bluuebunny/crossref_metadata_2025 huggingface dataset:
Long‐term foster care or adoption? The evidence examined
Authors: Triseliotis John
Published: March 2003

Based on an examination of the research literature, this paper contrasts six variables connected with the outcome of adoption and long‐term fostering. It provides some answers to the question often being asked by policy makers and family placement workers, as well as judges, about the relative merits and limitations of these two forms of substitute parenting for children who cannot return to live with their birth families. Because of the type of child currently adopted or fostered, breakdown rates by themselves are increasingly an unreliable outcome measure. The main defining difference found between these two forms of substitute parenting appears to be the higher levels of emotional security, sense of belonging and general well‐being expressed by those growing up as adopted compared with those fostered long term. However, for reasons outlined in the paper, long‐term fostering still has a definite place for a range of children who require long‐term plans.
Adoption from care in Northern Ireland: problems in the process
Authors: Kelly Greg , McSherry Dominic
Published: March 2003

ABSTRACT This is a study of the processes for freeing children for adoption in Northern Ireland. The focus was the time taken from admission to care to adoption order. The findings confirmed that the process is dogged by delay at each stage. In total the average time from the child becoming looked after to the granting of an adoption order was 4.5 years. Most of the time taken was in the stages for which social services had lead responsibility, principally the decision to pursue adoption as the plan for a child. The children were very young when admitted to care – average age 1 year 7 months. Most were admitted to care because they were being neglected. Their parents were well known to social services and had multiple problems. Most parents unsuccessfully contested the social services’ application and this contributed much to the delay. Their former foster parents adopted almost half of the children and these children tended to be placed more quickly with their adopters than those placed with adopters who were not their foster parents prior to the adoption process.
Regulating inclusivity: reforming adoption law for the 21st century
Authors: Ball Caroline
Published: March 2003

ABSTRACT The process of the reform of current adoption law in England and Wales to better meet the needs of adoption practice has been a lengthy one. The extent to which the regulatory framework set out in the Adoption Act 1976 reflects an exclusive model of adoption no longer suited to current practice is well recognized. In this paper the reforms (about to be) enacted in the Adoption and Children Act 2002 are critically considered in the light of the identified requirements of a regulatory system supportive of an inclusive model better suited to the changed nature of adoption. Key themes running through the requirements are explored in the context of the reforms, and the extent to which the paramountcy of the welfare of the child will be underpinned by respect and support for the needs and rights of all parties to the so‐called adoption triangle. Whilst the new legislation is specific to England and Wales, the issues discussed are relevant not only in other common law jurisdictions but throughout the developed world.
Short stature at school entry — an index of social deprivation? (The Wessex Growth Study)
Authors: Voss  , Mulligan  , Betts
Published: March 2003

This study was carried out to examine the biological and environmental variables associated with non‐organic short stature. We observed an unselected population of very short normal children (SN) and their age‐ and sex‐matched controls (C) within the community. All 14346 children in two health districts entering school during 2 consecutive years were screened for short stature, and those whose height lay below the 3rd centile, according to Tanner and Whitehouse standards (n= 180) were identified. Excluding 32 with pathology, five from ethnic minorities and three who refused to take part, the remaining SN children (mean height SDS — 2.26) were matched with 140 age‐ and sex‐matched controls (C) of average height (mean height SDS 0.14). Birth weight, target height and predicted adult height (based on parental height and bone age respectively), medical and social background (obtained from parental interviews), and school performance (assessed by class teachers) were the main outcome measures. Mean birth weight of the SN children was significantly lower than C (SN = 2845 g, C = 3337 g, P < 0.001). Mean mid‐parental target height was also very different (SN = 162.0 cm, C = 170.9 cm, P < 0.001). Thirty‐five per cent of SN children (C = 6%) had height SD scores below parental target range, though only 10% had predicted heights below target range (mean delay in bone age 0.68 years). There was a significant difference between SN children and C in the number of children in the household (SN = 2.8, C = 2.4 (P= 0.007) and in socio‐economic status (P < 0.002). Many more SN children were in social classes IV and V (SN = 31%, C = 13%, P < 0.002), and had an unemployed father (SN = 22%, C = 10%, P < 0.010), highlighting the importance of environmental influences on growth. One in four SN children was judged to have serious psychosocial problems. However, the lower the socio‐economic class, the less likely the SN children were to be inappropriately short for parents. Significantly more SN children were reported to have asthma (SN = 18%, C = 7%, P < 0.007) and eczema (SN = 19%, C = 5%, P < 0.001), though only the latter was significantly associated with stature below target height for both SN and C groups. Biological variables are often insufficient to explain short stature. No child, whatever the parental height, should be dismissed as normal without careful evaluation, as poor growth in the early years may be an important pointer to an adverse but potentially remediable environment.
Children's and adolescents' perception of their asthma bronchiale
Authors: Noeker  , Petermann
Published: March 2003

The present study examines the perception of asthma bronchiale in a large sample of 382 children and adolescents (mean age = 12.5 years) across three different treatment settings (outpatient, short‐term rehabilitation, residential treatment) by using a revised child version of the ‘Asthma Problem Behavior Checklist.’ A PCA reveals two factors (eigenvalues: 26.3; 4.2; 0.9 ..) with a complementary structure: ‘appraisal of asthma‐related distress’ (explained variance: 48.5%) and ‘appraisal of resources in coping with asthma‐related distress’ (explained variance: 20.9%). Implications for clinical psychological assessment of young patients with asthma and the congruence with the LAZARUS transactional conceptualization of stress and coping are discussed.
Educating young children about asthma: comparing the effectiveness of a developmentally appropriate asthma education video tape and picture book
Authors: Holzheimer  , Mohay  , Masters
Published: March 2003

Asthma self‐management programmes have been shown to increase children's knowledge about asthma and improve their management practices and health status. However, existing programmes have rarely addressed the unique learning needs of very young children. This study aimed to develop and assess the effectiveness of a video tape and picture book designed to teach children about the prevention and management of acute episodes of asthma. The information content of the educational resources was determined by analysis of relevant medical information and asthma management skills. Social Learning Theory and consideration of the developmental stage of the target population informed the format and style of presentation of the resources. Eighty children aged between 2 and 5 years who had been diagnosed with asthma by their medical practitioner and who required daily asthma medication participated in a controlled experimental study. The study evaluated the impact of the asthma education resources on children's knowledge about asthma, compliance with medication regimens and health status. Children were randomly allocated to one of three experimental groups. Children in these groups were exposed to either the video tape alone, the book alone or both the video tape and book, or to a control group who viewed materials unrelated to asthma. The results for the three experimental groups were compared with the control group who did not receive exposure to any of the asthma education resources. The results showed that children in each experimental group had significantly greater gains in asthma‐related knowledge than children in the control group and children exposed to both resources showed the greatest increases in knowledge. Children in each of the three experimental groups also had better compliance and health than children in the control group. These findings indicate that carefully designed asthma education resources are useful for providing even the youngest children with information about asthma and its management.
How easy is it for young people to obtain cigarettes, and do test sales by trading standards have any effect? A survey of two schools in Gateshead
Authors: Bagott  , Jordan  , Wright  , Jarvis
Published: March 2003

Smoking prevalence among young people continues to rise and cigarettes are easily available from many shops. Test sales are used by trading standards departments to try to reduce under‐age sales, but it is not known whether this has any real impact on cigarette purchase and consumption. This study aims to evaluate the impact of test sales on purchase and consumption of cigarettes by young people. A survey of two schools in Gateshead, one in the intervention area and one acting as a control was carried out. A series of test sales were targeted to shops within 1.5 km of the intervention school. A questionnaire was administered in both schools among year 10 pupils, age 14–15 years, prior to the intervention and again 1 year later. The outcomes measured were number of successful test sales, reported availability of cigarettes and change in smoking prevalence following the intervention. Some 224 pupils from both schools were surveyed in 1995 and 163 pupils from the new cohort of year 10 pupils in 1996. Prior to the intervention, the levels of regular smoking in the intervention school were 39% for girls and 26% for boys. In the control school these levels were 24% and 14%, respectively. The intervention by trading standards resulted in no purchases and hence no prosecutions, but children reported being able to buy cigarettes with ease from the nearby shops; only three (2.5%) reported sales refused in 1995 and five (5.8%) in 1996. Not surprisingly there was no significant change in smoking prevalence in either school in 1996. This study suggests that test sales may not be effective in modifying cigarette availability to young people and that they are not a reliable measure of access to cigarettes by children.
Diet during pregnancy in relation to birthweight in healthy singletons
Authors: Petridou  , Stoikidou  , Diamantopoulou  , Mera  , Dessypris  , Trichopoulos
Published: March 2003

We have investigated the relationship between consumption of food groups and intake of energy‐generating macronutrients on the one hand, and birthweight on the other among apparently healthy singleton, term babies. Three hundred and sixty‐eight women who delivered in six maternity clinics in two Greek cities during specified days over an 8‐month period completed a 190‐item, interviewer‐administered, validated, semiquantitative food frequency questionnaire. Study participants also provided information on sociodemographic, reproductive and lifestyle variables. Data were analysed using multiple regression modelling. Nutritional variables were energy‐adjusted, and non‐nutritional correlates of birthweight were accounted for. The analysis revealed most of the established non‐nutritional associations of birthweight — an indication of study validity. Among food groups, meat and meat products and fish and sea food were suggestively associated with increased birthweight (two tailed P‐values 0.08 and 0.16, respectively). Among energy‐generating nutrients, monounsaturated fat was positively associated with birthweight and significantly so in several of the models. We consider our findings are considered as compatible with hypotheses linking fish and meat intake to fetal growth and as indicative of a positive association between intake of monounsaturated fat and birthweight.
Models of service support for parents of disabled children. What do we know? What do we need to know?
Authors: Sloper P.
Published: March 2003

Research carried out over a number of years provides a consistent picture of the experiences and needs of parents of disabled children. Recent studies, based on models of stress and coping, have identified factors which relate to high or low levels of parental distress. Whilst this research can provide useful information for service development, there appears to have been little change over the years in parents' reports of unmet need. It is clear that parental need covers a wide range of aspects of family life and holistic models of service support are required. Although evaluation studies which identify models of services that can change this situation are few, there are positive examples of models of support. The paper reviews the findings of such evaluation and identifies a number of important characteristics of effective service models.
Breast‐feeding and weight change in newborns in Jamaica
Authors: Jolly P E , Humphrey M , Irons B Y , Campbell‐Forrester S , Weiss H L
Published: March 2003

This study was conducted to examine weight change of exclusively breast‐fed infants during the first week and through the first 24 days of life, and to evaluate the effect of breast‐feeding factors and maternal characteristics on early weight change in the infants. The weights of 21 infants were recorded on day 1 (day of birth), and on days 3, 7, 10, 17, and 24, and the data analysed to evaluate weight change over the period. Multiple regression analysis was used to assess whether birth weight as well as maternal and breast‐feeding factors were significant predictors of weight on day 24. Nineteen of the 21 infants gained weight between days 1 and 3, and 20 infants gained weight between days 3 and 7. All infants gained weight over the 24‐day period and their weights at day 7 and day 24 were significantly different (P < 0.05 and P < 0.01, respectively) from their birth weights. Multiple linear regression analysis showed that significant (P < 0.01) predictors of weight gain by day 24 included birth weight, mother’s educational level, whether the baby cried before feeding, and length of feeding time periods. This is the first study of weight change in the early days and weeks of life of exclusively breast‐fed newborn infants in Jamaica. The infants showed significant weight gain during the study period and weight gain was affected by certain maternal and breast‐feeding factors.
Validation of the Warwick Child Health and Morbidity Profile in routine child health surveillance
Authors: Spencer N J , Coe C
Published: March 2003

Objective To further validate a simple instrument for the measurement of parent‐reported health and morbidity in infancy and childhood when used in routine child health surveillance as part of a whole year birth cohort study.

Setting The socially and ethnically diverse city of Coventry.

Methods Health visitors administered the Warwick Child Health and Morbidity profile (WCHMP), incorporated into the Parent Held Record (PHR), to the parents of infants born in 1996 and enrolled in the Coventry Cohort study as part of routine child health surveillance at 8 weeks and 8 months. Criterion validity was estimated for Hospital admission status and immunization status against health records and validity against medically plausible constructs was tested by comparing responses between domains and between the two data collection points for the whole cohort.

Results Criterion validity for parental reporting of immunization status (Kappa 0.824 [95% CIs, 0.708, 0.940]) and hospital admission (Weighted Kappa 0.987 [95% CIs, 0.977, 0.997]) were high. There was a high level of concordance between parental responses to related domains and the medically plausible constructs. The proportion of parents reporting chronic illness, acute significant illness, chronic illness and accidents increased as expected between 8 weeks and 8 months. As expected, adverse outcomes at 8 weeks were associated with an increased risk of the same outcomes at 8 months.

Conclusions The WCHMP is a simple measure of parent‐reported health and illness which was shown to be reliable and valid with low inter‐observer variation on initial field‐testing. Further validation of the WCHMP, incorporated into the PHR, in a routine child health surveillance programme demonstrates its suitability for use in infancy to collect cross‐sectional and longitudinal health and morbidity data for research and service planning purposes.
Gender role attitudes and other determinants of breast feeding intentions in Brazilian women
Authors: Paine P , Dorea J G
Published: March 2003

This study of 230 Brazilian mothers examined the associations of several sociodemographic variables, maternal attitudes and perceptions with intended breast feeding duration. The usual relationships of sociodemographic variables such as mother’s age, education, smoking, parity and infant birth weight with intended breast feeding duration were not found. However, mother’s intentions were related to gender role attitudes with both the least and the most traditional women intending to breast feed longer than women with moderately traditional gender role attitudes. Mother’s attitude toward breast feeding, help with household tasks, and the attitudes of friends and relatives toward breast feeding were also very significantly related to intended breast feeding duration. Women who did not work outside the home intended to breast feed significantly longer than those who were employed.
Development of a global motor rating scale for young children (0–4 years) including eye–hand grip coordination
Authors: Vaivre‐Douret L , Burnod Y
Published: March 2003

A comparative study of the eight motor rating scales available in Western countries demonstrated methodological differences in the choice of items and standardization. We have developed a global motor rating scale that includes items which measure postural‐motor, locomotor (PML) and eye–hand grip coordination (EHGC), and which allows the assessment of an average of motor function level (MFL), PML and EHGC development. Scores obtained were used to define the acquisition of motor age based on the skills completed. The items were selected on the basis of the average age at which the function developed in two populations of healthy full‐term French infants, followed from birth to 4 months (n = 60) and from 4 months to 4 years (n = 63). Recent French developmental standards (mean age and standard deviation) of acquisition allow the identification of neuro‐psychomotor deviations from normal motor behaviour. This includes both static and dynamic motor coordination sequences. Inter‐examiner correlations (n = 3) for 15 randomly selected children indicated a coefficient of 0.90. The scale revealed a sequence in the organization of learned postural‐motor, locomotor and eye–hand gripping skills which can contribute to the understanding of brain areas implicated in this maturation process.
Attitudes and practices of breastfeeding mothers regarding fasting in Ramadan
Authors: Ertem I Ozturk , Kaynak G , Kaynak C , Ulukol B , Gulnar S Baskan
Published: March 2003

Objective To investigate the attitudes and practices of breastfeeding mothers regarding fasting in Ramadan.

Design Cross‐sectional observational survey.

Setting Well‐child care clinic at Ankara University Medical School and a health station serving an impoverished population in Ankara, Turkey.

Participants Breastfeeding mothers of infants aged 12 months or younger.

Main outcome measures Fasting during Ramadan.

Results Of the 164 participating mothers, 61 (37%) were from the health station and 103 (63%) from the university clinic. Most mothers were older than 25 years of age (55%), had more than primary school education (64%), a single child (53%), were living in a nuclear family setting (70%), supplementing breastfeeding (73%) and fasting (52%). Among the 129 mothers of infants aged 6 months or younger, 22% perceived a decrease in their breast milk and 23% an increase in the amount of solid supplements the infant was receiving. Belief that breastfeeding mothers should fast (RR = 6.45, 95% CI: 2.44–17.06), that fasting does not decrease breast milk (RR = 6.24, 95% CI: 1.85–21.05), receiving well‐child care at the health station (RR = 3.14, 95% CI: 1.33–7.44), giving supplements (RR = 2.82, 95% CI: 1.09–7.27) and having multiple children (RR = 2.78, 95% CI: 1.23–6.28) were associated with fasting, in a logistic regression model.

Conclusions Fasting by breastfeeding mothers of infants is common during Ramadan, and rates are affected by beliefs of mothers on the effects of fasting on breastfeeding. We believe that child health care providers need to be knowledgeable about religious and cultural phenomena, study the effects of Ramadan fasting and form links with Islamic teachings to find religiously and culturally appropriate methods to combat the possible unfavourable effects for infants and children.
Psychotropic prescribing practices of paediatricians in the UK
Authors: McNicholas F
Published: March 2003

Objective This study examines the prescribing practices and attitudes to psychotropic medication by paediatricians in the UK.

Design Questionnaires were sent to 100 randomly chosen paediatricians in the UK to assess their prescribing practices of psychotropic medication in children.

Results Paediatricians see and treat many children with a wide variety of psychotropic medications on a regular basis. However, few of them feel competent, and most requested regular psychopharmacology seminars.

Conclusions In the US, primary care physicians and paediatricians are recognized as primarily responsible for the continuing increase in psychotropic prescriptions in children. This study shows that, in the UK, paediatricians also contribute to such prescribing and need to be taken into account when estimating the prevalence and appropriateness of such medication use in children.
Do community‐based support services benefit bereaved children? A review of empirical evidence
Authors: Curtis K , Newman T
Published: March 2003

Aims To consider the evidence of effect from English language, empirically based quantitative evaluations of community‐based interventions for bereaved children; community‐based interventions being understood as those taking place outside a clinical setting.

Methods MedLine, PsychInfo, Applied Social Sciences Index and Sociological Abstracts were searched for documents containing the words ‘child’, ‘bereavement’ and ‘program’, ‘group’, ‘intervention’, ‘support’ or ‘evaluation’. The criterion for inclusion was that studies use a control group or pre‐ and post‐test measurements using a standardized instrument.

Results Nine relevant studies were identified. However, empirical evidence of positive outcomes for children was limited and compromised by methodological weaknesses in the design of the studies. Small sample sizes, irregular attendance, high levels of attrition, short time scales between pre‐ and post‐testing and difficulty in developing appropriate instrumentation, including assessment of adherence to the agreed intervention programme, all created problems.

Conclusions The case for universal inclusion of this group of children in such support programmes remains unproven, and further exploration of the outcomes of a range of different community interventions is required, with a specific focus on long‐term and/or unwanted effects and evaluation of the basis for referral.
Statutory health assessments for looked‐after children: what do they achieve?
Authors: Hill C. M. , Watkins J.
Published: March 2003

Objective  To examine the outcomes of statutory health assessment of children looked after by an English City Council.

Design  Retrospective longitudinal documentary analysis.

Setting and participants  Health records of all children looked after by Southampton City Council who had attended at least two statutory health assessments within a designated paediatric service from 1996 to 1999.

Main variables studied   Demographic characteristics of the children; physical and mental health problems identified at assessment and extent to which health recommendations were implemented.

Results  Twenty‐seven boys and 22 girls aged 6 months−15 years were identified who had attended at least two assessments. One‐hundred and four physical and mental health needs were identified at care entry requiring further assessment or intervention. More health problems were identified for girls than boys. At care entry 15/49 of the children were not fully immunized. At review, on average 14 months later, recommendations had only been implemented in just over half of children.

Conclusions  In common with previous studies this work confirms that the statutory health assessment identifies health need and health neglect that may otherwise go unrecognized. Whereas children's needs and problems were diverse, many continued to suffer health neglect in the system of public care designed to help them. In order to be effective, statutory health assessments must be a health promoting rather than disease screening exercise delivered by professionals skilled to address diverse health needs. Crucially, the heath assessment can only succeed as a tool for health advocacy if complementary to and integrated with local authority care and review.
Children's experiences of school toilets present a risk to their physical and psychological health
Authors: Vernon S. , Lundblad B. , Hellstrom A. L.
Published: March 2003

Objective   To ascertain why children and parents frequently describe problems with school toilets.

Setting   Two contrasting cities in Northern England (Newcastle upon Tyne 394 pupils) and Southern Sweden (Goteborg/Mölndal 157 pupils)

Methods   Self‐administered questionnaires were given to children aged 9–11 years in England and Sweden. Researchers administered questionnaires to Head teachers and recorded their observations of facilities according to predetermined basic standards.

Results   Children from both countries said they found school toilets unpleasant, dirty, smelly, and frightening and that bullying occurred there. Many children avoided using the school toilets (62% of boys and 35% of girls (in the UK site) and 28% boys and girls in Swedish site avoided using the school toilets to defaecate). Results were similar in both centres.

Conclusion   European standards are needed for school toilets in order to prevent children developing problems such as constipation, urinary tract infections and incontinence.
Development and validation of a tool to measure the impact of childhood disabilities on the lives of children and their families
Authors: Jessen E.C. , Colver A.F. , Mackie P.C. , Jarvis S.N.
Published: March 2003

Objective   Information on registers of children with special needs will be more meaningful if a validated measure of the severity of impact of a child's disability on life and family is included.

Design   We describe the development and initial validation of a parent‐completed questionnaire (Generic Lifestyle Assessment Questionnaire LAQ‐G) aimed at measuring such impact.

Results   Data were collected on 95 case children, representing various disabilities, and 65 control children without disability, and analysed for case–control, test–re‐test and inter‐reporter reliability. Multidimensional scaling techniques were then used to derive six domains, representing impact of disability in a structure analogous to the participation domains of the revised International Classification ICF (WHO 2001).

Conclusions   Initial results suggest that the LAQ‐G is a reliable measure of the impact of disability for children with a range of common disabling conditions.
Ecology of development in children with brain impairment
Authors: Lebeer J. , Rijke R.
Published: March 2003

Background  Many children with brain impairments develop well in spite of negative risk factors or prognoses. Most follow‐up and review studies do not show uncontroversial effects of particular physiotherapy or activation programmes. Evidence is accumulating of environmental influence on brain plasticity, but it is not clear what exactly this means for human beings. This paper reports a qualitative study of the life histories of 20 children, with severe developmental disturbance of neurological origin, who showed marked functional improvements.

Methods  Qualitative analysis of a group of 20 children, heterogeneous in aetiology or severity of brain impairments (hydrocephalus, porencephalic brain cysts, cerebral palsy, Rubinstein–Taybi, Down's or other genetic syndromes), in methods of rehabilitation as well as in outcome.

Results  In these particular children, gross brain abnormalities apparent on initial imaging and early functional testing did not appear highly predictive of final outcome. There was no observed association between final functioning and any particular type of rehabilitation. The outcome rather seems to be the result of a complex process of interaction between the child and his/her human ecology; the way the child, as well as significant people in his/her environment, perceive problems and possible solutions; and the quality and quantity of activation and mediated learning experience.

Conclusion  Development in children with brain impairment does not seem to happen spontaneously. It is not a linear but an unpredictable process. Both outer (a stimulating environment with lots of activities) as well inner aspects (will and interactive processes) constitute a child's rehabilitative ecology. The findings are also suggestive for a brain plasticity influenced by the ecology of the child.
CD4+ cells proliferate after peanut‐extract‐specific and CD8+ cells proliferate after polyclonal stimulation of PBMC of children with atopic dermatitis
Authors: Laan  , Tibbe  , Oranje  , Bosmans  , Neijens  , Savelkoul
Published: March 2003

Background

Few studies describe in vitro food‐allergen induced proliferative responses and cytokine production of PBMC of children with atopic dermatitis. This is especially true for peanut‐allergen.

Objectives

To analyse the specificity of the T cell in proliferative responses, in children with atopic dermatitis with or without peanut allergy and healthy age‐matched children.

Methods

Proliferative responses were measured by [3H]‐thymidine incorporation and by expression of the intracellular Ki67‐antigen using flow cytometry after antigen‐specific stimulation of PBMC with peanut‐extract (day 7) or polyclonal stimulation with Phorbol‐12myristate‐13acetate and Ca‐ionophore (day 3). Cytokine mRNA (Interferon‐gamma (IFNγ), IL‐4) was detected by semiquantitative RT‐PCR. Cytokine production (IL‐4, IFNγ) was measured by ELISA.

Results

Peanut‐extract induced proliferative responses of PBMC from children with atopic dermatitis and peanut allergy (AD+PA+) were significantly higher as compared with the other groups studied. Ki67‐antigen double staining revealed that 80–100% of the proliferating cells were CD4+. These proliferative responses correlated significantly with the increase in IL‐4 mRNA expression after peanut‐extract specific stimulation. After polyclonal stimulation, however, CD8+ cells preferentially proliferated. The degree of proliferation after polyclonal stimulation correlated inversely with the ratio of IL‐4/IFNγ production.

Conclusions

The principal responding population of T cells in proliferative responses is different after peanut‐extract specific and polyclonal stimulation of PBMC from AD+PA+ patients. Furthermore, we found indirect evidence that the PBMC fraction of AD+PA+ children contains increased frequencies of peanut‐specific T helper‐2 cells.
The frequency and clinical significance of specific IgE to both wasp (Vespula) and honey‐bee (Apis) venoms in the same patient
Authors: Egner  , Ward  , Brown  , Ewan
Published: March 2003

Background

Changeover from Phadebas RAST to Pharmacia AutoCAP increased double‐positivity to both honey‐bee and common wasp (vespula) venom in our patients.

Objective

We examined the frequency of IgE double‐positivity, its clinical relevance and utility in investigating potentially allergic patients.

Methods

One hundred and eighty‐two patients with hymenoptera allergy were tested using RAST (n = 51) and AutoCAP (n = 131) assays over 4 years. Patients had a history of reactions to vespulae (22), honey‐bee (10) and unidentified hymenoptera (vespinae) (7).

Results

After changing from RAST to AutoCAP double‐positivity increased from 10 (5/ 51) to 30% (39/131) (P < 0.01). RAST and CAP assays gave similar median class results (vespula = 3, honey‐bee = 2). Thirty‐six CAP patients had systemic reactions of Mueller grade II and above. In vespula‐allergic double‐positive subjects, high CAP classes ( class 3) to honey‐bee were common (30%). In 25% the CAP classes were equal. In honey‐bee‐allergic subjects, all vespula venom CAP IgE was low titre (class 1 or 2) and 20% were equal for both venoms. In 43% of vespinae‐allergic patients the CAP class was equal to both (class 2 and 3). In contrast, intradermal skin test double‐positivity was uncommon. Double‐negative skin test results were common in the CAP double‐positive population (22% of honey‐bee‐allergic, 13% of vespula‐allergic and 43% of vespinae‐allergic patients). Vespula allergic patients have higher bee‐venom IgE than vice versa. Twenty‐seven per cent of CAP double‐positive patients (representing 8% of all venom allergic patients tested over this period) had equal class IgE to both venoms which was not helpful in diagnosis. Combination of skin testing and CAP is unhelpful in only 5/37 (14%) of patients with double‐positive serology.

Conclusion

If used in isolation CAP may be misleading, especially if only one venom is tested. Identification of the causative venom must utilize both clinical history and skin testing in these double‐positive patients, and challenge testing if indicated.
Serum eosinophil cationic protein, eosinophil protein X and eosinophil peroxidase in relation to pulmonary function in cystic fibrosis
Authors: Koller D. Y. , Nilsson M. , Enander I. , Venge P. , Eichler I.
Published: March 2003

Background

Recently, increased serum levels of eosinophil cationic protein (ECP) in cystic fibrosis (CF) have been reported which were closely related to the levels in sputum. In the present study we investigated other eosinophil proteins such as eosinophil peroxidase (EPO) and eosinophil protein X (EPX) in sera of patients with CF and their relation to pulmonary function.

Methods

Serum samples from 42 patients with CF and from 25 healthy control subjects were measured for ECP, EPO and EPX. Lung function tests were performed by using whole body plethysmographic technique, and the results were correlated with the levels of eosinophil granule proteins.

Results

Serum ECP (median: 20.9 μg/L), EPO (median: 30.3 μg/L) and EPX (median: 37.9 μg/L) levels were significantly increased in CF compared with healthy controls (3.5 μg/L, P < 0.0001, 5.6 μg/L, P < 0.0001 and 14.6 μg/L, P < 0.0001, respectively) whereas eosinophil counts were not different. There was a strong correlation between the levels of eosinophil proteins and variables of pulmonary function, like between ECP and forced vital capacity (r = − 0.764, P < 0.0001). In addition, ECP concentrations were significantly related to the levels of EPO and EPX, albeit, in some patients with low ECP levels, increased EPO and EPX concentrations were observed.

Conclusion

These results indicate that in patients with CF, ECP, EPO and EPX concentrations also were increased with a significant relationship between these three eosinophil proteins. Since eosinophil activity in patients with CF is strongly correlated with pulmonary function, the assessment of eosinophil granule proteins might be useful for clinical monitoring in CF.
Heat shock protein 70 upregulation is related to HLA‐DR expression in bronchial asthma. Effects of inhaled glucocorticoids
Authors: Bertorelli  , Bocchino  , Zhuo  , Chetta  , Del Donno  , Foresi  , Testi  , Olivieri
Published: March 2003

Background and objective

Antigen processing determines the production of peptides from antigens — including allergens — and their binding to class II major histocompatibility complex molecules, that stimulate T‐cell responses. Heat shock protein (hsp) 70 are recognized to have a role in chaperoning antigenic peptides and in facilitating class II peptide assembly. We studied the HLA‐DR and hsp70 expression on BAL cells and bronchial biopsies from asthmatics, as well as the effect of low dose fluticasone propionate treatment.

Methods

Twenty‐three asthmatics and eight normal subjects were selected. In each subject BAL and bronchial biopsies were performed. Eighteen out of 23 asthmatics, underwent the second bronchoscopy after 6 weeks of low dose inhaled fluticasone propionate treatment (250 μg bd) in a placebo‐controlled double‐blind study. BAL fluid and biopsies were processed to evaluate HLA‐DR and hsp70 expression by immunochemistry methods.

Results

Hsp70 and HLA‐DR upregulation was present on professional and non‐professional antigen presenting cells (APCs). In asthmatics, the hsp70 and HLA‐DR expression was higher in BAL (hsp70 P < 0.001, HLA‐DR P < 0.001) and bronchial epithelium (hsp70 P < 0.001, HLA‐DR P < 0.001) when compared with controls. We also observed a significant correlation between hsp70 and HLA‐DR expression in BAL (P < 0.005) and epithelium (P < 0.001). Fluticasone propionate treatment down‐regulated the hsp70 and HLA‐DR expression in BAL (hsp70 P < 0.001, HLA‐DR P < 0.05) and bronchial epithelium (hsp70 P < 0.05, HLA‐DR P < 0.05). A serial section comparison study showed that CD1a+ cells and macrophages were positive for both hsp70 and HLA‐DR in the submucosa.

Conclusions

Our results support the hypothesis that hsp70 over‐expression implies a potential role for these proteins in antigen processing and/or presentation resulting in an increased activity of APCs, which is essential for the initiation and modulation of the asthmatic immune response in chronic asthma. Fluticasone propionate induces down‐regulation of HLA‐DR and hsp70 molecules thus regulating inflammation by affecting key mechanisms of the allergic response.
Inhalant allergy to egg yolk and egg white proteins
Authors: Quirce  , DÍez‐GÓmez  , Eiras  , Cuevas  , Baz  , Losada
Published: March 2003

Background

Several egg white and egg yolk and avian proteins have been described as a cause of inhalant allergy. Sometimes inhalational type I hypersensitivity to these proteins is associated with food allergy to egg.

Objective

We studied two patients who experienced respiratory and food allergic symptoms upon exposure to egg or avian antigens through the inhalative or digestive routes. Clinical and immunological studies were carried out in order to identify individual allergens from these sources that could be responsible for crossreactivity reactions.

Results

Patient 1 showed IgE sensitization to egg yolk livetins, feathers, and chicken serum. Specific bronchial challenge with chicken albumin and livetin extracts elicited a positive early asthmatic response and an increase in serum eosinophil cationic protein. Immunoblot and CAP‐inhibition studies in this patient supported that chicken albumin (α‐livetin) was the crossreactive antigen present in egg yolk and chicken serum and feathers. Patient 2 showed sensitization to egg white, ovomucoid and lysozyme. However, SDS‐PAGE and immunoblot studies demonstrated contaminating lysozyme in the ovomucoid extract and identified lysozyme as the main allergen causing egg sensitization in this patient. Conjunctival challenge test confirmed allergy to lysozyme.

Conclusion

Egg yolk and egg white proteins may act not only as ingested allergens but also as aeroallergens. Immunological studies using highly purified preparations of egg proteins are useful for the accurate diagnosis of allergic reactions to egg proteins and to identify individual allergens that may be responsible for crossreactivity reactions.
Association of polymorphisms within the tumour necrosis factor (TNF) genes and childhood asthma
Authors: Albuquerque  , Hayden  , Palmer  , Laing  , Rye  , Gibson  , Burton  , Goldblatt  , LesouËF
Published: March 2003

Background

Tumour necrosis factor alpha (TNFα) is a potent modulator of immune and inflammatory responses, and has been implicated in a variety of autoimmune diseases, including asthma. Increased levels of TNFα have been detected in both sputa and bronchoalveolar lavage fluid of asthmatic subjects during acute attacks. Interindividual variation in TNFα levels may be genetically determined and polymorphisms within the TNF genes and nearby HLA Class II region have been associated with differences in TNFα production. Objective To investigate the association of differences in asthma‐related phenotypes with two biallelic polymorphisms: a G to A substitution at position −308 of the TNFα gene promoter (TNF1 and TNF2 alleles) and an NcoI polymorphism in the first intron of the lymphotoxin alpha gene (LT‐α*1 and LT‐α*2 alleles).

Methods

The regions of interest were amplified from genomic DNA using specific primers and PCR. Dot blot analysis was used for genotyping individuals for the TNFα− 308 polymorphism, while restriction enzyme digestion was used for genotyping individuals for the LT‐α gene NcoI polymorphism. A case‐control analysis was then performed on 74 asthmatic and 50 non‐asthmatic unrelated children for each polymorphism.

Results

The TNFα−308 TNF1 allele was present at a significantly higher frequency in cases than controls (OR = 2.4, P = 0.003), and homozygosity for the TNF1 allele was associated with a fivefold increased risk of physician diagnosed asthma relative to the other genotypes (OR = 5.23, P = 0.004). The LT‐α*2 allele showed similar associations, including an approximately fivefold higher risk of physician diagnosed asthma for LT‐α*2 homozygotes (OR = 4.89, P = 0.019). Evidence of a significant linear trend in asthma risk across the three genotypes was found for both polymorphisms.

Conclusion

These results suggest an important role for the TNFα gene or a linked locus in an inherited asthma diathesis.
Atopic dermatitis in early infancy predicts allergic airway disease at 5 years
Authors: Bergmann  , Edenharter  , Bergmann  , Forster  , Bauer  , Wahn  , Zepp  , Wahn
Published: March 2003

Background

Screening tests for atopy risk in newborns have a low predictive value. If early atopic symptoms and signs could be used as predictors for the next expected atopic disorder then secondary prevention could be employed. The aim of this study was to evaluate the capacity of early atopic dermatitis to predict aeroallergen sensitization and the manifestation of respiratory atopic disorders at 5 years of age.

Methods

1314 children of a German prospective birth cohort study MAS‐90 were followed from birth up to 5 years of age. Atopic dermatitis, asthma and rhinoconjunctivitis were diagnosed from symptoms and signs at physical examinations and by interviews of the parents. Blood was drawn at 1, 2, 3, and 5 years of age. Aeroallergen sensitization was diagnosed by a specific IgE value of at least 0.35 kU/L (CAP class ≥ 1) against any of five respiratory allergens (mite, cat, dog, birch, grass).

Results

Atopic dermatitis in the first 3 months was a risk factor for aeroallergen sensitization at 5 years. The risk increased with a positive family history for atopic diseases. Seventy‐seven per cent of children with two atopic parents and early atopic dermatitis were sensitized against aeroallergens at 5 years, i.e. could have been predicted in early infancy without any laboratory tests. Although these risk factors were also significantly associated with the manifestation of allergic airway disease, the positive predictive value for this outcome at age 5 years was not yet as high, i.e. 50%.

Conclusion

Infants with very early signs of atopic dermatitis and a positive family history are candidates for early intervention measures against respiratory allergies.
Genetic and environmental factors affecting the allergenicity of birch (Betula pubescens ssp. czerepanovii [Orl.] Hämet‐Ahti) pollen
Authors: Ahlholm  , Helander  , Savolainen
Published: March 2003

Background

Environmental variation, such as an increase of mean temperature due to the greenhouse effect, as well as the genetic factors may affect the allergenicity of pollen and thus, the prevalence of allergies. The connection between these factors and the allergen content of pollen is poorly understood.

Objectives

To evaluate the role of environmental and genetic factors on the allergenicity of birch pollen.

Methods

Mountain birch (Betula pubescens ssp. czerepanovii (Orl.) Hämet‐Ahti) pollen was studied using SDS‐PAGE and IgE‐immunoblotting. Pollen samples were collected from the trees of 10 half‐sib families. The study trees from each family were reared in two tree line gardens where the daily mean temperatures were different during the growing season.

Results

The quantitative analysis of band intensities suggested that the responses of the major birch pollen allergen, Bet v 1, were stronger in the samples collected from the garden with higher daily mean temperature. Half‐sib families and individual trees differed in their Bet v 1 content.

Conclusions

Our results show that both genetic and environmental factors have an effect on the amount of Bet v 1. This suggests that breeding for trees low in allergen content may be possible.
Bee sting allergy in beekeepers
Authors: Eich‐Wanger  , MÜller
Published: March 2003

Background

Beekeepers are strongly exposed to honey bee stings and therefore at an increased risk to develop IgE‐mediated allergy to bee venom.

Objective

We wondered whether bee venom‐allergic beekeepers were different from normally exposed bee venom‐allergic patients with regard to clinical and immunological parameters as well as their response to venom immunotherapy.

Method

Among the 459 bee venom‐allergic patients seen over the 5 year period 1987–91, 62 (14%) were beekeepers and 44 (10%) family members of beekeepers. These two groups were compared with 101 normally exposed bee venom‐allergic patients matched with the allergic beekeepers for age and sex, regarding clinical parameters, skin sensitivity, specific IgE and IgG antibodies to bee venom as well as safety and efficacy of venom immunotherapy.

Results

As expected, allergic beekeepers had been stung most frequently before the first allergic reaction. The three groups showed a similar severity of allergic symptoms following bee stings and had an equal incidence of atopic diseases. Allergic beekeepers showed higher levels of bee venom‐specific serum IgG, lower skin sensitivity and lower levels of bee venom specific serum IgE than bee venom‐allergic control patients. A negative correlation between number of stings and skin sensitivity as well as specific IgE was found in allergic beekeepers and their family members, while the number of stings was positively correlated with specific IgG in these two groups. Venom immunotherapy was equally effective in the three groups, but better tolerated by allergic beekeepers than the two other groups. The majority of allergic beekeepers continued bee‐keeping successfully under the protection of venom immunotherapy.

Conclusion

The lower level of sensitivity in diagnostic tests and the better tolerance of immunotherapy in allergic beekeepers is most likely related to the high level of specific IgG in this group.