Clinical characteristics and serum essential fatty acid levels in hyperactive children

This study compared 48 hyperactive children with 49 age-and-sex-matched controls. Significantly more hyperactive children had auditory, visual, language, reading, and learning difficulties, and the birth weight of hyperactive children was significantly lower than that of controls (3,058 and 3,410 g, respectively; p less than 0.01). In addition, significantly more hyperactive children had frequent coughs and colds, polydypsia, polyuria, and a serious illness or accident in the past year than controls, but there was no increase in asthma, eczema, or other allergies. Serum essential fatty acid (EFA) levels were measured in 44 hyperactive subjects and 45 controls. The levels of docasahexaenoic, dihomogammalinolenic, and arachidonic acids were significantly lower in hyperactive children than controls (docosahexaenoic: 41.6 and 49.5 micrograms/ml serum respectively, p = 0.045; dihomogammolinolenic: 34.9 and 41.3 micrograms/ml serum, p = 0.007; arachidonic: 127.1 and 147.0 micrograms/ml serum, p = 0.027). These findings have possible therapeutic and diagnostic implications, but further research is needed to attempt to replicate these differences.

Measles epidemic in Auckland 1984-85

Epidemics of measles had been seen biennially over the past two decades at Princess Mary Hospital, Auckland, until 1980. After a four year gap, there has been a further epidemic. The medical records of 201 measles cases seen between July 1984 and August 1985 were reviewed. Maori and Pacific Island children were over-represented (86%), as were children aged less than 2 years (53%). Two children died. The most common complications were otitis media (98 cases), pneumonia (70 cases) and croup (28 cases, for which five children were ventilated). The epidemic was chiefly due to low immunisation rates and represents a failure of current immunisation programmes. Recommendations are made for improved immunisation strategies.

Postneonatal mortality review in Auckland: two years experience

Postneonatal deaths in the Auckland Region in 1984 and 1985 were reviewed. There were 134 deaths and most deaths could be placed into four broad categories, namely sudden infant death syndrome (SIDS, 80 60%), congenital anomalies (24, 18%), infections (9, 7%) and problems arising in the perinatal period (8, 6%). There was good agreement with the cause of death as recorded by the National Health Statistics Centre (98.5%) Potentially preventable causes of death were infrequent (14, 10%), but notable factors were present in 90% of SIDS. For SIDS cases the following notable factors were identifiable: young mothers, Maori, low socioeconomic status, poor accommodation, frequent changes of address, maternal smoking, previous postneonatal death, poor antenatal care, male infant, low birth weight, twin, poor infant weight gain.

The effects of essential fatty acid supplementation by Efamol in hyperactive children

Thirty-one children, selected for marked inattention and overactivity, were studied in a double-blind, placebo-controlled crossover study of essential fatty acid (EFA) supplementation. Subjects received the active treatment and placebo conditions for 4 weeks each and were assessed on a variety of cognitive, motor, and standardized rating scale measures. EFA supplementation (evening primrose oil; Efamol) resulted in significantly lower levels of palmitoleic acid (a nonessential fatty acid) and higher concentrations of dihomogammalinolenic acid, an EFA previously found to be deficient in some hyperactive children. Supplementation was also associated with significant changes on two performance tasks and with significant improvement to parent ratings on the subscales designated as Attention Problem and Motor Excess of the Revised Behavior Problem Checklist. However, a variety of eight other psychomotor performance tests and two standardized teacher rating scales failed to indicate treatment effects. When the experiment-wise probability level was set at .05, only 2 of 42 variables showed treatment effects. Baseline EFA concentrations appeared to be unrelated to treatment response. It was concluded that EFA supplementation, as employed here, produces minimal or no improvements in hyperactive children selected without regard to baseline EFA concentrations.

Asthma education by community child health nurses

A randomised controlled study of an educational programme for children with asthma and their families was carried out by community child health nurses. Three hundred and sixty eight children aged 2 to 14 years were enrolled in the study after admission to hospital for asthma. The intervention group was visited monthly by a nurse for six months. The subjects were assessed six months later by a postal, self administered questionnaire. European children in the intervention group were taking significantly more drugs for the treatment of asthma six months after the index admission to hospital than those in the control group (mean (SD) intake 2.7 (1.1) v 2.1 (1.0), respectively). In particular, they were using more theophylline (56.6% v 37.0%) and inhaled steroids (34.9% v 21.0%). There was no difference between the groups for parental reports of improvement, of missed schooling, and in severe attacks of asthma of not responding to the usual treatment at home. European children in the intervention group used the hospital services for severe attacks of asthma more than controls (34.2% v 10.5%). There were more re-admissions in the European intervention group in the subsequent six months after the index admission than in the control group (mean (SD) 0.51 (0.97) v 0.29 (0.65). Re-admission continued to be higher in the 12 months after the nurse had stopped visiting (0.81 (1.65) v 0.25 (0.65]. There was no difference in the duration of hospital stay between the intervention and control groups. For Polynesian children there was no difference between the groups for any outcome measures.

Demographic characteristics of asthma admissions to hospitals

The age, sex, race, domicile and geographic distribution of patients admitted to hospital for asthma in New Zealand in 1981 were studied. The 0-14 year age group had a higher admission rate than the older age group. Males were admitted more frequently than females in the youngest and eldest age groups, but the converse was found in the 15-64 year age group. The Polynesian admission rates were more than double those of Europeans in all age groups. The effect of urban or rural domicile on asthma admission rates is age dependent. Urban dwellers under 25 years of age have higher admission rates than those with rural domiciles, however, in those over 45 there is a higher admission rate from rural areas than from urban areas. There was a highly significant difference in the admission rates between hospital boards (p = 0.003). For hospital boards serving populations of 50,000 or more there was a 9 fold difference between the highest (Hawkes Bay) and lowest (Nelson) admission rates. The geographical distribution of asthma admission rates show distinct areas with high (south of the North Island) and low (Auckland and Waikato) rates. The national admission rates almost doubled between 1976 and 1981 and the spatial pattern of admission rates was similar in these two years (r = 0.627 p less than 0.001). This indicates that the increase in admissions occurred uniformly throughout the country.

Cystic fibrosis heterozygotes have normal autonomic innervation of the heart

Five simple tests of autonomic nerve function based on measurements of cardiovascular responses to various stimuli were used to investigate possible autonomic dysfunction in obligate heterozygotes for cystic fibrosis. There were no significant differences between the heterozygotes and control groups in any of the tests, suggesting that cystic fibrosis heterozygotes have normal autonomic innervation of the heart.

Tests for autonomic neuropathy in diabetic children

Five simple tests of autonomic nerve function were studied in 38 children (12.0 years, s.d. = 3.3) with insulin-dependent diabetes mellitus and a further 38 age and sex matched controls in order to validate the use of these tests in children. The five tests included one test (immediate heart rate response to standing) previously reported. Compared to controls, diabetics showed a significantly faster heart rate at rest (P = 0.022), a reduced heart rate variation during quite respiration (P = 0.003), a smaller change in heart rate following a single deep breath (P = 0.006), a lower Valsalva ratio (P = 0.084) and a lower maximum R-R/minimum R-R ratio in response to standing (P = 0.033). The heart rate response to the Valsalva manoeuvre is less suitable for use in children than adults as it requires considerable co-ordination and co-operation and it did not correlate with the other tests of autonomic nerve function. The other tests significantly correlated with each other and were quick and easy to perform. They required no special co-operation and required no special equipment other than a standard ECG machine. Three diabetics had abnormalities in four of the tests (mean heart rate, heart rate variations during quiet respirations, change in heart rate produced by a single deep breath and the previously reported immediate heart rate response to standing). None of the controls had abnormalities in more than two of the tests.

International trends in hospital admission rates for asthma

Trends in annual hospital admission rates for asthma in the 0 to 14 year age group were examined in New Zealand, England and Wales, the United States, Canada, and Australia. There has been a striking increase in hospital admissions for asthma in children in all these countries since the mid 1960s.

Trends in sales of drugs for asthma in New Zealand, Australia, and the United Kingdom, 1975-81

As part of an investigation into the recent epidemic of deaths from asthma in New Zealand, trends in the sales of drugs for asthma in New Zealand, Australia, and the United Kingdom during 1975-81 were examined. Data on sales of drugs were obtained from an international pharmaceutical market research organisation. A striking increase in sales of sympathomimetic aerosols, steroid aerosols, and theophylline per caput occurred in all three countries, with the greatest increase occurring in New Zealand. Sales of sodium cromoglycate also increased in New Zealand and the UK but fell in Australia. By 1981 New Zealand had the highest sales of all these drugs per caput. Explanations for the rising mortality from asthma in New Zealand despite large increases in drug sales need to be explored. Although the temporal association between mortality and sales of drugs suggests that direct drug toxicity is unlikely, there may be more subtle adverse effects of drug use.

Paediatric admissions to Auckland Hospital for asthma from 1970-1980

Paediatric admissions to Auckland Hospital were examined for 1970 to 1980. The number of individual patients admitted for asthma each year increased significantly over the study period. The rate was higher in the 0-4 year age group than in the 5-14 year age group and was higher in Maori and Pacific Islander children than in Europeans. The male to female ratio was 1.4:1 over the period. The readmission rate increased between 1972 and 1980 and was higher for Polynesians than Europeans although there was no difference in the readmission rates of the 0-4 year age group compared to that of the 5-14 year age group. The mean length of hospital stay decreased significantly, but was longer in Polynesians than in Europeans.

Essential fatty acids and maladjusted behaviour in children

It has been suggested that hyperactivity may be produced by a deficiency in essential fatty acids (EFA) leading to a deficit in prostaglandin (PG) formation. The red blood cells EFAs levels were examined in 23 maladjusted children and in 20 normal children. Although no individual EFA showed statistically significant differences between the normal and maladjusted children, multivariate analysis showed that the levels of EFA series 2 PG precursors in maladjusted children were significantly lower than in controls as predicted (P = 0.0001).

Trends in hospital admission rates and drug treatment of asthma in New Zealand

Trends in hospital admission rates from asthma and sales of anti-asthma drugs in New Zealand for the past two decades were examined. In this period there has been a marked increase in hospital admissions for asthma and in sales of anti-asthma medications. These findings and the recently reported increase in asthma mortality in New Zealand indicate that asthma is an important health problem in this country.

Diabetic autonomic neuropathy in children: immediate heart-rate response to standing

The immediate heart-rate response to standing was used to investigate possible autonomic neuropathy in a group of 38 insulin-dependent diabetic patients in the paediatric age group. The controls and most of the diabetics showed the characteristic response to standing of a rapid increase in heart-rate and a fall to the resting rate within 15 seconds. Some diabetics showed a flat response or a prolonged gradual increase of heart-rate on standing. The usual method of describing the change in heart rate that occurs in response to standing is to compare the R-R intervals at the 30th and 15th beats (30:15 ratio). This is considered less appropriate in children because of the wider variability in heart rate due to sinus arrhythmia. An alternative ratio, the "maximum R-R/minimum R-R ratio" is proposed. This ratio is calculated by dividing the length of the maximum R-R interval (which occurred after the minimum R-R interval during the 30 second recording) by the length of the minimum R-R interval. Compared to 38 index-selected age and sex matched controls, the diabetics showed a significantly lower mean "maximum R-R/minimum R-R ratio (P = 0.033). Six of the diabetics had results lower than the lowest control result. This test gives a prevalence rate of changes suggestive of diabetic autonomic neuropathy of approximately 15% in this age group.

Hospital admissions for asthma in children: a prospective study

One hundred consecutive admissions to hospital for asthma in children aged three to 14 were studied prospectively. There was considerable morbidity in these patients; the mean number of admissions for asthma was 5.7 and 46 percent of patients of school age had issued four weeks or more in the previous 12 months due to asthma. 27 percent of the patients were Polynesian Pacific Islanders (PI) compared to 7 percent in the Auckland urban areas (p less than 0.01). PI were readmitted more frequently during the study period compared to Europeans (p less than 0.005). No difference in the general form of asthma was seen between ethnic groups. However, there were marked socioeconomic differences implied by lower home ownership, larger families and relative overcrowding in the home of PI. The higher admission rates of PI may be related to these and to lower drug usage, in particular fewer patients were using sodium cromoglycate and different admission criteria.

HLA and idiopathic thrombocytopenic purpura

HLA antigens were determined in 24 patients with chronic idiopathic thrombocytopenic purpura (ITP) who had had splenectomy and in 524 normal blood donors. There was no significant association of any HLA antigen in patients with ITP as compared to controls.

Controlled trial of an electrostatic precipitator in childhood asthma

A cross-over trial was conducted on 10 children with moderate to severe asthma, who had positive skin tests to Dermatophagoides pteronyssinus and nocturnal wheeze. An electrostatic precipitator was used during the night to remove airborne particles from the bedroom. During use of the precipitator peak expiratory flow rates were no better than in a control period.

Meconium ileus equivalent in a child with cystic fibrosis taking cimetidine

A child with cystic fibrosis was given cimetidine in addition to pancreatic extract. Although the stool frequency was reduced the cimetidine had to be withdrawn because meconium ileus equivalent developed.

Pharmacokinetics of Nuelin-SR 250 mg in asthmatic children: a new sustained-release theophylline

The pharmacokinetics of Nuelin-SR 250 mg was studied in asthmatic children. This study suggests that this new sustained-release theophylline will be useful for the purpose of maintaining serum theophylline levels within the safe and therapeutic range with a twice daily dosing schedule.

Serum and hair zinc in cystic fibrosis

Zinc levels were measured in serum and hair of normal children and children with cystic fibrosis (CF). The only significant difference found was a higher mean zinc level in hair of CF patients with growth retardation compared to that of CF patients with normal growth.