OBJECTIVES: This study examined the association between socioeconomic factors and asthma symptoms. METHODS: A total of 6,919 elementary school children in Seoul were enrolled in the study. Data were obtained from a web-based questionnaire survey. The questionnaire was based on the International Study of Asthma and Allergies in Childhood core module. The prevalence of wheeze in the past 12 months and severe asthma symptoms were obtained. The potential risk factors for asthma symptoms included household income and the number of siblings. A multiple logistic regression analysis was used to calculate the odds ratios (OR) and 95% confidence interval (CI) for the risk factors of asthma symptoms. RESULTS: The prevalence of current wheeze (wheeze in the past 12 months) was 5.2%. Household income and asthma symptoms were inversely associated after adjusting for other potential risk factors (p for trend=0.03). This association was modified by the number of siblings. With two or more siblings, the effect of household income on asthma symptoms was not significant. However, low household income was still a significant variable for patients with fewer than two siblings (OR 1.41; 95% CI, 1.09-1.81). CONCLUSIONS: It appears that childhood asthma disparity is dependent on household income. Therefore, policies to improve childhood health inequities should be emphasized.
Asthma ; Child ; Family Characteristics ; Humans ; Hypersensitivity ; Logistic Models ; Odds Ratio ; Prevalence ; Risk Factors ; Siblings ; Socioeconomic Factors ; Surveys and Questionnaires

No abstract available.
Fetus* ; Heart Rate* ; Heart*

PURPOSE: Allergic disease and its comorbidities significantly influence the quality of life. Although the comorbidities of allergic diseases are well described in adult populations, little is known about them in preschool children. In the present study, we aimed to assess the prevalence and comorbidity of allergic diseases in Korean preschool children. METHODS: We conducted a cross-sectional study comprising 615 Korean children (age, 3 to 6 years). Symptoms of allergic diseases were assessed using the Korean version of the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire that was modified for preschool children. Comorbidities of allergic diseases were assessed by 'In the last 12 months, has your child had symptoms?'. RESULTS: The prevalence of symptoms of asthma, allergic rhinitis, and atopic dermatitis as recorded using the ISAAC questionnaire, within the last 12 months was 13.8%, 40.7%, and 20.8%, respectively. The symptom rates of allergic conjunctivitis, food allergy, and drug allergy were 14.8%, 10.4%, and 0.8%, respectively. The prevalence of allergic rhinitis in children with asthma was 64.3% and that of asthma in children with allergic rhinitis was 21.6%. The prevalence of rhinitis in children with conjunctivitis was 64.8% and that of conjunctivitis in children with rhinitis was 23.6%. CONCLUSION: The prevalence of current rhinitis in our preschool children is shown to be higher than that previously reported. Allergic conjunctivitis is closely associated with asthma and allergic rhinitis. However, further studies are warranted to determine the prevalence and effects of these comorbidities on health outcomes in preschool children.
Adult ; Asthma ; Child ; Child, Preschool ; Comorbidity ; Conjunctivitis ; Conjunctivitis, Allergic ; Cross-Sectional Studies ; Dermatitis, Atopic ; Drug Hypersensitivity ; Food Hypersensitivity ; Humans ; Hypersensitivity ; Prevalence ; Quality of Life ; Surveys and Questionnaires ; Rhinitis ; Rhinitis, Allergic, Perennial

Many patients assume that allergic reactions against foods are responsible for triggering or worsening their allergic symptoms. Therefore, it is important to identify patients who would benefit from an elimination diet, while avoiding unnecessary dietary restrictions. The diagnosis of food allergy depends on the thorough review of the patients's medical history, results of supplemented trials of dietary elimination, and in vivo and in vitro tests for measuring specific IgE levels. However, in some cases the reliability of such procedures is suboptimal. Oral food challenges are procedures employed for making an accurate diagnosis of immediate and occasionally delayed adverse reactions to foods. The timing and type of the challenge, preparation of patients, foods to be tested, and dosing schedule should be determined on the basis of the patient's history, age, and experience. Although double-blind, placebo-controlled food challenges(DBPCFC) are used to establish definitively if a food is the cause of adverse reactions, they are time-consuming, expensive and troublesome for physician and patients. In practice, An open challenge controlled by trained personnel is sufficient especially in infants and young children. The interpretation of the results and follow-up after a challenge are also important. Since theses challenges are relatively safe and informative, controlled oral food challenges could become the measure of choice in children.
Appointments and Schedules ; Child ; Diet ; Follow-Up Studies ; Food Hypersensitivity ; Humans ; Hypersensitivity ; Immunoglobulin E ; Infant

PURPOSE: The purposes of this study were to determine the normal values of spectral and chaotic indexes and to assess the maturational process of autonomic and chaotic control of fetal heart rate according to gestational age. METHODS: Three hundred and thirty-seven mothers with normal singleton pregnancies, who were 23 weeks or more in gestational age, was randomly chosen. For more than 40 minutes fetal heart rates and fetal movements were recorded and were downloaded to a computer. From each heart rate data, we extracted 25 minutes (3,000 points) worth of time series of dimension were calculated and then 2 weeks' average were compared to find the maturational change of them. RESULTS: LF power and LF/HF ratio which are indexes of cardiac sympathetic tone increased significantly (P=0.0001) with gestational age from 23 to 38 weeks. The HF power did not show significant developmental change. Correlation dimension, an index of chaotic control, tended to decrease with the gestational age (P=0.0001). It was 4.07 +/- 0.13 before 24 weeks and, after it reached the peak of 4.15 +/- 0.14 at 31-32 weeks, it gradually decrease to a slight but significant lower value of 3.67 +/- 0.08 at 41-42 weeks. CONCLUSION: Magnitude of cardiac sympathetic modulation increases until 37-38 weeks. On the average, fetal heart rate is regulated at least by four independent variables throughout the gestation and after 23 weeks of gestation. Complexity of heart rate control system peaks at 31-32 weeks then slightly decreases until term gestation, probably to synchronize the heart rate to other physiologic functions.
Female ; Fetal Movement ; Fetus* ; Gestational Age ; Heart Rate* ; Heart Rate, Fetal ; Heart* ; Humans ; Mothers ; Pregnancy ; Reference Values

PURPOSE: We assessed the usefulness of the Korean Infant and Child Developmental Screening Test(KICDT) by applying the test to children with epilepsy, identifying developmental delay and analyzing the results of the test based on the various factors that influence development. METHODS: The KICDT was performed on two hundred and eighty-seven children who were diagnosed with epilepsy at Asan Medical Center in Seoul, Korea, from March, 2005 to December, 2009. Utilizing chart review, we compared the causes of epilepsy, the specific diagnosis, the types of treatment, and the developmental quotient as a result of the treatments. The data and results were analyzed using SPSS. RESULTS: Children with epilepsy had significantly lower KICDT scores in all areas which differed according to seizure etiology, specific diagnosis and types of treatment(P<0.01). Also, children with poor seizure control had lower KICDT scores(P<0.01) indicating a good correlation between the KICDT scores and the results of treatments. CONCLUSION: The KICDT was useful in assessing the developmental status of children diagnosed with epilepsy.
Child ; Child Development ; Epilepsy ; Humans ; Infant ; Korea ; Mass Screening ; Seizures

PURPOSE: Two different disorders, Prader-Willi syndrome (PWS) and Angelman syndrome (AS) are caused by the deletion of 15q11-13 or the maternal/paternal uniparental disomy of chromosome 15 (mUPD(15)/pUPD(15)) through the genomic imprinting phenomenon. We studied the clinical manifestations of both diseases and genotype-phenotype correlations in PWS. METHODS: We retrospectively analyzed medical records of patients who had been genetically confirmed as PWS or AS from December 1998 to March 2010 at Asan Medical Center. Clinical characteristics at diagnosis and genetic causes were reviewed. In PWS, clinical characteristics of the patients with microdeletions were compared with those with mUPD(15). RESULTS: During the study period, we found 90 patients with PWS and 30 with AS. In cases of PWS, the male to female ratio was 1.65:1 and the mean age at initial diagnosis was 41 months. Symptoms at first diagnosis were hypotonia (70 cases) and developmental delay (66 cases). More hypopigmentation and eye abnormalities occurred in the microdeletion group (n=62) than in the mUPD(15) group (n=21). In AS, the male to female ratio was 1.3:1 and the mean age at initial diagnosis was 23 months. Distinguishing symptoms were speech impairment, seizure, and behavioral uniqueness. Microdeletion by FISH was detected in 19 patients among 20 patients and one of the non-deletion patient showed pUPD(15) on a DNA methylation test. CONCLUSION: PWS and AS, two distinct neurogenetic disorders with different clinical presentations were the first known examples of human diseases involving imprinted genes. This study about clinical characteristics and genetic analysis of PWS and AS may help our understanding of these diseases and thus, assist in making correct diagnoses.
Angelman Syndrome ; Chromosomes, Human, Pair 15 ; DNA Methylation ; Eye Abnormalities ; Female ; Genetic Association Studies ; Genomic Imprinting ; Humans ; Hypopigmentation ; Male ; Medical Records ; Muscle Hypotonia ; Prader-Willi Syndrome ; Retrospective Studies ; Seizures ; Uniparental Disomy

PURPOSE: Leukodystrophies have been defined as inherited metabolic disorders of myelin resulting in abnormal development or progressive destruction of the white matter. This study was performed to investigate the clinical manifestations and treatments of leukodystrophies in a single Korean tertiary center. METHODS: We retrospectively analysed the medical records of patients who had been diagnosed with leukodystrophy from May 1995 to May 2010 at the Asan Medical Center. RESULTS: During the 15-year study period, 36 cases of leukodystrophies were diagnosed with an verage age at symptom presentation of 49 months. Prominent symptoms at presentation were developmental delay (41%) and seizure (25%); however, nystagmus, developmental regression, hearing loss, gait disturbance, visual disturbance, attention deficit, hypotonia, hyperpigmentation, and hemiparesis were also observed. On MRI, periventricular involvement was noted frequently. The most common diagnoses were adrenoleukodystophy (25%), metachromatic leukodystrophy (11%), Krabbe disease (11%), and Pelizaeus-Merzbacher disease (8.3%). No final diagnosis was made in 14 cases (41%). Bone marrow transplantation was performed in 4 patients and showed favorable prognoses. CONCLUSION: Clinical features of leukodystrophies are not specific to diagnosis and most leukodystrophies remain undiagnosed; however, a logical algorithm based on prevalence could aid the laboratory testing. Because early detection and diagnosis is crucial for treatment and prognosis, it is important to have a high index of suspicion and watchful screening of familial history.
Adrenoleukodystrophy ; Bone Marrow Transplantation ; Canavan Disease ; European Continental Ancestry Group ; Gait ; Hearing Loss ; Humans ; Hyperpigmentation ; Leukodystrophy, Globoid Cell ; Leukodystrophy, Metachromatic ; Logic ; Mass Screening ; Medical Records ; Muscle Hypotonia ; Myelin Sheath ; Paresis ; Pelizaeus-Merzbacher Disease ; Prevalence ; Prognosis ; Retrospective Studies ; Seizures

Pelizaeus-Merzbacher disease (PMD) is a rare, X-linked recessive disorder characterized by dysmyelination in the central nervous system. PMD results from deletion, mutation, or duplication of the proteolipid protein gene (PLP1) located at Xq22, leading to the failure of axon myelination by oligodendrocytes in the central nervous system. PMD may be suspected when there are clinical manifestations such as nystagmus, developmental delays, and spasticity, and genetic analysis can confirm the diagnosis. Further diagnostic manifestations of the disease include a lack of myelination on brain magnetic resonance (MR) imaging and aberrant N-acetyl aspartate (NAA) and choline concentrations that reflect axonal and myelination abnormalities on phroton MR spectroscopy. We report 5 cases of PMD (in 1 girl and 4 boys). PLP1 duplication was detected in 2 patients. Brain MR analyses and MR spectroscopy were performed for all the patients. The brain MR images showed white matter abnormalities typical of PMD, and the MR spectroscopic images showed diverse patterns of NAA, creatinine, and choline concentrations. We propose that MR spectroscopic analysis of metabolic alterations can aid the PMD diagnosis and can contribute to a better understanding of the pathogenesis of the disease.
Aspartic Acid ; Axons ; Brain ; Central Nervous System ; Choline ; Creatinine ; Humans ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Muscle Spasticity ; Myelin Sheath ; Oligodendroglia ; Pelizaeus-Merzbacher Disease

PURPOSE: The clinical interpretation of children sensitized to allergens is challenging, particularly in children with food allergies. We aimed to examine clinical differences between children with monosensitization and those with polysensitization to common food allergens and to determine risk factors for polysensitization in young children <10 years of age with immediate-type food allergies. METHODS: The study included children <10 years of age with signs and symptoms indicative of immediate-type food allergies. Serum total IgE level was measured, and ImmunoCAP analysis for food allergens was performed. RESULTS: The mean age of the study subjects was 1.6+/-1.6 years (75 boys and 51 girls). Thirty-eight children (30.2%) were monosensitized and 88 children (69.8%) were polysensitized. Multivariate logistic regression analysis showed that the development of polysensitization to common food allergens was positively associated with a parental history of allergic rhinitis (adjusted odds ratio [aOR], 6.28; 95% confidence interval [CI], 1.78-22.13; P=0.004), season of birth (summer/fall) (aOR, 3.10; 95% CI, 1.10-8.79; P=0.033), and exclusive breastfeeding in the first 6 months of age (aOR, 3.51; 95% CI, 1.20-10.25; P=0.022). CONCLUSION: We found significant clinical differences between children with monosensitization and those with polysensitization to common food allergens and identified risk factors for the development of polysensitization in young children with immediate-type food allergies. Clinicians should consider these clinical risk factors when evaluating, counseling, treating, and monitoring young children with food allergies.
Allergens ; Breast Feeding ; Child* ; Counseling ; Food Hypersensitivity* ; Humans ; Immunoglobulin E ; Logistic Models ; Odds Ratio ; Parents ; Parturition ; Rhinitis ; Risk Factors ; Seasons