Feasibility of spirometry testing in preschool children.

RATIONALE: The primary purpose of this study was to evaluate the feasibility of obtaining acceptable and reproducible spirometry data in preschool aged children (3-5 years) by technicians without prior experience with spirometry. METHODS: Two technicians were trained to perform spirometry testing (ndd Easy on-PC) and to administer standardized questionnaires. Preschool aged children were enrolled from two Head Start centers and a local primary care clinic. Subjects were trained in proper spirometry technique and tested until at least two acceptable efforts were obtained or the subject no longer produced acceptable efforts. RESULTS: 200 subjects were enrolled: mean age 4.0 years (± 0.7 SD); age distribution: 51 (25.5%) 3 years old, 103 (51.5%) 4 years old, and 46 (23%) 5 years old. Fifty-six percent male and 75% Hispanic. One hundred thirty (65%) subjects produced at least one acceptable effort on their first visit: 23 (45%) for 3 years old, 67 (65%) for 4 years old, and 40 (87%) for 5 years old. The number of acceptable efforts correlated with age (r = 0.29, P < 0.001) but not gender. The mean number of acceptable efforts on the first visit was 2.66 (± 2.54 SD; range 0-10). One hundred twenty subjects (60%) had two acceptable efforts; 102 had FEV0.5 within 10% or 0.1 L and 104 had FVC within 10% or 0.1 L of best effort. The Asthma Health Screening Survey (AHSS) was 78% sensitive when compared to a specialist exam and 86% compared to a self-reported prior diagnosis of asthma. CONCLUSIONS: Technicians without prior experience were able to obtain acceptable and reproducible spirometry results from the preschool aged children; the number of acceptable efforts correlated significantly with age.

Implementing provider-based sampling for the National Children's Study: opportunities and challenges.

BACKGROUND: The National Children's Study (NCS) was established as a national probability sample of births to prospectively study children's health starting from in utero to age 21. The primary sampling unit was 105 study locations (typically a county). The secondary sampling unit was the geographic unit (segment), but this was subsequently perceived to be an inefficient strategy. METHODS AND RESULTS: This paper proposes that second-stage sampling using prenatal care providers is an efficient and cost-effective method for deriving a national probability sample of births in the US. It offers a rationale for provider-based sampling and discusses a number of strategies for assembling a sampling frame of providers. Also presented are special challenges to provider-based sampling pregnancies, including optimising key sample parameters, retaining geographic diversity, determining the types of providers to include in the sample frame, recruiting women who do not receive prenatal care, and using community engagement to enrol women. There will also be substantial operational challenges to sampling provider groups. CONCLUSION: We argue that probability sampling is mandatory to capture the full variation in exposure and outcomes expected in a national cohort study, to provide valid and generalisable risk estimates, and to accurately estimate policy (such as screening) benefits from associations reported in the NCS.

Development of the pediatric environmental health specialty unit network in North America.

Training in environmental health in general, and pediatric environmental health in particular, is inadequate. The Agency for Toxic Substances and Disease Registry began to develop pediatric environmental health specialty units (PEHSUs) after noting the dearth of practitioners who could evaluate and manage children with exposures to environmental health hazards. The Environmental Protection Agency subsequently joined in providing support for what has developed into a network of 13 PEHSUs in North America. PEHSUs provide services to families, act as consultants to clinicians and public agencies, develop educational materials, and respond to natural disasters, including hurricanes and wildfires. PEHSUs are relatively easy to organize and should be replicable internationally.

Children's health in the rural environment.

The rural environment is not as wholesome as some might think. In fact, smoking, drinking, illicit drug use, and obesity are more prevalent in rural than in urban youngsters. Childhood mortality is higher in rural areas, with drowning, motor vehicle accidents, firearm injuries, and farm machinery accidents as the leading causes. Air and water quality are monitored less and actually may be worse in the country than in urban areas. This article describes children's health problems associated with the rural environment and provides a list of resources for addressing these problems.

An unexplained case of elevated blood lead in a Hispanic child.

A 6-month-old child presented to a local pediatrician with an elevated blood lead level (BLL) of 41 microg/dL. The child was treated as an outpatient for chelation therapy by a toxicologist. Subsequent BLLs obtained at 8 and 13 months of age were 40 microg/dL and 42 microg/dL, respectively. Siblings and family members had BLLs < 5 microg/dL except for the mother, who had a BLL of 14 microg/dL when the child was 6 months of age. Home inspections and phone calls to the family revealed no sources of lead from paint, dust, toys, mini-blinds, keys, food, water, or any take-home exposure. The family denied use of folk remedies such as Greta and Azarcon. The child was breast-fed, but the mother's BLL was not sufficiently high to explain the elevated BLL in the child. Housekeeping was excellent. The mother did admit to cooking beans in Mexican pottery (pieces found outside were positive for lead), but she discontinued use after the initial lead check at 6 months. The bean pot was not a likely source, as none of the family had elevated BLLs including a 5-year-old sister. Follow-up testing of blood lead when the child was 15 months of age revealed values of 28 microg/dL for the child and 9 microg/dL for the mother. Subsequent testing of the child shows a slow decline. The slow release of lead suggests depletion of bone stores acquired during pregnancy, possibly due to pica behavior of the mother during pregnancy.