Kuo-Wei Yeh

Associations of Age, Gender, and BMI with Prevalence of Allergic Diseases in Children: PATCH Study

Background. Little is known about the prevalence of allergic diseases in children of different ages. This study aimed to investigate the prevalence of allergic diseases and allergic sensitization in children over a wide age range, with emphasis on the influence of age, gender, and body mass index (BMI). Methods. In a cross-sectional study, we assessed 5351 Taiwanese children aged 4–18 years using an International Study of Asthma and Allergies in Childhood questionnaire, BMI, and total and specific serum immunoglobulin E. Results. Forty-eight percent were currently symptomatic for at least one of three allergic diseases. Prevalence of wheeze ever, current wheeze, and diagnosed asthma were 17.0%, 7.5%, and 9.8%, respectively; analogous features for rhinitis were 47.8%, 44.2%, and 39.8%. Allergic sensitization was very common (57.3%). Half of the children (50.6%) with current wheeze had not been diagnosed with asthma by physicians, whereas undiagnosed rates were 32.3% for rhinitis and 25.3% for eczema. The male-to-female prevalence ratios of current wheeze increased with age from <1 at 4–5 years, peaked at 10–11 years (2.24), then reversed to 0.57 at 16–18 years. Childhood wheezing tended to remit with age, but rhinitis and eczema were more persistent. Total immunoglobulin E levels increased with age until 14–15 years, and declined thereafter. Elevated BMI was associated with greater prevalence of wheezing and eczema, with no evidence of significant effect modification by either gender or age. Multivariate analyses revealed that younger age, boys, and obesity were significantly and independently associated with current wheezing in children (all p < .01). Conclusions. The burden and co-morbidity of childhood allergies are substantial. There are striking age-dependent gender differences in asthma prevalence, exhibiting an inverted U-shaped curve for male-to-female prevalence ratios by age. Obesity is associated with a greater prevalence of asthma in children with no evidence of a significant modulation by either gender or age.

Effects of a Self‐Management Asthma Educational Program in Taiwan Based on PRECEDE‐PROCEED Model for Parents with Asthmatic Children

This study was conducted to evaluate the comparative effectiveness of two different asthma educational programs. One was self‐management asthma education based on the PRECEDE‐PROCEED model to change the influential factors based on a previous need assessment study in Taiwan. The other consisted of regular outpatient asthma education. The purposes were: 1) to compare differences in the asthma knowledge, self‐efficacy, perceived effectiveness, childrens cooperation, doctor–patient communication, and self‐management behaviors in the experimental and control groups before education, and 2 weeks, 3 months, and 6 months after education; and 2) to compare differences in drug use, medication utilization, asthma severity, signs/symptoms of asthma, school absenteeism, and exercise ability before education, and 2 weeks, 3 months, and 6 months after education. Parents of asthmatic children were recruited from among outpatients of Chang Gung Childrens Hospital, Taoyuan, Taiwan. They were grouped by registration number: those with even numbers were assigned to the experimental group, and those with odd numbers were assigned to the control group. Measurements were collected four times from all parents by means of a questionnaire and chart review. The General Linear Model: Repeat Measurement was used to compare variance differences. The following results were found. 1) Asthma knowledge, self‐efficacy, perceived effectiveness, childrens cooperation, and self‐management behaviors significantly improved after the self‐management asthma educational program based on PRECEDE‐PROCEED. Except for perceived effectiveness, all variables still had good effectiveness after 6 months of follow‐up. The experimental group was better than the control group in knowledge, childrens cooperation, and self‐management behaviors at the 3‐month follow up, as well as in knowledge and childrens cooperation at the 6‐month follow‐up. 2) In both the experimental and control groups, the educational program had a good impact on the health outcome. The average degree of drug use was reduced from 2.7 to 2.1. The number of visits was reduced from 4.75 to 3.55 per half year in the experimental group, and from 5.8 to 3.48 in the control group. The severity of asthma was reduced from 2.7 to 2.1. The signs/symptoms of asthma decreased, school absenteeism was reduced, and exercise ability improved after education at the 6‐month follow‐up in both groups. From the results of this study, the theory‐based educational program had a good effect on self‐management behaviors. From the repeat measurement analysis, we can understand the changing trend of the determinants, behaviors, and outcome indicators. The trend indicated that educational effects were sustained for at least 3 months, with some for 6 months. In order to maintain the educational effects, further specific series of educational programs can be designed based on the patterns of self‐management behavior stages every 6 months. The effects of health outcomes may show significant differences using longer follow‐up times in future clinical trials.

PFAPA SYNDROME (PERIODIC FEVER, APHTHOUS STOMATITIS, PHARYNGITIS, ADENITIS)

Abstract: This paper aims to remind paediatric clinicians to suspect and confirm ‘PFAPA’ syndrome (Periodic Fever, Aphthous stomatitis, Pharyngitis and cervical Adenitis syndrome). We report two cases of PFAPA syndrome: a 3-year-old healthy boy with atopic rhinitis and a boy aged 8 years 5 months who simultaneously had lymphocytic vasculitis syndrome treated with immunosuppressive drugs. Both met Marshall’s criteria. The literature regarding PFAPA syndrome was complied using a Medline search for articles published between 1963 and 1998 and we then reviewed the reference lists of the articles. The Medline search revealed 28 cases with available clinical manifestations, management and prognosis. Our study describes two additional cases. We divided the cases into typical (28 cases) and atypical (two cases) PFAPA syndrome. In typical PFAPA, the age of onset was less than 5 years in most cases and the patients presented 4.9 ± 1.4 days of fever (100%), pharyngitis (89.3%), cervical adenitis (72.1%), stomatitis (71.4%), malaise (64.3%), headache (60.7%), abdominal pain (53.6%) and nausea/vomiting (17.9%). Afebrile intervals were 3.2 ± 2.4 months and increased with age. The time from initial onset to final episode was 3 years 7 months ± 3 years 6 months. The total number of episodes was 8.3 ± 2.5 (range 6–14). Effective treatment included steroids, tonsillectomy/adenoidectomy and cimetidine. The general outcome was good. In atypical PFAPF, the clinical manifestations were similar to those of typical PFAPA except that the age of onset was more than 5 years, and life-threatening intestinal perforation happened once in a patient with underlying Fanconi’s anaemia. It was concluded that typical PFAPA syndrome is benign and can be diagnosed by detailed history-taking and from physical findings during repeated febrile episodes with tests to rule out other periodic fever syndromes. A review of the literatures since the first report in 1987 has shown that typical PFAPA syndrome is not associated with significant long-term sequelae and has a good response to steroids. One patient with atypical PFAPA, who received low-dose steroids for over 1 year, developed intestinal perforation after an increment of the 7-day steroid dose. If an underlying problem requires long-term immunosuppressive medication, it is wiser to choose cimetidine rather than increasing the steroid dosage to resolve atypical PFAPA.

Lymphopenia is a risk factor in the progression of carotid intima‐media thickness in juvenile‐onset systemic lupus erythematosus

OBJECTIVE To characterize the atherosclerotic risk factors in the progression of subclinical atherosclerosis in patients with juvenile-onset systemic lupus erythematosus (SLE). METHODS This was a longitudinal study of 76 patients with juvenile-onset SLE. Carotid arteries were evaluated using ultrasonography at baseline and at followup visits at 6-month intervals over the 6-year study period. Clinical and laboratory parameters, disease activity, treatment, and traditional risk factors for atherosclerosis were evaluated. Data were analyzed using generalized estimating equations. RESULTS The mean+/-SD age of the patients at baseline was 15.01+/-3.48 years and the mean+/-SD disease duration was 2.65+/-2.5 years. The mean+/-SD duration of followup was 3.74+/-1.24 years. The mean+/-SD intima-media thickness (IMT) of the common carotid arteries differed significantly between the patient and control (n=38) groups (0.63+/-0.08 mm versus 0.54+/-0.06 mm; P<0.001). The presence of lymphopenia at diagnosis and at baseline and higher levels of serum creatinine and C-reactive protein at baseline were positively associated with progression of carotid IMT (P=0.006, P=0.043, P=0.037, and P=0.049, respectively). In multivariate analysis, only lymphopenia at baseline and at diagnosis were consistently associated with progression of IMT (P=0.012 and P=0.045, respectively). CONCLUSION In patients with juvenile-onset SLE, some nontraditional risk factors for the progression of subclinical atherosclerosis were identified. Lymphopenia was the only independent risk factor for the progression of IMT. The pathogenic mechanisms warrant further investigation.

Increasing the hospitalization of asthma in children not in adults – from a national survey in Taiwan 1996–2002

Prevalence of asthma has risen gradually in past 30 yr in Taiwan, but less is known about the trend of asthma hospitalization and different hospitalization patterns between children and adult groups in the Chinese population. The implementation of National Health Insurance (NHI) in Taiwan was in 1995, and it covered health care for >96% of the population. Using NHI data from 1996 to 2002, we investigated the admission rate, length of stay, cost and the readmission rate of hospitalization with primary diagnosis of asthma in this period. We also compare the difference between the children group (<18 yr old) and adult group (≥18 yr old). The average incidence of hospitalization in the age group below 18 was 105.0 cases per 100,000 children, and was 116.7 per 100,000 population in the adult group during that period. It increased by 6.5% annually in the children group, though it was 0.1% annually in the adult group. The hospitalization days were 3.6 ± 2.4 days in the children group, and were 8.2 ± 8.9 days of those age ≥18 (p < 0.0001). The hospitalization cost was

Clinical features of children with juvenile idiopathic arthritis using the ILAR classification criteria: A community-based cohort study in Taiwan

288.7 ± 

Differences in Disease Features Between Childhood-Onset and Adult-Onset Systemic Lupus Erythematosus Patients Presenting with Acute Abdominal Pain

292.9 and

Early predictors of outcomes in pediatric lupus nephritis: Focus on proliferative lesions

717.5 ± 

Association of disease activity and anti-rheumatic treatment in juvenile idiopathic arthritis with serum lipid profiles: a prospective study.

1409.4, respectively (p < 0.0001). Autumn was the most frequent admission season in the children group, but the winter season was the most common in the adult group. The average readmission rate in this period was 20.4%. It was 13.0% in the children group, and was 22.6% in the adult group (p < 0.0001). The general hospitalization rate of asthma in the children group was lower than the adult group. It increased significantly in the children group from 1996 to 2002, but the admission cost rose prominently in the adult group during the same period. The hospitalization days, admission cost, and readmission rate were also significantly lower in the children group.

The outcome of patients with renal involvement in pediatric-onset systemic lupus erythematosus – a 20-year experience in Asia

BACKGROUND/PURPOSE The aim of the study was to describe the clinical features of children affected by juvenile idiopathic arthritis (JIA) under the International League of Associations for Rheumatology-derived classification criteria in a community-based setting. METHODS Consecutive cases of JIA from defined geographic areas of Taiwan were diagnosed and followed in an observational cohort from 1995 to 2010. In addition to the clinical and laboratory data required for the International League of Associations for Rheumatology system, information about the medication and disease activity during the study period was also recorded. RESULTS Out of 292 children with chronic joint pain, 195 were diagnosed as JIA: systemic arthritis (19%), oligoarthritis (persistent 16.4%; extended 6.7%), polyarthritis rheumatoid factor-negative (11.8%), polyarthritis rheumatoid factor-positive (4.6%), psoriatic arthritis (1.5%), enthesitis-related arthritis (ERA; 37.4%), and undifferentiated arthritis (2.6%). Human leukocyte antigen-B27 was positive in 82.2% of patients with ERA. Uveitis was observed in 6.7% of patients. Disease-modifying anti-rheumatic drugs, including biologic medications, were used in 73.3% of children during the observational period. At the last follow-up, 40% of patients experienced a continuously active or relapsing course. CONCLUSION Compared with previous reports on Western populations, a remarkably high prevalence was found in the ERA of the Chinese cohort, but a relatively low rate of uveitis. Ongoing disease activity was evident in a substantial number of children. These results provided a good starting point in understanding the epidemiology of this serious disease in the Chinese population.