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BMJ No 7132 Volume 316 Papers - Abstracts Saturday 28 February 1998
Population based study of risk factors for underdiagnosis of
asthma in adolescence: Odense schoolchild study
Population based study of risk factors for underdiagnosis of asthma in adolescence: Odense schoolchild studyHans C Siersted, Jesper Boldsen, Henrik S Hansen, Gert Mostgaard, Niels Hyldebrandt See Editorial by O'Brien, p 564 AbstractObjective: To describe factors related to underdiagnosis of asthma in adolescence. Design: Subgroup analysis in a population based cohort study. Setting: Odense municipality, Denmark. Subjects: 495 schoolchildren aged 12 to 15 years were selected from a cohort of 1369 children investigated 3 years earlier. Selection was done by randomisation (n=292) and by a history indicating allergy or asthma-like symptoms in subject or family (n=203). Main outcome measures: Undiagnosed asthma defined as coexistence of asthma-like symptoms and one or more obstructive airway abnormalities (low ratio of forced expiratory volume in 1 second to forced vital capacity, hyperresponsiveness to methacholine or exercise, or peak flow hypervariability) in the absence of physician diagnosed asthma. Risk factors (odds ratios) for underdiagnosis. Results: Undiagnosed asthma comprised about one third of all asthma identified. Underdiagnosis was independently associated with low physical activity, high body mass, serious family problems, passive smoking, and the absence of rhinitis. Girls were overrepresented among undiagnosed patients with asthma (69%) and underrepresented among diagnosed patients (33%). Among the risk factors identified, low physical activity and problems in the family were independently associated with female sex. The major symptom among those undiagnosed was cough (58%), whereas wheezing (35%) or breathing trouble (50%) was reported less frequently than among those diagnosed. Less than one third of those undiagnosed had reported their symptoms to a doctor. Conclusions: Asthma, as defined by combined symptoms and test criteria, was seriously underdiagnosed among adolescents. Underdiagnosis was most prevalent among girls and was associated with a low tendency to report symptoms and with several independent risk factors that may help identification of previously undiagnosed asthmatic patients. Section of Respiratory
Diseases, Department of
Cardiology, Centre for
Health and Social Policy, Private Specialist Clinic, Correspondence to: Dr Siersted email: hc.siersted@winsloew.ou.dk
Numbers of deaths related to intrapartum asphyxia and timing of birth in all Wales perinatal survey, 1993-5Jane H Stewart, Joan Andrews, Patrick H T CartlidgeSee Editorial by Spencer, p 640 AbstractObjectives: To investigate the relation between the timing of birth and the occurrence of death related to an intrapartum event.Design: Analysis of 107,206 births to Welsh residents in 1993-5, including 608 cases of stillbirth and 407 of neonatal death identified in the all Wales perinatal survey, the cause of death classified with the clinicopathological system. Subjects: 79 normally formed babies stillborn or who died in the neonatal period, birth weight >1499 g, for whom cause of death was related to an intrapartum event.
Main outcome measures: Relative risk of death due to
an intrapartum event according to the hour, day, and month of birth.
Department of Child Health, Correspondence to: Dr Cartlidge email: cartlidge@cf.ac.uk
Effect of asthma and its treatment on growth: four year follow up of cohort of children from general practices in Tayside, ScotlandC McCowan, R G Neville, G E Thomas, I K Crombie, R A Clark, I W Ricketts, A Y Cairns, F C Warner, S A Greene, E WhiteAbstractObjective: To investigate whether asthma or its treatment impairs children's growth, after allowing for socioeconomic group.Design: 4 year follow up of a cohort of children aged 1-15. Setting: 12 general practices in the Tayside region of Scotland. Subjects: 3,347 children with asthma or features suggestive of asthma registered with the general practices. Main outcome measures: Height and weight standard deviation scores. Results: Children who lived in areas of social deprivation (assessed by postcode) had lower height and weight than their contemporaries (mean standard deviation score -0.26 (SD 1.02) and -0.18 (1.15) respectively, P<0.001 for both). Children who were receiving 400 0icro;g daily of inhaled steroids and who were attending both hospital and general practice for asthma care had lower height and weight than average, independent of the effect of deprivation (mean standard deviation score -0.62 (1.01), P=0.002, for height and -0.58 (0.94), P=0.005, for weight). Children receiving high doses of inhaled corticosteroids also showed lower growth rates (mean change in standard deviation score -0.19 (0.51), P=0.003). However, no other children with asthma showed growth impairment. Conclusion: Most children with asthma were of normal height and weight and had normal growth rates. However, children receiving high doses of inhaled steroids and requiring both general practice and hospital services had a significant reduction in their stature. This effect was independent from but smaller than the effect of socioeconomic group on stature.
Tayside Centre for General Practice, Correspondence to: Mr McCowan email: c.mccowan@dundee.ac.uk
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