加拿大努纳武特地区因纽特人儿童的头围数值:一项回顾性队列研究。

IF 9.4 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Kristina May Joyal, Sorcha Collins, Amber Miners, Nick Barrowman, Ewa Sucha, Jean Allen, Sharon Edmunds, Amy Caughey, Michelle Doucette, Selina Khatun, Gwen Healey Akearok, Laura Arbour, Sunita Venkateswaran
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引用次数: 0

摘要

背景:据观察,努纳武特地区的因纽特人儿童患有巨头畸形的比例很高,这有时会导致他们不得不长途跋涉进行医疗评估,而评估结果往往无法确定病因。鉴于有报道称世界卫生组织(WHO)的生长图表可能无法反映所有人群的情况,我们试图将因纽特人儿童队列的头围测量结果与世界卫生组织的图表进行比较:我们从之前的一项回顾性队列研究中提取了头围数据。在这项研究中,我们与因纽特人合作,审查了 2010 年 1 月 1 日至 2013 年 12 月 31 日期间出生并居住在努纳武特地区的因纽特人儿童(从出生到 5 岁)的医疗记录。为了建立一个与世卫组织生长图表制定过程中使用的人群相似的因纽特人儿童人群,我们排除了早产、有记录的神经或遗传疾病以及大多数先天畸形的儿童。我们使用广义加法模型估算的百分位数将头围值与 2007 年世界卫生组织图表进行了比较:我们分析了 1960 名因纽特儿童的记录(8866 个数据点),其中 993 名(50.8%)为女性。大部分数据来自 0 到 36 个月大的儿童。我们发现,在所有年龄点上,研究对象的头围在统计学上都明显大于世界卫生组织的中位数,因纽特人儿童头围测量的 z 值大多比世界卫生组织的参考值高出 0.5-1 个标准差(p < 0.001)。在 12 个月大时,因纽特男童和女童的头围中位数分别大 1.3 厘米和 1.5 厘米。根据世界卫生组织的生长曲线,巨头畸形的诊断率明显偏高,而小头畸形的诊断率偏低(p < 0.001):我们的研究结果支持这一观点,即努纳武特地区的因纽特人儿童的头围大于其他人群,因此使用世界卫生组织的图表可能会导致巨头畸形的过度诊断和小头畸形的诊断不足。应考虑因纽特人儿童的特定人口生长曲线,以便及时、适当地诊断小头畸形,避免过度调查大头畸形。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Head circumference values among Inuit children in Nunavut, Canada: a retrospective cohort study.

Background: Inuit children from Nunavut have been observed to have high rates of macrocephaly, which sometimes leads to burdensome travel for medical evaluation, often with no pathology identified upon assessment. Given reports that World Health Organization (WHO) growth charts may not reflect all populations, we sought to compare head circumference measurements in a cohort of Inuit children with the WHO charts.

Methods: We extracted head circumference data from a previous retrospective cohort study where, with Inuit partnership, we reviewed medical records of Inuit children (from birth to age 5 yr) born between Jan. 1, 2010, and Dec. 31, 2013, and residing in Nunavut. To create a cohort of Inuit children similar to the cohorts used in the development of the WHO growth charts, we excluded children with preterm birth, documented neurologic or genetic disease, and most congenital anomalies. We compared head circumference values with the 2007 WHO charts using centiles estimated with a generalized additive model.

Results: We analyzed records of 1960 Inuit children (8866 data points), of whom 993 (50.8%) were female. Most data were from ages 0 to 36 months. At all age points, we found that the study cohort had statistically significantly larger head circumferences than WHO medians, with most z scores for head circumference measurements among Inuit children falling 0.5-1 standard deviations above the WHO reference (p < 0.001). At age 12 months, median head circumferences were 1.3 cm and 1.5 cm larger for male and female Inuit children, respectively. Using WHO growth curves, macrocephaly was significantly overdiagnosed and microcephaly was underdiagnosed (p < 0.001).

Interpretation: Our results support the observation that Inuit children from Nunavut have larger head circumferences than other populations, and use of the WHO charts may thus lead to overdiagnosis of macrocephaly and underdiagnosis of microcephaly. Population-specific growth curves for Inuit children should be considered to provide timely and appropriate diagnoses of microcephaly and avoid overinvestigation of macrocephaly.

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来源期刊
Canadian Medical Association journal
Canadian Medical Association journal 医学-医学:内科
CiteScore
8.30
自引率
4.10%
发文量
481
审稿时长
4-8 weeks
期刊介绍: CMAJ (Canadian Medical Association Journal) is a peer-reviewed general medical journal renowned for publishing original research, commentaries, analyses, reviews, clinical practice updates, and editorials. Led by Editor-in-Chief Dr. Kirsten Patrick, it has a significant impact on healthcare in Canada and globally, with a 2022 impact factor of 17.4. Its mission is to promote knowledge vital for the health of Canadians and the global community, guided by values of service, evidence, and integrity. The journal's vision emphasizes the importance of the best evidence, practice, and health outcomes. CMAJ covers a broad range of topics, focusing on contributing to the evidence base, influencing clinical practice, and raising awareness of pressing health issues among policymakers and the public. Since 2020, with the appointment of a Lead of Patient Involvement, CMAJ is committed to integrating patients into its governance and operations, encouraging their content submissions.
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