'Children are exposed to temptation all the time'- parents' lifestyle-related discussions in focus groups.

AIM: To explore parents' perspectives on providing their preschool child with a healthy lifestyle, including obstacles and resources. METHODS: Five semi-structured focus group interviews were conducted, with 30 parents of 4-year-olds in Sweden. Interviews were transcribed verbatim and analysed using Systematic Text Condensation. RESULTS: Four themes emerged from the qualitative analysis: Lifestyle -'The way you live is parents' responsibility', Challenges to promote children's healthy lifestyle, Support from professionals, and peers might facilitate, and Request for an overall responsibility from society. Parents felt that they were role models for their child's lifestyle, a concept including many factors. Attractive and tempting sedentary activities and unhealthy foods were perceived as obstacles, and parents were frustrated by the media's contradictory lifestyle messages. Child health services were expected to more actively invite parents to discuss their child's lifestyle issues. Parents desired some collective responsibility for children's lifestyles through agencies, services and media messages that support and promote healthy choices. CONCLUSION: Parents struggled to give their children a healthy lifestyle and the 'temptations' of daily unhealthy choices causing hassles and conflicts. Parents desired professional support from preschool, Child Health Care and a collective responsibility from society with uniform guidelines. Parents groups were mentioned as peer support.

Family stress and BMI in young children.

AIM: The aim of this study was to investigate if family stress and parental attachment style are associated with body mass index (BMI) in young children, and identify possible explanations. METHODS: A cross-sectional survey with a two-stage design was used. Parents of 873 children participated. They completed a demographic questionnaire, the Swedish Parenthood Stress Questionnaire (SPSQ), the Relationship Questionnaire (RQ) and reported their children's television-viewing habits (as a marker of physical activity). Children's height, weight and BMI were obtained from a general population-based register, BASTA. Associations with over- and underweight in children were assessed using multiple logistic regression analysis. RESULTS: Family stress indicated by SPSQ-score was associated with suboptimal BMI. Maternal, but not paternal, SPSQ-stress score was statistically significantly associated with overweight and underweight, with adjusted odds ratios (and 95% confidence interval) of 4.61 (3.11-6.84; p < 0.001) and 3.08 (1.64-5.81; p < 0.001) respectively. Associations between childhood BMI and parental attachment style were identified, but were not independent of maternal SPSQ-score. CONCLUSION: Our findings support a role for family stress in development of both overweight and underweight among young children. This is likely to be attributed to behavioural mechanisms but a more direct metabolic influence of stress could also be involved.

Association between Chlamydia pneumoniae antibodies and wheezing in young children and the influence of sex.

BACKGROUND: The proposed association between Chlamydia pneumoniae (Cpn) infection and wheezing needs further clarification. METHODS: Serum samples obtained from 1581 children aged 4 years in a population based cohort were tested for antibodies to Cpn and IgE antibodies to common allergens. Data on environmental factors and disease were collected prospectively from birth. RESULTS: The occurrence of IgG antibodies to Cpn at 4 years of age was associated with reported wheezing at different ages; however, these findings were most often not significant. In girls, the occurrence of anti-Cpn IgG was associated with wheezing at the ages of 1, 2, and 4 years (odds ratios (ORs) 3.41 (95% confidence interval (CI) 1.46 to 7.96), 2.13 (95% CI 1.02 to 4.44), and 2.01 (95% CI 1.14 to 3.54), respectively), and even higher ORs were observed for each age category when only high level antibody responses to Cpn were analysed. At the time of blood sampling the association between anti-Cpn IgG and wheezing was restricted to girls without atopic sensitisation (OR 2.39 (95% CI 1.25 to 4.57). No associations with wheezing were detected in boys, in whom IgE sensitisation was inversely associated with the presence of anti-Cpn IgG (OR 0.49 (95% CI 0.26 to 0.90)). CONCLUSIONS: This study suggests an association between evidence of earlier Cpn infection and a history of wheezing in young girls. Infection with Cpn may be an important risk factor for wheezing and possibly for non-atopic asthma, predominantly in girls.

Chlamydia pneumoniae in children undergoing adenoidectomy.

UNLABELLED: Chlamydia pneumoniae is a common respiratory pathogen which is often found in paediatric populations. Little is known about the true colonization rate and the localization of the bacteria in the respiratory tract. In this study, immunohistochemistry was used to examine adenoids from 69 children undergoing elective adenoidectomy. Throat swabs for polymerase chain reaction (PCR) and blood samples for serology were also obtained. Chlamydia pneumoniae was demonstrated in the adenoids by immunohistochemistry in 68 of the children. Five children (7%) had a positive C. pneumoniae PCR test from throat swabs and 14 children (20%) had detectable antibodies by the microimmunofluorescence technique. CONCLUSION: The results suggest that C. pneumoniae is a common finding in the adenoids of children undergoing adenoidectomy. Whether or not C. pneumoniae plays a pathogenic role in this patient population could not be determined from the data obtained in this investigation.

Chlamydia pneumoniae in children attending day-care centers in Gävle, Sweden.

BACKGROUND: The epidemiology of Chlamydia pneumoniae in healthy children has not been established. METHODS: This investigation used polymerase chain reaction (PCR) to study the epidemiology of C. pneumoniae in presumed healthy children. Four hundred fifty-three children and 142 personnel at 9 day-care centers were investigated for carriage of C. pneumoniae. Children found to be positive by PCR were also investigated with serology, and their family members were tested with PCR. RESULTS: One hundred and three (22.7%) children had a positive PCR, as had 33 (23.2%) personnel. Fourteen percent of the children younger than 3 years had a positive PCR test compared with 26% of the older children (P < 0.01). No correlation was found between respiratory symptoms and carriage of C. pneumoniae. Mothers were more often positive in the PCR test as compared with fathers (relative risk, 2.59; 95% confidence interval, 1.16 to 5.78). Antibodies to C. pneumoniae were found in 27 of 97 PCR-positive children; only 2 of whom were younger than 3 years. CONCLUSION: C. pneumoniae can be commonly found in young children attending day care. Most of the youngest children did not develop specific antibodies. Children may have subclinical infections with C. pneumoniae. The organism seems to be easily communicable among individuals living in close proximity.

Chlamydia pneumoniae in children with acute respiratory tract infections.

Children seeking medical attention for acute respiratory tract infections were investigated for evidence of Chlamydia pneumoniae infection. Blood samples were obtained from 367 children. Nasopharyngeal or throat swabs for PCR analysis (polymerase chain reaction) were taken from 360 children. Serology was found to be useful for diagnosis of infection only in children aged > 5 y. Using PCR, a prevalence of 8 and 10% of C. pneumoniae was found in male and female children aged < 2 y; 17 and 19%, respectively, in the age group 2-4 y and 32 and 21%, respectively, in the age group 5-16 y. We conclude that Chlamydia pneumoniae is a common finding in young children with respiratory tract infections. Younger children were more often found to have a moderate disease, but may have been ill for a long period.

Interleukin (IL)-6 and IL-8 in children with febrile urinary tract infection and asymptomatic bacteriuria.

Urine and serum interleukin (IL)-6 and IL-8 responses were higher in children with febrile urinary tract infection (n = 61) than in those with asymptomatic bacteriuria (n = 39). By univariate analysis, cytokine levels were related to age, sex, reflux, renal scarring, urine leukocytes, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and bacterial properties (P fimbriae but not hemolysin). Multivariate modeling showed that urine IL-6 responses were higher in girls than boys, increased with age, and were positively associated with CRP, ESR, serum IL-6, and urine leukocyte counts. The urine IL-8 response was not influenced by age, but it was influenced by P fimbriae and was associated with ESR, CRP, urine leukocytes, and female sex. The results show that cytokine responses to urinary tract infection vary with the severity of infection and that cytokine activation is influenced by a variety of host and bacterial variables.

Intestinal carriage of P fimbriated Escherichia coli and the susceptibility to urinary tract infection in young children.

This prospective study analyzed the intestinal carriage of P fimbriated Escherichia coli as a host susceptibility factor in urinary tract infection (UTI). P fimbriation was defined by the pap and G adhesin (papG1A2, prsGJ96) genotypes. Children with UTI carried pap+ E. coli in the fecal flora more often than healthy controls both at diagnosis (86% vs. 29%) and during infection-free intervals (approximately 40%; P < .01). P1 blood group-positive children carried pap+ E. coli in the fecal flora more often (88%) than those with P2 blood group (40%; P < .05). A pap+ E. coli strain caused UTI in 53 of 55 patients who carried both pap+ and pap- strains in their fecal flora. These results suggest that persons who develop UTI have an increased tendency to carry pap+ E. coli in the large intestine and that these pap+ E. coli cause UTI more often than pap E. coli strains in the fecal flora of the same host.

Six year follow up of infants with bacteriuria on screening.

OBJECTIVE: To determine the value of screening for bacteriuria in infants with special emphasis on the natural course of untreated asymptomatic bacteriuria, renal growth, and renal damage. DESIGN: Prospective six year follow up of infants with bacteriuria on screening in an unselected infant population. SETTING: Paediatric outpatient clinic. PATIENTS: 50 Infants (14 girls, 36 boys) with bacteriuria on screening verified by suprapubic aspiration from an unselected population of 3581 infants in a defined area of Gothenburg. INTERVENTIONS: Children with asymptomatic bacteriuria and normal findings on initial urography were untreated, although other infections were treated. MAIN OUTCOME MEASURES: Culture of urine and determination of C reactive protein concentration every six weeks for the first six months after diagnosis, every three months from six months to two years, and every six months between two and three years; thereafter yearly urine culture. Evaluation of renal concentrating capacity with a desmopressin test; radiological examination, including first and follow up urography and micturition cystourethrography without antibiotic cover; and measurement of renal parenchymal thickness and renal surface area. RESULTS: Of the original 50 infants, 37 (12 girls, 25 boys) were followed up for at least six years. Two infants developed pyelonephritis within two weeks after bacteriuria was diagnosed; the others remained free of symptoms. 45 Infants were untreated; the bacteriuria cleared spontaneously in 36 and in response to antibiotics given for infections in the respiratory tract in eight. Recurrences of bacteriuria were observed in 10 of the 50 children, of whom one had pyelonephritis. No child had more than one recurrence. At follow up urography in 36 of the 50 children (9 girls, 27 boys) after a median of 32 months no child had developed renal damage. First samples tested for renal concentrating capacity showed significantly higher values than those from a reference population (mean SD score 0.50, 95% confidence interval 0.21 to 0.79; p less than 0.001), but the last samples showed no significant difference (mean SD score 0.08, -0.24 to 0.40; p greater than 0.05). CONCLUSIONS: Mass screening for bacteriuria in infancy results primarily in detection of innocent bacteriuric episodes and is not recommended.

Spontaneous clearance of asymptomatic bacteriuria in infants.

In an unselected population of 3,581 infants, 14 girls and 36 boys were found to have bacteriuria verified by suprapubic aspiration. Among the bacteriuric infants, one girl and one boy developed symptoms of pyelonephritis close to the time of detection; the others remained asymptomatic. Eleven girls and 34 boys were left untreated. One of these girls and 7 of the boys became abacteriuric after treatment for respiratory tract infections. Ten girls and 26 boys became spontaneously abacteriuric, with a median persistence of bacteriuria of 2 months in girls and 1.5 months in boys. Recurrences were observed among boys only in those who had been treated with antibiotics.

Bacterial virulence and inflammatory response in infants with febrile urinary tract infection or screening bacteriuria.

Two populations were analyzed prospectively after a first episode of urinary tract infection. Asymptomatic infants were screened at 2 weeks and at 3 and 10 months of age, and bacteriuria was confirmed by bladder puncture. Infants with febrile urinary tract infection were enrolled during the same study period. The inflammatory response was characterized by the presence of fever, serum C-reactive protein, microsedimentation rate, urinary leukocyte excretion, and width of the ureters. The bacteria were defined for O:K:H serotype, hemolysin production, resistance to the bactericidal effect of serum, attachment to uroepithelial cells, and specificity for the globoseries of glycolipid receptors. In agreement with previous studies, the frequency of increased inflammatory signs and of attaching Escherichia coli was significantly higher in infants with febrile urinary tract infection than in the screening group. Within both patient groups, however, children infected with attaching E. coli strains had significantly more inflammatory signs. The results suggest that adherence facilitates the presentation of bacterial components capable of causing inflammation in the tissues in the urinary tract.

Ureteral dilatation in children with febrile urinary tract infection or bacteriuria.

Little information is available on the relationship between urinary infection in children and infants, with or without vesicoureteral reflux, and dilatation of the urinary tract. The purpose of this study was to determine the effects of infection and reflux on the diameter of the ureter at excretory urography in children with acute, febrile urinary tract infections and in infants with bacteriuria found at screening. Standardized measurements of ureteral diameter were obtained for 79 children (2 months to 6 years old) with urinary tract infections and for 45 infants with bacteriuria. Patients with urinary tract obstruction or malformations were excluded. Seventy-one children with febrile urinary tract infection had ureteral visualization that allowed measurements. Ureteral diameter in this group was significantly wider than in a reference group, and 42 children (59%) had ureteral diameters that were more than 2 standard deviations above the normal mean. Ureteral diameter at excretory urography increased with increasing grades of reflux, but dilatation occurred also in the absence of reflux. Twenty-two of the 45 infants in the group with bacteriuria had sufficient ureteral visualization for measurements. The ureters in this group were wider than in the reference group, and eight infants had ureteral diameters that were more than 2 standard deviations above the normal mean. We conclude that ureteral dilatation is a common effect of acute urinary tract infection and bacteriuria in children.

Epidemiology of bacteriuria during the first year of life.

Bacteriuria was studied in an unselected population of 3,581 infants. Screening was performed at three time intervals during the infants' first year of life. The public Child Health Centers cooperated in the screening and bag samples were obtained from the infants with the parents help. Bacteriuria was verified by suprapubic aspiration. 94% of the infants took part in the screening and bacteriuria was confirmed in 14 girls (0.9%) and 36 boys (2.5%). An additional 20 girls (1.1%) and 20 boys (1.2%) in the study population presented with symptomatic urinary tract infection before 12 months of age. Bacteriuria in boys was predominantly found early in infancy both with screening techniques and through symptomatic urinary tract infections.

The immune response of the mammary gland and its significance for the neonate.

The immune response of the mammary gland is dominated by local production of secretory IgA antibodies (SIgA). These milk antibodies, amounting to about 0.5-1 g/day throughout lactation, are directed against food proteins and microorganisms often present in the intestine. This is presumably explained by the enteromammaric link: after antigenic exposure in the Peyer's patches of lymphoid cells they home to various exocrine glands, including the mammary gland. Similarly, lymphoid cells from the bronchial mucosa, may contribute to the antibody-producing cell population in the mammary gland. SIgA antibodies against common foods like cow's milk and soy proteins are regularly found in milk if such proteins are part of the mother's diet. It is possible, but unproven, that milk antibodies can decrease the exposure of the infant's intestinal mucosa to foreign food proteins introduced during continued breast-feeding. Milk SIgA antibodies do not prevent intestinal colonization by microorganisms, against which the milk antibodies are directed. The SIgA antibodies are thought to exert protection primarily by preventing contact between the microorganisms and the mucosal membranes. In this manner, human milk blocks attachment of otitis media-causing strains of pneumococci and H. influenzae to retropharyngeal cells, possibly explaining why breast-feeding may prevent otitis media. Milk antibodies have anti-attachment capacity, but there is also low molecular weight material in the milk with this capacity. It probably consists of analogues to the oligosaccharide receptor for pneumococci on the retropharyngeal cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Influence of breast feeding on the development of cow's milk protein antibodies and the IgE level.

In 48 infants unselected with regard to atopic heredity, the levels of serum IgG, IgA and IgM antibodies against native cow's milk proteins and IgG antibodies against beta-lactoglobulin were measured with ELISA and the total serum IgE concentration with Phadebas PRIST. Using multiple regression analysis the level of each type of antibody was related to the age at weaning, at first exposure to cow's milk and at sampling. The longer the infants were exposed to cow's milk protein without concomitant breast feeding and the younger they were at the introduction of cow's milk formula, the higher were the IgG antibody levels against native cow's milk proteins. The investigated variables explained only 17% of the variation of the antibody level, however. The IgG antibodies against beta-lactoglobulin showed significant negative correlations to the age at weaning and the age at first cow's milk exposure, explaining 8% of the variation. Specific IgA and IgM antibody levels an those of total serum IgE did not show any significant relation to the investigated independent variables.