Experiences of Inner-City Fathers of Children With Chronic Illness

We aim to explore the experiences of fathers from inner-city families caring for children affected by chronic health conditions or disabilities. A systematic scoping review was conducted using the Arskey and O'Malley framework. Fourteen of the 5114 articles were included in the full review and were qualitatively evaluated in terms of stressors, resources, perception, coping, and adaptation according to the Double ABCX model. Stressors included financial strain and health care access barriers. Resources ranging from immediate to extended family members depended on ethnicity. Fathers' perceptions of their primary caregiver roles depended on ethnicity in the context of cultural gender norms. While inner-city fathers desired information about their children's health, some were uncomfortable asking physicians. They had a higher risk for coping difficulties and maladaptation, including depression. We highlight a need for pediatricians to advocate for additional resources to provide comprehensive care for inner-city fathers caring for their children with chronic health conditions or disabilities.

International study of wheezing in infants: risk factors in affluent and non-affluent countries during the first year of life

Risk factors for wheezing during the first year of life (a major cause of respiratory morbidity worldwide) are poorly known in non-affluent countries. We studied and compared risk factors in infants living in affluent and non-affluent areas of the world. A population-based study was carried out in random samples of infants from centres in Latin America (LA) and Europe (EU). Parents answered validated questionnaires referring to the first year of their infant's life during routine health visits. Wheezing was stratified into occasional (1-2 episodes, OW) and recurrent (3 + episodes, RW). Among the 28687 infants included, the most important independent risk factors for OW and RW (both in LA and in EU) were having a cold during the first 3 months of life [OR for RW 3.12 (2.60-3.78) and 3.15 (2.51-3.97); population attributable fraction (PAF) 25.0% and 23.7%]; and attending nursery school [OR for RW 2.50 (2.04-3.08) and 3.09 (2.04-4.67); PAF 7.4% and 20.3%]. Other risk factors were as follows: male gender, smoking during pregnancy, family history of asthma/rhinitis, and infant eczema. Breast feeding for >3 months protected from RW [OR 0.8 (0.71-0.89) in LA and 0.77 (0.63-0.93) in EU]. University studies of mother protected only in LA [OR for OW 0.85 (0.76-0.95) and for RW 0.80 (0.70-0.90)]. Although most risk factors for wheezing are common in LA and EU; their public health impact may be quite different. Avoiding nursery schools and smoking in pregnancy, breastfeeding babies >3 months, and improving mother's education would have a substantial impact in lowering its prevalence worldwide.

[Prevalence of asthma symptoms and risk factors among adolescents in Tubarão and Capivari de Baixo, Santa Catarina State, Brazil]

This study aimed to measure the prevalence and severity of asthma symptoms and to investigate the association between asthma symptoms and personal, geographic, and socioeconomic variables in 13-14-year-old schoolchildren enrolled in the 7th and 8th grades in Tubarão and Capivari de Baixo, Santa Catarina State, Brazil. This was a cross-sectional study using the ISAAC (International Study of Asthma and Allergies in Childhood) written questionnaire, applied to 1,870 adolescents enrolled in 42 schools in the two cities, from March to May 2005. Prevalence of current asthma (defined as wheezing in the previous 12 months) was 11.8%, and there was a 7.8% lifetime prevalence of physician-diagnosed asthma. Prevalence of wheezing that interrupted sleep (one or more nights per week) was 2.1%; 8.1% had 1-3 wheezing attacks per year; and 3.7% had wheezing that disturbed their speech. According to multivariate analysis, female gender, family history, parental asthma, rental housing, and smoking inside the home were risk factors for current asthma. Prevalence and severity of current asthma were less than in other Brazilian studies.

Prevalence of allergic rhinitis in 3-6-year-old children in Wuhan of China

BACKGROUND

Only a few prevalence studies of allergic rhinitis (AR) have been reported in China. This study aimed to evaluate the prevalence of AR in a population of 3-6-year-old children in Wuhan, China.

METHODS

Sixteen kindergartens in Wuhan City were randomly selected; for each kindergarten, there were three classes from three grades (top, middle and bottom grade, 3-6 years old, respectively). Questionnaires generated by the authors were distributed and filled out by parents of the selected children, with a telephone interview subsequently. Skin prick test (SPT) was carried out on the children after a written consent was signed by the parents.

RESULTS

A total of 1211 (89.5%) valid questionnaires were returned for evaluation. The adjusted current prevalence of AR in 3-6-year-old children was 10.8% with the diagnostic criterion of nasal symptoms(+) and SPTs(+). In the SPTs(+) children, the most common inhalant allergen was house dust mites (94.7%), followed by moulds (28.4%). The prevalence of AR was higher in males than that in females (13.0% vs. 7.7%, P < 0.05). 15.8% and 23.2% of AR children were sensitive to egg and milk, respectively. The percentage of children sensitive to both inhalant and food allergens was 27.4%.

CONCLUSIONS

We found an unexpectedly high prevalence of diagnosed AR in 3-6-year-old children within the investigated population. Dust mite was the most important allergen source for 3-6-year-old children in Wuhan.

Asma em escolares de 13 e 14 anos do Município de Nova Iguaçu, Rio de Janeiro, Brasil: estimativas de prevalência, gravidade e diferenças de gênero

O objetivo deste estudo foi descrever a prevalência, a gravidade e os sintomas associados à asma e sua relação com o gênero em escolares de 13 e 14 anos do Município de Nova Iguaçu, Rio de Janeiro, Brasil. Trata-se de estudo transversal, no qual se utilizou o questionário escrito auto-aplicável para asma do International Study of Asthma and Allergies in Childhood (ISAAC). Participaram 3.033 escolares de 37 escolas públicas e privadas selecionadas aleatoriamente. A prevalência de sibilância alguma vez na vida foi de 26% e nos últimos 12 meses (asma atual) de 11,7%, sendo essas taxas maiores entre as meninas (razão de prevalência - RP = 1,46; IC95%: 1,31-1,62 e RP =1,72; IC95%: 1,35-2,21, respectivamente). Sintomas associados à gravidade da doença, como distúrbio do sono e limitação da fala por sibilos, também se associaram positivamente com o gênero feminino (RP = 2,57; IC95%:1,77-3,73 e RP = 2,07; IC95%:1,25-3,43). A prevalência da asma mostrou-se menor quando comparada com as de outras cidades brasileiras, porém ainda é alta entre adolescentes de Nova Iguaçu, sendo mais freqüente e mais grave no gênero feminino. Outros estudos são necessários para explicar tais diferenças.

Allergic rhinoconjunctivitis: epidemiology

Allergic rhinoconjunctivitis has been studied much less frequently than asthma using epidemiologic approaches. Population-based studies are difficult to conduct because of misclassification arising from the reliance on self-reported questionnaires that use terms such as allergic rhinitis or hay fever to establish the diagnosis. In addition, many epidemiologic studies focus on diagnostic skin testing or allergen-specific IgE antibodies (RASTs) as an objective outcome to assess for hay fever. These techniques are helpful but not perfect measures for predicting hay fever outcomes in epidemiologic studies. It is generally accepted, however, that allergic rhinoconjunctivitis is one of the most common of chronic diseases and is the most common atopic disorder. This article reviews the definition of allergic rhinoconjunctivitis, the epidemiology of this disorder from infancy into adulthood, and environmental risk factors for development of sensitization to certain allergens.

[Satellite symposium: Asthma in the World. Asthma among children in Latin America]

The prevalence of respiratory symptoms related to asthma in children from Latin America has been largely ignored. This region participated in phases I and III of the International Study of Asthma and Allergies in Childhood (ISAAC) with 17 participating centers in phase I and 78 centers in phase III. Data were obtained on asthma, rhinitis and eczema from countries and centers with markedly different climactic, cultural and environmental conditions and socioeconomic development. The results for phase I are presented herein because data from phase III are currently being revised at the ISAAC international data control center and will be officially available in the second half of 2004. Phase I provided important information on the prevalence of asthma in the participating countries and demonstrated wide variation among centers in the same country and among countries. The participating Latin American countries are all developing countries and share more or less the same problems related to low socioeconomic status. Therefore, the results and figures should be analyzed within that context. The range for accumulative and current asthma symptoms in children from the Latin American countries that participated in phase I (89,000) were as follows: the prevalence of asthma ranged from 5.5% to 28% in children aged 13-14 years and from 4.1% to 26.9% in children aged 6-7 years. The prevalence of wheezing in the previous 12 months ranged from 6.6% to 27% in children aged 13-14 years and from 8.6% to 32.1% in children aged 6-7 years. The high figures for asthma in a region with a high level of gastrointestinal parasites infestation, a high burden of acute respiratory and gastrointestinal infections occurring early in life, severe environmental and hygiene problems, suggest that these factors, considered as protective in other (developed) regions of the world, do not have the same effect in this region. Furthermore, those aggressive environmental conditions acting together from very early in life might condition different asthmatic phenotypes with more severe clinical presentation in infancy (first 2 years of life), lower atopy and enhanced airways reactivity. The present study indicates that the prevalence of asthma and related symptoms in Latin America is as high and variable as described previously for industrialized or developed regions of the world and that the environmental risk factors, mainly related with poverty, could be responsible for the different clinical and functional presentations of asthma in children from developing regions.

Do risk factors for childhood infections and malnutrition protect against asthma? A study of Brazilian male adolescents

OBJECTIVES

We studied the association between early life conditions and asthma in adolescence.

METHODS

We conducted a population-based birth cohort study involving 2250 male 18-year-olds residing in Brazil.

RESULTS

Approximately 18% of the adolescents reported having asthma. Several childhood factors were found to be significantly associated with increased asthma risk: being of high socioeconomic status, living in an uncrowded household, and children being breastfed for 9 months or longer.

CONCLUSIONS

The present results are consistent with the "hygiene hypothesis," according to which early exposure to infections provides protection against asthma. The policy implications of our findings are unclear given that risk factors for asthma protect against serious childhood diseases in developing countries.