JAMA Pediatrics最新文献

Importance: Environmental heat and cold exposure (EHCE) remains the principal preventable cause of morbidity and mortality in children and adolescents globally.

Objective: To report EHCE-related burden and analyze its temporal trends among children and adolescents from 1990 to 2019.

Design, setting, and participants: This repeated cross-sectional study used data from the Global Burden of Disease Study 2019, which encompassed 204 countries and territories from 1990 to 2019. Children and adolescents aged 0 to 19 years were included in the study. Data analysis occurred from December 2023 to March 2024.

Exposure: EHCE in children and adolescents from January 1990 to December 2019.

Main outcomes and measures: The primary outcomes were cases and rates of EHCE incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and average annual percentage changes (AAPCs). Global trends in these metrics were also analyzed by sex, age, and sociodemographic index (SDI), which is a comprehensive indicator of the socioeconomic status of a country or region. A linear regression model was used to calculate AAPCs and a joinpoint regression model was used to identify the years in which trends changed significantly.

Results: From 1990 to 2019, EHCE-related incidence, prevalence, mortality, and DALYs showed a downward trend globally. However, an upward trend in EHCE incidence and prevalence was detected between 2010 and 2019 (incidence AAPC, 1.46; 95% CI, 1.05-1.87; prevalence AAPC, 1.25; 95% CI, 1.01-1.50). Regionally, although EHCE-related incidence showed a decreasing trend in most regions from 1990 to 2019, there were still some regions with an increasing trend (Southern sub-Saharan Africa AAPC, 0.23; 95% CI, 0.01-0.44). In 2019, the mortality and DALYs of EHCE were higher among children and adolescents in countries with low SDI levels. Additionally, the burden of EHCE among children and adolescents varied according to sex and age.

Conclusions and relevance: In this cross-sectional study, a global increase was observed in EHCE incidence and prevalence since 2010. Furthermore, children and adolescents in low-SDI regions, which bear the brunt of the climate crisis, were disproportionately impacted. This suggests that future responses to climate change crises should emphasize health equity, which implies that vulnerable populations, such as children and adolescents, should be given priority in the allocation of resources to address climate change.

Importance: A meta-analysis published in 2001 suggested that exposure to infections measured by day care attendance may be important in the pathogenesis of type 1 diabetes. Several new studies on the topic have since been published.

Objective: To investigate the association between day care attendance and risk of type 1 diabetes and to include all available literature up to March 10, 2024.

Data sources: Data from PubMed and Web of Science were used and supplemented by bibliographies of the retrieved articles and searched for studies assessing the association between day care attendance and risk of type 1 diabetes.

Study selection: Studies that reported a measure of association between day care attendance and risk of type 1 diabetes were included.

Data extraction and synthesis: Details, including exposure and outcome assessment and adjustment for confounders, were extracted from the included studies. The multivariable association with the highest number of covariates, lowest number of covariates, and unadjusted estimates and corresponding 95% CIs were extracted. DerSimonian and Laird random-effects meta-analyses were performed and yielded conservative confidence intervals around relative risks.

Main outcomes and measures: The principal association measure was day care attendance vs no day care attendance and risk of type 1 diabetes.

Results: Seventeen articles including 22 observational studies of 100 575 participants were included in the meta-analysis. Among the participants, 3693 had type 1 diabetes and 96 882 were controls. An inverse association between day care attendance and risk of type 1 diabetes was found (combined odds ratio, 0.68; 95% CI, 0.58-0.79; P < .001; adjusted for all available confounders). When the 3 cohort studies included were analyzed separately, the risk of type 1 diabetes was 15% lower in the group attending day care; however, the difference was not statistically significant (odds ratio, 0.85; 95% CI, 0.59-1.12; P = .37).

Conclusions and relevance: These results demonstrated that day care attendance appears to be associated with a reduced risk of type 1 diabetes. Increased contacts with microbes in children attending day care compared with children who do not attend day care may explain these findings. However, further prospective cohort studies are needed to confirm the proposed association.