The effects of illness and treatment of diabetes mellitus extend beyond medica l outcomes. We therefore evaluated health-related quality of life (HRQOL) in ch ildren (aged 8-12 years) and adolescents (aged 13-16 years...The effects of illness and treatment of diabetes mellitus extend beyond medica l outcomes. We therefore evaluated health-related quality of life (HRQOL) in ch ildren (aged 8-12 years) and adolescents (aged 13-16 years) with type 1 diabet es to compare their results with healthy peers and to identify HRQOL determinant s. A total of 68 children and adolescents from a tertiary care clinic which spec ialises in the management of diabetes, completed the generic KINDL-R questionna ire. This instrument for children and adolescents has six dimensions and an addi tional module assessing condition-related HRQOL. Overall, the HRQOL was not dif ferent between patients with type 1 diabetes and healthy controls. In some areas , children and adolescents with diabetes reported a better HRQOL compared to hea lthy peers: adolescents reported better psychological wellbeing ( P < 0.05) and children higher levels of well-being in the school domain ( P < 0.05). In gener al, children reported a better HRQOL ( P < 0.05) than adolescents with type 1 di abetes confirming age-related differences in HRQOL in the general popu lation. Lower HbA1c ( < 8%) and intensified insulin therapy ( > 3 injections/ day) were associated with a better HRQOL in different domains ( P < 0.05). The s ubscale “chronic illness”showed a better HRQOL ( P < 0.001) in children and ad olescents with diabetes compared to age-matched controls with other chronic con ditions. Conclusion:Children and adolescents from a paediatric department specia lising in diabetes management report good health-related quality of life. Young er age, good metabolic control and intensified insulin therapy are associated wi th a better health-related quality of life. Dimensions of health-related quali ty of life appear to play different roles at different ages, emphasising the imp ortance of the multidimensional health-related quality of life concept and the value of age-appropriate self-reports.展开更多
Background: Epidemiological studies have shown inverse associations between geohelminth (intestinal helminth) infection and atopy, leading to the suggestion that geohelminths might protect against allergy. Periodic de...Background: Epidemiological studies have shown inverse associations between geohelminth (intestinal helminth) infection and atopy, leading to the suggestion that geohelminths might protect against allergy. Periodic deworming of school children with anthelmintics is a widely implemented intervention and has raised concerns that such programmes could increase allergy. We investigated the effect of repeated anthelmintic treatments with albendazole over 12 months on the prevalence of atopy and clinical indices of allergy. Methods: We did a cluster-randomised controlled trial in schoolchildren from 68 rural schools. Children were randomly assigned by school to either albendazole (34 schools, 1164 children) every 2 months for 12 months, or to no intervention (34 schools, 1209 children). The intervention schools received a total of seven albendazole treatments. The primary outcome was atopy at 12 months (allergen skin-test reactivity), and analysis was by intention-to-treat for whole-school analyses and per protocol for children. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN61195515. Findings: Data for analysis were available for all schools and from 67.4%(784 of 1164) and 70.1%(848 of 1209) of children in albendazole and no-treatment groups, respectively. Albendazole treatment caused large reductions in geohelminth prevalence over the study period (adjusted odds ratio 0.13, 95%CI 0.09-0.19, p < 0.001), but there was no evidence that treatment was associated with an increase in atopy prevalence (0.97, 0.68-1.39, p=0.862), or clinical allergy (wheeze, 1.07, 0.54-2.11, p=0.848) in the albendazole compared with the no-treatment group. Interpretation: We saw no increase in the prevalence of atopy or clinical allergy associated with albendazole treatment. Deworming programmes for schoolchildren are unlikely to be accompanied by an increase in allergy.展开更多
PURPOSE. This study investigated the incidence and progression, as well as factors associated with changes in astigmatism in school children. METHODS. This was a prospective cohort study. Children 7 to 9 years of age,...PURPOSE. This study investigated the incidence and progression, as well as factors associated with changes in astigmatism in school children. METHODS. This was a prospective cohort study. Children 7 to 9 years of age, of Chinese, Malay, and Asian Indian ethnicity, were examined annually over a 4- year period. Cycloplegic autorefraction was performed. A questionnaire was used to evaluate risk factors for incidence and progression of astigmatism. RESULTS. The cumulative 3- year incidence rate of astigmatism was 33.6% (cylinder power of 0.5 D or worse) or 11.5% (cylinder power of 1.0 D or worse). Myopic children had a higher incidence rate of astigmatism than nonmyopes (P < .0.001). The mean J0 change per year was 0.012 D (95% CI: 0.007- 0.018), whereas J45 did not show a significant change each year (mean, 0.001 D per year). Chinese children had greater worsening of J0 per year (P < .0.001). Girls also had significantly greater progression of J0 than did boys (P < 0.001). Similarly, myopia at baseline (P < 0.001)- and the hours of computer use (P=0.049) were associated with a greater progression rate of J0. J0 tended to improve in children with compound hyperopic astigmatism, worsen in children with compound myopic astigmatism, and remain stable in mixed astigmatics. CONCLUSIONS. Although there was minimal progression of astigmatism in school age children (0.44- 0.53 D) over this period of follow- up, incident cases of astigmatism ( > 1.0 D) were not uncommon. The progression rate of astigmatism was affected by the ethnicity, presence of myopia, axis, and subtype of astigmatism.展开更多
文摘The effects of illness and treatment of diabetes mellitus extend beyond medica l outcomes. We therefore evaluated health-related quality of life (HRQOL) in ch ildren (aged 8-12 years) and adolescents (aged 13-16 years) with type 1 diabet es to compare their results with healthy peers and to identify HRQOL determinant s. A total of 68 children and adolescents from a tertiary care clinic which spec ialises in the management of diabetes, completed the generic KINDL-R questionna ire. This instrument for children and adolescents has six dimensions and an addi tional module assessing condition-related HRQOL. Overall, the HRQOL was not dif ferent between patients with type 1 diabetes and healthy controls. In some areas , children and adolescents with diabetes reported a better HRQOL compared to hea lthy peers: adolescents reported better psychological wellbeing ( P < 0.05) and children higher levels of well-being in the school domain ( P < 0.05). In gener al, children reported a better HRQOL ( P < 0.05) than adolescents with type 1 di abetes confirming age-related differences in HRQOL in the general popu lation. Lower HbA1c ( < 8%) and intensified insulin therapy ( > 3 injections/ day) were associated with a better HRQOL in different domains ( P < 0.05). The s ubscale “chronic illness”showed a better HRQOL ( P < 0.001) in children and ad olescents with diabetes compared to age-matched controls with other chronic con ditions. Conclusion:Children and adolescents from a paediatric department specia lising in diabetes management report good health-related quality of life. Young er age, good metabolic control and intensified insulin therapy are associated wi th a better health-related quality of life. Dimensions of health-related quali ty of life appear to play different roles at different ages, emphasising the imp ortance of the multidimensional health-related quality of life concept and the value of age-appropriate self-reports.
文摘Background: Epidemiological studies have shown inverse associations between geohelminth (intestinal helminth) infection and atopy, leading to the suggestion that geohelminths might protect against allergy. Periodic deworming of school children with anthelmintics is a widely implemented intervention and has raised concerns that such programmes could increase allergy. We investigated the effect of repeated anthelmintic treatments with albendazole over 12 months on the prevalence of atopy and clinical indices of allergy. Methods: We did a cluster-randomised controlled trial in schoolchildren from 68 rural schools. Children were randomly assigned by school to either albendazole (34 schools, 1164 children) every 2 months for 12 months, or to no intervention (34 schools, 1209 children). The intervention schools received a total of seven albendazole treatments. The primary outcome was atopy at 12 months (allergen skin-test reactivity), and analysis was by intention-to-treat for whole-school analyses and per protocol for children. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN61195515. Findings: Data for analysis were available for all schools and from 67.4%(784 of 1164) and 70.1%(848 of 1209) of children in albendazole and no-treatment groups, respectively. Albendazole treatment caused large reductions in geohelminth prevalence over the study period (adjusted odds ratio 0.13, 95%CI 0.09-0.19, p < 0.001), but there was no evidence that treatment was associated with an increase in atopy prevalence (0.97, 0.68-1.39, p=0.862), or clinical allergy (wheeze, 1.07, 0.54-2.11, p=0.848) in the albendazole compared with the no-treatment group. Interpretation: We saw no increase in the prevalence of atopy or clinical allergy associated with albendazole treatment. Deworming programmes for schoolchildren are unlikely to be accompanied by an increase in allergy.
文摘PURPOSE. This study investigated the incidence and progression, as well as factors associated with changes in astigmatism in school children. METHODS. This was a prospective cohort study. Children 7 to 9 years of age, of Chinese, Malay, and Asian Indian ethnicity, were examined annually over a 4- year period. Cycloplegic autorefraction was performed. A questionnaire was used to evaluate risk factors for incidence and progression of astigmatism. RESULTS. The cumulative 3- year incidence rate of astigmatism was 33.6% (cylinder power of 0.5 D or worse) or 11.5% (cylinder power of 1.0 D or worse). Myopic children had a higher incidence rate of astigmatism than nonmyopes (P < .0.001). The mean J0 change per year was 0.012 D (95% CI: 0.007- 0.018), whereas J45 did not show a significant change each year (mean, 0.001 D per year). Chinese children had greater worsening of J0 per year (P < .0.001). Girls also had significantly greater progression of J0 than did boys (P < 0.001). Similarly, myopia at baseline (P < 0.001)- and the hours of computer use (P=0.049) were associated with a greater progression rate of J0. J0 tended to improve in children with compound hyperopic astigmatism, worsen in children with compound myopic astigmatism, and remain stable in mixed astigmatics. CONCLUSIONS. Although there was minimal progression of astigmatism in school age children (0.44- 0.53 D) over this period of follow- up, incident cases of astigmatism ( > 1.0 D) were not uncommon. The progression rate of astigmatism was affected by the ethnicity, presence of myopia, axis, and subtype of astigmatism.
