Sixth Year Of Life Research Articles

Respiratory Infections and the Risk of Celiac Disease.

The increasing incidence of celiac disease (CD) suggests that common infections before the onset of autoimmune diseases could be an important factor in switching the immune response. We aimed to explore the relationship between early clinical events and the development of CD in genetically predisposed infants. In this study, 373 newborns from families with at least 1 relative with CD were recruited, and human leukocyte antigen DQ2- or DQ8-positive infants were followed up with clinical and serological evaluations. Cross tabulation and odds ratios were used to explore the risk associated with single variables, and logistic regression analysis was performed to determine the variables that contributed to the risk of developing CD. Stepwise discriminant analysis was used to determine which variables could distinguish case patients from controls before diagnosis. The cumulative incidence of CD in this cohort was 6% at 3 years and 13.5% at 5 years of age, and l34 children (14%) developed CD before the sixth year of life. An analysis of adverse events showed a higher frequency of respiratory tract infections among CD patients during the first 24 months of life. In a stepwise discriminant analysis, which included sex and human leukocyte antigen risk class, only respiratory infections in the second and first years of life significantly contributed to discrimination of case patients versus controls. A multivariate model of discriminant analysis showed that the frequency of respiratory infections in the first 2 years of life could distinguish children who developed CD from those who did not.

Esthetic Concerns and Acceptability of Treatment Modalities in Primary Teeth: A Comparison between Children and Their Parents.

Background and Aim. Esthetic concerns in primary teeth have been studied mainly from the point of view of parents. The aim of this study was to study compare the opinions of children aged 5–8 years to have an opinion regarding the changes in appearance of their teeth due to dental caries and the materials used to restore those teeth. Methodology. A total of 107 children and both of their parents (n = 321), who were seeking dental treatment, were included in this study. A tool comprising a questionnaire and pictures of carious lesions and their treatment arranged in the form of a presentation was validated and tested on 20 children and their parents. The validated tool was then tested on all participants. Results. Children had acceptable validity statistics for the tool suggesting that they were able to make informed decisions regarding esthetic restorations. There was no difference between the responses of the children and their parents on most points. Zirconia crowns appeared to be the most acceptable full coverage restoration for primary anterior teeth among both children and their parents. Conclusion. Within the limitations of the study it can be concluded that children in their sixth year of life are capable of appreciating the esthetics of the restorations for their anterior teeth.

Timing of fluoride intake and dental fluorosis on late-erupting permanent teeth.

Very few studies have examined the relationship between timing of fluoride intake and development of dental fluorosis on late-erupting permanent teeth using period-specific fluoride intake information. This study examined this relationship using longitudinal fluoride intake information from the Iowa Fluoride Study. Participants' fluoride exposure and intake (birth to 10 years of age) from water, beverages, selected food products, dietary fluoride supplements, and fluoride toothpaste was collected using questionnaires sent to parents at 3- and 4- month intervals from birth to 48 months of age and every 6 months thereafter. Three trained and calibrated examiners used the Fluorosis Risk Index (FRI) categories to assess 16 late-erupting teeth among 465 study participants. A tooth was defined as having definitive fluorosis if any of the zones on that tooth had an FRI score of 2 or 3. Participants with questionable fluorosis were excluded from analyses. Descriptive and logistic regression analyses were performed to assess the importance of fluoride intake during different time periods. Most dental fluorosis in the study population was mild, with only four subjects (1%) having severe fluorosis (FRI Score 3). The overall prevalence of dental fluorosis was 27.8%. Logistic regression analyses showed that fluoride intake from each of the individual years from age 2 to 8 plays an important role in determining the risk of dental fluorosis for most late-erupting permanent teeth. The strongest association for fluorosis on the late-erupting permanent teeth was with fluoride intake during the sixth year of life. Late-erupting teeth may be susceptible to fluorosis for an extended period from about age 2 to 8. Although not as visually prominent as the maxillary central incisors, some of the late-erupting teeth are esthetically important and this should be taken into consideration when making recommendations about dosing of fluoride intake.

Ataxia rating scales are age‐dependent in healthy children

To investigate ataxia rating scales in children for reliability and the effect of age and sex. Three independent neuropaediatric observers cross-sectionally scored a set of paediatric ataxia rating scales in a group of 52 healthy children (26 males, 26 females) aged 4 to 16 years (mean age 10y 5mo SD 3y 11mo). The investigated scales involved the commonly applied International Cooperative Ataxia Rating Scale (ICARS), the Scale for Assessment and Rating of Ataxia (SARA), the Brief Ataxia Rating Scale (BARS), and PEG-board tests. We investigated the interrelatedness between individual ataxia scales, the influence of age and sex, inter- and intra-observer agreement, and test-retest reliability. Spearman's rank correlations revealed strong correlations between ICARS, SARA BARS, and PEG-board test (all p<0.001). ICARS, SARA, BARS and PEG-board test outcomes were age-dependent until 12.5, 10, 11, and 11.5 years of age respectively. Intraclass correlation coefficients (ICCs) varied between moderate and almost perfect (interobserver agreement: 0.85, 0.72, and 0.69; intraobserver agreement: 0.92, 0.94, and 0.70; and test-retest reliability: 0.95, 0.50, and 0.71; for ICARS, SARA, and BARS respectively). Interobserver variability decreased after the sixth year of life. In healthy children, ataxia rating scales are reliable, but should include age-dependent interpretation in children up to 12 years of age. To enable longitudinal interpretation of quantitative ataxia rating scales in children, European paediatric normative values are necessary.

Allergic Rhinitis Is Associated With Otitis Media With Effusion: A Birth Cohort Study

E Kreiner-Moller, BLK Chawes, P Caye-Thomasen, K Bonnelykke, H Bisgaard. Clin Exp Allergy. 2012;42(11):1615–1620 Otitis media with effusion (OME) is often considered to be associated with allergic diseases. This study investigated the association of objectively determined OME at age 6 with asthma, eczema, allergic and nonallergic rhinitis, nasal inflammation, and eosinophilia. A single-center birth cohort of 262 children born to asthmatic mothers from the Copenhagen Prospective Study on Asthma in Childhood study were evaluated during their sixth year of life for OME. OME was diagnosed on the basis of otoscopic findings and tympanometry. Nasal …

Object processing for action across childhood

Human adults process and select the opportunities for action in their environment rapidly, efficiently, and effortlessly. While several studies have revealed substantial improvements in object recognition skills, motor abilities, and control over the motor system during late childhood, surprisingly little is known about how object processing for action develops during this period. This study addresses this issue by investigating how the ability to ignore actions potentiated by a familiar utensil develops between ages 6 and 10 years. It is the first study to demonstrate that (1) the mechanisms that transform a graspable visual stimulus into an object-appropriate motor response are in place by the sixth year of life and (2) graspable features of an object can facilitate and interfere with manual responses in an adult-like manner by this age. The results suggest that there may be distinct developmental trajectories for the ability to ignore motor responses triggered by visual affordances and the stimulus response compatibility effects typically assessed with Simon tasks.

Prevalence of snoring and symptoms of sleep disordered breathing among primary school pupils in Ilorin, Nigeria

Background/AimSnoring is the production of sound from the upper aero-digestive tract during sleep due to turbulent airflow This study is to determine the prevalence, pattern, night and daytime symptoms of snoring among nursery and primary school pupils in Ilorin, Nigeria due to its public health importance. Materials and methodsThis cross sectional survey was carried out among nursery /primary school pupils in Ilorin, Kwara state between April and September, 2010.Ten schools were selected randomly from 100 schools sited within the 3LGAs of Ilorin municipality. Also private and public schools with different parental social economic status were selected.The pupils were selected from nursery 2 to primary 6 in each school using the class registers with the aid of a table of random numbers with 1500 children assessed. The parents/guardians were made to fill the questionnaires and same returned with visitations to the schools twice weekly and reminders sent via phone calls. Data were analyzed using EPIINFO 2002 version 2 software. Results1500 questionnaires were given out but 909 were completely filled and returned (response rate of 61%.). There were 598(65.8%) non snorers (NSn) and 311(34.2%) snorers (Sn) at different scales with 153 male snorers to 158 female snorers. The ages of the children ranges from 3 to 16years (mean±SD, 8.3±4.8years. The mean age for the Sn was 8.2 and 8.3 for NSn (range 3–6years). No statistical difference in age, gender or socio-economic status between Sn and NSn. 598(65.8%) were non snorers (NSn) and 311(34.2%) were snorers (Sn) especially in the age groups 3–6years, 121(38.9%) and above 6years of age 101(32.7%) and below 3years were 89(28%). ConclusionSnoring is an important health problem among the pupils as a significant percentage snores and most of them are between third and sixth year of life.

Tobacco Smoke Exposure Before, During, and After Pregnancy and Risk of Overweight at Age 6

Maternal smoking during pregnancy has been associated with overweight and obesity in childhood and is strongly correlated with children's tobacco smoke exposure before and after pregnancy. We investigated the independent association of tobacco smoke exposure at various pre- and postnatal periods and overweight at age 6. A total of 1,954 children attending the 2001-2002 school entrance health examination in the city of Aachen, Germany, were included into this study. Height and weight were measured, BMI was calculated. Tobacco smoke exposure at various periods, other lifestyle and sociodemographic factors were ascertained by questionnaire. Multiple logistic regression models were used to assess the association between tobacco smoke exposure and overweight. Prevalence of overweight was 8.9%. Significant positive associations were found with maternal smoking before and during pregnancy and during the first and sixth year of life. When all smoking periods were included into one logistic model simultaneously, secondhand smoke exposure after birth remained positively associated with overweight at age 6 at either one of the two time periods (first year only: odds ratio (OR) (95% confidence interval (CI)): 2.94 (1.30-6.67), sixth year only: 2.57 (1.64-4.04), respectively) or at both (4.43 (2.24-8.76)). Exposure to tobacco smoke during the first years of life appears to be a key risk factor for development of childhood overweight.

Trajectories of childhood wheeze

More than 15 years ago, a seminal article was published in the New England Journal of Medicine describing the natural course of wheeze in the first 6 years of life in the Tucson Children’s Respiratory Study. The authors identified a distinct subgroup of infants whose airway function was diminished at birth, predisposing them to transient wheeze, which disappeared after the age of 3 years once the airways had grown out of diameters small enough to causewheezing symptoms on viral infection. This transient condition had no relation to atopic sensitization and asthma later in life. Thus a distinctive conditionwith definable underlying pathophysiology had been recognized by carefully studying the natural course of wheeze. In numerous subsequent studies the natural course of wheezing symptoms has been further interrogated in an attempt to dissect and partitionmore of thewheezing syndrome.At first, delineationswere based on investigators’ observations at various follow-up periods. Thereby the TucsonChildren’s Respiratory Study group identified 2 categories. Onewas ‘‘late-onsetwheeze,’’ comprising children starting to wheeze after the third but before the sixth birthday, and the other was ‘‘persistent wheeze,’’ which included children wheezing from the first to the sixth years of life. Although many researchers have subsequently shown that these phenotypes differ in their association to atopy, airway function, and genetic background, the demarcation has never been as clear cut as for the transientwheezing condition. Rather, much overlap between the features associated with these wheezing phenotypes has been observed. Other methods allow classifications that are less dependent on an investigator’s intuition but instead use statistical approaches, such as latent class analysis. Latent variables are inferred from observed variables through use of a mathematic model. The use of latent variables reduces the dimensionality of data by aggregating a large number of observable variables into a model to represent an underlying concept. Latent class analysis for classification of wheezing symptoms was first used as a statistical tool in the Avon Longitudinal Study of Parents and Children in the United Kingdom. This study confirmed the presence of transient and persistent wheezing phenotypes but split the late-onset phenotype

High asthma prevalence and increased morbidity among rural children in a Medicaid cohort

Urban children represent a group at high risk for asthma development and adverse asthma outcomes. Although rural children also encounter sociodemographic disparities that might be expected to worsen asthma, asthma in the rural United States is poorly studied. To determine rural-urban differences in childhood asthma diagnosis and morbidity. We studied a statewide population of 117,080 children continuously enrolled in Tennessee Medicaid from birth through the sixth year of life, using linked Tennessee Medicaid, vital records, and pharmacy claims databases to determine asthma diagnosis and residence. The cohort was 45% urban, 23% suburban, and 33% rural. Compared with urban children, rural children were more likely to be white, have a history of bronchiolitis, and have mothers who smoked. Eleven percent of urban, 12% of suburban, and 13% of rural children met study criteria for asthma diagnosis (adjusted odds ratio for rural children, 1.16; 95% confidence interval, 1.09-1.24; adjusted odds ratio for suburban children, 1.22; 95% confidence interval, 1.14-1.30; with urban as the referent; P < .001). Rural children had greater use of outpatient asthma care, whereas urban children had greater use of inhaled corticosteroids. Compared with urban children, rural children had fewer asthma emergency department visits but were hospitalized for asthma at similar rates and had similar use of asthma rescue medications. In this pediatric Medicaid population, rural children had increased asthma prevalence and similar asthma morbidity compared with urban children but differences in patterns of asthma care and resource use, suggesting that optimal interventions for asthma may differ in rural compared with urban populations.

Ready for the sixth year of Internal and Emergency Medicine

With this issue IEM starts its sixth year of life. For those who have worked in this project, it is a great pleasure to see the continuous growth of our creature. After the successful obtaining of the first impact factor (IF 2009 = 2.371) we all continue to work to increase the quality of the papers published and the pleasure of the readers to have nice and useful articles. Our journal is now internationally recognized as an important one in our academic field. Much work still needs to be done. The section of Clinical evidence and Health Technology Assessment leaded by the past Editor-in-chief Gian Franco Gensini with the invaluable work of Lorenzo Moja and Gianni Virgili (among the others) is growing. The Emergency section, leaded by my co-editor Peter Rosen, with Kevin Ban and a group of distinguished experts of different countries, receives many submissions and our colleagues do a great job. Also the Internal Medicine section has an increased number of submissions and several members of Editorial Board have begun to directly manage some papers as editors. All the work of IEM, as a whole, has much increased during the second half of 2010, because of the announcement of Impact Factor. We have received over 250 new submissions versus 120 in the first part of the year. Thus, the submission rate is over ?100% in the second part of the year versus the first and ?60% in the all 2010 versus 2009. This means, on the other hand, that, more or less, the mean rejection rate should be 70–75% at the moment. Thus, there has been more work for all the members of Editorial board, Advisory board and Operative group that again I thank for their invaluable work together with all people from Springer. Usage of IEM articles increased by 19% from 2008 to 2009. Moreover, in the period January–August, the 2010 growth rate of full-text downloads reached 36%. PubMed linkouts number represents the number of links from PubMed to SpringerLink full-texts. The more the linkouts are, the more the visibility of the journal grows. Comparing the data related to the period January–August, PubMed linkouts increased by 21% from 2009 to 2010. A special thank to all reviewers who have contributed to the success of our Journal, for the time and dedication spent. We have still the problem of those colleagues who do not reply after having been invited to act as reviewers, which produces delays in the process of reviewing. Again we ask potential reviewers to help us at least with a prompt reply and with the suggestion of other potential reviewers when they cannot do the job. As I previously wrote, we encourage our members to provide feedback on the Journal and its content. If there are suggestions, please let us know. I am sure you will continue to support our Journal and I wish you all a wonderful 2011! Domenico Prisco Editor-in-Chief Internal and Emergency Medicine

Early-life Otitis Media and Incident Atopic Disease at School Age in a Birth Cohort

Otitis media is a common and costly disease that peaks in early childhood. Recent reviews concluded that the relationship between otitis media and atopy is not well understood, and that further research is warranted. Logistic regression was used to analyze data from a German Birth Cohort (n = 1690; born 1997–1999). Parental questionnaires were used to assess children for physician-diagnosed otitis media throughout the first 2 years of life and for incident atopic disease (asthma, allergic rhinitis, and eczema) during the sixth year of life. Odds ratios were adjusted for gender, older siblings, city, parental education, breast-feeding, and daycare. Parallel analyses were completed for the full birth cohort and for a population subset with atopic mothers. The adjusted odds of asthma were elevated for children with early-life otitis media, but were statistically significant only for those children with at least 3 episodes (adjusted odds ratio: 4.26 [95% confidence interval: 1.34–13.6]). Associations between early-life otitis media and allergic rhinitis were largely inconsistent. There was a positive association between early-life otitis media and late-onset allergic eczema (≥2 episodes: 2.68 [1.35–5.33], ≥3 episodes: 3.84 [1.80–8.18]). Similar results were found for the maternal atopy subgroup but with greater effect estimates. Children diagnosed with otitis media during infancy were at greater risk for developing late-onset allergic eczema and asthma during school age, and associations were stronger for frequent otitis. These results indicate that frequent otitis media during infancy may predispose children to atopic disease in later life.

Direct non-medical and indirect costs for families with children with congenital cardiac defects in Germany: a survey from a university centre

Parents of children with congenital cardiac disease suffer from psychological stress and financial burdens. These costs have not yet been quantified. In cooperation with paediatricians, social workers, and parents, a questionnaire was devised to calculate direct non-medical and indirect costs. Direct non-medical costs include all costs not directly related to medical services such as transportation. Indirect costs include lost productivity measured in lost income from wages. Parents were retrospectively queried on costs and refunds incurred during the child's first and sixth year of life. The questionnaire was sent out to 198 families with children born between 1980 and 2000. Costs were adjusted for inflation to the year 2006. Children were stratified into five groups according to the severity of their current health status. Fifty-four families responded and could be included into the analysis (27.7%). Depending on severity, total direct non-medical and indirect costs in the first year of life ranged between an average of euro1654 in children with no or mild (remaining) cardiac defects and an average euro2881 in children with clinically significant (residual/remaining) findings. Mean expenses in the sixth year of life were as low as euro562 (no or mild (remaining) cardiac defects) and as high as euro5213 (potentially life-threatening findings). At both points in time, the highest costs were lost income and transportation; and day care/ babysitting for siblings was third. Families of children with congenital cardiac disease and major sequelae face direct non-medical and indirect costs adding up to euro3000 per year on average. We should consider compensating families from low socioeconomic backgrounds to minimise under-use of non-medical services of assistance for their children.

The moral, epistemic, and mindreading components of children’s vigilance towards deception

Vigilance towards deception is investigated in 3- to-5-year-old children: (i) In Study 1, children as young as 3 years of age prefer the testimony of a benevolent rather than of a malevolent communicator. (ii) In Study 2, only at the age of four do children show understanding of the falsity of a lie uttered by a communicator described as a liar. (iii) In Study 3, the ability to recognize a lie when the communicator is described as intending to deceive the child emerges around four and improves throughout the fifth and sixth year of life. On the basis of this evidence, we suggest that preference for the testimony of a benevolent communicator, understanding of the epistemic aspects of deception, and understanding of its intentional aspects are three functionally and developmentally distinct components of epistemic vigilance.

Management of choanal atresia in cases of craniofacial malformation

To report the method and results of endonasal endoscopic approach in congenital choanal atresia in cases of craniofacial malformation. The pathology of unilateral and bilateral choanal atresia and the treatment results in seven children treated between 1999 and 2006 are presented. 5 infants suffering from bilateral atresia also had severe malformations (Charge syndrome [2 patients], trisomy 18, microcephalus, central cranioschisis, cleft lip and anophthalmia 9). The surgical intervention was carried out immediately after birth. 2 patients with unilateral atresia were treated in their second and sixth year of life respectively. CT scan was the diagnostic procedure of choice. Intraoperative endoscopy showed both membraneous and osseous atresia. Trocars of different sizes were used to open the atresia plate, while the osseous parts were removed with diamond drills. Silicone tubes were inserted transnasally and remained in place for several months to improve the infants'ability to breath and drink. In all cases of bilateral atresia the tubes either had to be changed repeatedly or replaced with larger tubes due to dislocation and head growth. The septum was perforated in one case. No further stenoses were detected following the removal of the tubes (after 3-6 months). The transnasal access is particularly suited to newborns and infants because it induces a minor surgical trauma and carries a low risk of bleeding if endoscopes are used. The results show that the risk of restenoses can be minimised with sufficient fixating and in-patient care.

OBSERVATIONS ON THE VISUAL ACUITY OF CHILDREN DURING THE FIRST FEW YEARS OF LIFE*

This paper discusses evidence for the development of ability in the physical, physiological and psychological phases of visual acuity. Visual acuity tests of various kinds were administered to 674 children between the first and sixth year of life and the results suggest that high levels of visual acuity are present at a very early age. The data show no development trend in the age groups beyond the third year of life. Apparent development prior to age three may be an artifact due to the inability of examiners to present comparable tests. Comparison of the present sample and a sample of older children shows the preschool sample to possess a higher level of visual efficiency. This suggests that growth and environment are effective in reducing efficiency earlier in life than was thought heretofore.

Hepatitis B Virus: Something Old, Something New

Hepatitis B Virus: Something Old, Something New

Antibody titer in Iranian children 6 years after hepatitis B vaccine administration

Objective The purpose of study was to evaluate the immune response in a sample of vaccinated children aged 6 years. Background Although immunization of infants against hepatitis B virus (HBV) is the most effective way to prevent infection, duration of the afforded immunization is unknown. Methods The immunity derived from the HBV vaccine was assessed by measuring the antibody in 3752 children who were vaccinated in a routine vaccination program in three cities of Iran (Isfahan, Khoramabad, Shahrekord). Results Seven hundred and twenty-three (19.3%) children had antibodies levels <10 MIU/mL and 1096 (29.2%) had antibodies levels ≥100 MIU/mL. The total GMT was 34.5 ± 0.66, and GMT was statistically different in non-immune and immune children (3.1 ± 0.36 versus 49.1 ± 0.52). No correlation was found between HbsAb titers and growth pattern during the first and sixth years of life, number of vaccine, time of vaccination and drug use. The predictors were low birth weight and chronic disease. Conclusion It is recommended that high risk children should be monitored regularly for anti-HBS, and booster must be administrated, if necessary.

Social and biological early life influences on severity of dental caries in children aged 6 years

To investigate the relationship between social and biological conditions experienced in very early life and dental caries in children aged 6 years. The design was a dental caries cross-sectional study nested in a birth cohort study started in Pelotas, Brazil, in 1993. The cross-sectional study was carried out in 1999. A random sample of 400 6-year-old children was selected from among 5249 live births in 1993. The World Health Organization (1997) criteria were used to diagnose dental caries. Results from the oral health study were linked to the data concerning perinatal and childhood health and illnesses and family social conditions collected at birth, 1, 3, 6 and 12 months, and in the sixth year of life. Dental caries was the outcome measured at two levels of severity (very low: dmft < or = 1; high: dmft > or = 4). Unconditional univariate and multiple logistic regression analysis were performed. Self-employed and employees/unemployed, fathers with <8 years of education at time child was born, child's height deficit for age at 12 months; child who did not attend day care centre in sixth year of life; brushing teeth less than once a day, and children with sweet consumption of at least once a day at 6 years were risk factors for high dental caries after controlling for possible confounders. Harmful social and biological risk factors accumulated in early life contributed to the development of a high level of dental caries in childhood.

Intergenerational Communication of Violent Traumatic Experience Within and by the Dyad The Case of a Mother and Her Toddler

This article considers the phenomenon of intergenerational transmission of trauma during the first years of life with particular attention to interpersonal violent trauma. A review of the literature is followed by a detailed case report of a violence-exposed mother and her initially 14-month-old daughter. This case report takes the reader from baseline assessment through multimodal treatment of the family and provides follow-up into the child's sixth year of life. Maternal communication of trauma-associated affect and memory traces via action and language in day-to-day interactions is discussed, along with a hypothetical mechanism to account for distorted maternal perception and disorganizing interactive behavior in the wake of violent trauma.