AIM:To identify a hypothesis on:Supine sleep,sudden infant death syndrome(SIDS) reduction and association with increasing autism incidence.METHODS:Literature was searched for autism spectrum disorder incidence time tr...AIM:To identify a hypothesis on:Supine sleep,sudden infant death syndrome(SIDS) reduction and association with increasing autism incidence.METHODS:Literature was searched for autism spectrum disorder incidence time trends,with correlation of change-points matching supine sleep campaigns.A mechanistic model expanding the hypothesis was constructed based on further review of epidemiological and other literature on autism.RESULTS:In five countries(Denmark,United Kingdom,Australia,Israel,United States) with published time trends of autism,change-points coinciding with supine sleep campaigns were identified.The model proposes that supine sleep does not directly cause autism,but increases the likelihood of expression of a subset of autistic criteria in individuals with genetic susceptibility,thereby specifically increasing the incidence of autism without intellectual disability.CONCLUSION:Supine sleep is likely a physiological stressor,that does reduce SIDS,but at the cost of impact on emotional and social development in the population,a portion of which will be susceptible to,and consequently express autism.A re-evaluation of all benefits and harms of supine sleep is warranted.If the SIDS mechanism proposed and autism model presented can be verified,the research agenda may be better directed,in order to further decrease SIDS,and reduce autism incidence.展开更多
Objective: To estimate the diagnostic accuracy of chest radiography in the detection of chest lymphadenopathy in children with clinically suspected pulmonary tuberculosis. Methods: Design: Prospective cross sectional ...Objective: To estimate the diagnostic accuracy of chest radiography in the detection of chest lymphadenopathy in children with clinically suspected pulmonary tuberculosis. Methods: Design: Prospective cross sectional study. Setting: Ashort stay ward in a children’s hospital in South Africa. Patients: Consecutive children under 14 years of age admitted with suspected pulmonary tuberculosis. Diagnostic test: Antero-posterior and/or lateral chest x rays interpreted independently and blind to the reference standard by three primary care clinicians and three paediatricians, all with a special interest in tuberculosis. Reference standard: Spiral chest computed tomography (CT) with contrast injection. Results: One hundred children (median age 21.5 months) were enrolled. Lymphadenopathy was present in 46 of 100 reference CT scans and judged to be present in 47.1% of x ray assessments. Overall sensitivity was 67% and specificity 59% . Primary care clinicians were more sensitive (71.5% v 63.3% , P=0.047) and less specific (49.8% v 68.9% , P < 0.001) than paediatricians. Overall accuracy was higher for the paediatricians (diagnostic odds ratio 3.83 v 2.49, P=0.008). The addition of a lateral to an antero-posterior view did not significantly increase accuracy (diagnostic odds ratio 3.09 v 3.73, p=0.16). Chance adjusted inter-observer agreement (K) varied widely between viewer pairs, but was around 30% . Conclusions: Detection of mediastinal lymphadenopathy on chest x ray to diagnose pulmonary tuberculosis in children must be interpreted with caution. Diagnostic accuracy might be improved by refining radiological criteria for lymphadenopathy.展开更多
文摘AIM:To identify a hypothesis on:Supine sleep,sudden infant death syndrome(SIDS) reduction and association with increasing autism incidence.METHODS:Literature was searched for autism spectrum disorder incidence time trends,with correlation of change-points matching supine sleep campaigns.A mechanistic model expanding the hypothesis was constructed based on further review of epidemiological and other literature on autism.RESULTS:In five countries(Denmark,United Kingdom,Australia,Israel,United States) with published time trends of autism,change-points coinciding with supine sleep campaigns were identified.The model proposes that supine sleep does not directly cause autism,but increases the likelihood of expression of a subset of autistic criteria in individuals with genetic susceptibility,thereby specifically increasing the incidence of autism without intellectual disability.CONCLUSION:Supine sleep is likely a physiological stressor,that does reduce SIDS,but at the cost of impact on emotional and social development in the population,a portion of which will be susceptible to,and consequently express autism.A re-evaluation of all benefits and harms of supine sleep is warranted.If the SIDS mechanism proposed and autism model presented can be verified,the research agenda may be better directed,in order to further decrease SIDS,and reduce autism incidence.
文摘Objective: To estimate the diagnostic accuracy of chest radiography in the detection of chest lymphadenopathy in children with clinically suspected pulmonary tuberculosis. Methods: Design: Prospective cross sectional study. Setting: Ashort stay ward in a children’s hospital in South Africa. Patients: Consecutive children under 14 years of age admitted with suspected pulmonary tuberculosis. Diagnostic test: Antero-posterior and/or lateral chest x rays interpreted independently and blind to the reference standard by three primary care clinicians and three paediatricians, all with a special interest in tuberculosis. Reference standard: Spiral chest computed tomography (CT) with contrast injection. Results: One hundred children (median age 21.5 months) were enrolled. Lymphadenopathy was present in 46 of 100 reference CT scans and judged to be present in 47.1% of x ray assessments. Overall sensitivity was 67% and specificity 59% . Primary care clinicians were more sensitive (71.5% v 63.3% , P=0.047) and less specific (49.8% v 68.9% , P < 0.001) than paediatricians. Overall accuracy was higher for the paediatricians (diagnostic odds ratio 3.83 v 2.49, P=0.008). The addition of a lateral to an antero-posterior view did not significantly increase accuracy (diagnostic odds ratio 3.09 v 3.73, p=0.16). Chance adjusted inter-observer agreement (K) varied widely between viewer pairs, but was around 30% . Conclusions: Detection of mediastinal lymphadenopathy on chest x ray to diagnose pulmonary tuberculosis in children must be interpreted with caution. Diagnostic accuracy might be improved by refining radiological criteria for lymphadenopathy.
