To determine whether seeking advice prior to an unscheduled visit to a pediatric emergency department (PED) influences appropriate use of this setting for minor illnesses.
Cross-sectional questionnaire survey.
The medical emergency department of the Montreal (Quebec) Children's Hospital, a major referral and urban teaching hospital.
Four hundred eighty-nine of 562 consecutive parents visiting the PED over two periods, one in February and the other in July 1989.
Parents of children between 0 and 18 years of age visiting the PED were asked whether they had previously sought advice from family, friends, or a physician. Other factors possibly related to the decision to seek care were also measured. Appropriateness was rated, blind to discharge diagnosis, by two pediatricians using a structured series of questions incorporating the child's age, time of the visit, clinical state, and problem at presentation. Thirty-four percent of visits among respondents were judged appropriate. In bivariate analysis, appropriate visits occurred significantly more often when a parent spoke to both a physician and a nonphysician (47%) prior to visiting the PED than when no advice was sought (29%; P
Antibody to herpes simplex virus (HSV) type 1 and Epstein-Barr virus (EBV) capsid antibody were determined in 333 children from the Faroe Islands, aged 4, 8 and 13 years. An analysis of multi-way frequency tables was performed, testing seropositivity for each virus against combinations of the following variables: sibship size, birth order, mother's age at birth, birth weight, actual height and weight, age and sex. HSV-seropositivity was associated to sibship size, height and age, while EBV-seropositivity was related only to age.--It is discussed how the findings fit into epidemiological patterns described for Hodgkin's disease and multiple sclerosis, which are both supposed to be of viral origin. Our results suggest that HSV, but not EBV, may be among the candidates to be considered.
Many studies have identified urban-rural differences in schizophrenia risk. Hypothetical underlying cause(s) may include toxic exposures, diet, infections, and selective migration. The authors investigated whether the underlying cause(s) responsible for the urban-rural differences were rooted in families or in individuals. Linking data from the Danish Civil Registration System and the Danish Psychiatric Central Register, a population-based cohort of 711,897 people aged 15 years or more was established. Overall, 2,720 persons developed schizophrenia during the period 1970-2001. The authors evaluated whether the nearest older sibling's place of birth had an independent effect on schizophrenia risk. If the cause(s) responsible for the urban-rural differences are rooted in individuals only, the nearest older sibling's place of birth should have no independent effect. In this analysis, the nearest older sibling's place of birth had an independent effect; among persons who lived in a rural area during their first 15 years of life, the relative risk was 1.59 (95% confidence interval: 1.10, 2.30) if their nearest older sibling had been born in the capital area as compared with a rural area. Some of the cause(s) responsible for the urban-rural differences in schizophrenia risk are rooted in families, but some might also be rooted in individuals.
Comment In: Am J Epidemiol. 2006 Jun 1;163(11):979-8116675534
ICES uOttawa, Ottawa, Ontario, Canada ; Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada ; Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada.
We investigated the association between a child's birth order and emergency room (ER) visits and hospital admissions following 2-,4-,6- and 12-month pediatric vaccinations.
We included all children born in Ontario between April 1(st), 2006 and March 31(st), 2009 who received a qualifying vaccination. We identified vaccinations, ER visits and admissions using health administrative data housed at the Institute for Clinical Evaluative Sciences. We used the self-controlled case series design to compare the relative incidence (RI) of events among 1(st)-born and later-born children using relative incidence ratios (RIR).
For the 2-month vaccination, the RIR for 1(st)-borns versus later-born children was 1.37 (95% CI: 1.19-1.57), which translates to 112 additional events/100,000 vaccinated. For the 4-month vaccination, the RIR for 1(st)-borns vs. later-borns was 1.70 (95% CI: 1.45-1.99), representing 157 additional events/100,000 vaccinated. At 6 months, the RIR for 1(st) vs. later-borns was 1.27 (95% CI: 1.09-1.48), or 77 excess events/100,000 vaccinated. At the 12-month vaccination, the RIR was 1.11 (95% CI: 1.02-1.21), or 249 excess events/100,000 vaccinated.
Birth order is associated with increased incidence of ER visits and hospitalizations following vaccination in infancy. 1(st)-born children had significantly higher relative incidence of events compared to later-born children.
Cites: Am J Epidemiol. 2002 Nov 1;156(9):882; author reply 883-412397007
Cites: J Epidemiol Community Health. 2002 Mar;56(3):209-1711854343
Birth order is associated with outcomes such as birth weight and adult socioeconomic position (SEP), but little is known about the association with adult height. This potential birth order-height association is important because height predicts health, and because the association may help explain population-level height trends. We studied the birth order-height association and whether it varies by family characteristics or birth cohort.
We used the Swedish Military Conscription Register to analyse adult height among 652,518 men born in 1951-1983 using fixed effects regression models that compare brothers and account for genetic and social factors shared by brothers. We stratified the analysis by family size, parental SEP and birth cohort. We compared models with and without birth weight and birth length controls.
Unadjusted analyses showed no differences between the first two birth orders but in the fixed effects regression, birth orders 2, 3 and 4 were associated with 0.4, 0.7 and 0.8 cm (p
The association between birth outcome and subsequent fertility was analyzed by using linked Norwegian birth certificates. All births of order 1, 2, and 3 which occurred during 1967 through 1974 were considered index births; there were approximately 207,000 index births of order 1, 165,000 of order 2, and 87,000 of order 3. The mothers' fertility after these index births was summarized with a life-table technique. Fertility was most pronounced if there were no survivors of an index birth, intermediate if there was one survivor, and lowest if both members of a set of twins survived. Advanced maternal age was associated with markedly reduced fertility. The sex of a surviving singleton had little effect on a mother's subsequent fertility. However, there was a sex-related difference if index twins survived; fertility was lower after the birth of unlike-sex twins and higher after the birth of like-sex twins. This probably reflects reproductive limitation rather than a differential fecundity for mothers of dizygotic and monozygotic twins. A comparison of fertility after births of like-sex and unlike-sex twins with one survivor may indicate that mothers of dizygotic twins were more fertile, but the number available for study was small. Reproduction among women who had two index births during 1967 through 1974 was examined separately. Fertility was most marked if neither of the first two infants survived and lowest where three survived (i.e., where one of the index births involved twins). If there were two survivors, the sex composition of the pair influenced fertility; fertility was greater if the two survivors were of the same sex and lower if they were of unlike sex. Since a woman who has an unfavorable outcome in one pregnancy will be at a higher risk of having an unfavorable outcome in a subsequent pregnancy, the higher fertility of such women will, to some degree, inflate the frequency of unfavorable outcomes in a population of births.