bluuebunny/crossref_metadata_2025 huggingface dataset:
Distress and depression in new motherhood: research with adoptive mothers highlights important contributing factors
Authors: Gair
Published: March 2003

Feminist, sociological literature concerned with mothering and motherhood reveals that the reality of mothering within the sometimes contradictory and invalidating context of western society may bring forth a range of emotional responses, some of which are unexpected negative responses. In a recent study with adoptive mothers in Queensland, Australia, experiences at significant points across the adoption life cycle were explored. These experiences included, for mothers of babies and young children, a wide range of emotional responses in the early post‐adoption period. Methods for the collection of data included the introduction of several scales, including a postnatal depression scale (EPDS), and in‐depth interviews. The findings have implications for social work practice with adoptive mothers, and also for the delivery of health services to all mothers and babies.
Children in permanent foster care in Sweden
Authors: Andersson
Published: March 2003

The Swedish child welfare system has no permanency planning as we know it from, for example, the United States and Great Britain. Regardless of whether the child is placed in foster care with or without the parents’ consent, the law requires semi‐annual reviews and there is no time limit set on reunion. Nevertheless, there are foster children who remain in the foster home throughout the whole of childhood, on terms similar to permanent foster care or adoption. This paper concerns a selection of findings from a research project entitled ‘Is there a difference in being a foster child?’. Foster children aged 10–11 were interviewed three times and the children’s perspective was focused on, complemented by the perspective of their foster parent(s). When interviewed about their relationship to their natural family as well as to the foster family, and about having a sense of family belonging and expectations for the future, 11 of the 22 children perceived their stay in the foster home as permanent and regarded themselves as belonging only to the foster family, although all of the children had contact with their birth parents. The study concerns the children’s views as well as those of the foster parents. The perception of permanency in the absence of a legal option of permanency is discussed.
Discrimination in child protection work: recurring themes in work with Asian families
Authors: Humphreys  , Atkar  , Baldwin
Published: March 2003

When the relationships within the institutions and social practices of a society cannot be explained by the intentions, good or bad, of individual men and women, they can be described as structural ( Weedon 1987, p. 3). This paper reports on research in a Midlands Social Services Department which examined child protection practice in relation to Asian families who had attended case conferences. The research shows that in spite of the good intentions of many individual workers, Asian families experienced a discriminatory service. Discriminatory policies and practices were perpetuated at an organizational level. Three themes from the research are explored: the use of interpreters, the accommodation of children, and the lack of attention to the mental and physical health of the child’s mother and father. Each theme is explored to highlight the issues which Asian families faced and the problems which created barriers to good practice.
Assessment and decision‐making in a case of child neglect and abuse using an attachment perspective
Authors: Howe  , Dooley  , Hinings
Published: March 2003

Assessment and decision‐making in complex cases of child abuse and neglect is a difficult and taxing process. Although social workers have become increasingly good at collecting information, often under the direction of agency checklists and manuals, there is less confidence in knowing how to make sense of that information for purposes of assessment and decision‐making. Theories help organize knowledge and attachment theory is proving to be a powerful player in helping practitioners make sense of what they know. The paper outlines the basic tenets of attachment theory. When adapted to the context of social work, a key principle of an attachment‐based practice is the recognition that young children develop a range of adaptive strategies that are designed to help them cope with, survive, and function in whatever caregiving environment they happen to find themselves, including ones in which there is abuse and neglect. Although these strategies are functional within the context of adverse caregiving environments, they carry the risk of children suffering a variety of developmental impairments and failure to develop social competence. A case is described in which there are elements of abuse and neglect both within and across the generations. An attachment perspective is used to analyse and assess the quality and character of parenting and the different adaptive strategies developed by each child in the caregiving context in which they have found themselves. The assessment is then used to inform the decision whether or not to leave the children in the care of their mother or to place them with a long‐term substitute family, with or without contact.
The design and development of an instrument for assessing the quality of partnership between mother and social worker in child and family care
Authors: Sheppard M.
Published: March 2003

Partnership with parents has become a central feature of child care policy and practice. It is related to a general emphasis on the importance of parents evident in issues such as parental responsibility and family support. As such it would be extremely helpful to have an instrument which provides a measure of the quality of partnership. It would be useful both in individual cases, where it could be used to help strengthen partnerships between social workers and parents, and on a wider basis, providing authorities with data with which to assess, in general, the quality of partnership. This paper reports on the design and development of an instrument for assessing the quality of partnership with mothers. First it focuses on key conceptual elements of partnership, which are considered to be role, and role relationship (of social worker and mother), and power. The paper then identifies key dimensions to the notion of partnership, dimensions which are generally agreed, and relate to the key conceptual elements. The ways these are operationalized are described, and the use of the instrument is analysed. The findings go some way to showing the instrument has both validity and reliability, when considered in the context of practice. It is suggested that this instrument may be used both in research and in practice.
Trained volunteers for families coping with a child with a life‐limiting condition
Authors: McGrath P.
Published: March 2003

One hundred and seven families with a child diagnosed with a life‐limiting condition, from all over Queensland (Australia), were surveyed on their need for a trained volunteer. Their comments provide important insights into an area which has not previously been researched or documented. In summary, their responses indicate that many families have only minimal or no support, and are coping with extraordinary physical, emotional and social demands from the child’s condition and treatment. The majority of the participants are very positive about the need for a trained volunteer and are clear about the activities that trained volunteers could provide assistance with. These activities range from practical assistance such as baby‐sitting and help with household chores and errands to emotional support. Not all families would be comfortable using a volunteer, and some respondents did outline perceived obstacles to including a volunteer in family activities. For others there were comments about why volunteers would be perceived as unproblematic. Respondents specified important criteria that would need to be addressed in volunteer training. The largest number of respondents were coping with cystic fibrosis and muscular dystrophy. It is the hope and expectation that, with the communication of the insights gathered from this geographically diverse group of families, encouragement will be given to others working in this area to explore the possibility of establishing outreach volunteer programmes for such families.
Mandatory reporting of child abuse and neglect: does it really make a difference?
Authors: Ainsworth Frank
Published: March 2003

Mandatory reporting of child abuse and neglect has its origins in the USA, where model statutes for laws designed to introduce this process were first drafted in the early 1960s. Indeed, every state and the District of Columbia passed a child abuse reporting law between 1963 and 1967. Some 10 years later, in 1977, New South Wales was the first Australian state to pass comparable legislation. Mandatory reporting of suspected cases of child abuse and neglect is now in place in all Australian states and territories, with the exception of Western Australia. The question considered in this paper is: ‘What evidence is there that children are abused and neglectedlessin jurisdictions where mandatory reporting exists by comparison with jurisdictions where it does not exist?’ This question is examined by way of a comparison between two states, New South Wales and Western Australia. This paper also raises questions about the cost of mandatory reporting and the extent to which it diverts financial resources away from support services for families. There is also a question about the new New South Wales child protection legislation that extends mandatory reporting and possible negative consequences for ordinary families. The final question is about the role assigned to health care and education professionals under this legislation.
Responding to the experiences of minority ethnic children in virtually all‐white communities
Authors: Scourfield Jonathan , Evans Jonathan , Shah Wahida , Beynon Huw
Published: March 2003

This paper aims to contribute to the relatively small body of literature on the minority ethnic experience in almost entirely white communities, by reporting the findings of qualitative research into the experiences of minority ethnic children living in the South Wales valleys. Twenty‐eight interviews were conducted with children and their parents/carers. Interviews with children also included sentence completion and card‐sorting tasks. The paper focuses on the views expressed about quality of life, sense of community, leisure activities, experience of racism and dealings with institutions. The children and adults revealed a complex picture, which challenges both optimistic accounts of ‘traditional’ communities and also the negativity of pressure group reports on racism in similar areas. There is considerable variety of experience, mediated by class and gender. Whilst racism is in many respects an ever‐present reality for these children, many of them find creative ways of responding to their situation. Several also spoke of their lives in the valleys in generally very positive terms. The paper concludes by reflecting on the potential implications of the research for policy and practice.
‘Your friends don’t understand’: Invisibility and unmet need in the lives of ‘young carers’
Authors: Thomas Nigel , Stainton Timothy , Jackson Sonia , Cheung Wai Yee , Doubtfire Samantha , Webb Amanda
Published: March 2003

This paper is based on a study of the experiences of people identified as ‘young carers’, commissioned by the National Assembly for Wales as part of a wider review of carers’ needs and services. Following a brief review of some of the previous research in this area, the paper reports key findings of the research, using the words of children and young people as much as possible. It then goes on to explore some of the wider implications of this and other research for the identification and support of ‘young carers’ and their families, and for the understanding of the needs and wishes of children and young people so defined. The paper concludes with an alternative definition of a ‘young carer’ and with some recommendations for professional practice, suggesting that the role of social work is crucial in this area of service.
Sleep disorders and their relationship to psychological disturbance in children with epilepsy
Authors: Stores  , Wiggs  , Campling
Published: March 2003

By means of parental questionnaires, sleep disturbances were assessed in 79 schoolchildren with epilepsy (mean age 10.12, range 5–16 years) for comparisons with 73 healthy control children matched for gender and to within a maximum of 6 months of age. The daytime behaviour of the children with epilepsy was also assessed by questionnaire. The children with epilepsy were considered representative of such children under general paediatric care. Sleep disturbance was classified into five basic types (poor quality sleep, anxieties about sleep, disturbances during sleep, symptoms of disordered breathing during sleep and short duration sleep) and the behaviour questionnaire provided scores on five factors (conduct problems, hyperactivity, attention problems, anxiety and physical complaints). Compared with normal controls children with epilepsy showed much higher rates of sleep disorders, particularly poor quality sleep and anxieties about sleep. In children aged 5–11 years associations were found between disturbed daytime behaviour and sleep problems, particularly poor quality sleep. There was also a significant association between seizure frequency and anxieties about sleeping. This study highlights the potentially serious psychological and other developmental implications of persistent sleep disturbance to children with epilepsy, and the need for further research on specific types of epilepsy with careful identification of the nature of both sleep disturbance and related psychological dysfunction.
Characteristics of paediatric home care provision: the two dominant models in England
Authors: While A E , Dyson L
Published: March 2003

Aim To describe characteristics of paediatric home care teams

Background Home care provision is increasing and recent government initiatives such as support for Princess Diana Memorial Fund nursing teams will provide additional impetus to universal provision. However, little is known about the characteristics of paediatric home care teams.

Method A postal survey of all services in England (n= 137) listed in the 13th edition of RCN 1996 Directory of Community Children’s Nursing Services was undertaken. A response rate of 85.5% was achieved.

Findings More than half (54.6%) of the teams had been founded after 1990. Most (72.2%) were managed through paediatric or child health directorates and most (77.8%) were based in hospitals. The size of teams varied enormously (range 1–22; median 3). Only a small (5.6%) minority of teams provided care at night although over a third (37%) reported making special arrangements for terminally ill children.

Conclusion The survey revealed two dominant models of paediatric home care: the community model with strong links to primary health care and other local provisions and the hospital outreach model with strong links to the hospital service. A number of weaknesses in current provision are identified: variability in geographical coverage; undesirably low core staffing numbers; poor 24‐h coverage; and potentially compromised staff skills and knowledge. The need for research to clarify the strengths of the different models and their effectiveness is highlighted.
Organising habilitation services: team structures and family participation
Authors: Larsson M
Published: March 2003

This study is part of a project focusing on co‐operation between receivers of habilitation services (families) and professionals. The study focuses on the organisation and co‐ordination of the services, and compares two structures for their accomplishment. The first is the typical multiprofessional habilitation team (MHT), and the second is the individualised team (ISP). MHT teams are organised within the habilitation agency, while ISP teams span institutional boundaries. An ISP team is formed around the individual child who receives services from the habilitation centre, and includes parents (sometimes the child), professionals from the habilitation centre, and professionals from other service‐providing institutions that are actively involved (for instance pre‐school teacher, schoolteacher etc.). The team maps child and family needs, organises assessments and services and formulates goals that subsequently are monitored and followed up. A questionnaire (Measures of Processes of Care) was used to assess the experiences of 385 service receivers. The questionnaire focuses on service receivers' experiences of the family‐centredness of the service, operationalised in 56 items, along with five items concerning perceptions of level of control over service provision. The experiences of families having individualised teams were compared to those not having these teams. Significant differences were obtained, suggesting the impact of the form of service organisation on the content. Families having ISP teams report both more family‐centred service, and a greater level of control over service provision. Results are discussed in terms of organising structures and co‐ordination of services, and in terms of family participation.
The development of a theoretically driven generic measure of quality of life for children aged 6–12 years: a preliminary report
Authors: Eiser C , Vance Y H , Seamark D
Published: March 2003

Objective To report the development and psychometric properties of a generic computer‐delivered measure of quality of life (QoL) suitable for children aged 6–12 years: the Exqol. The theoretical model adopted is based on an assumption that poorer QoL is the result of discrepancies between an individual's actual (‘like me’) and ideal self (‘how I would like to be’).

Method The Exqol consists of 12 pictures, each of which is rated twice; first in terms of ‘like me’ and second as ‘I would like to be’. The Exqol is delivered using a Macintosh Powerbook and takes approximately 20 min to complete. Data are reported for 58 children with asthma (Mage = 8.95 years) and 69 healthy children (Mage = 7.49 years). In order to determine validity of the Exqol, children with asthma also completed the Childhood Asthma Questionnaire (CAQ) and their mothers completed a measure of child vulnerability and caregiver QoL.

Results Higher discrepancies were found for children with asthma compared with healthy children (P < 0.05). For children with asthma, significant correlations were found between discrepancy scores and two of the four subscales of the CAQ. Children who rated their asthma to be more severe also had higher discrepancy scores (P < 0.05).

Conclusions The Exqol has acceptable internal reliability and validity and distinguishes between children with asthma and healthy children. These data provide preliminary support for the theoretical assumption that QoL reflects perceived discrepancies between an individual's actual and ideal self. Methodological refinements to the Exqol are suggested.
The construct validity of the Griffiths Scales of Mental Development
Authors: Luiz D M , Foxcroft C D , Stewart R
Published: March 2003

The aim of this study was to contribute to our knowledge of the construct validity of the Griffiths Scales of Mental Development (Griffiths Scales) through an examination of the underlying dimensions tapped by the six subscales, using Common Factor Analysis. A sample of 430 South African children, from four ethnic groups (i.e. White, Mixed Race, Asian and Black) participated. The correlation coefficients obtained for the South African groups were compared to those Griffiths obtained in her work with the British standardization sample of the Griffiths Scales. The pattern of correlation for South African and British subjects was found to be similar. This suggests that the Scales are measuring a construct which is consistent across cultures and through time. A factor analysis was performed with the data for each South African ethnic group separately and the factor solutions were compared to determine whether the Griffiths Scales measure similar or different constructs for the groups. The results indicate that the Griffiths Scales tend to measure one factor, and including only common variables, the factor appears to be similar cross‐culturally.
Working children and accidents: understanding the risks
Authors: White L , O’Donnell C
Published: March 2003

Recent research suggests that a significant proportion of school children aged 10–16 years are employed outside the home during the school term. Delivery work represents only a minority of such employment and children are found working in a wide range of ‘adult’ jobs, particularly in the service sector. This raises concerns about health and safety hazards faced by working children. There is an absence of data on the effects of different kinds of work and working conditions on child health and development, which is thus a barrier to defining goals, policies and effective action. This paper aims to address these issues through presenting some research findings on child employment and incidences of accident. The study is based on surveys of school children in North Tyneside and Norfolk. Our analysis shows that there is a high level of accidents occurring at work among children aged 10–16 years old. While legislation exists in the UK to prevent children from working in the most hazardous environments and to prohibit young children from undertaking any employment, it is clear that such work does take place. Our findings indicate that it is time to look at the occupational health of children as a major concern.
Treatment demands and differential treatment of patients with cystic fibrosis and their siblings: patient, parent and sibling accounts
Authors: Foster C , Eiser C , Oades P , Sheldon C , Tripp J , Goldman P , Rice S , Trott J
Published: March 2003

Cystic fibrosis (CF) is a progressive disease with no known cure. Advances in diagnosis and treatment have resulted in patients living longer and thus families live with the illness for longer. Treatments are becoming increasingly demanding and are largely performed in the family home. Mothers are often reported to experience greater stress and poorer adjustment than mothers of well children or population norms. Patients and siblings are also reported to display adjustment difficulties. Siblings have rarely been included in research designs. This qualitative study investigates the impact of CF and treatment on eight patients, eight mothers, one father and eight siblings. A family systems perspective was adopted. Each individual was interviewed independently using semistructured interviews. Patients and siblings were aged between 9 and 21 years. Qualitative analyses revealed high levels of non‐adherence (intentional and unintentional) and parental involvement in treatment, minimal involvement of siblings, and preferential treatment towards patients. Demanding treatment, coupled with the progressive nature of CF, promote high levels of parental involvement for younger children as well as older teenagers, often due to attempted or actual non‐adherence. Siblings may receive less attention while patients' needs take priority. Future development of a measure of adherence suitable for children and adolescents should take into account different motivations for non‐adherence, particularly regarding the level of personal control over adherence to treatment. In addition, the potential impact of having a brother or sister with CF should not be underestimated and the needs of siblings should not go unnoticed.
The long‐term costs of preterm birth and low birth weight: results of a systematic review
Authors: Petrou S , Sach T , Davidson L
Published: March 2003

The high rates of morbidity and mortality arising from preterm birth and low birth weight impose an immense burden on the health, education and social services, and on families. This paper presents the results of a systematic review of the published and unpublished evidence regarding the long‐term economic implications of preterm birth and low birth weight for various sectors of the economy and for individuals. The paper highlights the variable methodological quality of the bulk of long‐term economic studies of preterm birth and low birth weight and suggests ways in which these methodological limitations can be overcome. The paper reveals that preterm birth and low birth weight can result in substantial costs to the health sector following the infant's initial discharge from hospital. It can also impose a substantial burden on special education and social services, on families and carers of the infants and on society generally. In addition to the costs identified by the literature, preterm birth and low birth weight can have other long‐term consequences that require evaluation from an economic perspective.
Sanitary towel provision and disposal in primary schools
Authors: Jones R , Finlay F
Published: March 2003

This study was designed to look at arrangements for menstruating girls in primary schools. We report the results of a questionnaire sent to the head teachers of 344 randomly selected primary schools throughout the UK. Although sanitary towels were available in 90% of schools, most girls had to ask an adult for a towel. Almost 60% of schools had disposal facilities, but in only 43% were facilities situated within individual toilet cubicles. The deficiencies identified in provision for girls in primary schools should be addressed.
Child care in Slovenia: an example of a successful transition
Authors: Stropnik N
Published: March 2003

Slovenia is a country which has managed to retain most of its advantages and achievements in preschool child care attained in the socialist period, while, during the transition years, rather successfully reforming services according to principles of the market economy. The female activity rate has been high since the mid 1940s, and female employment has been the main factor influencing the demand for preschool child care services. Slovenian mothers work full‐time and after 1 year of paid maternity and parental leave they mostly stay in the labour market. Child care facilities, 70% of them constructed in the period 1971–1985, are sufficient for almost 60% of the preschool population, and just a very small percentage of demand remains unmet. Child care services are traditionally highly subsidised. On average, parents finance up to a quarter of the current costs, so that the average in‐kind transfer for a child in child care amounts to about 30% of the average net salary. Social assistance recipients are exempt from paying fees altogether, while the rest of the parents pay from 15% to 80% of the current costs. The highest fee is paid by families with a per capita income > 110% of the average salary in Slovenia. Research into the burden of parental fees for child care in Ljubljana in 1994 has shown that three‐quarters of families spent between 5 and 15% of their total net income on child care (for one or more children). For three‐quarters of families, the total of fees paid did not exceed 30% of their net income per family member. The lower middle income group was relatively most burdened by child care fees.
Environmental barriers in mainstream schools
Authors: Hemmingson H. , Borell L.
Published: March 2003

Research on students with disabilities in mainstream schools often focuses on the students’ personal abilities rather than on the establishment itself. To promote inclusive education, the environmental prerequisite for participation has to be explored also. The aim of this study was to identify the barriers to participation in Swedish mainstream schools, from the personal perspective of students with physical disabilities. The study also investigated how gender, diagnosis, level of mobility, academic years and availability of an assistant were related to student–environment fit. A total of 34 students with physical disabilities, aged between 10 and 19 years, participated in the study. The students were assessed by ‘The school‐setting interview’. Results show that two‐thirds of the students experienced barriers to participation in both the physical and the social environment. A majority of the barriers originated from the way in which school activities were organized and carried out in schools. Failure to provide adequate environmental adjustments resulted in restricted participation or exclusion from some of the activities in class. Older students experienced significantly more barriers than younger ones because the school organization was less favourable. The results suggest that the way in which activities are organized in school is the area in need of most improvements to promote participation of students with physical disabilities.
‘I’ve come for his throat’: roles and identities in doctor–parent–child communication
Authors: Tates K. , Meeuwesen L. , Elbers E. , Bensing J.
Published: March 2003

Previous studies on doctor‐parent‐child communication at the general practitioner’s surgery showed that the GP and the parent differ fundamentally in the way they enable or constrain child participation. The question how to explain these differences is at the core of the present study. The aim is to describe how the three participants display their orientation to their institutional roles and identities; how they collaboratively co‐construct the course of action; and how these discursive constructions structure the ongoing interaction. A qualitative analysis of 106 videos shows that although GP and parent initially show incongruent orientations toward child participation, in the further course of the encounter all three participants jointly establish a situation in which child participation appears to be rather an exception. It is concluded that parental speaking for the child is, in a way, institutionally co‐constructed; parents take their responsibility, which is hardly ever questioned by children, and GPs ratify this behaviour by refraining from meta‐communicative comments and by aligning with the parent in the course of the interaction. The results are discussed in terms of enabling child participation and implications for medical practice.
Predictors of parental adjustment to children’s epilepsy in rural India
Authors: Pal D. K. , Chaudhury G. , Das T. , Sengupta S.
Published: March 2003

Background Negative societal attitudes towards disability affect the adjustment of parents when their child is diagnosed with epilepsy. Recent studies have suggested that parental and child outcomes, including adjustment, can be influenced by non‐directed social support to mothers of children with disability. The objective of our study was to test the hypothesis that maternal satisfaction with social support, measured at the beginning of treatment, would predict parental adjustment to the child’s epilepsy after 1 year of treatment.

Methods We enrolled 46 mothers of children aged 6–18 years with epilepsy in the study. We measured social support using the modified Dunst family support scale, and parental adjustment using a locally validated instrument (S‐PAM). Correlation was tested using a multiple linear regression model, allowing for confounding variables.

Results Parental adjustment at outcome was positively independently correlated with satisfaction with social support at baseline, and negatively with severity of the child’s epilepsy. The regression model explained 34% of the total variance.

Conclusions Taken together with evidence from previous studies, this finding supports the idea that helping parents to find more satisfaction within their (new or existing) social networks will promote adjustment to their child’s disability.
Functional limitations of school‐aged children seen in primary care
Authors: Palermo T. Mizell , Childs G. , Burgess E. S. , Kaugars A. Seja , Comer D. , Kelleher K.
Published: March 2003

Objective

The purpose of the present study was to assess the prevalence of functional limitations in children seen in a large paediatric practice network and to identify sociodemographic, family and psychosocial factors related to functional limitations.

Study design

Cross‐sectional analysis.

Population

Children were recruited from two large, practice‐based primary care research networks during their paediatric office visits. For the present study, participants included 14 630 school‐aged children (ages 6–15 years) and their caregivers.

Outcomes measured

Parents completed written questionnaires including the Pediatric Symptom Checklist, the Family Apgar and the Functional Limitations Index.

Results

Findings indicated that 15% of children surveyed had some limitation in their daily functioning. More children had schoolwork and physical function limitations than limitations in personal and self‐care. Logistic regression equations predicted functional limitations and health status in children from a model of sociodemographic factors, psychosocial symptoms and family functioning.

Conclusions

A low but significant number of school‐age children seen in the primary care setting experience functional limitations. Children with any psychosocial symptoms were at increased risk for functional limitations, indicating the critical need to screen for functional impairment in children with suspected behavioural or emotional problems. A screening tool of functional limitations may be useful for assessing the presence or absence of such limitations in children's daily function and warrants further investigation.
Requirement of CD28‐CD86 costimulation for allergen‐specific T cell proliferation and cytokine expression
Authors: Van Neerven  , Van DE Pol  , Van Der Zee  , Stiekema  , DE Boer  , Kapsenberg
Published: March 2003

Background

Allergen‐specific T lymphocytes biased to the production of type 2 cytokines play an important role in the pathophysiology of atopic disease. It is not known whether optimal activation of these T cells requires costimulation via interaction of B7 (CD86/CD80) with CD28.

Methods

Peripheral blood mononuclear cells (PBMC), isolated from 10 house dust mite Dermatophagoides pteronyssinus (Der p)‐allergic asthma patients and 10 non‐allergic control individuals, were stimulated with house dust mite (Der p) and the control antigens Candida albicans (CA) and tetanus toxoid (TT). The role of costimulation in activation for proliferation and cytokine mRNA production of peripheral blood T cells was studied by blocking CD28, CTLA‐4, and their ligands CD80 (B7–1) and CD86 (B7–2).

Results

The proliferation and the production of type 1 and 2 cytokine mRNA by T cells in response to Der p as well as the control antigens TT and CA was inhibited by simultaneously masking CD80 and CD86 using CTLA4‐Ig, a soluble form of CTLA‐4. Notably, Der p‐specific proliferation of T cells from Der p‐allergic asthma patients and non‐allergic controls were inhibited equally well. Additional experiments with MoAbs revealed that activation of these T cells was optimally inhibited by blocking the interaction of CD28 with CD86.

Conclusion

In vitro responses of allergen‐ and antigen‐specific T cells of allergic patients and non‐allergic control persons are equally dependent on costimulation via the CD28‐CD86 pathway, suggesting that inhibition of this pathway may prevent complete activation of allergen‐specific T cells in allergic individuals in vivo.
Association of pyrazolone drug hypersensitivity with HLA‐DQ and DR antigens
Authors: Kowalski  , Woszczek  , Bienkiewicz  , Mis
Published: March 2003

Background

In sensitive patients pyrazolone drugs can precipitate adverse reactions ranging from urticaria and angioedema to anaphylactic shock, presumably by immunological, IgE‐mediated mechanism. However, up to now no genetic factors influencing the development of allergic reaction have been reported in this type of hypersensitivity.

Objective

The aim of our study was the investigation whether the susceptibility to development of pyrazolone drugs hypersensitivity (PDH) reactions was associated with HLA class II antigens.

Methods

To test this hypothesis we studied the distribution of HLA‐DR and DQ antigens in 26 pyrazolone sensitive patients and control groups including unselected general population and clearly defined atopic and non‐atopic groups.

Results

Significantly higher frequencies of DQ 7 and DR11 antigens were found in PDH group as compared with control unselected population (RR= 16.48, P < 0.0001; Pcor < 0.002 and RR = 4.57, P = 0.0002; Pcor = 0.003 for DQ and DR antigen respectively). Similarly, statistically significant increased frequencies of DQ 7 and DR11 in patients with PDH were observed compared with atopic control group (RR = 18.43, P < 0.0001; Pcor < 0.002 and RR = 6.33, P = 0.0007; Pcor = 0.01, for DQ and DR antigen respectively). However, in comparison to non‐atopic control group only the frequency of DQ 7 antigen was significantly increased (RR = 15.42, P = 0.0001; Pcor = 0.0015). DQ 7 antigen was present in 46.1% of PDH patients compared with 4.9%, 4.4% and 5.3% in the general population, atopic and non‐atopic groups respectively, suggesting pyrazolone hypersensitivity as a trait positively correlated with this HLA antigen.

Conclusion

Our data suggest a genetic predisposition to pyrazolone hypersensitivity reactions, linked to HLA‐DQ locus.
Food allergy to peanuts in France–evaluation of 142 observations
Authors: Moneret‐Vautrin  , Rance  , Kanny  , Olsewski  , Gueant  , Dutau  , Guerin
Published: March 2003

Background

The increase in frequency of peanut allergy and fatal cases have been reported.

Objectives

The objective of this study is to document the severity of food allergy to peanuts by evaluating the reactive dose of peanuts and to search for the role of peanut oil.

Methods

This study is carried out on the basis of 142 observations collected according to the same diagnostic methodology in two allergy centres in France. Skin‐prick‐tests were performed with peanut powder, peanut oil and peanut oil proteinic extract. Labial provocation tests were performed on 121 patients. The reactive dose of peanuts and the role of peanut oil were determined by standardized oral provocation tests in 50 and 62 patients respectively. The data are computerized and the data bank includes 509 food allergic patients.

Results

Allergy to peanuts represents 28% of food allergies and occurs under 1 year of age in 46% of cases, under 15 years of age in 93%. The clinical features were atopic dermatitis (40%), angioedema (37%), asthma (14%), anaphylactic shock (6%) and digestive symptoms (1.4%). The specific IgE were class 3 or higher in 80% of cases. The total reactive dose was less than 100 mg in 25% of cases, from 100 mg to 1 g in 62.5%. All patients reacted to a dose of less than 7.1 g. The threshold of peanut reactivity was lower than the threshold of egg reactivity. An allergy to peanut oil was demonstrated in 14 patients.

Conclusion:

The severity of peanut allergy and the early onset of the occurrence of this allergy is documented. The role of residual allergenic proteins in peanut oil is established by positive skin‐prick tests to proteic extracts from peanut oil and by double‐blind placebo‐ controlled challenges to peanut oil. The increased consumption of allergens in the form of peanut oil and fats can contribute to the occurrence or persistence of symptoms and may be suspected to increase the risk of sensitisation.
The International Study of Asthma and Allergies in Childhood (ISAAC)
Authors: Asher  , Weiland
Published: March 2003

Despite considerable research, the aetiology of asthma and allergic disease remains poorly understood. The International Study of Asthma and Allergies In Childhood (ISAAC), was founded to maximize the value of epidemiological research into asthma and allergic disease by establishing a standardized methodology and facilitating international collaboration. It has achieved its specific aims which are to describe the prevalence and severity of asthma, rhinitis and eczema in children living in different centres and to make comparisons within and between countries; to obtain baseline measures for assessment of future trends in the prevalence and severity of these diseases; and to provide a framework for further aetiological research into genetic, lifestyle, environmental and medical care factors affecting these diseases.

 The ISAAC design comprises three phases. Phase One used simple core written questionnaires for two age groups, and was completed in 156 collaborating centres in 56 countries and a total of 721 601 children participated. In the 13–14 years age group 155 centres from 56 countries participated, of which 99 centres completed a video questionnaire. For the 6–7 years age group there were 91 collaborating centres in 38 countries. ISAAC Phase One has demonstrated a large variation in the prevalence of asthma symptoms in children throughout the world including hitherto unstudied populations. It is likely that environmental factors were responsible for major differences between countries. The results provide a framework for studies between populations in contrasting environ‐ments which are likely to yield new clues about the aetiology of asthma. ISAAC Phase Two will investigate possible aetiological factors, particularly those suggested by the findings of Phase One. ISAAC Phase Three will be a repetition of Phase One in the year 2000 to assess trends in prevalence.
A double‐blind placebo‐controlled study of the effect of inhaled beclomethasone dipropionate for 2 years in patients with nonasthmatic chronic obstructive pulmonary disease
Authors: Weir D. C. , Bale G. A. , Bright P. , Sherwood Burge P.
Published: March 2003

Treatment of chronic obstructive pulmonary disease (COPD) with inhaled and oral corticosteroids is common, although their exact role is unclear. Previous studies suggest these drugs may reduce decline in lung function in this group of patients. We report a study investigating the effect of inhaled beclomethasone diproprionate (BDP) on lung function and symptoms in a group of patients with COPD. Treatment was given for 2 years, and the decline in FEV1 in individual patients calculated over this period. Ninety‐eight patients were randomized for the study, 59 completing 2 years of treatment. Patients withdrawn had more severe airflow obstruction. Decline in FEV1, measured both prior to and after bronchodilator, was less in patients receiving inhaled BDP, although the differences failed to reach statistical significance except in a subgroup of patients with more severe airflow obstruction. Exacerbation rates were also reduced by inhaled BDP, but again the differences failed to reach conventional levels of statistical significance. The results of this study are consistent with previous published work, but further insight into the long‐term role of corticosteroids in COPD await the publication of large studies which have recently been completed. Although the changes seen in this study and others are numerically small, the rate of decline in FEV1 returned to normal levels expected from age‐related decline, and hence such treatment combined with other strategies may well have a significant role in the long‐term treatment of this condition.
The effect of montelukast (MK‐0476), a cysteinyl leukotriene receptor antagonist, on allergen‐induced airway responses and sputum cell counts in asthma
Authors: DIAMANT  , GROOTENDORST  , VESELIC‐CHARVAT  , TIMMERS  , DE SMET  , LEFF  , SEIDENBERG  , ZWINDERMAN  , PESZEK  , STERK
Published: March 2003

Background

Cysteinyl leukotrienes are capable of inducing chemotaxis of eosinophils in vitro and within the airways of animals and humans in vivo.

Objective

We hypothesized that montelukast (MK‐0476), a potent cysLT1 receptor antagonist, would protect against allergen‐induced early (EAR) and late (LAR) asthmatic responses by virtue of anti‐inflammatory properties. Hence, we studied the effect of pretreatment with oral montelukast on allergen‐induced airway responses. As an exploratory endpoint, changes in inflammatory cell differentials and eosinophil cationic protein (ECP) were evaluated in hypertonic saline‐induced sputum.

Methods

Twelve asthmatic men (20–34 years, FEV1 79–109% predicted, histamine PC20FEV1 < 4 mg/mL) with dual responses to inhaled house dust mite extract participated in a two‐period, double‐blind, placebo‐controlled, crossover study. Three oral doses of montelukast (10 mg) or matching placebo were administered 36 and 12 h before, and 12 h post‐allergen. The airway response to allergen was measured by FEV1, and the EAR and LAR were expressed as the corresponding areas under the time‐response curves (AUC0–3 h and AUC3–8 h, respectively). During each study period, sputum was induced with 4.5% NaCl 24 h before and 24 h after a standardized allergen challenge. Processed whole sputum cytospins were stained with Giemsa, and cell counts expressed as percentage nonsquamous cells. ECP was measured by FEIA in sputum supernatants.

Results

All subjects completed the study. The changes in baseline FEV1 were not significantly different between the two pretreatments (P = 0.183). Montelukast significantly inhibited the EAR and LAR, reducing the AUC0–3 h by 75.4% (P < 0.001) and the AUC3–8 h by 56.9% (P = 0.003) as compared with placebo. Sputa of nine subjects could be included in the analysis (< 80% squamous cells). Allergen challenge significantly increased sputum eosinophils after placebo (mean change ±sd: 4.8 ± 5.8%, P = 0.038), with a similar trend after montelukast (mean change ±sd: 4.1 ± 5.4%; P = 0.056). The allergen‐induced changes in sputum eosinophils and ECP, however, were not significantly different between the two pretreatments (P = 0.652 and P = 0.506, respectively).

Conclusion

We conclude that oral montelukast protects against allergen‐induced early and late airway responses in asthma. However, using the present dosing and sample size, this protection was not accompanied with changes in sputum eosinophil percentage or activity, which may require more prolonged pretreatment with cysLT1 receptor antagonists.
Soluble cytokine receptor CD30 in atopic disorders: a case‐control study
Authors: LATZA  , DAVIS  , WILHELM  , McKNIGHT  , SEYFARTH  , STEIN
Published: March 2003

Background

The cytokine receptor CD30 is an activation marker of T cells which preferentially associates with the production of the TH2 cytokine IL‐4. Therefore, it may potentially be a candidate marker for atopic disorders and a target molecule for new therapeutic approaches.

Objective

To test the hypothesis that elevated levels of soluble CD30 (sCD30) are significantly associated with atopic disorders after adjustment for other predictors of atopy.

Methods

The presence of elevated sCD30 (≥ 20 U/mL) in atopic disorders was evaluated in a nested case‐control study. Cases (n = 60) were blood donors with specific IgE antibodies, total serum levels of IgE ≥ 100 kU/L and presence or history of allergic symptoms. Controls (n = 59) were blood donors without presence or history of allergic symptoms and serum levels of IgE < 50 kU/L. sCD30 was determined from serum samples by an enzyme‐linked immunosorbent assay. Odds ratios (OR) and confidence intervals (CI) were calculated from logistic regression coefficients.

Results

Mean sCD30 levels for cases were 75 U/mL ( sd 110 U/mL) as compared with 35 U/mL (
sd 59 U/mL) for controls. Serum levels of sCD30 were elevated in 65% of cases and 32% of controls (OR 3.9, 95% CI 1.8–8.4). The odds ratio for elevated sCD30 as a predictor of atopic disorders slightly decreased to 3.7 after controlling for smoking, age and gender. Blood eosinophilia which was a strong predictor of atopy (OR 11.7) was a weak confounder of the association between sCD30 levels and atopic disorders. Family history of allergy, another strong predictor of atopy (OR 8.6), did not confound the association.

Conclusions

The results are consistent with the hypothesis that CD30 is involved in the pathogenesis of atopic disorders independent of eosinophilia and family history of allergy.