Early age at debut is a predictor of steroid-dependent and frequent relapsing nephrotic syndrome.

The purpose of this study was to identify characteristics of patients with steroid-sensitive nephrotic syndrome (SSNS) that point to a high risk of frequent relapsing (FR) or steroid-dependent (SD) SSNS. A retrospective analysis of 54 consecutive patients with SSNS was performed. In this cohort, the incidence of idiopathic NS was 1.9/100,000, age at debut was 5.5 years, and the mean follow-up was 4.0 years. A total of 56% (30/54) of our patients were classified with FR/SD SSNS. FR/SD patients were significantly younger at debut than non-FR/SD patients (3.5 vs. 8.5 years, respectively; p < 0.002). Males were overrepresented in the FR/SD group (69 vs. 38%; p = 0.03). No differences were found in terms of haematuria, hypoalbuminaemia, or days to achieve remission. In total, 31 and 23 patients were on a 6 + 6-week (pred-long) and 4 + 4-week (pred-short) steroid treatment regimen, respectively. There was a reduction in the number of FR/SD patients in the pred-long group relative to the pred-short group (38 vs. 80%, respectively). In the pred-long group, the 12 FR/SD patients were younger than the 19 non-FR/SD patients (4.4 +/- 3.1 vs. 8.4 +/- 4.1 years; p<0.005). Low age at debut and male gender was associated with a high risk of SD/FR in this unselected series of SSNS patients despite the prolongation of the steroid course at debut of SSNS.

[22q11 deletion syndrome]. / 22q11-deletionssyndrom.

22q11 deletion syndrome (formerly named CATCH22, DiGeorge, Velo-Cardio-Facial, Caylor, Kinouchi and Shprintzen syndrome) occurs in approximately 1/2000 to 4000 children. The genetic lesion is remarkably uniform, occurring mainly as 3 or 1.5 MB deletions in the 22q11.2 region. However, the clinical manifestations are variable and manifestation in several organ systems often occur. In this review we describe the various manifestations of the syndrome. Finally, we suggest strategies for diagnosing, evaluating and organizing the treatment for Danish patients with this syndrome.

Clustering of acute respiratory infection hospitalizations in childcare facilities.

AIM: To estimate how risk of acute respiratory infection (ARI) hospitalization in children attending childcare facilities with a recently (within 1 month) hospitalized child is affected by gender, age and other characteristics. METHODS: Population-based prospective cohort study of 436 434 Danish 0-5-year-old children attending childcare during 1989-2004. Information was collected from Danish registers. Main outcome measure was incidence rate ratios (IRRs) of in-patient hospitalization for ARI. RESULTS: During 1 777 999 person-years of follow-up 42 681 hospitalizations for ARI occurred, of which 362 (1%) occurred within 1 month after another child was hospitalized for ARI in the facility. Children attending a facility with a recent ARI hospitalization had an increased risk of 42% (95% CI 27%;60%) compared with other children. The increased risk was higher in 0-2-year-old children than in 3-5-year-old children (55% vs 17%, p = 0.02) and if the latest hospitalized child was 0-2 years rather than 3-5 years (52% vs 19%, p = 0.04). The increased risk was similar in boys and girls, but was higher if the latest hospitalized child was a boy rather than a girl (52% vs 13%, p = 0.02). CONCLUSION: Although occurring infrequently, clustering of ARI hospitalizations involve 0-2-year-olds and boys as first hospitalized child relatively more often than would be expected.

Association between social position and congenital anomalies: a population-based study among 19,874 Danish women.

AIMS: To examine the association between maternal and paternal educational level and household income and the risk of giving birth to a baby with a congenital anomaly in a population of Danish women. METHODS: We performed a population-based cohort study, based on record linkage of data from Danish administrative registries. For each pregnant woman in the cohort, we described financial and educational resources and congenital anomalies in her offspring. We used logistic regression to model the association between social position and congenital anomalies. RESULTS: The analyses included all 19,874 primiparous singleton deliveries in North Jutland county, Denmark, from 1991 to 1998. There were 1025 (5.2%) babies with congenital anomalies. The odds ratios (ORs) for giving birth to a baby with a congenital anomaly showed a dose- response decline, as the mothers' educational level increased. Women with less than 10 years of schooling had an almost three-fold increased risk of giving birth to an infant with a congenital anomaly, as compared with women with more than 4 years of higher education (OR=2.9, 95% confidence interval = 1.8-4.6). Paternal educational level and household income were, to a lesser degree, associated with congenital anomalies in the offspring. CONCLUSIONS: Maternal educational level, and to a lesser degree paternal educational level and household income, were associated with the risk of giving birth to a baby with a congenital anomaly. However, the analysis did not take into account maternal health status, and the results might be due to differential misclassification or residual confounding.

Associations between socio-economic factors and the use of prescription medication during pregnancy: a population-based study among 19,874 Danish women.

OBJECTIVE: To examine the association between socio-economic factors and use of prescription medication during pregnancy in a population of Danish women. METHODS: This was a population-based cohort study. Using record linkage from public administrative registries, we described the use of prescription medication during pregnancy and the financial and educational resources for each pregnant woman in the cohort. RESULTS: The analyses included all 19,874 primiparous women delivering singletons in North Jutland county, Denmark, in 1991-1998. We identified 24,243 prescriptions filled by the women during their pregnancies. The highest overall prescription medication use was among women with basic schooling (OR 1.3; 95% CI 1.2-1.4), and lowest among women with the highest education (OR: 0.8; 95% CI 0.7-0.9) compared with women who had vocational education. Stratified analysis of therapeutic subgroups revealed that socio-economic factors were associated with the use of anti-infective and anti-asthmatic medications during pregnancy. CONCLUSION: Maternal educational level, and to a lesser degree household income, paternal educational level and cohabitation status, was associated with the use of prescription medication during pregnancy. However, the analyses did not take into account important clinical variables such as maternal illness, and the results could be affected by differential misclassification of exposure information, by confounding or chance.

Socioeconomic factors and risk of hospitalization with infectious diseases in 0- to 2-year-old Danish children.

Although the association between low socioeconomic status and illness in childhood is well known, the impact of socioeconomic factors on risk and frequency of hospitalizations for infectious diseases, the most frequent disease category, during the first 2 years of life has scarcely been studied. Through linkage of records drawn from public administrative and health registries, we conducted a population-based cohort study of 5024 Danish children born in 1997 to examine the frequency of hospitalization for infectious diseases in very young children. The main exposure variables, adjusted for potential confounding factors, were mother's education level, household income, and cohabitation status. The outcome was number of hospital admissions (0, 1-2, or 3+) for infectious diseases. A total of 737 children (14.7%) were admitted to hospital 1-2 times, and 83 (1.6%) were admitted 3-10 times. The risk of hospitalization was increased in children of mothers with a low level of education compared with vocational education (1-2 admissions: adjusted odds ratio (OR) 1.3 (95% confidence interval [CI]: 1.1-1.6). Children from low-income families had an increased risk of 3 or more admissions (low cf middle income: adjusted OR 2.0 [95% CI: 0.6-6.0]). Children of single mothers had an increased risk of hospitalization (1-2 admissions: adjusted OR 1.7 [95% CI: 1.1-2.6]. We found the highest risk of hospitalization for infectious diseases in children of mothers with only basic schooling, and particularly among those coming from single parent homes with a low income.

Socioeconomic factors and prescription of antibiotics in 0- to 2-year-old Danish children.

OBJECTIVES: The aim was to examine the impact of socioeconomic factors on the use of systemic antibiotics during the first 2 years of life. METHODS: This was a population-based cohort study of 5024 Danish children born in 1997. The study was conducted by linking records drawn from public administrative registries. The main predictor variables were mother's education level, household income and cohabitation status. The outcome was the number of antibiotic courses (0, 1-5, > or =6) during the first 2 years of life. RESULTS: A total of 3273 children (65.1%) received 1-5 antibiotic courses, and 337 (6.7%) received > or =6 courses of antibiotics during the first 2 years of life. The risk of receiving > or =6 courses of antibiotics was increased in children of mothers with a low educational level (< or =10 years) compared with vocational education [OR 1.3 (95% CI 1.0-1.7)]. Children of mothers with a higher education >4 years had a reduced risk of receiving > or =6 courses [OR 0.3 (95% CI 0.1-0.7)]. Children from high-income families had a reduced risk (not statistically significant) of receiving antibiotics, compared with children from middle-income families [1-5 and > or =6 courses: adjusted OR 0.6 (95% CI 0.3-1.2)]. Children of single mothers had an increased risk of receiving antibiotics, particularly if the child did not attend day care. CONCLUSIONS: Socioeconomic factors have some impact on antibiotic prescription in young children. Children of mothers with only basic schooling were at highest risk of receiving multiple prescriptions, whereas children of mothers with a high education, and/or high household income, had the lowest risk.