Management of tuberculosis in Wales: 1986-92.
Explore the source record for details and available documents.
Adolescent↗
Biomedical subjects
J Y Paton
Publications and source records attributed to J Y Paton.
Adequacy of clinical formulae for estimation of energy requirements in children with cystic fibrosis.
BACKGROUND: Two clinical formulae (CF conference formula and estimation based on 120% of average requirement for energy) have been recommended for the estimation of energy requirements in cystic fibrosis but their accuracy is unknown. AIM: To compare the accuracy of estimates of energy requirement derived from the two formulae. METHODS: Energy requirement, defined as total daily energy expenditure, was measured using the doubly labelled water method in 15 patients (six girls, nine boys; mean (SD) age, 10.0 (2.4) years) who were well and clinically stable. The accuracy of the formulae was assessed using calculation of biases and limits of agreement relative to measured energy requirement. RESULTS: Estimates from the CF conference formula were lower than measured values (mean paired difference, 0.52 MJ/day; 95% confidence interval (CI), -1.10 to 0. 10), but this bias was not significant, and was smaller than that from the alternative formula (mean paired difference, 0.77 MJ/day; 95% CI, -0.20 to 1.74). Limits of agreement relative to measured total daily energy expenditure were narrower for the CF conference formula (-2.72 to 1.68 MJ/day) than for that based on 120% of estimated average requirement (-2.75 to 4.29 MJ/day), but with both formulae errors in estimation at the individual level were large. CONCLUSIONS: The CF conference formula offers improved prediction of energy requirements, but the accuracy of both formulae at the individual level is not sufficiently good for clinical purposes.
Adolescent↗
The evolution of liver disease in cystic fibrosis.
OBJECTIVES: To describe prospectively the evolution of liver abnormalities in cystic fibrosis (CF), and to assess their impact on nutritional status. STUDY DESIGN: 124 children (61 boys) with CF (median age, 5.4 years; range, 0.1-13.9) were followed longitudinally for a median of four years. Annual clinical examination, biochemistry, and ultrasound assessment were performed. Chrispin-Norman score, anthropometry, and bacterial colonisation of airway secretions were measured at each assessment. RESULTS: At initial assessment, 45% of the patients had no liver abnormalities, 42% had biochemical abnormality, 35% ultrasound abnormality, and 6% had clinical abnormality of the liver. In this cross sectional analysis, abnormal biochemistry was present in 40% of children with ultrasound or clinical abnormalities, but when longitudinal follow up data were analysed, abnormal biochemistry preceded or coincided with abnormal ultrasound or clinical hepatosplenomegaly in three quarters of 53 children developing new abnormalities. Eighty four of 124 children (68%) showed ultrasound or clinical evidence of liver abnormality at some point during the four years of follow up. No association was found between liver disease and nutritional status. CONCLUSIONS: Hepatic abnormality was common in this group of children with CF, was often predicted by intermittent biochemical abnormalities, and was not associated with deterioration in nutritional status.
Adolescent↗
Surfactant protein levels in severe respiratory syncytial virus infection.
Infection with respiratory syncytial virus (RSV) is a common cause of respiratory disease in infancy. Surfactant phospholipids have been shown to be reduced in severe RSV infection. Reduction in surfactant proteins might also contribute to the pathogenesis of this disease. We investigated daily levels of surfactant proteins in bronchoalveolar lavage (BAL) fluid from 18 ventilated infants with RSV infection (median age 3.1 mo) and in a control group of 16 ventilated surgical patients (median age 0.4 mo). Surfactant proteins were measured by ELISA, total protein by the Lowry method. Surfactant protein A (SP-A) was reduced in BAL fluid from children with RSV infection (median 5.6 micrograms/ml; range 0.6 to 151.9 micrograms/ml) compared with control samples (median 9.0 micrograms/ml; range 0.5 to 139.6 micrograms/ml, p = 0.0368). Surfactant protein B (SP-B) was lower in the RSV group (median 12.0 ng/ml; range 0 to 60. 8 ng/ml) than in control patients (median 118.1 ng/ml; range 0 to 778.2 ng/ml, p < 0.0000). Surfactant protein D (SP-D) was also reduced in the RSV group (median 130.3 ng/ml; range 0 to 1,486.0 ng/ml) versus median 600.4 ng/ml; range 0 to 1,869.0 ng/ml, p < 0. 0000. Total protein levels were higher in the RSV group (median 0.49 mg/ml; range 0.13 to 2.46 mg/ml versus median 0.36 mg/ml; range 0.07 to 1.65 mg/ml, p = 0.0079). The median value of SP-A was significantly lower in the initial sample (2.3 micrograms/ml) than in the final one (6.0 micrograms/ml). However, no significant correlation was found between surfactant protein concentrations and disease severity measured by arterial alveolar oxygen ratio. We conclude that alterations in surfactant protein concentrations are present in severe RSV infection and speculate that these may contribute to the abnormalities of lung function seen in this condition.
Bronchoalveolar Lavage Fluid↗
Recombinant DNase in cystic fibrosis: a protocol for targeted introduction through n-of-1 trials. Scottish Cystic Fibrosis Group.
Nebulized recombinant human deoxyribonuclease (DNase) reduces sputum viscosity and improves lung function in some cystic fibrosis patients, but individual responses are unpredictable. The aim of this study was to investigate how DNase can be targeted to those cystic fibrosis patients who would benefit most. The Scottish Cystic Fibrosis Group agreed on a randomized, double-blind, placebo-controlled n-of-1 assessment protocol. Patients underwent a maximum of three 4-week assessment periods (2 weeks saline, 2 weeks DNase each). Measurements performed at hospital (exercise, oximetry and spirometry) and home (symptom scores) were used to derive a scoring system to discriminate maximally between DNase and placebo effects. The data on 89 4-week assessments in 52 patients were reported. Twenty-four patients have completed the assessment process (12 responders and 12 nonresponders) to date. Forced expiratory volume in one second (FEVI) was the best discriminator of response, rising by >200 mL after DNase in 33 of 89 (37%) assessments compared with 3 of 89 (3%) after saline. N-of-1 trials, while laborious, permitted genuine treatment effects to be quantified within individuals with confidence, permitting appropriate treatment targeting. This provides a model of how other new expensive therapies may be introduced to maximize patient benefit.
Adolescent↗
The rapid diagnosis and clinical features of human herpesvirus 6.
Since human herpesvirus 6 (HHV6) was first linked with exanthem subitum in 1988 there has been increasing evidence that the morbidity associated with acute HHV6 infection may be more significant and variable. However, the clinical appreciation of HHV6 infection has been hampered by the lack of rapid and clinically useful diagnostic methods. In this prospective study of hospitalized febrile children under 3 years of age we compared three rapid viral diagnostic methods, (polymerase chain reaction assay (PCR), IgM serology and direct antigen detection), with conventional serology on paired serum samples. In addition, we documented the range of clinical features associated with acute HHV6 infection. Of 67 children recruited, 11 (16%) had evidence of acute HHV6 infection: six had detectable, specific, IgM; four were PCR positive; and one was PCR positive with IgM. Direct antigen testing on batched frozen samples detected no infections. Apart from high fever (median peak 38.5 degrees C), common features were non-specific. Two children had febrile convulsions and only one child had a non-specific rash. We conclude that rapid microbiological diagnosis at present requires two tests (IgM and PCR). HHV6 is a common cause of febrile illness in hospitalized infants with no rash and should be considered in their diagnosis.
Antibodies, Viral↗
Submaximal running economy in run-trained pre-pubertal boys.
There is an increasing tendency for young children to participate in training and competitive running. The impact long-term training has upon stimulating functional physiological adaptation has yet to be fully understood. In this study cardio-respiratory and kinematic differences were assessed at submaximal and maximal exercise intensities in run-trained and non-run-trained boys. Thirty three pre-pubertal boys volunteered to take part in the study. The subjects were in two groups: 15 run-trained subjects [age 11.7 +/- 1.06 yrs, mean +/- SD] and 18 non-run-trained (control) subjects [age 11.3 +/- 0.90 yrs]. Two separate (4 x 3 min) submaximal protocols were used for the trained and non-run-trained groups, with two of the speeds overlapping for comparison purposes. In addition, all boys also performed a maximal oxygen consumption test. Mean VO2max value for the run trained group was 60.5 +/- 3.3 ml/kg/min and for the control group 51.1 +/- 4.3 ml/kg/min, (p < 0.001). No significant differences were found for submaximal running economy at either comparison speed. In addition, no significant (p > 0.05) differences were noted between the groups for any of the kinematic variables at the two comparison speeds. However, selected physiological differences did exist at the submaximal running speeds. The source of the differences that did exist between the two groups may be the result of training, genetic pre-selection or developmental differences between the groups.
Child↗
Measured bronchodilator use in preschool children with asthma.
OBJECTIVE: To investigate how parents use bronchodilator treatment for relief of symptoms when treating their asthmatic preschool children. DESIGN: A commercial electromechanical timer device was attached to a large volume spacer to record the time and date of each use of inhaled bronchodilator over two months. The recorded time and dates were compared with symptoms noted in an asthma diary card. SETTING: Large paediatric teaching hospital in Glasgow. SUBJECTS: 29 preschool children with moderately severe asthma attending a specialist paediatric asthma clinic. MAIN OUTCOME MEASURES: Inhaler use measured by the timer device; symptoms and inhaler use recorded by parents in a daily asthma diary. RESULTS: Satisfactory data were obtained in 22 of the 29 children; the median number of study days was 53 (range 18-77). Asthmatic symptoms were recorded on a median of 30 (3-77) days. Bronchodilator was used on a median of 19 (2-73) days, or on 63% (7-100%) of days when symptoms occurred. The median number of puffs used in a day was 1 (range 0-100) and was significantly related to symptom severity in only 14 of the 22 children. In only two of the 22 children was bronchodilator given more frequently than four hourly, and only five children ever used more than 12 puffs a day. CONCLUSIONS: The frequency of parental administration of bronchodilator treatment was variable and not closely related to the parent's record of symptom severity. Parents often recorded symptoms in their children but did not treat them.
Asthma↗
Physiologic correlates to running performance in pre-pubertal distance runners.
In adults, four major variables have been shown to be associated with success in distance running performance: submaximal oxygen consumption (running economy), peak oxygen consumption (Peak VO2), ventilatory threshold (VT) and fractional utilisation (FU). The primary aim of this study was to describe the relationship between the 3000 m race times of run-trained prepubertal boys to these four variables. Thirteen male run-trained pre-pubertal boys (age 11.7 +/- 1.1 yrs, mean +/- SD), volunteered to take part in a 3000 m time trial and laboratory assessment, consisting of treadmill running at four submaximal speeds (8, 9.6, 11.2 and 12.8 km.h-1) as well as a peak VO2 test. The group demonstrated a heterogeneous array of peak VO2 data. A high level of association (p < 0.05) was found between mass-relative peak VO2 and 3000 m time trial results (r = -0.83). In addition ventilatory threshold expressed as %peak VO2, VO2 at VT and estimated velocity at VT was also highly related to 3000 m time trial (r = -0.78, -0.77 and -0.77) respectively. Fractional utilisation (%peak VO2) was significantly (p < 0.05) associated with race time at the final two submaximal running speeds only (11.2 and 12.8 km.h-1) (r = 0.61 and 0.67, respectively). Respiratory Exchange Ratio (RER) was also found to be significantly (p < 0.05) associated with 3000 m race time at 11.2 and 12.8 km.h-1. Overall peak VO2 appeared to be the single most important factor associated with success at 3000 m.
Adolescent↗
Core knowledge, skills, and attitudes in child health for undergraduates.
Explore the source record for details and available documents.
Attitude of Health Personnel↗
Reproducibility of cardiorespiratory measurements during submaximal and maximal running in children.
With the increased use of oxygen consumption measurements in clinical and sporting studies, measurement variability has become more important to both the paediatric clinician and the sports scientist. In this study we assessed the reproducibility of cardiorespiratory measurements during submaximal and maximal running in children. Ten healthy, physically active boys (mean(s.d.) age 10.7(0.71) years) performed two submaximal and two maximal running tests within a 4 week period. The submaximal protocol consisted of three 6 minute runs at 7.2, 8.0 and 8.8 km/h. Every attempt was made to minimize the sources of non-biological variability at each testing session. During submaximal exercise, oxygen consumption (VO2), heart rate (HR) and fractional utilization appeared to be the most reliable measures accounting for over two-thirds of the total variation (coefficients of reliability (CR) of 68%, 94% and 82% respectively). Ventilation (Ve) and respiratory exchange ratio (RER) proved to be only moderately reliable accounting for less than half of the total variation (CR 50% and 45% respectively). At maximal exercise, VO2, Ve and time to exhaustion were most reliable, accounting for approximately two-thirds of the total variation (CR 65%, 63% and 63% respectively). Within this test environment, a two visit submaximal assessment was capable of estimating VO2 with a standard error of +/- 1.25 ml/kg/min. Similarly, for maximal testing a two visit assessment estimated peak VO2 with a standard error of +/- 2.28 ml/kg/min. On the evidence of these results a two visit assessment for submaximal and maximal exercise testing seems adequate to estimate the stability of submaximal cardiorespiratory measures and peak VO2 in healthy, normally active boys.
Body Weight↗
Outcome of Burkholderia (Pseudomonas) cepacia colonisation in children with cystic fibrosis following a hospital outbreak.
BACKGROUND: While there are reports on the outcome in adults and teenagers with cystic fibrosis of colonisation with Burkholderia (Pseudomonas) cepacia, there is little information in children. METHODS: In December 1991 only one of 115 children with cystic fibrosis attending a paediatric centre was colonised with B cepacia. Over the next 12 months there was a rapid increase with 23 (20%) becoming colonised; eighteen (79%) of these became colonised in hospital at a time that overlapped with the admission of a B cepacia positive child. Three different bacteriocin types were isolated, with one type (S22/PO) being present in 17 (74%) patients. The outcome for children who became colonised with B cepacia was compared with that in 33 children who continued to be colonised with Pseudomonas aeruginosa alone. RESULTS: Children colonised with B cepacia were older and more poorly nourished than those colonised with P aeruginosa, but did not have poorer pulmonary function. After colonisation, the forced expiratory volume in one second (FEV1) deteriorated between consecutive annual tests, with the average deterioration being greater in those with higher initial levels. Five children with B cepacia died from respiratory failure although none showed a fulminant deterioration. Introduction of segregation measures within hospital led to a dramatic decrease in the number of newly colonised patients. CONCLUSIONS: This study provides further evidence for person-to-person spread of B cepacia and confirms the effectiveness of simple isolation measures in interrupting spread. Colonisation with B cepacia and P aeruginosa in children is associated with a more rapid decline in lung function and a significantly increased mortality compared with cases colonised with P aeruginosa alone.
Adolescent↗
Compliance with inhaled asthma medication in preschool children.
BACKGROUND: Previous studies have shown poor compliance with regular drug therapy in children and adults with asthma. In preschool children the parents supervise and are responsible for drug administration, but little is known of compliance in this group. In addition, there are few data on the patterns of drug use of inhaled prophylactic asthma therapy or of the relation between compliance and symptom control. A study was undertaken to address these issues with the hypothesis that parental supervision would result in good compliance. METHODS: The subjects were 29 asthmatic children aged 15 months to five years already established on inhaled prophylactic medication delivered through a large volume spacer. The prescribed drug regimens varied between subjects. This was an observational study using an electronic inhaler timer device to record the date and time of each actuation of the aerosol canister. Diary cards were used for parallel recording of symptoms and parentally reported compliance with a drug regimen. RESULTS: Variable and generally poor compliance was demonstrated with a median of 50% of study days with full compliance (subject range 0-94%) and an overall median of 77% of prescribed doses of therapy taken during the study period. No relation was found between frequency of prescribed regimen and good compliance. Day care was associated with poorer compliance. No relation between good compliance and low symptom scores was found. CONCLUSION: Compliance with inhaled prophylactic therapy is poor in preschool children with asthma whose medication is administered under parental supervision.
Administration, Inhalation↗
Home nebuliser use in children with asthma in two Scottish Health Board Areas.
OBJECTIVE: To audit the use of home nebulisers in children with asthma. DESIGN: Postal questionnaire. SETTING: Two Health Board Areas in Central Scotland--one large industrialised city, one mixed urban and rural. SUBJECTS: 297 children with asthma. MEASURES EVALUATED: Initial supply and technical support for the compressor. EDUCATION: Pattern of drug usage. SYMPTOM CONTROL: Monitoring and treatment of acute attacks. RESULTS: The full burden of the home nebulised therapy is not being met by the NHS. Supply and servicing arrangements for home nebuliser therapy were poorly organised. Chronic asthma symptoms did not appear to be optimally controlled on present medication, with 61% reporting sleep disturbance in the previous three months. About 20% of parents admitted that they would give nebulised bronchodilator therapy more frequently than the recommended 3 to 4 hourly. CONCLUSION: Re-organisation of resources and arrangements could improve the service and bring it in line with recognised standards of care.
Acute Disease↗
Beta 2-agonists and running economy in prepubertal boys.
Asthmatic athletes (adults and junior) have competed successfully at the highest level for many years assisted by pre-event medication with beta 2-agonists. To examine the impact of beta 2-agonists upon submaximal running economy (oxygen consumption at a given submaximal work load), we studied 10 nonasthmatic boys (age, 10.4 +/- 0.48 years, mean +/- SD). They each completed submaximal (speeds, 7.2, 8.0 and 8.8 km/hr) and peak treadmill running protocols preceded by treatment with beta 2-agonist (terbutaline, 500 micrograms via nebuhaler) or placebo in a randomized, crossover single-blind study. No significant differences were found between running economy and heart rate during the submaximal exercise tests or between peak oxygen consumption (VO2), peak respiratory exchange ratio, peak heart rate (HR), or total running time during the peak VO2 test. Pretreatment with terbutaline did produce small but nonsignificant increases in aerobic fractional utilization (percent peak VO2 on drug: 65.9%, 72.6%, and 76.7% vs. placebo: 65.1%, 70%, and 75.5%), at the three submaximal work loads. Respiratory exchange ratio (RER) values were elevated throughout the submaximal tests (on drug: 0.94, 0.93, and 0.94 vs placebo: 0.91, 0.92, and 0.91, P < 0.05). No significant differences were found between drug and placebo for minute ventilation (VE) and ventilatory equivalent for oxygen (VE/VO2), at both submaximal and peak exercise intensities.(ABSTRACT TRUNCATED AT 250 WORDS)
Administration, Inhalation↗
Flexible bronchoscopy under 10 kg.
We report 35 bronchoscopies performed in 27 post-neonatal subjects weighing less than 10 kg using an Olympus BC3F20 (3.5 mm diameter) bronchoscope. Twenty-three procedures were performed primarily for investigation of airway anatomy and 12 primarily for broncho-alveolar lavage. Mild oxygen desaturation responsive to increased O2 administration was common. Major complications were infrequent with two children developing lower respiratory tract infection and one patient requiring ventilation overnight. The diagnostic yield was high with 76% of studies in children suspected of airway anomalies proving positive. We conclude that bronchoscopy in this age group is well tolerated and identifies a significant number of abnormalities.
Body Weight↗
Clinical manifestations of the 'athlete's heart' in prepubertal male runners.
Cardiac findings in adult endurance athletes are well characterized, but data regarding the "athlete's heart" in children are limited. This study evaluated cardiovascular features of 10 male prepubertal distance runners ages 11-13 years compared to 18 physically active but untrained boys. Mean VO2max values on treadmill testing for the two groups were 61.2 (3.2) and 51.1 (4.3) ml.kg-1.min-1, respectively. No significant differences in the frequency of carotid bruits, cervical venous hums, heart murmurs, or third and fourth heart sounds were observed between the groups. Mean resting heart rate was 71 (9) bpm for the runners and 73 (8) for the controls (p > 0.05). No significant differences were seen in EKG intervals, axes, or precordial voltages between runners and controls, and echocardiographic chamber sizes, wall thicknesses, and mass indexed to body surface area were also similar (p > 0.05). This study failed to identify clinical features of the "athlete's heart" in competitive child endurance runners compared to non-trained subjects.
Adolescent↗
Validation of the sensormedics (S2900Z) metabolic cart for pediatric exercise testing.
The accuracy of many microprocessor controlled exercise testing systems has not been established, particularly for testing children. A metabolic cart (Sensormedics S2900Z) was validated against a reference system (Douglas bag) in children. The systems were tested using 10 active, healthy children (age 11.6 +/- 2.3 yrs) during physiological steady state at two exercise intensities, submaximal walking and running. Eight children performed a high ventilatory flow (HVF) protocol, running for 11 min. All 10 performed a low ventilatory flow (LVF) protocol, walking for 11 min. In both, gas samples were measured after 6 to 7 and 10 to 11 min into the Douglas bag, and after 8 to 9 min by the test system. There was minimal evidence of bias for VO2 at either ventilation rate. Greater variability was noted for FeCO2 and VCO2. In conclusion, the Sensormedics S2900Z appears to be adequate for testing children.
Bias↗