Underrecognition and undertreatment of asthma in Cape Town primary school children

BACKGROUND: In view of the high local prevalence of asthma, the extent of recognition and appropriate management of childhood asthma was studied in a large suburban area of Cape Town. DESIGN: Cross-sectional study based on random community sample of schools. METHOD: 1,955 parents of sub B pupils from 16 schools completed a questionnaire, followed by: (i) an interview of the parents of 348 symptomatic children; and (ii) bronchial responsiveness testing on 254 children. The final case group consisted of 242 children with reported asthma or multiple asthma symptoms on both questionnaires. Children in whom asthma was acknowledged were compared with those in whom it was not. RESULTS: Overall, any past or current ('ever') asthma was acknowledged by respondents in only 53% of the children, and current asthma in only 37.1%. While most children had received treatment in the previous 12 months, 66.1% of the recognised group were on current treatment (23.2% on daily treatment), compared with 37% of the unrecognised group (3% daily). Salbutamol and theophylline syrups were the most common types of medication, while inhalers and anti-inflammatory medications were underused. Only a minority of parents reported the child ever having used a peak flow meter, or volunteered knowledge of preventive measures. Current treatment, and to a lesser degree recognition of asthma by parents, were more common among children on medical aid and of higher socio-economic status. CONCLUSIONS: These findings suggest that ways need to be found: (i) to increase the use of current asthma treatment guidelines by practitioners; (ii) to provide access to comprehensive care by children not on medical aid; and (iii) to improve education of parents in home management measures such as severity assessment and avoidance of smoking, allergen and dietary triggers.     

Prevalence of wheeze and asthma and relation to atopy in urban and rural Ethiopia

BACKGROUND: Asthma and allergy in developing countries may be associated with adoption of an urbanised "western" lifestyle. We compared the rates of asthma symptoms and atopy in urban populations in Jimma, southwest Ethiopia, at an early stage of economic development with those among the population of remote, rural, subsistence areas, and assessed the potential role of environmental aetiological factors leading to the differences. METHODS: Information on wheeze of 12 months' duration, diagnosed asthma, and cough for 3 months of the year was gathered by questionnaire in random household samples of 9844 people from urban Jimma and of 3032 from rural areas. Atopy was defined by allergen skin-test response to Dermatophagoides pteronyssinus and mixed threshings measured in a one-in-four subsample of those aged 5 years and older from both groups. FINDINGS: All respiratory symptoms were rare in children and were significantly less common overall in the rural than in urban group (wheeze odds ratio 0.31 [95% CI 0.22-0.43], p < 0.0001). Asthma was reported by 351 (3.6%) of the urban group, with a median reported duration of 8.5 years (IQR 4-17 years) that was unrelated to age. Atopy was a strong risk factor for asthma in urban Jimma. In the rural areas, skin sensitivity to mixed threshings was only slightly less common than in urban Jimma (0.67 [0.40-1.12], p = 0.13), whereas sensitivity to D pteronyssinus was significantly more common (3.24 [2.40-4.38], p < 0.0001), and since none of the 119 atopic individuals in the rural area reported wheeze or asthma, atopy was possibly associated with a reduction in the risk of disease among this group. Wheeze or D pteronyssinus sensitivity were positively associated with housing style, bedding materials, and use of malathion insecticide, but no single factor accounted for the urban-rural differences. INTERPRETATION: Wheeze and asthma are especially rare in rural subsistence areas, and atopy may be associated with a reduced prevalence of these symptoms in this environment. In urban Jimma, self-reported asthma seemed to emerge as a clinical problem about 10 years before our study began, which is consistent with an effect of new environmental exposures. The factor or factors leading to the increase in asthma and allergy have not been identified, although exposures related to general changes in the domestic environment are likely to be involved.     

Viral gastroenteritis among young children in northern Jordan

Perforating and penetrating globe injuries secondary to peribulbar and retrobulbar anaesthesia are often complicated by vitreous haemorrhage and retinal detachment. We describe the effectiveness of primary silicone oil tamponade in the repair of three perforated globes secondary to local anaesthesia for ophthalmic surgery. Three patients with axial myopia had peribulbar and retrobulbar anaesthesia for extracapsular cataract extraction (two patients) and cryotherapy (one patient). All eyes sustained a vitreous haemorrhage obscuring the view to the fundus. Retinal detachments were detected by B-scan ultrasound. In all eyes, scleral buckling, pars plana vitrectomy and silicone oil tamponade were performed as a primary surgical procedure. All the patients had complete anatomic reposition. In two patients, after two years follow-up, visual acuity was between 6/12 to 6/36 with the retina attached and no proliferative vitreoretinopathy (PVR). The third patient had blind painful eye and enucleation was performed. Primary use of silicone oil tamponade, in the management of perforated globe with retinal detachment due to local anaesthesia injection, is recommended.     

Increasing prevalence of wheeze and asthma in Nottingham primary schoolchildren 1988-1995

The prevalence of asthma in children has increased substantially in many countries in recent decades, but it is not clear how much this trend has continued into the 1990s. This study aimed to estimate the current prevalence of asthma and wheeze in British primary schoolchildren and to determine whether there has been any increase in the prevalence of these conditions since 1988. The prevalence of self-reported wheeze and asthma was measured by parental questionnaire in 22,968 children aged 4-11 yrs attending primary schools in the Nottingham area of England in 1995, and these estimates were compared with data from a subsample of the same schools in 1988. In 1995, wheezing ever was reported in 24.0% of children, wheezing in the past year in 15.1% and diagnosed asthma symptomatic in the past year in 8.8%. All measures have increased in prevalence since 1988, in absolute terms by 7.7% for wheeze ever, by 2.6% for wheeze in the past year and by 2.7% for asthma. The increases were greater in females than males, but did not vary with age. In conclusion, the prevalence of asthma has continued to rise in British schoolchildren since the late 1980s, particularly in females, and across all ages.     

Prevalence and characteristics of exercise-induced asthma in children

We have evaluated the prevalence and the characteristics of exercise-induced asthma (EIA) in a group of 71 patients with a prior history of mild, moderate or severe asthma (42 males and 29 females), aged 6-16 years-old. Measurements of the forced expiratory volume in 1 second (FEV1) were obtained before and at regular intervals up to 8 hours following exercise. As a control, the same patients were evaluated at similar time intervals on another day when they had not been submitted to an exercise challenge. Using pre-exercise FEV1 values as the reference, 32 patients (45.1%) had a positive exercise challenge, defined as a fall in FEV1 value equal to or greater than 15% from baseline following exercise. Among the patients with a positive exercise challenge, the majority (23/32, 71.8%) had an immediate response alone, with no significant changes in FEV1 within the 8-hour follow-up. However, a subgroup of patients (9/32, 28.1%) had both an immediate and a late-phase response to exercise. During the control day, no significant fall in FEV1 were observed. In keeping with previous investigations, no correlation was found between a history of EIA and a positive exercise challenge in the present study. Positive exercise challenges were found more frequently among patients with moderate and severe asthma than patients with mild asthma.     

Trends in the prevalence of asthma in Scottish and English primary school children 1982-92

BACKGROUND: Some doubts exist as to whether the increase in the prevalence of asthma is real or an artefact. The 10 year trend of asthma up to 1993 in England and Scotland was therefore assessed. METHODS: Information on asthma and bronchitis attacks, occasional wheeze, and persistent wheeze in the last 12 months, was obtained using a self administered questionnaire completed by the parents. Exactly the same questions were asked in 14 study areas in Scotland and 22 study areas in England in 1982 or 1983 and in 1992 or 1993 in 5-11 year old children. RESULTS: The numbers of children with data for all respiratory illness were 5556 (85.2%) and 5801 (87.1%) in England and 3748 (90.4%) and 3738 (90.4%) in Scotland in 1982 and 1992, respectively. There was a significant increase in asthma attacks (approximately three times more in 1992 than in 1982) and occasional wheeze (30-60% more in 1992 than in 1982) in both sexes in England and Scotland. Persistent wheeze also increased in both countries, but the increase was significant only in England (30-40% more in 1992 than in 1982). CONCLUSIONS: The study coincides with others that suggest that the increased prevalence of asthma may be due, in part, to changes in diagnostic behaviour. However, the continuing increase of persistent wheeze in the total sample suggests that part of the increase is real. There was no difference in the increase of persistent wheeze between Scotland and England, but the trend was only significant in England.     

Prevalence of Cryptosporidium species in elementary school children

The project described here was conducted to study the prevalence of various parasites in elementary school children in northern Jordan. A single stool specimen was collected from each of 1,000 students in the 6- to 14-year-old age group. A questionnaire covering demographic information, health status, and other relevant information was filled out by one of the parents of each student. Fresh stool specimens were processed by using wet mount preparations, formalin-ether, and Sheather's sugar flotation techniques. Permanently stained slides were prepared by acid-fast, Giemsa, and trichrome staining. Cryptosporidium species was found in 40 specimens (4%); however, only 15 specimens had Cryptosporidium species alone, and these 15 specimens were from symptomatic children with diarrheic stools. The symptoms reported most often were abdominal pain, cramps, malaise, nausea, and headache. The number of cases of infection was higher in villages, where contact with animals was evident and where contaminated drinking water could have been a major source of the infections.     

Epidemiological study of wheeze, doctor diagnosed asthma, and cough in preschool children in Leicestershire

OBJECTIVE: To determine the cumulative prevalences of wheeze and doctor diagnosed asthma and the point prevalences of recurrent cough and wheeze in children aged 5 years and under. DESIGN: Questionnaire survey of population based random sample of children registered on regional authority's child health index for immunisation; questionnaire completed by parents. SETTING: Leicestershire. SUBJECTS: 1650 white children born in 1985-9 who were surveyed in 1990. MAIN OUTCOME MEASURES: Cumulative prevalences of wheeze and doctor diagnosed asthma and point prevalences of recurrent cough and wheeze by age and sex. RESULTS: There were 1422 replies (86.2%; 726 for boys, 696 for girls). Overall, 11.0% (95% confidence interval 9.4% to 12.6%) of children had formally been diagnosed as having asthma, the cumulative prevalence in boys (12.7%) being somewhat higher than in girls (9.2%) (age adjusted odds ratio 1.47, p = 0.03). As expected, the cumulative prevalence of asthma increased significantly with age (7.5% (13/173) in children under 1 year, 15.9% (61/383) in children of 4 years and over; p < 0.001). The cumulative prevalence of wheeze overall was 15.6% (13.7% to 17.5%), being higher in boys (17.6%) than in girls (13.5%) (odds ratio 1.38, p = 0.03). The overall prevalence of recurrent cough without colds was 21.8% (19.6% to 23.9%), with a non-significant excess in boys (23.1% v 20.4%). The overall prevalence of wheezing attacks during the previous 12 months was 13.0% (11.3% to 14.8%) with a non-significant excess in boys (14.5% v 11.5%). CONCLUSIONS: These findings are baseline results and emphasise the importance of studying the age group of interest rather than relying on the recall of parents of school age children.     

The impact of asthma and asthma-like illness in Seattle school children

The impact of asthma and asthma-like illness was measured in a population of 5-9-year-old Seattle public school children. Child health information was obtained from a survey of 1665 parents of first and second grade students to assess medical services use and impaired physical functioning among diagnosed asthmatics and those with current wheezing, defined as wheezing in the past 12 months without a diagnosis of asthma, relative to an asymptomatic population with neither condition. Relative to the asymptomatic population, the prevalence of respiratory-related activity limitation, and perception of poorer child health was larger among diagnosed asthmatics than children with current wheezing. However, the prevalence of sleep disturbances, school absences, medical services use, and parental concern over their child's health was similar for both the asthmatic and wheezing groups relative to the asymptomatic group. Also, in both symptomatic groups, a history of moderate or severe wheezing was associated with an increased prevalence of respiratory-related sleep disturbances and activity limitation. The similarity between the impact of diagnosed asthma and undiagnosed asthma-like illness suggests that the overall social and economic burden of asthma may be higher than previously estimated.     

Race, asthma, and persistent wheeze in Philadelphia schoolchildren

OBJECTIVES: Many studies show asthma to be more common in Black than in White children. This study assessed how much of this difference remains after adjustment for other potentially race-associated predictors of asthma. METHODS: We assessed the predictors of active diagnosed asthma and persistent wheeze in 1416 Black and White Philadelphia children aged 9 to 11 years, as reported by parents. RESULTS: Black race remained a significant predictor of active diagnosed asthma (odds ratio [OR] = 2.3; 95% confidence interval [CI] = 1.3, 4.1) but not of persistent wheeze (OR = 1.0; 95% CI = 0.6, 1.8). The excess risk of asthma in Black children was not appreciably altered by adjustment for other demographic and environmental factors. CONCLUSIONS: Black race is an important risk factor for active diagnosed asthma in these urban children, a relationship not explained by social factors. This finding and the lack of an association of race with persistent wheeze after adjustment for social factors suggest that race may be more important to the acquisition of an asthma diagnosis than to the prevalence of the symptoms.     

Prevalence of migraine in a sample population of school children

INTRODUCTION: The object of this study was to determine the prevalence of migraine in school children in our area, since few such studies have been done. MATERIAL AND METHODS: The study was carried out by means of a questionnaire given to school children aged between 6 and 14. We selected a representative sample of the population, the size of which was determined by accepting as a reference value the 4% mentioned by Bille. The questionnaire was drawn up after a search of the literature for similar questionnaires and a preliminary trial on children known to suffer from migraine (giving a specificity of 96.6% and a sensitivity of 96.5%). RESULTS: Using the criteria of Vahlquist there was a prevailence of 7.0% and with IHS of 6.7%. There was a predominance (not significant) of females (54.4%). In 89.1% there was a positive family history (parents and/or siblings) of migraine.     

Prevalence of hypertension in children with primary vesicoureteral reflux

The role of aluminum accumulation in articular tissues of patients affected by dialysis-associated arthropathy (DAA) is questioned. The aim of this work is to identify the nature of these aluminum accumulations by the use of secondary ion mass spectrometry (SIMS). Al/Si ratios of about 1, measured by SIMS, strongly suggest for the first time the presence of aluminum silicates and possibly aluminum hydroxides in amyloid synovial tissue and articular cartilage of 1 patient with DAA and aluminum intoxication. This is thermodynamically consistent with the total dissolved Al and Si contents and pH measured in the synovial fluids. These results are similar to the abnormal Al distribution recently found by SIMS in the forebrain of chronic renal dialysis patients and to the amorphous aluminum silicates identified in the core of senile plaques in Alzheimer's disease.     

Peer relations and school adjustment in ungraded primary children.

Researchers have reported a significant relationship between peer relations and school adjustment in same-age classrooms, but little is known about the contribution of peer relations to school adjustment in mixed-age classrooms. The present study investigated the contributions of peer acceptance, friendship, social status, and age relative to mixed-age classmates to children's attitudes toward school and to achievement in ungraded primary. Children's attitudes toward school were positively related to composite achievement scores. Achievement was predicted from demographic variables, children's attitudes, peer acceptance, and friendship status. With the effects of gender and race controlled, differences in school adjustment were related to both children's social status and whether they had friends. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Overall and meal-specific macronutrient intake in Belgian primary school children

The present study, first of its kind, was conducted with the objectives to understand hitherto little known aspects of candidal mastitis, like its sequential pathology, pathogenesis and clinico-biochemical changes. For this purpose, unilateral intramammary inoculation of 10 goats with Candida albicans (1.2 x 10(7) yeast cells) resulted in the development of mastitis, with gross and microscopic lesions being restricted to the infected udder halves only and without dissemination of infection to the opposite uninfected udder halves as well as other organs of the body. The experiment was continued for 40 days and after infection, there was sharp fall in milk yield and Candida albicans was directly demonstrated in the milk and re-isolated from the milk and udder tissues up to 30th day after inoculation. An increase in total immunoglobulins in the milk and plasma along with increase in total plasma proteins were also observed. Haematology revealed leukocytosis and neutrophilia. Microscopically, there was acute purulent mastitis, which later became chronic, nonpurulent and interstitial with formation of granulomas. It was concluded that Candida albicans was highly pathogenic to the lactating goat mammary gland even without immunosuppression or antibiotic treatment, resulting in severe irreversible tissue damage and nearly complete agalactia.     

Prevalence and susceptibility of vaginal yeast isolates in Jordan

The prevalence of vaginal yeast species has been studied in 140 women (41 pregnant, 66 infertile and 33 healthy controls) attending a gynaecological private clinic in Amman, Jordan. Yeast species were isolated from pregnant (68.2%), infertile (51.5%) and healthy control (48.4%) women. Patients manifesting one, two or three symptoms of vulvovaginitis were 22.1%, 26.8% or 24.2% respectively. Asymptomatic cases and cases with more than three symptoms were 22.4% and 4.5% respectively. Candida albicans was the dominant species (in 51.3% of the patients) followed by C. glabrata (17.9%). The percentage occurrence as well as the pattern of Candida species differed among the different groups of patients. Candida kefyr was found to be significantly higher in the infertile women. In vitro sensitivity tests using amphotericin B, nystatin, miconazole nitrate and chlorhexidine were carried out; amphotericin B was the most effective and miconazole nitrate the least.     

Development of spelling ability and letter--sound orientation in primary school children

Recent research has established the link between disorders of spoken and written language. Consequently, speech and language therapists serving paediatric populations often need to assess children's spelling abilities. However, there are few appropriate assessments of normal abilities available. In order to describe, quantitatively and qualitatively, the normal development of spelling ability in the primary school years, a modified version of the Schonell Graded Spelling Test (1956) was used to assess 1372 children in grades 2-6 in five city and two rural schools. The results were analysed in terms of three scores: percentage of words spelled correctly; words not attempted; and misspellings that were phonologically plausible. Spelling ability varied according to the school attended and the social status of the child. Children in higher socioeconomic status groups were better spellers. Children who were good spellers tended to generate more phonologically plausible misspellings. Further, there was a strong tendency for the percentage of errors which were phonologically plausible to increase developmentally. Thus, the results support models of spelling development showing that phonological awareness is associated with the acquisition of adequate spelling ability. However, alternative strategies must also be acquired to account for the successful spelling of orthographically irregular words.     

Prevalence of Fasciola infection among school children in Sharkia Governorate, Egypt

This study was performed on 1350 school children from 9 different villages in Sharkia Governorate to investigate the real situation of endemicity of fascioliasis in the area. Stool examination using modified Kato thick smear method was performed to detect Fasciola infection and other parasites. Those with negative stool samples were examined serologically by ELISA test to detect anti-Fasciola IgG. All cases with positive anti-Fasciola IgG were further examined by circum-oval precipitin test (COPT) against viable S. mansoni eggs to exclude the crossly reacted Schistosoma infections. Sixty nine cases were found to pass Fasciola eggs in their stool samples (5.1%). Anti-Fasciola IgG was detected in the sera of 231 children (17.1%) using ELISA test. Eighty four out of the 231 children were found positive by COPT and were considered as schistosomal cases. The remaining 147 who gave negative COPT were considered as Fasciola infections. All of the 69 Fasciola positive stool cases were found positive by ELISA test and negative by COPT test. The sensitivity of stool analysis was 47% versus 100% sensitivity of ELISA, whereas the specificity of ELISA was 63%. The total number of Fasciola positive cases by ELISA and stool analysis were 147 cases among 1350 children indicating a prevalence of 10.9% among school children in Sharkia Governorate. This results highlighting the importance of health education and snail control in decreasing the high prevalence.     

Prevalence of heart disease in school children in rural Kenya using colour-flow echocardiography

In a survey using colour-flow echocardiography and a portable generator, of one thousand one hundred fifteen children, three had clinical and echocardiographic evidence of rheumatic heart disease giving a prevalence rate of 27/1000. Sixty nine (6.2%) of the children examined had trivial mitral regurgitation (TMR). Of these, three had associated trivial aortic regurgitation. Isolated trivial aortic regurgitation was not seen. Four children had isolated mild-moderate regurgitation of the pulmonary valve. Congenital heart disease (CHD) was found in two children-one with secundum atrial septal defect and one with a ventricular septal defect and pulmonary stenosis, giving a prevalence of 1.8/1000. One child had a bicuspid aortic valve and two persistent left superior vena cava. It is feasible to carry out an echocardiographic survey using a portable generator in schools where electricity is not available. The prevalence of rheumatic heart disease (RHD) is higher than previously found in Kenya. The prevalence of TMR is surprisingly high. This was associated with familial clustering reminiscent of RHD. The importance of these findings must await the results of further investigation.     

Prevalence of alpha-thalassemias in northern Thailand

The population of northern Thailand has one of the highest frequencies of alpha-thalassemia in the world. However, the available distributional data are controversial. In addition to deletional types of alpha-thalassemia Hb, type Constant Spring should also be taken into consideration in alpha-thalassemia population studies, because it causes clinical alpha-thalassemia in the homozygous state or when present with both alpha-globin genes deleted in trans. We have examined a sample of 215 healthy subjects from four rural districts of Chiang Mai province. Out of these, 77 exhibited anomalies of the alpha-globin genes (alpha alpha/-alpha 3.7 in 36; -alpha 3.7/-alpha 3.7 in 3; -SEA in 30; alpha alpha/alpha CS alpha in 5; alpha alpha alpha anti 3.7 in 3). Therefore, no fewer than 2% of the children in northern Thailand are expected to be born with HbH disease or thalassemic hydrops fetalis. The considerable public health problem of hemoglobinopaties and the increasing acceptance of family planning necessitates facilities for the pre- and postnatal diagnosis of these disorders at the DNA level.     

Prevalence of rheumatic fever in children from a public high school in Belo Horizonte

Genetic studies have suggested homogeneity between the Baltic-type and Mediterranean-type progressive myoclonic epilepsy. Magnetoencephalography was applied to elucidate the mechanism underlying the giant evoked responses in cortical reflex myoclonus. A new concept of negative myoclonus mediated by cortical reflex mechanism was proposed. Cortical myoclonus was demonstrated in various neurodegenerative or metabolic disorders, such as presenile or senile dementia, olivopontocerebellar atrophy, and myoclonus epilepsy associated with ragged-red fibres. Myoclonus in corticobasal degeneration is especially noteworthy because it has clinical and electrophysiological features of cortical reflex myoclonus, but its latency is shorter compared with the conventional cortical reflex myoclonus. Clinical features of 'palatal myoclonus' were reported by the name of 'palatal tremor'.