摘要：Objective: To determine the association among diabetes-related bullying, diabetes self-management, metabolic control,and depression in children and adolescents with type I diabetes(TID). Study design: Measures of diabetes-related bullying and depression were administered to 167 youth with TID at their regularly scheduled diabetes care visits. Parents were administered a clinician-rated index of their child’s diabetes self-management. HbA1c levels were assessed. Results:Diabetes-related bullying was positively related to HbA1c concentration and negatively related to overall self-management and specifically to adherence to glucose testing and dietary tasks. Depressive symptoms partially mediated the relation between diabetes-related bullying and overall self-manageme- ***: Given the associations between diabetes-re lated bullying and regimen self-management, the issue of illness-related bullying merits serious attention for pediatricians and school personnel.

摘要：在后基因组时代．通过科研。小儿健康改善的步伐将不断加速。通过基因组学、蛋白质组学和纳米技术的应用．加之对环境对人类基因影响的更多了解．我们预防、改善或治愈很多小儿疾患的能力将得到加强。本文复习了一些造成小儿发病和死亡的较为紧迫、重要的原因。讨论了这些新技术可能用于疾病研究的方式。对这些新发现改善小儿疾患预后的效果进行了预测。对于那些源自社会的可预防问题（虐待儿童、酒精中毒、药物滥用以及杀人）。为了确定可以有效减小其负担的方法。作者强调需要设计并进行前瞻性的长期研究。医生-科学工作者还必须阐明医学进步引发的伦理、政治和社会问题。

摘要：儿童具有生长和发育两个特点，其个体发育包括药物代谢酶、转运蛋白、受体和器官的发育。儿童的生长和发育使得药物的吸收、分布、代谢和排泄及药物在儿童的不同发育阶段对发育中器官的药效都存在着与成人显著不同的差异。

摘要：目的:为了评估儿童尿酶联免疫吸附试验(ELISA) 抗幽门螺杆菌免疫球蛋白G抗体试剂盒(尿- HpELISA)的准确性,笔者将其同13C尿素呼吸试验(UBT)和幽门螺杆菌粪便抗原试验(HpSA)做一对比, 以分析其敏感性和特异性。研究设计:选择没有明显上腹部症状的100例日本儿童分别用UBT、HpSA及尿- HpELISA法进行测试(平均年龄7岁,介于2-15岁之间)。结果:通过UBT和HpSA试验,100例儿童中,36例幽门螺杆菌阳性,64例阴性。36例阳性试验者中尿- HpELISA法测试出34例为阳性,而64例阴性者中用尿-HpELISA法测试出62例为阴性,因此,尿-HpELISA 法有94.4%的敏感度及96.9%的特异性,准确率达到了96.0%。结论:尿-HpELISA法是诊断儿童幽门螺杆菌感染的迅速、廉价、可靠并易于操作的一种方法。它不仅对诊断儿童幽门螺杆菌感染有价值,而且对儿童群体大规模流行病学筛查也有价值。

摘要：目的:测定血清中维生素A的含量与生长、营养状况及血液学状况的关系,及其含量与镰刀细胞性疾病- SS(S等位基因纯合子,SCD-SS)住院患儿数量的关系。试验设计:选择2-9.9岁的患有SCD-SS的患儿, 测定其血清维生素A、血色素、红细胞比积、网织红细胞计数、患儿的身高、体重、身体质量指数及以往的饮食摄入量。维生素A含量的定义以血清中维生素A的浓度为基准,当浓度<3 mg/L为异常,浓度≥3 mg/L为正常。在评估维生素A含量后,住院患儿人数的确定持续了1 年。结果:在66例受试者中(39例女孩)。

摘要：Objective:To evaluate risk factors for recurrent thrombosis in pediatric patients. Study design:This prospective observational cohort study enrolled 120 patients with acute venous thromboembolism from January 2003 to April 2005. Datacollection included medical and family history,radiologic and laboratory studies,therapy,and follow-up. Results:The overall prevalence of recurrent thrombosis in our cohort was 19/120(15.8%). Patients with recurrence were older,with a median age of 14.8 years (range 2 weeks-23.6 years),compared with 10.1years (range newborn 23.4 years) in patients without recurrence(P = 0.03). Six of the 19 patients with recurrent thrombosis had cystic fibrosis (CF),compared with 0/101without recurrence (P< 0.001). Five of these 6 patients were colonized with Burkholderia cepacia in their sputum. Central venous catheters were associated with most,but not all,of the thromboses in patients with CF. Conclusions:In this study,patients with CF had a high risk of recurrent venous thrombosis,as well as a high prevalence of colonization with B cepacia. The cause of this risk has not been defined. This observation may have important implications for thromboprophylaxis,particularly in the setting of central venous catheters.

摘要：To evaluate the relationship between neonatal oxygen supplementation (O2) and childhood cancer in the Collaborative Perinatal Project (CPP). Study design: The CPP consisted of 54,795 children born between 1959 and 1966 and followed to age 8 years. We used Cox proportional hazards modeling to examine the association between history of neonatal O2 and cancer (n=48). Results: The hazard ratio (HR) for any O2 was 1.77 (95% confidence interval [CI]=0.94 to 3.35). The HR for continuous duration of O2 was near 1 and not significant. However, theHRs were 0.69 (95% CI=0.17 to 2.88) and 2.87 (95% CI=1.46 to 5.66) when comparing 0 to 2 and 3 or more minutes of O2, respectively, to no O2. The latter association was weaker (HR=2.00; 95% CI= 0.88 to 4.54) and not significant (P=.10) when analysis was restricted to cancers diagnosed after age 1 year (n=41). Conclusions: These findings are consistent with an association between O2 for 3 minutes or longer and cancer in childhood, and should serve as a basis for further study.

摘要：Objective:To investigate cases of severe congenital neutropenia(SCN) to ascertain SCN inheritance after determining that the same sperm donor was used by 4 different families to impregnate mothers. Study design:Because the donor sperm was not available,alternative methods were used to determine whether the sperm donor transmitted SCN. DNA isolated from leukocytes was used to sequence the ELA2 gene in the affected children and their mothers. ELA2 was amplified by polymerase chain reaction (PCR),and the product was sequenced. PCR was also performed with genomic DNA from the mothers and affected children using a set of 22 microsatellite PCR primerson chromosomes 14 and 19 to establish linkage to the paternalallele. Results:None of the mothers had a mutation in ELA2,but all 5 affected children had the same mutation affecting the fourth exon at site S97L. Linkage mapping analysis confirmed that all affected children had the same paternal allele on chromosome 19,which contains ELA2. Conclusions:Our findings indicate that the father provided consistent haplotypes leading to the expression of SCN in all affected children,supporting an autosomal dominant inheritance in which ELA2 mutations occur.

摘要：背景:不合理用药是患者安全的重要隐患,对于老年人尤其如此.按照明确的标准,以前的研究发现,1987年和1992年分别有23.5%和17.5%的社区老年人至少使用过20种潜在不合理用药中的1种.目的:确定1996年社区老年人潜在不合理用药的发生情况,评价10年来不合理用药趋势,按照明确的标准对不合理用药进行分类,检查不合理用药的危险因素.设计、地点和参与者:对1996年医疗支出调查做出答复的年龄≥65岁(n=2 455)的老年人.该工作对美国非机构(noninstitutionalized)人群进行了调查,具有全国代表性.由一个7人专家小组对不合理用药情况进行分类.主要观察指标:33种潜在不合理用药的现状.结果:1996年美国有21.3%(95%可信区间[CI],19.5%～23.1%)的社区老年患者至少使用过33种潜在不合理用药中的1种.采用专家组的分类,大约2.6%(95%CI,2.0%～3.2%)的老年人至少使用过11种老年人禁用药物中的一种;9.1%(95%CI,7.9%～10.3%)至少使用过8种慎用药物中的一种;13.3%(95%CI,11.7%～14.9%)至少使用过14种对症但常使用不当药物中的一种.一些不合理用药情况在1987年和1996年间有所下降.体质较差,服药较多的患者不合理用药的危险显著升高.结论:总体上,老年患者不合理用药情况仍然很严重.尽管对老年人不合理用药评价标准仍有质疑,但是此标准可以用于人群调查,从而确认提高医疗质量和患者安全的概率.完善现有数据资料,包括剂量、作用时间和适应证,可以提高美国的医疗和监督水平.

摘要：目的:评价早产儿的白喉-破伤风-非细胞性的百日咳-未激活的脊髓灰质炎-流感嗜血杆菌B型(DtaP-IPV-HIB)免疫的安全性。研究设计:我们对78 例极低体重早产儿(平均胎龄28±2周;平均出生体重1045±357 g)进行了观察性研究。在他们出院前给予DtaP-IPV-HIB疫苗注射。在接种疫苗前后,分别对呼吸暂停、心动过缓、需要吸氧和氧饱和度、喂养练习及医学干预等指标进行评估。根据临床情况的严重程度和早产症状的持续情况对评估的结果进行分析。结果:使用DtaP-IPV-HIB后有47%的婴儿诱发或加重了心肺症状(15%出现呼吸暂停,21%出现心动过缓,42%出现低氧血症)。大部分由接种疫苗引起的症状自然减轻或者在短暂的刺激后减轻。接种时,相对危险性在有严重临床症状或持续心肺症状的婴儿中高出5-8倍。78例婴儿中有5例接受了面罩呼吸支持,在有慢性肺病的21例婴儿中有4例出现短暂的吸氧量增加,所有患儿均不需要再次通气。亦不需要再次吸氧、终止积极的经口喂养或推迟出院。结论:心肺症状在DTaP-IPV-