Characteristics in Pediatric Patients with Coronavirus Disease 2019 in Korea

Background@#Based on the reports of low prevalence and severity of pediatric severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, the Korean government has released new SARS-CoV-2 infection response and treatment guidelines for children under the age of 12 years. The government has further directed school reopening under strict preventive measures. However, there is still considerable concern on the impact of school reopening on community transmission of Coronavirus disease 2019 (COVID-19). In the present study, we aimed to evaluate the appropriateness of these directives and the severity of SARS-CoV-2 infections in children as compared to adults using sufficient national sample data. @*Methods@#In the present study, we evaluated the severity of SARS-CoV-2 infection in pediatric patients as compared to adults by analyzing the length of hospital stays (LOS), medical expenses, and hospital and intensive care unit (ICU) admission rates. A multivariate linear regression analysis was carried out to examine the effects of COVID-19 patients that the characteristics on the LOS and medical expenses, and multivariate logistic regression analysis were performed to identify COVID-19 characteristics that affect hospital and ICU admission rates and to prove the low SARS-CoV-2 infection severity in pediatric patients. @*Results@#The hospitalization period for children aged 0–9 was 37% shorter and that of patients aged 10–19 years was 31% shorter than those of older age groups (P < 0.001). The analysis of the medical expenses by age showed that on average, medical expenses for children were approximately 4,900 USD lower for children than for patients over 80 years of age. The linear regression analysis also showed that patients who were 0–9 years old spent 87% and those aged 10–19 118% less on medical expenses than those aged 70 and over, even after the correction of other variables (P < 0.001). The probability of hospitalization was the lowest at 10–19 years old (odds ratio [OR], 0.05; 95% confidence interval [CI], 0.03–0.09), and their ICU admission rate was also the lowest at 0.14 (OR, 0.14; 95% CI, 0.08–0.24). On the other hand, the likelihood of hospitalization and ICU admission was the highest in children aged 0–9 years, and among patients under the age of 50 years in general. @*Conclusion@#This study demonstrated the low severity of SARS-CoV-2 infection in younger patients (0–19 years) by analyzing the LOS, medical expenses, hospital, and intensive care unit admission rates as outcome variables. As the possibility to develop severe infection of coronavirus at the age of 10–19 was the lowest, a mitigation policy is also required for middle and high school students. In addition, children with underlying diseases need to be protected from high-risk infection environments.

Characteristics in Pediatric Patients with Coronavirus Disease 2019 in Korea

Background@#Based on the reports of low prevalence and severity of pediatric severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, the Korean government has released new SARS-CoV-2 infection response and treatment guidelines for children under the age of 12 years. The government has further directed school reopening under strict preventive measures. However, there is still considerable concern on the impact of school reopening on community transmission of Coronavirus disease 2019 (COVID-19). In the present study, we aimed to evaluate the appropriateness of these directives and the severity of SARS-CoV-2 infections in children as compared to adults using sufficient national sample data. @*Methods@#In the present study, we evaluated the severity of SARS-CoV-2 infection in pediatric patients as compared to adults by analyzing the length of hospital stays (LOS), medical expenses, and hospital and intensive care unit (ICU) admission rates. A multivariate linear regression analysis was carried out to examine the effects of COVID-19 patients that the characteristics on the LOS and medical expenses, and multivariate logistic regression analysis were performed to identify COVID-19 characteristics that affect hospital and ICU admission rates and to prove the low SARS-CoV-2 infection severity in pediatric patients. @*Results@#The hospitalization period for children aged 0–9 was 37% shorter and that of patients aged 10–19 years was 31% shorter than those of older age groups (P < 0.001). The analysis of the medical expenses by age showed that on average, medical expenses for children were approximately 4,900 USD lower for children than for patients over 80 years of age. The linear regression analysis also showed that patients who were 0–9 years old spent 87% and those aged 10–19 118% less on medical expenses than those aged 70 and over, even after the correction of other variables (P < 0.001). The probability of hospitalization was the lowest at 10–19 years old (odds ratio [OR], 0.05; 95% confidence interval [CI], 0.03–0.09), and their ICU admission rate was also the lowest at 0.14 (OR, 0.14; 95% CI, 0.08–0.24). On the other hand, the likelihood of hospitalization and ICU admission was the highest in children aged 0–9 years, and among patients under the age of 50 years in general. @*Conclusion@#This study demonstrated the low severity of SARS-CoV-2 infection in younger patients (0–19 years) by analyzing the LOS, medical expenses, hospital, and intensive care unit admission rates as outcome variables. As the possibility to develop severe infection of coronavirus at the age of 10–19 was the lowest, a mitigation policy is also required for middle and high school students. In addition, children with underlying diseases need to be protected from high-risk infection environments.

Clinical characteristics of lower respiratory tract infection in low birth weight children

PURPOSE: Lower respiratory tract infection (LRTI) is one of the most common causes of hospitalization in the pediatric population. In this study, we investigated the clinical characteristics of LRTI, particularly in low birth weight children. METHODS: We reviewed medical records of children at ages 0–6 years with LRTI in Korea University Anam Hospital between January and December of 2014. Clinical data including age, sex, birth history, viral pathogens, blood test results, and clinical courses were collected. RESULTS: In the 828 eligible cases, 617 (74.5%) were pneumonia and followed by bronchiolitis 180 (21.7%) and bronchitis 31 (3.7%). The median age of the subjects was 17 months (interquartile range [IQR], 7–28 months), the median gestational age was 39.0 weeks (IQR, 38.0–40.0 weeks) and the median birth weight was 3,200 g (IQR, 2,900–3,480 g). Sixty-four children (7.7%) were low birth weight (< 2,500 g) and their median gestational age and birth weight were 33.0 weeks (IQR, 30.0–36.0 weeks) and 2,045 g (IQR, 1,565–2,300 g), respectively. The rates of oxygen supplement (17.2% vs. 4.6%, P < 0.001) and systemic steroid use (20.3% vs. 4.7%, P < 0.001) were significantly higher in low birth weight children than normal birth weight children. Respiratory viruses were identified in 82.6% (519 of 628 subjects); RSV was detected in 240 subjects (38.2%), followed by rhinovirus 168 (26.8%) and adenoviruses 75 (11.9%). The distribution of respiratory viruses was not different between normal birth weight children and low birth weight children. CONCLUSION: Low birth weight children show more severe clinical manifestations than normal birth weight children during hospitalization for LRTI, although respiratory viral pathogens were not different. Clinicians should be aware that the severity may be increased when low birth weight children were hospitalized due to low respiratory tract infection.

Stop Discussing New Medical Specialty Boards

The Korean society is rapidly aging and the health care needs for aged people are increasing. In this context, some physicians claim to establish new medical specialty board (MSB) for geriatric medical experts but also MSB for primary medical care specialists, clinical pharmacologists, and public health experts. In Korea, basic concept for the specialty board system is still under debates and the legal support for the system is poor. At present, doctors with MSBs in private sectors supply 92.4% of primary medical care but the National Health Care System requires more primary care physicians than specialists in Korea. Therefore, the government must invest in the education of doctors more to improve the public health care system. The proposal of the new MSB for geriatric medicine must be gradually developed according to the national long-term health plan, social needs, and national budget for the public benefit. Please stop discussing unprepared new MSBs.

Are children with asthma in South Korea also associated with vitamin D deficiency?

Recently, epidemiologic studies have shown that the lack of serum vitamin D levels may be associated with high asthma prevalence, but its effect is still controversial, depending on season, area, and food consumption. We aimed to examine the association of serum vitamin D levels with the prevalence of pediatric asthma in Korea. A total of 80 children (50 asthmatic children and 30 healthy controls) aged 6-14 years were participated in this study. Serum vitamin D levels were measured and compared between the two groups. Moreover, the relationship of serum vitamin D levels with results of pulmonary function test and environmental factors (lifestyle habits and residential factors) collected by a questionnaire survey were examined in asthmatic patients. Serum vitamin D levels in asthmatic children (16.63±4.20 ng/mL) were significantly lower than that in healthy controls (24.24±6.76 ng/mL) (p<0.05). Also, we found that the prevalence of asthma increase to 0.79-fold (odds ratio, 0.79; 95% confidence interval, 0.71 to 0.88; p<0.001) as serum vitamin D level is 1 ng/mL decreases. The increased time spent in outdoor could affect the increases of serum vitamin D levels significantly. However, no associations of serum vitamin D with pulmonary function and residential environmental factors (i.e., housing type, living floor, and indoor activity time) were observed. Our findings suggest that serum vitamin D levels were also associated with pediatric asthma in Korea. Moreover, management of serum vitamin D level in asthmatic children would be a promising approach for preventing exaggeration of their severity.

What Factors Impact Consumer Perception of the Effectiveness of Health Information Sites? An Investigation of the Korean National Health Information Portal

Lay public's concerns around health and health information are increasing. In response, governments and government agencies are establishing websites to address such concerns and improve health literacy by providing better access to validated health information. Since 2011, the Korean government has constructed the National Health Information Portal (NHIP) website run in collaboration with the Korean Academy of Medical Sciences (KAMS). This study therefore aimed to 1) examine consumer use of NHIP, with respect to the usage patterns, evaluation on health information provided, and perceived effectiveness of the site; and 2) identify factors that may impact perceived effectiveness of the site. An online survey was conducted with 164 NHIP users, recruited through a popup window on the main screen of the portal website from October to November 2015. The significant predicting factors supported by the data include the relevance of health information on the site, the usefulness of information in making health decisions, and the effective visualization of information. These factors can inform future efforts to design more effective health information websites, possibly based on metadata systems, to further advance the lay public's information seeking and health literacy.

Macrolide Resistance and Its Impacts on M. Pneumoniae Pneumonia in Children: Comparison of Two Recent Epidemics in Korea

PURPOSE: The aim of this study was to investigate the change in macrolide resistance rate in pediatric Mycoplasma pneumoniae pneumonia and to evaluate the influence of macrolide-resistant M. pneumoniae (MRMP) on the clinical course of disease, by comparing 2 recent, consecutive epidemics in Korea. METHODS: A total of 250 patients with M. pneumoniae pneumonia admitted to a single tertiary hospital were enrolled in this study. Detection of MRMP was based on specific point mutations in domain V of the 23S rRNA gene. The medical records of enrolled patients were reviewed retrospectively, and the clinical courses and laboratory data were compared. RESULTS: The macrolide resistance rate of M. pneumoniae was 51.1% (48/94) in the 2011 epidemic, and 87.2% (136/156) in the 2015 epidemic. All MRMP isolates had the A2063G point mutation. In comparison of 2 epidemics, the mean age of patients with M. pneumoniae pneumonia was increased, and the total febrile days and febrile days after initiation of macrolides were prolonged in the 2015 epidemic. Overall severity of MRMP or macrolide-susceptible M. pneumoniae (MSMP) pneumonia over 2 epidemics was not significantly changed. However, the proportion of patients who had a fever lasting more than 72 hours after initiation of macrolides and who received corticosteroid treatment were higher in MRMP pneumonia during 2 epidemics. CONCLUSIONS: The macrolide resistance rate of M. pneumoniae has risen rapidly over 2 recent, consecutive epidemics, and this has been associated with a prolonged clinical course and increased use of corticosteroids to treat pediatric M. pneumoniae pneumonia.

CCR3 Monoclonal Antibody Inhibits Eosinophilic Inflammation and Mucosal Injury in a Mouse Model of Eosinophilic Gastroenteritis

PURPOSE: Although the role of eosinophils in eosinophilic gastroenteritis (EGE) is not fully understood, they are believed to be a principal effector cell. Previous studies have demonstrated that eotaxin and its specific receptor, cysteine-cysteine chemokine receptor-3 (CCR3), play a central role in eosinophil trafficking into the gastrointestinal (GI) tract. Thus, we examined the targeting of CCR3 as a potential therapeutic intervention for EGE in a mouse model. METHODS: Eight- to 10-week-old BALB/c mice were intraperitoneally sensitized and intragastrically challenged with ovalbumin (OVA). Different groups of mice were administered either an anti-CCR3 antibody or a control IgG by intraperitoneal injection 1 hour before each OVA challenge. Eosinophilic inflammation in the intestinal mucosa, mucosal injury, and severity of diarrhea were compared between different groups at 1 hour after final OVA challenge. RESULTS: Anti-CCR3 antibody reduced the number of eosinophils in peripheral blood and intestinal mucosa, but not in bone marrow. This reduction was associated with restoration of reduced villous crypt ratio, increased intestinal epithelial cell proliferation, and weight loss induced by OVA challenge. However, Anti-CCR3 antibody had no effect on the level of OVA specific immunoglobulin E (IgE) and the expression of critical chemokines or cytokines in eosinophil trafficking into the GI tract, such as eotaxin-1, interleukin (IL)-5, and IL-13. CONCLUSIONS: Anti-CCR3 antibody significantly reduced the severity of eosinophilic inflammation, mucosal injury, and diarrhea in a mouse model of food allergen-induced GI eosinophilic inflammation. CCR3 may be a novel therapeutic target for treatment of EGE and other GI eosinophil-mediated diseases.

Clinical characteristics of respiratory viral coinfection in pediatric Mycoplasma pneumoniae pneumonia

PURPOSE: Bacterial/viral coinfection is not uncommon in children with community acquired pneumonia. However, the data about viral coinfection in Mycoplasma pneumoniae pneumonia is limited. The aim of this study was to investigate the frequency and clinical characteristics of respiratory viral coinfection in pediatric M. pneumoniae pneumonia. METHODS: A retrospective cross sectional study was performed in 432 children hospitalized with M. pneumoniae pneumonia in a tertiary teaching hospital between June 2015 and May 2016. RESULTS: One hundred forty patients (32.4%) were coinfected with M. pneumoniae and respiratory viruses. Among coinfected viruses, rhinovirus (44.4%) was most commonly detected. Viral coinfection was more likely to occur under the age of 5 years in winter and spring. As compared with patients infected with M. pneumoniae monoinfection, patients coinfected with respiratory viruses showed a lower mean age and shorter total febrile days. Although total leukocyte count was higher, relative proportion of neutrophils and C-reactive protein level were significantly lower in these patients. CONCLUSION: Viral coinfection was common in pediatric M. pneumoniae pneumonia, especially in patients under the age of 5 years, and this was associated with shorter total febrile days and lower level of acute phase response as compared with M. pneumoniae monoinfection.

Are children with asthma in South Korea also associated with vitamin D deficiency?

Recently, epidemiologic studies have shown that the lack of serum vitamin D levels may be associated with high asthma prevalence, but its effect is still controversial, depending on season, area, and food consumption. We aimed to examine the association of serum vitamin D levels with the prevalence of pediatric asthma in Korea. A total of 80 children (50 asthmatic children and 30 healthy controls) aged 6-14 years were participated in this study. Serum vitamin D levels were measured and compared between the two groups. Moreover, the relationship of serum vitamin D levels with results of pulmonary function test and environmental factors (lifestyle habits and residential factors) collected by a questionnaire survey were examined in asthmatic patients. Serum vitamin D levels in asthmatic children (16.63±4.20 ng/mL) were significantly lower than that in healthy controls (24.24±6.76 ng/mL) (p<0.05). Also, we found that the prevalence of asthma increase to 0.79-fold (odds ratio, 0.79; 95% confidence interval, 0.71 to 0.88; p<0.001) as serum vitamin D level is 1 ng/mL decreases. The increased time spent in outdoor could affect the increases of serum vitamin D levels significantly. However, no associations of serum vitamin D with pulmonary function and residential environmental factors (i.e., housing type, living floor, and indoor activity time) were observed. Our findings suggest that serum vitamin D levels were also associated with pediatric asthma in Korea. Moreover, management of serum vitamin D level in asthmatic children would be a promising approach for preventing exaggeration of their severity.

Congenital miliary tuberculosis in an 18-day-old boy / 소아과

Congenital tuberculosis (TB) is a rare disease that is associated with high mortality. Mycobacterium tuberculosis, the causative agent, may be transmitted from the infected mother to the fetus by the transplacental route or by aspiration of infected amniotic fluid. Clinical symptoms and signs are not specific. Miliary patterns are the most common findings in the chest X-rays of many infants with congenital TB. In this case, an 18-day-old boy had jaundice on the fifth day of birth, and fever and respiratory distress appeared on the 18th day. Chest X-ray showed diffuse fine bilateral infiltration. Clinically, pneumonia or sepsis was suspected. Respiratory symptoms and chest X-ray findings worsened despite empirical antibiotic therapy. The lungs showed miliary infiltration suggestive of TB. Gastric aspirates were positive for M. tuberculosis. Respiratory distress and fever were gradually improved after anti-TB medication. Congenital TB is difficult to detect because of minimal or no symptoms during pregnancy and nonspecific symptoms in neonates. Hence, clinicians should suspect the possibility of TB infection even if neonates have non-specific symptoms. Early diagnosis and meticulous treatment are required for the survival of neonates with TB.

GIS-based Association Between PM10 and Allergic Diseases in Seoul: Implications for Health and Environmental Policy

PURPOSE: The role of PM10 in the development of allergic diseases remains controversial among epidemiological studies, partly due to the inability to control for spatial variations in large-scale risk factors. This study aims to investigate spatial correspondence between the level of PM10 and allergic diseases at the sub-district level in Seoul, Korea, in order to evaluate whether the impact of PM10 is observable and spatially varies across the subdistricts. METHODS: PM10 measurements at 25 monitoring stations in the city were interpolated to 424 sub-districts where annual inpatient and outpatient count data for 3 types of allergic diseases (atopic dermatitis, asthma, and allergic rhinitis) were collected. We estimated multiple ordinary least square regression models to examine the association of the PM10 level with each of the allergic diseases, controlling for various sub-district level covariates. Geographically weighted regression (GWR) models were conducted to evaluate how the impact of PM10 varies across the sub-districts. RESULTS: PM10 was found to be a significant predictor of atopic dermatitis patient count (P<0.01), with greater association when spatially interpolated at the sub-district level. No significant effect of PM10 was observed on allergic rhinitis and asthma when socioeconomic factors were controlled for. GWR models revealed spatial variation of PM10 effects on atopic dermatitis across the sub-districts in Seoul. The relationship of PM10 levels to atopic dermatitis patient counts is found to be significant only in the Gangbuk region (P<0.01), along with other covariates including average land value, poverty rate, level of education and apartment rate (P<0.01). CONCLUSIONS: Our findings imply that PM10 effects on allergic diseases might not be consistent throughout Seoul. GIS-based spatial modeling techniques could play a role in evaluating spatial variation of air pollution impacts on allergic diseases at the sub-district level, which could provide valuable guidelines for environmental and public health policymakers.

Relationships between fractional exhaled nitric oxide levels and FEF25%-75% in children with asthma

PURPOSE: Fractional exhaled nitric oxide (FeNO) is considered an indirect marker of airway inflammation, and forced expiratory flow between 25% and 75% of vital capacity (FEF25%-75%) is widely used as a sensitive indicator of small airway obstruction in asthma. The aim of this study was to investigate relationships between FeNO and FEF25%-75% in children with asthma. METHODS: A total of 118 children with asthma underwent spirometry and measurement of eosinophil markers. FeNO levels were measured, and skin prick tests to 13 common allergens were done. Study subjects were divided into 2 groups according to FEF25%-75% values (group 1, normal FEF25%-75%> or =65%pred, n=90; group 2, impaired FEF25%-75%<65%pred, n=28). RESULTS: The mean (+/-standard deviation, SD) age was not significantly different between groups 1 and 2 (10.3+/-2.8 years vs. 11.1+/-3.4 years), and the sex ratio was also not significantly different between 2 groups. The geometric mean (range of 1 SD) concentration of FeNO was significantly higher in group 2 than in group 1 (25.8 ppb [14.2-46.9 ppb] vs. 37.2 ppb [24.2-57.2 ppb], P=0.008). A significant inverse correlation between FeNO and FEF25%-75% was observed in group 2 (r=-0.493, P=0.038), but not in group 1 (r=-0.037, P=0.749) after adjustment for confounders, such as atopy, age, sex, weight, and height. CONCLUSION: FeNO levels were higher in group of asthmatic children with impaired FEF25%-75% level. FeNO levels were inversely correlated with FEF 25%-75% only in impaired small-airway obstruction group after adjustment for atopy. These results suggest that small-airway obstruction may relate more closely to airway inflammation in asthmatic children with impaired small-airway function.

Prevalence of atopic dermatitis and its associated factors for elementary school children in Gyeonggi-do province

PURPOSE: This study aimed to investigate the prevalence of atopic dermatitis (AD) and associated factors for AD in a total of 2,077 children from 5 elementary schools in Gyeonggi-do province. METHODS: AD was defined when parents answered "Yes" to a question in the on International Study of Asthma and Allergies in Childhood questionnaire "Has your child ever has itchy rashes with xax and wane pattern for at least 6 months?" in October 2012. SCORing Atopic Dermatitis index, skin prick testing and blood testing, were evaluated. RESULTS: The prevalence of AD was 25.9% among 2,077 elementary school children in Gyeonggi-do province. Proportions of obesity (8.0% vs. 4.5%, P=0.004) and breast-feeding over 6 months (46.6% vs. 41.3%, P=0.035) were significantly higher in children with AD than those without. No significant differences were found in terms of sex, age, body mass index, history of breast-feeding ever and mode of delivery beween AD and non-AD children. obesity (adjusted odds ration [aOR], 1.80; 95% confidence interval [CI], 1.13–2.75; P=0.006) and breast-feeding over 6 months (aOR, 1.35; 95% CI, 1.03–1.77; P=0.029) were found as significant associated factors for AD. When stratified by sex, obesity in boys (aOR, 2.67; 95% CI, 1.53–4.66; P=0.001) and breast-feeding history in girls (aOR, 1.47; 95% CI, 1.03–2.11; P=0.034) were independently considered significant associated factors for AD. We found more boys (66.7%, P=0.028) than girls among the severe AD cases. Male sex was considered an associated factor of having severe AD (aOR, 2.23; 95% CI, 1.01–4.73; P=0.048). CONCLUSION: The prevalence of AD was 25.9% in elementary school children in Gyeonggi-do. province obesity and breast-feeding over 6 months were found as associated factors of having AD. Male sex was considered an associated factor for severe AD.

Prediction of the severity and length of hospital stay in infants with acute bronchiolitis using the severity score

PURPOSE: This study aimed to evaluate the clinical factors that could influence the length of hospital stay (LHS) of infants with acute bronchiolitis using the bronchiolitis severity score (BSS). METHODS: The medical records of 105 infants aged 0–12 months with acute bronchiolitis who were admitted to a tertiary hospital between December 2014 and May 2015 were reviewed. The BSS was composed 5 factors, namely general condition, wheezing, chest retraction, respiration rate, and peripheral oxygen saturation, which were evaluated at admission. In addition, the age of the infants, LHS, body weight, birth history, familial history, laboratory test result, chest X-ray, and treatment modalities were reviewed. Subjects were classified into 3 groups according to their BSS, and logistic regression analysis was used to identify the association of the BSS with longer LHS. RESULTS: Among subjects, 62 were studied. Their mean LHS and age were 5.5±2.0 days and 3.9±2.7 months, respectively. Twelve infants were classified as mild (20.3%), 43 as moderate (68.8%), and 7 as severe (10.9%). Venous blood gas pH value and white blood cell count were the best predictors of disease severity. The LHS was associated with the BSS, age, body weight and pCO2 by venous blood gas analysis (P<0.05). CONCLUSION: The LHS was associated with the BSS, age, body weight, and pCO₂ by venous blood gas analysis at admission. The BSS could be a useful tool to predict disease severity and decide treatment strategies for infants with acute bronchiolitis who have no known risk factors.

Indoor air pollutants and atopic dermatitis in socioeconomically disadvantaged children

PURPOSE: The aims of this study were to examine indoor concentrations of air pollutants in socioeconomically disadvantaged houses and to investigate relationships between indoor air pollutant levels and the severity of atopic dermatitis (AD). METHODS: A total of 54 children who had a past history or current symptoms of AD were enrolled in the study. To evaluate the levels of indoor air pollutants, we measured concentrations of CO2, total volatile organic compounds (TVOC), formaldehyde, particulate matter with diameter less than 10 microm (PM10), airborne mold and numbers of house dust mite (HDM) in dust of the children's houses. All studied subjects completed physical examination for the severity of AD and blood tests. RESULTS: Although the mean (+/-standard deviation [SD]) concentration of indoor CO2 (600.6+/-179.4 ppm) was lower than the standard recommended levels of multiplex buildings in Korea, there was a significant correlation between CO2 concentrations and the severity of AD (r=0.302, P=0.030). The geometric means (range of 1 SD) of TVOC (42.5 microg/m3 [22.2-81.5]), formaldehyde (24.3 microg/m3 [15.0-39.9]), PM10 (26.6 microg/m3 [14.6-48.4]), and airborne mold (49.9 CFU [colony forming unit]/m3 [26.3-94.6]) were not significantly higher than the standard recommended levels of multiplex buildings. Two-thirds of the subjects were sensitized to at least 1 of the common allergens. CONCLUSION: Generally, indoor air pollution was not serious in socioeconomically disadvantaged households. However, indoor CO2 concentrations are closely related to the severity of AD in children living in socioeconomically disadvantaged houses. Environmental amelioration targeting vulnerable population may improve the quality of life and decrease the prevalence of environmental allergic diseases.

Sleep disturbance in children with allergic disease

PURPOSE: Although allergic disease has been recognized as a common chronic disease related to the sleep disturbance of children, studies on sleep disturbance in children with allergic disease are scanty in Korea. The aim of this study was to evaluate the sleep disturbance of children with allergic disease. METHODS: Children aged 2 to 12 years were assessed using the sleep questionnaires. From July 2011 to June 2012, surveys were conducted on patients who were diagnosed with allergies in 3 general hospitals and in an elementary school in Seoul and the capital area. The analysis was done in 3 groups according to age. RESULTS: The sleep questionnaires of 1,174 children were evaluated. Children with allergic disease were 341 (209 males and 132 females) and those in the control group were 833 (428 males and 405 females). Parasomnia symptoms were common in young children (ages 2 to 5 years) than in the control group (P<0.05). Symptoms of sleep-disordered breathing were more common in early adolescent children (ages 11 to 12 years) than in the control group (P<0.05). The presence of allergic rhinitis, gender, and body mass index did not correlate with a sleep disturbance in children with allergic disease. CONCLUSION: To our knowledge, this study was the first report of sleep disturbance in children with allergic disease in Korea. This study suggests that children with allergic disease from early children may have poor sleep quality than those without. Therefore, proper treatment of and great interest in sleep disturbance are required for children with allergic disease.

The Association between Asthma and Invasive Pneumococcal Disease: A Nationwide Study in Korea

The purpose of this study was to investigate the association between asthma and invasive pneumococcal disease (IPD) in Korea. A retrospective population-based cohort study was conducted using the Korean Health Insurance Review and Assessment database 2010-2011. The subjects included 935,106 (2010) and 952,295 (2011), of whom 398 (2010) and 428 (2011) patients with IPD were identified. There was significant difference in the prevalence of IPD in patients with and without asthma (0.07% vs. 0.02% in 2010 and 0.08% vs. 0.01% in 2011; P<0.001). After adjusting for age and gender, patients with asthma showed over a three-fold increased risk of IPD compared with patients without asthma (adjusted odds ratio [aOR] 3.90, 95% confidence interval [CI] 3.02-5.03 in 2010 / aOR, 5.44; 95% CI, 4.10-7.22 in 2011; P<0.001). These findings were also significant in children (aOR, 2.08; 95% CI, 1.25-3.45 in 2010; P=0.005 / aOR, 3.26; 95% CI, 1.74-6.11 in 2011; P<0.001). Although diabetes mellitus was also significantly associated with IPD, relatively low ORs compared with those of asthma were noted (aOR, 1.85; 95% CI, 1.35-2.54 in 2010 / aOR, 2.40; 95% CI, 1.78-3.24 in 2011; P<0.001). Both children and adults with asthma are at increased risk of developing IPD.

Qualitative assessment of atopic dermatitis-related mobile applications in Korea

PURPOSE: As the mobile internet spread, patients can access to health information via mobile applications. But this information must be a reliable for treatment. This study evaluated the quality of information of mobile applications that with atopic dermatitis. METHODS: On April 2014, the 98 mobile applications that had been searched on three application markets using the keywords, 'atopic dermatitis' etc. were enrolled. Thirty-one applications with information about atopic dermatitis written in Korean were surveyed. The informational quality of each application was examined using DISCERN tool and we also examined authorship, price, number of downloads. And we analyzed relations between these factors and informational quality. RESULTS: The mean score (+/-standard deviation) of overall rating of the publications of the 31 applications were 1.55 (+/-0.888) points. The overall quality of the publication was 'low' in 80.6% of applications, 'moderate' in 16.1%, 'high' in 3.2% of the applications we evaluated. There were no significant differences between the score of price of applications in all questions. However the mean score of group of downloads 1,000 and more were 2.25 (+/-1.035), significantly higher than group of downloads less than 1,000, 1.30 (+/-0.703) (P=0.043). CONCLUSION: The quality of mobile applications providing health information on atopic dermatitis needs significant improvement. Some guidelines and certifications of the mobile application are needed to provide health information about atopic dermatitis, association with experts.

Phenotype and endotype in pediatric asthma

Asthma is not a homogeneous disease presenting variable clinical features, but a complex disorder consisting of many different disease entities characterized by variable air-flow limitation. To date, there are little effective preventive-strategies for the development of asthma, and it has been emphasized that early identification and intervention are the best ways to reduce the associated morbidities, quality of life, and socioeconomic burden. Predicting the natural course of asthma is still difficult, although various phenotypic approaches and predictive scores are developed and widely used. The present phenotypes and predictive scores may be reliable in the population, but those appear to be unreliable in each individual in real practice. Either undertreatment or overtreatment in childhood asthma is an important issue, because they are associated with poor compliance, increments of socioeconomic burdens, and poor quality of life. There is no doubt about the clinical efficacy of inhaled corticosteroid (ICS) in childhood asthma, but the negative effect of long-term use of ICS on the height is emerging. Therefore general physicians should consider an individualized management using specific phenotypes and endotypes, and regularly re-evaluate the drug-response, level of control, and adherence/compliance to avoid inadequate treatment.