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Two studies (
) have cast doubt on the effectiveness of allergen-impermeable bedding covers for patients with asthma or allergic rhinitis. Both studies compared house dust mite – impermeable with permeable covers for mattresses, pillows, duvets, quilts, and blankets. House dust mite concentrations in mattresses were reduced by the impermeable covers. The first study included only adults with asthma. Both groups improved to the same extent. The second study included both adults and children with allergic rhinitis and, again, both groups improved but there were no significant differences between the groups. Impermeable bedding covers as a single measure were ineffective in these patients.
In four towns near Paris (
) giving a safety kit to families at increased risk of child injury because of medical, psychological, or socioeconomic problems resulted in an increase in apparent safety in the homes. The kits contained two pamphlets about safety at home along with cupboard and drawer latches, door handle covers, a non-skid bathtub mat, a smoke detector, and a phone sticker with the number of the poison centre. They were handed out (50 children randomised to kit plus counselling and 50 to counselling alone) when the children were 6–9 months old and household safety items were assessed at that time and 6–8 weeks later. The effect on injury rates was not assessed. In a commentary the study is criticised because of non-blinding (the person who delivered the intervention also collected the outcome data, by questionnaire to the parents rather than by direct observation).
Cognitive-behavioural therapy (CBT) is an effective intervention for children exposed to violence. At two schools in a socially deprived area of Los Angles (
) 159 of 769 10–11 year old children had been exposed to substantial violence (witness or victim of gun or knife violence or at least three lifetime events). They were randomised to early or delayed (by 3 months) 10 session, group CBT. Symptoms of post-traumatic stress disorder or depression and parent-reported psychosocial dysfunction were all significantly less in the early CBT group at 3 months. At 6 months, after treatment of the delayed CBT group, there were no significant differences between the groups.
Some 14% of children with drug resistant partial epilepsy have focal cortical dysplasia. At an epilepsy surgical centre in Milan (
) between May 1996 and September 2000 there were ten children aged between 26 months and 11 years who had surgery (corticectomy plus lesionectomy) for drug resistant partial epilepsy and had a diagnosis of focal cortical dysplasia confirmed on histology of surgical specimens. Preoperative MRI scans showed abnormalities in a single lobe in five patients (temporal 3, frontal 2), in two lobes (temporo-occipital and fronto-insular) in two, and in three lobes (fronto-parieto-temporal) in one. The two children with normal MRI scans both had frontal lobe epilepsy. Six children had lesional localisation using stereo EEG via intracerebral electrodes. After at least 25 months of postoperative follow up seven children were seizure free and one (with fronto-parieto-temporal involvement) had much fewer seizures. In two children (one with frontal and one with fronto-insular lesions) seizure frequency was unchanged. Cognitive development improved in all ten children. The authors of this paper emphasise the role of stereo EEG in localising the lesions.
In poor countries reported cure rates for acute lymphoblastic leukaemia in children are often less than 35% whereas in the developed world cure rates of about 80% are reported. In Honduras (
) the main cause of treatment failure was abandonment of treatment (38 of 168 patients). Abandonment was more likely with greater travelling time to the treatment centre and with age under 4.5 years. The researchers in Honduras see transport funding, satellite clinics, support groups, and prompt treatment for infections as the means of improvement but the Lancet commentator emphasises the need for simpler, more affordable, and less toxic treatments in both the developing and the developed world.
Increasing the target range for oxygen saturation for infants who still need supplemental oxygen at 32 weeks of postmenstrual age increases the burden on health services but does not benefit the infants. In Sydney (
) who still needed supplemental oxygen at 32 weeks postmenstrual age were then randomised to a target oxygen saturation of 91–94% (standard) or 95–98% (high) by randomly supplying pulse oximeters that read either 2% too high or 2% too low and using a target range of 93–96% using those oximeters and with staff blinded to the allocation. At a corrected age of 12 months there were no differences between the groups in height, length, or head circumference and major developmental abnormalities were present in just under a quarter of each group. In the higher saturation group there were more deaths from lung disease (6 vs 1), the incidence of chronic lung disease was greater (64% vs 46%), the duration of oxygen supplementation after randomisation was longer (40 days vs 18 days), and more infants received home oxygen (30% vs 17%).
Children’s viral upper respiratory tract infections cause anxiety among parents and it is useful to know how long they usually last. In a multiple general practice study in south Wales involving children not given antibiotics (
) children had had symptoms for an average of 3 days before seeing their general practitioner. The rates of recovery (from the time of first consultation) were 25% at 2–3 days, 50% at 4–5 days, 75% at 7 days and 95% at 14 days.
High heritability has been demonstrated for attention deficit hyperactivity disorder (ADHD). In Australia (
) a boy with ADHD and intellectual disability had a pericentric inversion of chromosome 3, 46N inv (3) (p14: q21). Ten of 21 family members tested also had the inversion, impulsive behaviour, and intellectual deficit. Further investigation showed that the inversion breakpoint on the short arm of chromosome 3 affected the dedicator of cytokinesis 3 (DOCK3) gene and the breakpoint on the long arm affected a new member of the solute carrier family 9 (sodium/hydrogen exchanger) isoform 9 (SLC9A9) gene. Both of these genes are expressed in the brain. It remains to be seen whether, or to what extent, these genes are involved in behavioural disorders.