RESUMEN
BACKGROUND: A gap has been reported between healthcare professionals' (hereafter "professionals") recognition of preschool children's diets and parents' perception of concern. This study investigated the gap between the concerns reported by professionals and parents' perceptions regarding health and dietary habits by age (18 months and 3 years) and gender in Japan. METHODS: The study design consisted of a cross-sectional, multilevel survey. The request letters were sent to all households with target children with the cooperation of local governments. After obtaining written informed consent from parents, questionnaires were distributed to them. The survey included 30 items on children's concerns about health and dietary habits. At the health checkup, parents indicated whether they were concerned in response to each item, and responded child's height and weight and birth height and weight. Next, the professionals provided counseling to the parents at a health checkup. After that, the professionals noted their concerns in response to the same 30 items as those given to parents. The participation rates were 82.9% (18 months) and 82.8% (3 years). Data of 239 persons for 18 months and 223 persons for 3 years old were analyzed. In the statistical analysis, the items that were judged as concerning by professionals but not by parents were identified; likewise, the items that were of concern to parents but not to professionals were identified. Sensitivity, false negative rate, specificity, false positive rate, and Youden index were calculated to analyze the discordance rate for each item. RESULTS: Many parents in this study were concerned about the issues that professionals did not consider to be concerning. Moreover, the parents worried about more issues for 3-year-olds than for 18-month-olds. The items for which ≥ 10 professionals indicated concerns and with higher discordance between the professionals and parents for both boys and girls were "picky eating" for 18-month-olds and "inconsistent amount of food" for 3-year-olds. CONCLUSIONS: The concerns that professionals have with respect to children's diets and the things that parents worry about show gaps. It might be necessary to provide professional counseling for parents to develop a correct understanding of their children's dietary habits.
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Conducta Alimentaria , Padres , Masculino , Femenino , Humanos , Preescolar , Japón , Estudios Transversales , Conducta Alimentaria/psicología , Padres/psicología , Encuestas y Cuestionarios , Atención a la SaludRESUMEN
AIM: Our aim was to examine whether serum levels of placental growth factor (PlGF) and soluble endoglin (sEng) at 19-25 and 26-31 weeks of gestation were associated with the occurrence of the 9-block categorization of placenta weight (PW) and fetal/placenta ratio (F/P ratio). METHODS: We performed a retrospective cohort study in 1391 women with singleton pregnancy. Serum levels of PlGF and sEng were measured by enzyme immunosorbent assay. A light placenta was defined as PW ZS < -1.28 SD. Based on the PW (light, normal, and heavy) and F/P ratio (relatively heavy, balanced growth, and relatively small), 9-block categorization were performed. Multivariable logistic regression analyses were performed. RESULTS: Low PlGF at 26-31 weeks was an independent risk factor for the birth of infants belonging to Block A (light placenta and relatively heavy infant), after adjusting for prepregnancy body mass index and serum levels of sEng. High sEng at 26-31 weeks was an independent risk factor for the birth of infants belonging to Block D (light placenta and balanced growth of infant), after adjusting for past history of either preeclampsia or gestational hypertension, high pulsatility index of uterine artery flow velocity waveforms in the second trimester, and serum level of PlGF. CONCLUSIONS: Low PlGF levels at 26-31 weeks of gestation may precede a light placenta and relatively heavy infant (Block A), and high sEng levels at 26-31 weeks of gestation may precede a light placenta and balanced growth of infant (Block D).
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Endoglina/sangre , Factor de Crecimiento Placentario/sangre , Preeclampsia , Proteínas Gestacionales , Antígenos CD , Biomarcadores , Peso al Nacer , Femenino , Humanos , Recién Nacido , Placenta , Embarazo , Receptores de Superficie Celular , Estudios Retrospectivos , Receptor 1 de Factores de Crecimiento Endotelial VascularRESUMEN
BACKGROUND: Little has been reported on how to introduce hen's egg into the diet of children with suspected egg allergy. We compared the efficacy, safety, and parental anxiety of two different dietary instruction methods to introduce egg. METHODS: Eligible participants were children aged 1-4 years who were positive for egg white IgE, and ovomucoid IgE <3.5 kUA/L. Participants were either naïve in egg consumption or had a history of an immediate, but non-anaphylactic, allergic reaction to egg. After a negative result of baseline 2 g boiled egg white oral food challenge (OFC), participants were randomly assigned to the step-up OFC testing (SOFT) or home incrementing group. The primary outcome was the proportion of participants who were able to ingest 20 g of boiled egg white 6 months after initiation. This study is registered with the University Hospital Medical Information Network clinical trial registry (UMIN000024192). RESULTS: Between September 2016 and August 2018, we randomly allocated 55 participants to the SOFT (n = 33 [60%]) and home incrementing (n = 22 [40%]) groups and analyzed 51 patients. Four patients were excluded because they were lost to follow-up. Thirty-one (96.9%) of 32 participants in the SOFT and 12 (63.2%) of 19 in the home incrementing group achieved the primary outcome (p = 0.003). No serious adverse reactions were observed in either group. Parental anxiety significantly improved during treatment in both groups. CONCLUSIONS: The SOFT method was more effective than home incrementing as dietary instruction to introduce egg in children with suspected egg allergy.
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Dieta/normas , Hipersensibilidad al Huevo/epidemiología , Hipersensibilidad al Huevo/psicología , Clara de Huevo/efectos adversos , Huevos/efectos adversos , Padres/psicología , Adulto , Alérgenos/inmunología , Animales , Pollos , Preescolar , Ensayos Clínicos como Asunto , Dieta/estadística & datos numéricos , Encuestas sobre Dietas , Hipersensibilidad al Huevo/diagnóstico , Hipersensibilidad al Huevo/inmunología , Humanos , Inmunoglobulina E/sangre , Inmunoglobulina E/inmunología , LactanteRESUMEN
ObjectivesãIn Japan, medical questionnaires on diet and lifestyle are administered during health checkups for children. Since the rate of health checkup participation is high, the information obtained from these questionnaires can be used for regional diagnoses. In this study, we evaluated the relationship between sweet snack eating habits (SSEHs) and lifestyle habits in toddlers using data from the questionnaires.MethodsãThis study was conducted across 35 municipalities in Aichi Prefecture, Japan, where individual toddlers can be tracked at medical examinations at the age of 1 year 6 months (18 m) and 3 years (36 m). The subjects were 18,251 toddlers (9,393 boys [51.5%]) who participated in the health checkup in the same municipalities at 18 m in 2013 and 36 m in 2014-2015. Subjects were divided into four categories based on their SSEHs at 18 m and 36 m: N-N (no SSEH at either 18 m or 36 m); Y-N (no SSEH at 36 m only); N-Y (no SSEH at 18 m only); Y-Y (SSEH at both 18 m and 36 m). Other lifestyle habits were divided into two levels: good habits and bad habits. A multinomial logistic regression analysis was performed using the SSEH category as the dependent variable and lifestyle as the independent variable. The control groups were the Y-Y category and bad habit for the dependent and independent variables, respectively.ResultsãThe proportions of N-N, Y-N, N-Y, and Y-Y subjects were 27.7%, 8.6%, 24.1%, and 39.6%, respectively. At 18 m, 48.2% toddlers had an SSEH, which increased to 63.7% at 36 m. Most toddlers (82.2%) had a habit of sweet snacking at 18 m and habitually consumed sweet snacks at 36 m. The absence of nursing at bedtime at 18 m was positively associated with the N-N group (odds ratio [99% confidence interval]=1.25 [1.11-1.41]) and the Y-N group (1.28 [1.07-1.52]); however, no association was found with the N-Y group (0.99 [0.88-1.11]). Parental finish polishing at 18 m tended to show a positive association only with the N-N group (1.10 [0.99-1.23]).ConclusionãNearly half of toddlers had SSEHs by 18 m, and most of them continued to have the habit at 36 m. Oral hygiene behavior at 18 m was associated with SSEHs of toddlers up to 36 m. A regional diagnosis using the results of the health checkup for children is useful for identifying factors related to health problems.
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Azúcares de la Dieta/administración & dosificación , Conducta Alimentaria/fisiología , Estado de Salud , Fenómenos Fisiológicos Nutricionales del Lactante/fisiología , Estilo de Vida , Bocadillos , Bebidas Azucaradas , Preescolar , Femenino , Conductas Relacionadas con la Salud , Humanos , Lactante , Conducta del Lactante , Japón , Masculino , Higiene Bucal/psicología , Examen FísicoRESUMEN
BACKGROUND: To clarify the status of admission to facilities for food allergy (FA) children. METHODS: Guardians of FA children who underwent oral food challenges at Sagamihara National Hospital from September to December 2018 were enrolled. We surveyed the experience of refusal to enter facilities, the reason for refusal and so on using a self-administered questionnaire. RESULTS: We distributed a questionnaire to 205 guardians, of which 168 responded (response rate 82%). The median age (range) at the time of the survey was 4.5 (0 to 12) years old, 2 (1 to 11) food items had been removed at the time of admission, and 56 (33%) had a history of anaphylaxis before admission. Twenty-nine patients (17%) were prescribed an adrenaline auto injector. Twenty patients (12%) had been denied entry, the median number of refusals (range) was 1.5 (1 to 30). History of anaphylaxis before admission (odds ratio 2.80 [1.08-7.22]) and having 5 or more causative foods (odds ratio 3.44 [1.27-9.32]) were associated with admission refusal. ã' Factors related to children with FAã, ãFactors related to facilitiesã, and ãFactors related to facility staffã were extracted as the reasons for refusal. CONCLUSIONS: In addition to the factors related to children with FA, the factors related to facilities and facility staff were related to admission refusal. Therefore, cooperation between medical care, local governments, and facility that comprehensively supports the living environment of children with FA is needed.
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Anafilaxia , Hipersensibilidad a los Alimentos , Alérgenos , Niño , Preescolar , Epinefrina , Hipersensibilidad a los Alimentos/epidemiología , Humanos , Encuestas y CuestionariosRESUMEN
Objective: To demonstrate the differences in intrauterine fetal deaths and neonatal deaths between small for date (SFD) and Non-SFD neonates by applying a novel classification from both Z scores of placental weight (PW) and fetal/placental weight ratio (F/P) to small for gestational age (SGA) neonates. Methods: From 93,034 placentas/infants of mothers who vaginally delivered a singleton infant (Japan Perinatal Registry Network database 2013), SGA (n=7,780) was chosen according to the reference to Japanese neonatal growth chart. They were divided into two subgroups: SFD (body weight and height less than the 10th percentile, n=3,379) and Non-SFD (only body weight less than the 10th percentile, n=4,401). Z scores of PW and F/P based on the standard curves for sex-, parity-, and gestational-age-specific PW and F/P were calculated. The population was classified into 9 groups according to the combination of 'low vs. middle vs. high' i) PW Z score and ii) F/P Z score. In both i) and ii), ± 1.28 standard deviations in the Z scores were used for classifying low vs. middle vs. high, with 3×3 making 9 groups. From top-left to bottom-right, we labeled the groups as Group A to Group I. Results: SFD and Non-SFD neonates distributed in the same 6 groups (A, D, E, G, H, I). In group E, which was considered to be balanced placental and infant growth, the incidence of intrauterine fetal death was significantly higher in Non-SFD neonates than in SFD neonates. In group D, which was considered to be small placenta and balanced infant growth, the incidence of neonatal death was significantly higher in SFD neonates than in Non-SFD neonates. Conclusion: Assessment of SGA neonates by dividing them into SFD and Non-SFD neonates and application of a 9-group classification by PW and F/P Z scores were informative to understand the pathophysiological involvement of an imbalance between placental and fetal sizes.
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Retardo del Crecimiento Fetal/fisiopatología , Recién Nacido Pequeño para la Edad Gestacional/fisiología , Muerte Perinatal , Placenta/fisiopatología , Peso al Nacer , Parto Obstétrico , Femenino , Retardo del Crecimiento Fetal/epidemiología , Edad Gestacional , Humanos , Lactante , Recién Nacido , Japón/epidemiología , Masculino , EmbarazoRESUMEN
AIM: The difference of placental weight (PW) and fetal/placental weight ratio (F/P) Z scores by mode of delivery is unclear. To investigate such differences and the actual conditions underlying the imbalance between fetal and placental growth. METHODS: The data from Japanese database 2013 were assessed. Light-for-dates (LFD, n = 12 884), appropriate-for-dates (n = 114 464) and heavy-for-dates (n = 13 164) from 140 512 placentas/infants of mothers delivered a singleton infant. Using Z scores of PW and F/P based on the standard curves of a sex-, parity- and gestational-age-specific PW and F/P, the rate of inappropriately heavy placenta according to the mode of delivery (vaginal [VD] vs cesarean [CS]) was investigated. RESULTS: (i) The PW and F/P were heavier and bigger in VD than in CS, in each subgroup. In the LFD groups, the PW Z score in VD was higher than that in CS, whereas the F/P Z score was lower than in VD than that in CS. (ii) Data of single regression analyses between the PW Z score and F/P Z score in VD groups were different from those in CS, especially in LFD infants. (iii) In the LFD subgroups, the rates of inappropriately heavy placenta in VD (n = 7781) and CS (n = 5103) were 0.54% and 0.86%, respectively. CONCLUSION: Difference in the mode of delivery influenced the PW and F/P, and the rate of inappropriately heavy placenta is associated with mode of delivery among LFD infants. This methodology might give us a clue to search a useful way for identifying the high-risk groups requiring postnatal counseling.
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Parto Obstétrico , Peso Fetal , Placenta/anatomía & histología , Peso al Nacer , Cesárea , Femenino , Humanos , Recién Nacido , Tamaño de los Órganos , EmbarazoRESUMEN
Objective: To classify the infants into 9 blocks based on the deviation of both placental weight (PW) and fetal/placental weight ratio (F/P) Z score and compared the incident rate of perinatal death in each of the small for date (SFD) vs. appropriate for date (AFD) vs. heavy for date (HFD) groups. Methods: The study population consisted of 93,034 placentas/infants from women who vaginally delivered a singleton infant. They were classified into 3 groups according to infants' weight: SFD (n=3,379), AFD (n=81,143) and HFD (n=8,512). The population was classified into 9 blocks according to the combination of i) low vs. middle vs. high placental weight (PW: a sex-, parity- and gestational-age-specific placental weight) and ii) low vs. middle vs. high F/P. In both i) and ii), ± 1.28 standard deviations in the in the Z scores was used for classifying low vs. middle vs. high, with 3x3 making 9 blocks. We then determined whether or not the perinatal death in each block differed among the three groups (SFD vs. AFD vs. HFD). Results: (1) The proportions of 'balanced growth of placenta and infant' (appropriate PW and F/P based on Z-score) were 37.6% in the SFD group, 78.8% in the AFD group, and 51.2% in HFD group. (2) The proportion of 'inappropriately heavy placenta' in the SFD group and that of 'inappropriately light placenta' in the HFD group were 0.3 and 0.4%, respectively, a very rare phenomenon. The proportions of 'inappropriately heavy placenta' and 'inappropriately light placenta' accounted for 4.1 and 5.5% in AFD group, respectively. (3) The rates of perinatal death in those with 'balanced growth of placenta and infant' were lowest in the SFD and AFD groups. Conclusion: By showing the fact that perinatal death was lowest in cases with balanced fetal/ placental growth, we conclude that 9-block categorization of PW and F/P based on deviation in the Z-score may be a candidate factor employable for understanding fetal and placental growth and perinatal deaths.
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Desarrollo Fetal/fisiología , Recién Nacido Pequeño para la Edad Gestacional/fisiología , Placenta/fisiología , Adulto , Peso al Nacer/fisiología , Femenino , Feto/fisiología , Edad Gestacional , Humanos , Recién Nacido , Tamaño de los Órganos , Paridad/fisiología , EmbarazoRESUMEN
BACKGROUND: Health personnel must provide continuous support in response to problematic results from health checks of infants and toddlers (hereinafter "infant[s]"). Among this support, it is important for health personnel to provide nutritional guidance to families as a collaborative effort between the staff from multiple disciplines and community organizations. This study aimed to clarify the factors affecting collaboration with community organizations in providing nutritional guidance to families following health checks for infants in Japan. METHODS: The design of this study consisted of a cross-sectional, multilevel survey. A self-administered questionnaire was mailed to all municipalities (1741 towns and cities) in Japan to be completed by the person responsible for nutrition advice. The research was performed in August 2015. We obtained 988 valid responses (response rate of 56.7%). To identify the factors that affect the collaboration with community organizations in providing nutritional guidance, we determined how municipalities responded to infants needing support (five items), how municipalities evaluated health guidance (five items), the number of distributed maternal and child health handbooks, and the number of infants who received follow-up evaluations. RESULTS: The results of multivariate analyses showed that the factors related to successful community collaboration in providing nutritional guidance included holding a multi-professional staff meeting after health checks (post-conference; odds ratio [OR], 2.34; P = 0.001); following up children suspected of having developmental and mental disabilities or delays before entering elementary school (OR, 1.77; P = 0.0004); and considering dental caries data from dental checkups in providing health guidance (OR, 1.56; P = 0.003). CONCLUSIONS: Holding a multi-professional meeting after infant health checks (post-conference) was strongly associated with community collaboration in providing nutritional guidance for infants.
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Consejo/métodos , Fenómenos Fisiológicos Nutricionales del Lactante , Comunicación Interdisciplinaria , Padres/psicología , Examen Físico , Relaciones Profesional-Familia , Preescolar , Estudios Transversales , Encuestas de Atención de la Salud , Humanos , Lactante , JapónRESUMEN
BACKGROUND: The unintentional usage of adrenaline auto-injectors may cause injury to caregivers or patients. To prevent such incidents, we assessed the causative factors of these incidents. METHODS: The Anaphylaxis Working Group of the Japanese Society of Pediatric Allergy and Clinical Immunology requested that society members register cases in which adrenaline auto-injectors were unintentionally used. One hundred cases were reported from June 2015 to March 2016. We identified the root causes of 70 child and 25 adult cases, separately. RESULTS: The incidents occurred with repeated prescriptions as well as the first prescription. Three cases resulted in a failure to administer an adrenaline auto-injector to children with anaphylaxis. Four caregivers used it with improper application (epilepsy or enteritis). Among the child cases, the median age at the time of the incident was 5.5 years (range, 2-14 years). Five children injected the adrenaline auto-injector on their own body trunk. Twenty children were not the allergic patients themselves. Improper management protocol of the device and the child's development were concomitantly involved in most of the cases. A variety of human behaviors were identified as the root causes in the adult cases. At least 34 cases were associated with mix-ups between the actual and training device. CONCLUSIONS: Health workers should provide sufficient education regarding safety use of adrenaline auto-injector for caregivers tailored to their experience levels at both first and repeated prescriptions. Such education must cover anticipatory behavior based on normal child development. Devices should also be further improved to prevent such incidents.
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Broncodilatadores/administración & dosificación , Epinefrina/administración & dosificación , Inyecciones Intramusculares/instrumentación , Errores de Medicación/estadística & datos numéricos , Adolescente , Adulto , Anafilaxia/prevención & control , Pueblo Asiatico , Cuidadores , Niño , Preescolar , Femenino , Humanos , Japón , MasculinoRESUMEN
AIM: A cohort study was performed to clarify the influence of risk factors on perinatal events (obstetric complications and/or perinatal deaths). METHODS: This cohort study reviewed 395 785 births from 2011 to 2013. Women with singleton pregnancies delivered after 22 weeks of gestation were included. The OR were determined on multivariate analysis. The perinatal event score (PES) for risk factors, which is the product of the OR of risk factors for obstetric complications, OR of risk factors for perinatal death, and OR of obstetric complications for perinatal death, was introduced to clarify the impact of each risk combination. RESULTS: There were 20 risk factors such as maternal age and medical complications relating to the 11 obstetric complications, including pregnancy-induced hypertension and preterm labor. As a result, 77 combinations of risk factors and obstetric complications were found to be significant. Six obstetric complications such as preterm labor and cervical insufficiency were found to be related to perinatal death. Two factors were found to be directly related to perinatal death: age >40 years old (OR, 1.24; 95%CI: 1.11-1.39) and essential hypertension (OR, 1.56; 95%CI: 1.19-2.05). As a result, PES ranged from 1.07 (primipara for premature rupture of membrane) to 40.1 (essential hypertension for placental abruption), and high PES (≥8) was identified in 21 combinations of risk factors and obstetric complications. CONCLUSION: This newly created score for perinatal events, PES, can be used as an indicator of the impact of risk factors on perinatal events.
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Complicaciones del Trabajo de Parto/diagnóstico , Complicaciones del Trabajo de Parto/epidemiología , Muerte Perinatal , Medición de Riesgo/métodos , Adulto , Femenino , Humanos , Recién Nacido , Japón/epidemiología , Embarazo , Factores de RiesgoRESUMEN
AIM: The aim of this study was to clarify the indication for cesarean section (CS) using the Robson Ten-Group Classification System (RTGCS) and to clarify the center variation using the Lorenz curve in the main institutions in Japan. METHODS: The records of 68 702 deliveries, which were performed in 125 institutions, were extracted from the Japanese perinatal database in 2013 and the cases were classified using the RTGCS, which classifies deliveries into one of 10 groups on the basis of five parameters. The equality of the CS rate of each hospital was evaluated by the Lorenz curve and the Gini coefficient. The standard error (SE) and 95% confidence intervals (95%CI) for the Gini coefficient were determined by the bootstrap method. The institutions were divided into three categories depending on their scale: comprehensive center (CC, Category I), regional center (RC, Category II) and others (Category III). RESULTS: The overall CS rate was 37.3%. The difference between Categories I (42.6%) and II (34.3%) was significant (P = 0.02). The CS rates that were classified as RTGCS group 3 (multiparous, single cephalic, ≥37 weeks, with spontaneous labor) were higher in Category I (4.0%) than in Category II (2.7%, P = 0.01). The Gini coefficient of Category I (0.119 ± 0.015; 95%CI, 0.092-0.152) was significantly lower than that of Category II (0.189 ± 0.013; 95%CI, 0.16-0.217). CONCLUSION: We clarified the indication of CS and center variation. These two types of methods are useful for the evaluation of medical intervention in the perinatal field.
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Cesárea/estadística & datos numéricos , Tasa de Natalidad , Cesárea/clasificación , Bases de Datos Factuales , Femenino , Humanos , Japón/epidemiología , EmbarazoRESUMEN
BACKGROUND: We have proposed a new scoring system (Anaphylaxis SCoring Aichi: ASCA) for a quantitative evaluation of the anaphylactic reaction that is observed in an oral food challenge (OFC). Furthermore, the TS/Pro (Total Score of ASCA/cumulative protein dose) can be a marker to represent the overall severity of a food allergy. We aimed to develop a prediction model for a severe allergic reaction that is provoked in a boiled egg white challenge. METHODS: We used two separate datasets to develop and validate the prediction model, respectively. The development dataset included 198 OFCs, that tested positive. The validation dataset prospectively included 140 consecutive OFCs, irrespective of the result. A 'severe reaction' was defined as a TS/Pro higher than 31 (the median score of the development dataset). A multivariate logistic regression analysis was performed to identify the factors associated with a severe reaction and develop the prediction model. RESULTS: The following four factors were independently associated with a severe reaction: ovomucoid specific IgE class (OM-sIgE: 0-6), aged 5 years or over, a complete avoidance of egg, and a total IgE < 1000 IU/mL. Based on these factors, we made a simple scoring prediction model. The model showed good discrimination in a receiver operating characteristic analysis; area under the curve (AUC) = 0.84 in development dataset, AUC = 0.85 in validation dataset. The prediction model significantly improved the AUC in both datasets compared to OM-sIgE alone. CONCLUSIONS: This simple scoring prediction model was useful for avoiding risky OFC.
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Alérgenos/inmunología , Hipersensibilidad al Huevo/diagnóstico , Hipersensibilidad al Huevo/inmunología , Huevos/efectos adversos , Modelos Teóricos , Administración Oral , Alérgenos/administración & dosificación , Anafilaxia/diagnóstico , Anafilaxia/inmunología , Niño , Preescolar , Femenino , Humanos , Inmunoglobulina E/inmunología , Masculino , Pronóstico , Curva ROC , Reproducibilidad de los Resultados , Factores de RiesgoRESUMEN
OBJECTIVES: In Japan; infants ranging from 3 to 4 months of age were excluded from the stan- dard vaccination period for Bacillus Calmette-Gu6rin in 2013. The aim of this study was to evaluate the contri- bution of immunization methods and the means of communication employed by municipalities to inform the parents of infants about this revision on the shift in the immunization age. METHODS: In 35 municipalities, I assessed the monthly proportion of infants vaccinated between 3 and 4 months of age relative to all infants in 2013, in reference to the immunization method (group or individual immunization) and the application of two-way communication (TWC) between the municipalities and parents, The types of communication that were defined as TWC were as follows: home guidance and face-to-face explanation at the health examination for the infants. RESULTS: In most municipalities, the proportion of infants vaccinated between 3 and 4 months of age relative to all infants gradually decreased after following revision of the vaccination period. No signi- ficant differences were observed in these proportions between the municipalities with group immunization and those with individual immunization; however, the variability of these proportions among the municipal- ities with group immunization increased with duration. In the municipalities with individual immunization schedules, the application of TWC to parents promoted the decrease of infants vaccinated between 3 and 4 months of age, as compared to that seen in the other municipalities. CONCLUSIONS: The municipalities with group immunization were characterized by variation in the shift of the immunization age. TWC with parents accelerated this shift in the municipalities with individual immunization.
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Vacuna BCG/inmunología , Esquemas de Inmunización , Vacunación/normas , Factores de Edad , Humanos , JapónRESUMEN
BACKGROUND: Autumn and winter birth (AWB) has been reported to be a risk factor for the development of food allergies. However, the association between seasonal factors and allergic sensitization during early infancy remains unclear. METHODS: We collected data from 732 patients regarding the total and specific immunoglobulin E (tIgE, sIgE) levels in infants younger than 6 months old from November 2001 to October 2012 from the institutional clinical database system. We then analyzed the relationship between the birth month and the value of each parameter. Furthermore, we identified any correlations between the number of sensitized patients and the monthly climatological parameters. RESULTS: The number of tIgE samples obtained from AWB patients (n = 482) was 2.1 times higher than that from patients born in the spring and summer (SSB, n = 225). The number of sIgE samples to egg white, cow's milk, and wheat, the sensitized ratio and the median sIgE titer were also all higher in AWB. The number of sensitized AWB patients to these allergens was 2.75, 3.05, and 3.97 times higher, respectively. A periodic change in the number of sensitized patients was observed annually (highest in October-November and lowest in May). Among the climatological parameters examined, the average solar radiation during the 3-month period after birth showed the strongest negative correlation with the number of sensitized patients (egg white: r = -0.976, cow's milk: r = -0.969, wheat: r = -0.975). CONCLUSIONS: The amount of solar radiation immediately after birth had a strong negative correlation with allergen sensitization before 6 months of age.
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Exposición a Riesgos Ambientales , Hipersensibilidad a los Alimentos/etiología , Estaciones del Año , Luz Solar , Biomarcadores/sangre , Femenino , Hipersensibilidad a los Alimentos/sangre , Hipersensibilidad a los Alimentos/diagnóstico , Hipersensibilidad a los Alimentos/inmunología , Humanos , Inmunoglobulina E/sangre , Lactante , Recién Nacido , Masculino , Factores Protectores , Estudios RetrospectivosRESUMEN
BACKGROUND: This study examined the relationship between the season of birth (SoB) and other factors with the development of FA. METHODS: A multicenter, cross-sectional pilot study recruited 1197 patients with FA. The main study recruited 440 incident cases (FA group) definitively diagnosed as FA at 0-1 year of age. In both studies, the frequency of autumn-winter births (AWBs) in FA patients was compared to the regional control population. In the main study, we analyzed the differences in the SoB and other factors between patients in the FA group and those in the non-FA group (n = 332) in allergy clinics. RESULTS: The pilot study showed that the frequency of AWB (57.6%) in the FA patients was significantly higher than that of the regional control population (50.4%, OR, 1.34; p < 0.001). The main study also showed the dominance of AWB (62.7%) in the FA group in comparison with that in the regional control population (50.2%, OR, 1.70; p < 0.001). Preterm birth (OR, 0.43; p = 0.027) and the presence of two or more elder siblings (OR, 0.27; p = 0.012) were significantly associated with a lower frequency of FA than those of non-FA. AWB (RR, 1.21; p = 0.020) and preterm birth (RR, 0.55; p = 0.017) were significantly associated with a number of trigger foods. The SoB effect was observed in FA patients irrespective of the presence of infantile eczema. CONCLUSIONS: AWB was predominant in the patients with newly diagnosed food allergies.
Asunto(s)
Hipersensibilidad a los Alimentos/etiología , Estaciones del Año , Edad de Inicio , Estudios Transversales , Femenino , Hipersensibilidad a los Alimentos/epidemiología , Humanos , Lactante , Recién Nacido , Japón/epidemiología , Modelos Logísticos , Masculino , Proyectos Piloto , Estudios Retrospectivos , Factores de RiesgoRESUMEN
BACKGROUND: School personnel are required to guarantee a secure school environment for children suffering from severe food allergies. We organized a workshop for school personnel to learn the appropriate management of anaphylaxis that included practical training with an adrenaline auto-injector (AAI). The objective of this study was to evaluate the workshop in terms of the improvement of self-efficacy (SE) of participants to deal with anaphylaxis. METHODS: All 93 school nurses, 73 schoolteachers and 110 childcare workers participating in the study completed a questionnaire before and after the workshop. The SE of the participants was evaluated using an original 15-item questionnaire. RESULTS: Before the workshop, the SE of school nurses was the highest among the profession groups, and being involved with children prescribed an AAI was a common factor associated with a high SE. After the workshop, the SE increased in all groups, but most apparently in school nurses and those involved with children prescribed an AAI. The presence of an emergency plan was positively associated with the SE of schoolteachers only after the workshop, even though no such association existed beforehand. CONCLUSIONS: Practical instruction of school nurses and school personnel involved with children prescribed an AAI resulted in dramatic improvement of the SE. These people are expected to play a central role in the development of an anaphylaxis management plan in their schools.
Asunto(s)
Anafilaxia/tratamiento farmacológico , Broncodilatadores/administración & dosificación , Epinefrina/administración & dosificación , Capacitación en Servicio , Instituciones Académicas , Adulto , Broncodilatadores/uso terapéutico , Niño , Cuidado del Niño , Educación , Epinefrina/uso terapéutico , Docentes , Femenino , Humanos , Inyecciones , Masculino , Persona de Mediana Edad , Enfermeras y Enfermeros , Servicios de Salud Escolar , Autoeficacia , Encuestas y Cuestionarios , Adulto JovenRESUMEN
Wheat-dependent exercise-induced anaphylaxis (WDEIA) is often reported in adults for whom the specific IgE to ω-5 gliadin can be a useful diagnostic test. However, few cases of WDEIA in children have been reported. We herein report six cases (aged 7-16 years) of children with WDEIA, who had no clinical history of immediate-type wheat allergy but who were diagnosed by a wheat ingestion + exercise provocation test. The specific IgE to wheat ranged <0.35-3.49 (median 1.64) UA/ml. Skin prick tests using wheat extract were performed on 3 patients who showed either a negative or low specific IgE titer to wheat, and all of them resulted in negative findings. The specific IgE to ω-5 gliadin was below the detection limit in all cases. Aspirin-supplemented provocation tests were performed to 4 cases who had negative results in the wheat + exercise test. All of these resulted in a positive reaction, and two of them provoked the occurrence of anaphylactic shock, which was relieved by the intramuscular injection of adrenaline. WDEIA in children cannot be ruled out by serological tests alone. On the other hand, severe symptoms might be provoked by the provocation test. Therefore, a safe procedure is warranted for the diagnosis of WDEIA in children.
Asunto(s)
Asma Inducida por Ejercicio/diagnóstico , Hipersensibilidad al Trigo/diagnóstico , Adolescente , Niño , Preescolar , Femenino , Humanos , Masculino , Pruebas CutáneasRESUMEN
A delay in the diagnosis of tuberculosis (TB) is a public health problem in Japan. This delay may increase the chance of a TB patient visiting in a medical institution without a TB ward. We evaluated the practices of nurses for fit testing and seal checking their N95 respirator masks at hospitals without tuberculosis wards in Kanagawa, Japan. Of 36 nurses who participated in a medical course on infection control and medical safety in June 2010, 33 (91.7%) answered a questionnaire. Seven (22.6%) and 8 (26.7%) nurses had practical experience of fit testing and seal checking N95 masks, respectively. Nurses affiliated with hospitals having sanatorium wards were more likely to be acquainted with fit testing and seal checking than nurses from hospitals with only general wards [6 (39.9%) vs. 0 (0%) and 7 (46.7%) vs. 0 (0%), respectively]. Fewer than 30% of nurses exposed to TB patients had no experience with fit testing and scale checking N95 masks. Only one nurse had practical experience fitting testing at the hospital where she worked. Although the sample size in this study was small, these results showed inadequate experience in handling N95 respirator marks among Japanese nurses at hospitals without tuberculosis wards, which suggests the need to educate nurses practically in fit testing and seal checking N95 respirator masks.