim that our findings were, in fact, very similar to theirs. As noted in Table 1 in our paper, we found that African Americans were diagnosed at a younger age compared with Caucasians, and dysphagia was more commonly reported among Caucasians than African Americans, similar to their report. Our findings were also in agreement that feeding difficulties were more common among African Americans, which may have been due to younger age at diagnosis. Additionally, the Supplementary Table included with our publication presents an age-stratified analysis to account for the known differences in the presentation of EoE in adults vs. children, and shows the exact numbers of subjects in each group. Among children, dysphagia was more common among Caucasians vs. African Americans, and failure-to-thrive was more common among African Americans, findings that were similar to other published reports (3,4). In both the overall and age-stratified analyses, the eosinophil counts were higher in African Americans, though this was not statistically significant. Although the relatively small number of non-Caucasian subjects is a potential limitation, our cohort is one of the largest published studies to date, as can be seen in Figure 1 in our paper, though their abstract including 54 non-Caucasian children with EoE is several-fold more than our pediatric cohort. Moving forward, we agree that a multi-center collaboration evaluating characteristics of EoE patients of different racial backgrounds would be a worthy goal.

Recent progress in the study of the genetics of height

Adult height is a classic polygenic trait of high narrow-sense heritability (h (2) = 0.8). In the late nineteenth to early twentieth century, variation in adult height was used as a model to set the foundation of the fields of statistics and quantitative genetics. More recently, with our increasing knowledge concerning the extent of genetic variation in the human genome, human geneticists have used genome-wide association studies to identify hundreds of loci robustly associated with adult height, providing new insights into human growth and development, and into the architecture of complex human traits. In this review, I highlight the progress made in the last 2 years in understanding how genetic variation controls height variation in humans, including non-Caucasian populations and children.

Moderators and Predictors of Clinical Outcome in a Randomized Trial for Behavior Problems in Pediatric Primary Care

To evaluate putative moderator, predictor, and treatment parameter variables in relation to three outcomes in a clinical trial that compared a modular protocol for on-site, nurse-administered intervention (PONI) and enhanced usual care (EUC) for pediatric behavioral problems in primary care. Patients were 163 clinically referred children for behavior problems in six primary care offices. PONI consisted of seven treatment modules adapted from prior treatment trials with this population, whereas EUC involved a facilitated referral to a community provider. Outcome measures were based on standardized scales reflecting one parent-rated aggregate (child dysfunction) and one child-rated aggregate (child health), and diagnostic interviews with both informants (remission in oppositional defiant disorder). Moderator analyses revealed that PONI was more effective than EUC in reducing child dysfunction by 12-month follow-up among Caucasian children, whereas EUC was more effective than PONI among non-Caucasian children. In the full sample, child health improvement was predicted by the severity of the child's depression and anxiety, and level of family conflict. Duration of child exposure to cognitive-behavioral treatment in PONI was related to greater improvement in overall child health, but other treatment parameters were unrelated to outcome. These few significant relationships notwithstanding the findings indicate that the two treatments had robust effects on several outcomes and across selected child, parent, family, and treatment variables. The findings extend efforts to incorporate mental health services in pediatric practice.

A study of dental development in a Caucasian population compared with a non-Caucasian population

The aim of the present investigation was to compare dental development in children from a non-Caucasian population (Saudi Arabia) with age- and gender- matched children from a Caucasian population (Australia). Randomised study comparing two population groups using a common set of standards. Dental ages of 842 Australian and 456 Saudi Arabian children were assessed from orthopantomograms (OPGs) using the method of Demirjian and co-workers. The children were divided into male and female groups of 5-6, 7-8, 9-10, 11-12, and 13-14 year-olds, and the dental age of each child compared to that the corresponding calendar age group. In both Australian and Saudi Arabian children, the dental ages were higher than the corresponding calendar ages. The largest difference between calendar and dental ages (1.10±0.80 years, p<0.001) was noted in 11-12 year-old Saudi Arabian girls, and the smallest difference (0.33±1.19 years, p<0.01) in 11-12 year-old Australian boys. These discrepancies between calendar and dental ages were significantly different between Australian and Saudi Arabian children (p<0.01). Although the results suggest that dental development of both Caucasian and non-Caucasian children are generally underestimated by current standards, a few age-specific differences between the two types of population can be discerned.

Using Television Mediation to Stimulate Nontraditional Gender Roles among Caucasian and African American Children in the US

An experiment with 146 Kindergarten, first-, fourth-, and fifth-grade children was conducted to determine whether the findings of previous mediation research can be generalized to a new television context (gender stereotyped television) and a new population (African American children). A 3 (mediation type) × 2 (grade) × 2 (race/ethnicity) experiment revealed that the results of prior work can be replicated among Caucasian children but not among African American children. Future work is encouraged to study non-Caucasian children to increase mediation research's theoretical scope and ability to address the needs of a larger, more diverse population.

Meta-Analysis of the INSIG2 Association with Obesity Including 74,345 Individuals: Does Heterogeneity of Estimates Relate to Study Design?

The INSIG2 rs7566605 polymorphism was identified for obesity (BMI≥30 kg/m2) in one of the first genome-wide association studies, but replications were inconsistent. We collected statistics from 34 studies (n = 74,345), including general population (GP) studies, population-based studies with subjects selected for conditions related to a better health status (‘healthy population’, HP), and obesity studies (OB). We tested five hypotheses to explore potential sources of heterogeneity. The meta-analysis of 27 studies on Caucasian adults (n = 66,213) combining the different study designs did not support overall association of the CC-genotype with obesity, yielding an odds ratio (OR) of 1.05 (p-value = 0.27). The I2 measure of 41% (p-value = 0.015) indicated between-study heterogeneity. Restricting to GP studies resulted in a declined I2 measure of 11% (p-value = 0.33) and an OR of 1.10 (p-value = 0.015). Regarding the five hypotheses, our data showed (a) some difference between GP and HP studies (p-value = 0.012) and (b) an association in extreme comparisons (BMI≥32.5, 35.0, 37.5, 40.0 kg/m2 versus BMI<25 kg/m2) yielding ORs of 1.16, 1.18, 1.22, or 1.27 (p-values 0.001 to 0.003), which was also underscored by significantly increased CC-genotype frequencies across BMI categories (10.4% to 12.5%, p-value for trend = 0.0002). We did not find evidence for differential ORs (c) among studies with higher than average obesity prevalence compared to lower, (d) among studies with BMI assessment after the year 2000 compared to those before, or (e) among studies from older populations compared to younger. Analysis of non-Caucasian adults (n = 4889) or children (n = 3243) yielded ORs of 1.01 (p-value = 0.94) or 1.15 (p-value = 0.22), respectively. There was no evidence for overall association of the rs7566605 polymorphism with obesity. Our data suggested an association with extreme degrees of obesity, and consequently heterogeneous effects from different study designs may mask an underlying association when unaccounted for. The importance of study design might be under-recognized in gene discovery and association replication so far.

Inflammatory Bowel Disease in African American Children Compared With Other Racial/Ethnic Groups in a Multicenter Registry

Few epidemiologic investigations characterize inflammatory bowel disease (IBD) in non-Caucasian children. Our study compared IBD characteristics between African Americans and non-African Americans enrolled in a multicenter pediatric IBD registry with endoscopic- and pathology-based diagnosis. The study retrieved data entered from January 2000 to October 2003 on children 1 to 17 years old, inclusive, followed by a consortium of academic and community US pediatric gastroenterology practices. Analyses examined racial/ethnic differences by comparing the proportions of African Americans and non-African Americans in the following categories: each diagnostic disease classification (any IBD, Crohn's disease, ulcerative colitis, indeterminate colitis); age group (<6 y, 6-12 y, or >12 y) at diagnosis or symptom onset; presence of extraintestinal manifestations, Z-scores for height and weight, immunomodulatory therapy, anatomic disease location, and abnormal hemoglobin, albumin, or sedimentation rate at diagnosis. A total of 1406 patients had complete data, 138 (10%) of whom were African American. African Americans more often were older than 12 years of age at diagnosis (52% vs 37%; odds ratio [OR], 1.82; 95% confidence interval [95% CI], 1.28-2.59) and symptom onset (46% vs 30%; OR, 1.99; 95% CI, 1.40-2.84); had Crohn's disease (78% vs 59%; OR, 2.36; 95% CI, 1.56-3.58); and had a low hemoglobin level at diagnosis (39% vs 17%; OR, 3.15; 95% CI, 1.92-5.17). IBD in African American children and adolescents presents more commonly with Crohn's disease and at older ages compared with non-African Americans. Racial/ethnic differences in the epidemiology of IBD, particularly Crohn's disease, among American youths require further investigation.

Commentary: Evidence-based Assessment of Pediatric Pain

Commentary: Evidence-based Assessment of Pediatric Pain