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The effects of academic achievement may extend beyond economic success to influence social functioning, including future parenting. To evaluate whether adolescent academic achievement forecasts future parenting (both positive and negative) and the family home environment of parents. We used prospectively gathered intergenerational data from a population‐based birth cohort born in 1972/1973 in Dunedin, New Zealand, including data from Generation 1 (parents of the birth cohort), the birth cohort (Generation 2; G2), and G2's children (Generation 3). Adolescent academic achievement in G2 was used to predict observed and reported parenting outcomes when offspring (G3) were aged 3 years after controlling for a range of covariates, including G2's adolescent wellbeing, early childhood socioeconomic status (collected from G1), and G2's age at child's birth. We also evaluated 2‐way interactions between academic achievement and G2 parent sex, G3 child behaviour, and G2 adolescent wellbeing. Greater G2 academic achievement, net of controls, predicted more positive and less negative parenting (for mothers only), and a more positive home environment. For the home environment outcome, the effect of adolescent academic achievement was moderated by wellbeing. Adolescent academic achievement may positively influence parenting behaviour and the quality of the home environment. [ABSTRACT FROM AUTHOR]

Summary: BACKGROUND: Economic wealth and income inequality may impact on childhood BMI distribution by affecting overconsumption of food and sedentary forms of transportation and entertainment across the whole or some of the population. OBJECTIVES: To determine whether BMI distribution of children differs by gross national income (GNI) per capita and Gini index derived from World Bank data. METHODS: Secondary analysis of largely self‐reported height and weight data from a multi‐country, cross‐sectional study (ISAAC), of 77,963 children aged 6–7 (from 19 countries) and 205,388 adolescents aged 13–14 (from 36 countries), were used to examine underweight vs obesity prevalence and BMI distribution skewness, median and dispersion. RESULTS: Children and adolescents from ‘lower’ GNI countries had higher prevalence of underweight than those from ‘higher’ GNI countries (6% vs 3%, p = 0.03; 2% vs 1%, p = 0.05 respectively), but the prevalence of obesity was not different (2% vs 5%, p = 0.29; 2% vs 2%, p = 0.66). BMI distribution of participants from ‘higher’ GNI countries had higher median, without significant difference in skewness or dispersion compared to ‘lower’ GNI countries (higher medians +1.1 kg/m2 for 6–7 year olds, and + 0.7 kg/m2, +1.2 kg/m2 for 13–14 year old girls and boys respectively). Gini index was not associated with underweight or obesity prevalence in either children or adolescents, nor with any BMI distribution characteristics with one exception. Adolescent girls from higher income inequality countries had a greater median BMI (+0.7 kg/m2) and a less skewed BMI distribution. CONCLUSIONS: It appears that the obesogenic impact of economic prosperity affects all children similarly. Income inequality may have a gender specific effect affecting BMI distribution in adolescent girls. [ABSTRACT FROM AUTHOR]

Background The reported association between birth weight and subsequent body mass index (BMI) is conflicting. Objectives To examine the relationship between birth weight and BMI in children aged 6-7 years. Methods Secondary analysis of data from a multi-centre, multi-country, cross-sectional study (International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three). Parents/guardians of children aged 6-7 years completed questionnaires about their children's birth weight, current height and weight and whether their mother smoked in the first year of the child's life. A general linear mixed model was used to determine the association between BMI and birth weight. Results A total of 72 111 children (17 countries) were included in the analysis. There was a positive association of birth weight with BMI (for each kg increase in birth weight the BMI at 6-7 increased by 0.47 (SE 0.02) kg/m2; p < 0.0001) with a clear gradient by birth weight category. There was no statistically significant interaction between birth weight and Gross National Income (GNI). Conclusions There is a positive linear relationship between birth weight and BMI in 6-7 year old children, which is present in both high and low income countries. [ABSTRACT FROM AUTHOR]

Background Breastfeeding is believed to reduce children's risk for obesity but data are conflicting. It is also uncertain if breastfeeding has different effects on obesity in high- and low-income countries. Objectives This study aimed to investigate the association between having been breastfed and body mass index ( BMI) in 6- to 7-year-old children in a large international survey. Methods Parents/guardians reported whether their child had been breastfed and their current height and weight. Some centres measured height and weight directly. Analyses adjusted for whether height and weight were reported or measured, child's age, sex, country gross national income and centre. Results Data were available for 76 635 participants from 31 centres in 18 countries. Reported breastfeeding rates varied from 27 to 98%. After adjusting for potential confounders, the estimated BMI difference was 0.04 kg m−2 lower among those who had been breastfed ( P = 0.07). The risk for being overweight or obese was slightly lower among breastfed children (odds ratio = 0.95, P = 0.012). There was no evidence that the association between breastfeeding and BMI was different in lower income countries compared with higher income countries. Conclusions The findings suggest that breastfeeding has little impact on children's BMI. Increasing breastfeeding is unlikely to reduce the global epidemic of childhood obesity. [ABSTRACT FROM AUTHOR]

Elevated levels of B-type natriuretic peptides among patients with exacerbations of chronic obstructive pulmonary disease ( COPD) are associated with higher mortality. The pathophysiology is unclear. To establish if elevated levels of N-terminal pro- B-type natriuretic peptide ( NT- proBNP) are due to right or left heart dysfunction, we performed echocardiograms in 18 patients admitted to hospital with COPD. Elevated levels of NT- proBNP were associated with both right and left heart dysfunction and indicate that these patients have biventricular dysfunction rather than isolated right ventricular compromise. [ABSTRACT FROM AUTHOR]

Background Studies indicate an increased risk of allergies among children born by caesarean section, possibly because immune development is altered by avoiding exposure to maternal vaginal flora. It is unknown if other obstetric interventions are associated with allergies. Objective To assess associations between delivery with forceps assistance and development of atopy and asthma. Methods In a population-based cohort of 1037 individuals born in 1972/73, atopy was assessed by skin-prick tests for common allergens at ages 13 and 32 years. A history of asthma was obtained at the same ages. Associations between birth with forceps assistance, atopy and asthma were assessed with adjustments for sex, head circumference at birth, parental atopy disease, birth order and socio-economic status. Results Children born using forceps were more likely to have atopy at ages 13 (53% vs. 44%) and 32 (68% vs 59%). They were also more likely to have asthma (21% vs. 11% and 23% vs. 16% at ages 13 and 32 respectively). Except for asthma at age 13, these associations were not statistically significant after adjustment for multiple confounding factors. Conclusions & Clinical Relevance Delivery with forceps assistance is associated with an increased risk of atopy and asthma, but the associations were weaker after adjustment for confounding factors. The previously reported association between caesarean birth and atopic disease may be due to confounding rather than altered exposure to maternal flora, although other factors associated with a difficult labour cannot be ruled out. [ABSTRACT FROM AUTHOR]

Background: Patients with chronic obstructive pulmonary disease (COPD) often have co-existing cardiovascular disease and may require beta-blocker treatment. There are limited data on the effects of beta-blockers on the response to inhaled β2-agonists and exercise capacity in patients with COPD. Objective: To determine the effects of different doses of cardio-selective and non-selective beta-blockers on the acute bronchodilator response to beta-agonists in COPD, and to assess their effects on exercise capacity. Methods: A double-blind, randomized, three-way cross-over (metoprolol 95 mg, propranolol 80 mg, placebo) study with a final open-label high-dose arm (metoprolol 190 mg). After 1 week of each treatment, the bronchodilator response to salbutamol was measured after first inducing bronchoconstriction using methacholine. Exercise capacity was assessed using the incremental shuttle walk test. Results: Eleven patients with moderate COPD were recruited. Treatments were well-tolerated although two did not participate in the high-dose metoprolol phase. The area under the salbutamol–response curve was lower after propranolol compared with placebo ( P = 0.0006). The area under the curve also tended to be lower after high-dose metoprolol ( P = 0.076). The per cent recovery of the methacholine-induced fall was also lower after high-dose metoprolol ( P = 0.0018). Low-dose metoprolol did not alter the bronchodilator response. Oxygen saturation at peak exercise was lower with all beta-blocker treatments ( P = 0.046). Conclusion: Non-selective beta-blockers and high doses of cardio-selective beta-blockers may inhibit the bronchodilator response to β2-agonists in patients with COPD. Beta-blockers were also associated with lower oxygen saturation during exercise. The clinical significance of these adverse effects is uncertain in view of the benefits of beta-blocker treatment for cardiovascular disease. [ABSTRACT FROM AUTHOR]

Background: To date, longitudinal studies of medications have been confined to older adults or clinical samples, with no data from prospective studies of younger adults. The aim of the study was to examine changes in medication usage between ages 26 and 32 in a prospective study of a representative birth cohort. Methods: Medication use during the previous 2 weeks was investigated among 960 individuals at ages 26 and 32. Results: Nearly two-thirds took at least one medication at each age, with medication prevalence higher among women than among men. Three-quarters of those taking at least one at age 26 were doing so at 32. Over-the-counter medication prevalence increased from 35 to 43% between 26 and 32 years of age. Although the prevalence of prescribed medications decreased (from just under half to just over one-third, and from two-thirds to below half among women), there was no significant difference between the ages once hormonal contraceptives were accounted for. By 32, reduced usage of hormonal contraceptives was apparent, with one-third of age-26 users still taking these at 32. Other categories showing major changes were analgesics (increased), anti-asthma drugs (decreased), antidepressants (increased) and antiulcer drugs (increased). At 32, 82% of those taking analgesics, 85% of those taking nutrient supplements, 71% of those taking antihistamines and 33% of those taking antiulcer drugs had self-prescribed them. Conclusion: A considerable proportion of the sample used medications by age 32, and there was considerable change between 26 and 32. The changes are likely to have been due to a mix of ageing and period effects. [ABSTRACT FROM AUTHOR]

Background: Despite the publication of several management guidelines for exacerbations of chronic obstructive pulmonary disease (COPD), there is little information on standards of care in clinical practice. The aim of this audit was to examine the assessment, management and outcome of COPD admissions to a secondary and tertiary referring New Zealand hospital during two different seasons. Compliance to current recommendations was examined and compared with the available international published work. Methods: All COPD-related admissions to Waikato Hospital during the months of May and October 2004 were reviewed. Ninety-four cases (from 84 patients) were audited. Results: General characteristics, clinical features and lung function tests were similar to that of other cohorts. Twenty-three per cent of the admissions were Maori and the mean age of Maori admissions were significantly less than that of the non-Maori admissions (57 and 72 years, respectively; P = 0.0001). The geometric mean length of stay was 3.4 days, which is significantly less than most other reported hospital lengths of stays related to exacerbations of COPD. Fifty-five per cent of the cohort was admitted more than once to the hospital for COPD in the 12 months before the index admission. Thirteen per cent of all admissions received assisted ventilation. Overall 30-day mortality was 8% and the 12-month mortality was 31%. Decreased body mass index was a risk factor for death as was an increased CURB-65 (confusion, urea, respiratory rate, blood pressure age) score – a simple bedside assessment score, which has previously been used to predict mortality in patients with community-acquired pneumonia. Conclusion: This audit documented the general characteristics, assessment, management and outcome of the COPD admissions to a secondary New Zealand hospital. Further investigations into factors contributing to shorter length of stay and predictors of mortality are needed. [ABSTRACT FROM AUTHOR]

Cite this as: R. J. Hancox and R. Beasley, Clinical & Experimental Allergy, 2010 (40) 1717-1718. [ABSTRACT FROM AUTHOR]

A response by C. L. Chang and R. J. Hancox to a letter to the editor about their article on acute admissions for chronic obstructive pulmonary disease (COPD) that was published in the previous issue is presented.