Study protocol. The Childhood Health, Activity, and Motor Performance School Study Denmark (The CHAMPS-study DK)

ABSTRACT: BACKGROUND: An increasingly passive life-style in the Western World has led to a rise in life-style related disorders. This is a major concern for all segments of society. The county council of the municipality of Svendborg in Denmark, created six Sport Schools with increased levels of suitable physical activities, which made it possible to study the health outcomes in these children whilst comparing them to children who attended the 'normal' schools of the region using the design of a "natural experiment". METHODS: Children from the age of 6 till the age of 10, who accepted to be included in the monitoring process, were surveyed at baseline with questionnaires, physical examinations and physical and biological testing, including DXA scans. The physical examination and testing was repeated during the early stage of the study. Every week over the whole study period, the children will be followed with an automated mobile phone text message (SMS-Track) asking questions on their leisure time sports activities and the presence of any musculoskeletal problems. Children who report any such problems are monitored individually by health care personnel. Data are collected on demography, health habits and attitudes, physical characteristics, physical activity using accelerometers, motor performance, fitness, bone health, life-style disorders, injuries and musculoskeletal problems. Data collection will continue at least once a year until the children reach grade 9. DISCUSSION: This project is embedded in a local community, which set up the intervention (The Sport Schools) and thereafter invited researchers to provide documentation and evaluation. Sport schools are well matched with the 'normal' schools, making comparisons between these suitable. However, subgroups that would be specifically targeted in lifestyle intervention studies (such as the definitely obese) could be relatively small. Therefore, results specific to minority groups may be diluted. Nonetheless, the many rigorously collected data will make it possible to study, for example, the general effect that different levels of physical activity may have on various health conditions and on proxy measures of life-style conditions. Specifically, it will help answer the question on whether increased physical activity in school has a positive effect on health in children.     

Secondary conditions of the musculoskeletal system in adolescents and adults with cerebral palsy

Cerebral palsy (CP) is a disability that affects individuals throughout their lifespan. Adolescents and adults with CP are at risk for many secondary conditions that cause a loss of function and deterioration of quality of life. This article presents a review of the literature of musculoskeletal conditions of people with CP that can develop or worsen across the lifespan as a consequence of the primary neuromotor impairments. Health care behaviors of adolescents and adults with CP are discussed and their impact on secondary conditions is examined. Suggestions for how pediatric occupational therapists and physical therapists can assist children and adolescents to take responsibility for their own health and wellbeing are presented. Lastly, occupational therapists and physical therapists are encouraged to take responsibility for treating musculoskeletal impairments and disabilities in adults with CP.     

Prevalence of complementary and alternative medicine and use among children in South Australia

AIM: To determine the use of complementary and alternative medicines and therapies (CAM) and common treatment modalities in children. METHODS: This is a cross-sectional, population-based survey of 2985 adult and 911 children aged 15 years or less, conducted in South Australia in Spring 2004. The outcome measures are CAM use in children in the previous 12 months. RESULTS: Overall, the 12-month prevalence of CAM use in children was 18.4% (95% confidence interval 15.9-21.0). A wide variety of CAM modalities were used by children including ingestible therapies (33%), chiropractic (34%) and massage (20%). Common reasons for use of CAM were to prevent illness or to maintain health (39%) and for musculoskeletal conditions (22%), respiratory problems (20%) and skin complaints (18%). There was little difference in the use of CAM treatment modality across child ages. CONCLUSION: Approximately one in five children used CAM in the past 12 months in South Australia. Our findings further highlight the importance of increasing public awareness about the need to inform doctors and primary health-care providers of CAM use in children. Health professionals working with children should ask parents about their children's use of CAM. There is a need for further research examining the safe and judicious use of CAM in children.     

Physical function assessment tools in pediatric rheumatology

Pediatric rheumatic diseases with predominant musculoskeletal involvement such as juvenile idiopathic arthritis (JIA) and juvenile dermatomyositis(JDM) can cause considerable physical functional impairment and significantly affect the children's quality of life (QOL). Physical function, QOL, health-related QOL (HRQOL) and health status are personal constructs used as outcomes to estimate the impact of these diseases and often used as proxies for each other. The chronic, fluctuating nature of these diseases differs within and between patients, and complicates the measurement of these outcomes. In children, their growing needs and expectations, limited use of age-specific questionnaires, and the use of proxy respondents further influences this evaluation. This article will briefly review the different constructs inclusive of and related to physical function, and the scales used for measuring them. An understanding of these instruments will enable assessment of functional outcome in clinical studies of children with rheumatic diseases, measure the impact of the disease and treatments on their lives, and guide us in formulating appropriate interventions.     

Health care use by children receiving mental health services

Reduction in medical care utilization is one criteria for assessing the impact of mental health treatment for children with psychosocial problems. This reduction has been termed the "offset" effect. Almost all published research concerning offset after mental health treatment concerns adults, and the few studies in pediatric populations are limited by methodologic problems. A study of health care utilization after mental health treatment for children was conducted. Mental health treatment for psychosocial problems was significantly associated with decreased use of medical care only for older children, after potentially confounding variables were controlled for. Furthermore, this decreased use was found only for nonmental health specialty care visits. No reduction in primary care visits occurred. Other factors such as previous patterns of use and the presence of other morbidity were stronger predictors of subsequent primary health care use than was mental health treatment. Mental health treatment does not have a major impact on the high utilization of most children with psychosocial problems in pediatric settings. Because the reasons for this may be particular morbidity patterns in these children, future studies should include some measure of case mix as a potentially important variable in assessment of mental health treatment effects.     

Annotation: Pathways to care for children with mental health problems

BACKGROUND: Although many children with mental health problems are in contact with primary health care services, few receive appropriate help. METHODS: Using a pathways to care model, this paper systematically reviews the literature relating to access to services. It separates out the various stages of help-seeking: parental perception of problems, use of primary care services, recognition within primary care, and referral to or use of specialist health services. RESULTS: Following parental awareness of child symptoms, parental perception of problems is the key initial step in the help-seeking process. Although children with mental health problems or disorders are regular attenders within primary care and most parents acknowledge that it is appropriate to discuss concerns about psychosocial issues in this setting, few children are presented with mental health symptoms even if their parents have such concerns. Subsequently, less than half of children with disorders are recognised in primary care. Amongst recognised children, about half are referred to specialist services. Overall, up to one-third of children with disorders receive services for mental health problems. Factors such as the type and severity of disorder, parental perceptions, child age and gender, and family and social background factors determine which affected children access services. CONCLUSIONS: As there are inequities in patterns of service use, a greater emphasis on developing resources at population and primary care levels is required. Barriers involving parental perceptions and expression of concerns within consultations should be minimised at these levels. This requires both public education approaches and improved training and specialist support for primary care services to enhance their ability to provide for these children.     

Hypertension, sports supplements and motivational interviewing

PURPOSE OF REVIEW: This article is intended to review the recent literature on three topics that are very important in pediatric office practice: hypertension, sports supplements and motivational interviewing. Review of current literature will help pediatricians understand current data on the epidemiology and pathophysiology of hypertension, as well as new diagnostic tools and criteria. This article also provides practitioners with a summary of the most current literature on sports supplements. We conclude with a summary of recent studies evaluating the utility of motivational interviewing in the primary care setting. RECENT FINDINGS: Recent literature demonstrates the increasing prevalence of pediatric hypertension, as well as new insight into the pathophysiology. Current literature also suggests that sports-supplement use by children is on the rise. Recent literature emphasizes the need for pediatric practitioners to become proficient in motivational interviewing as a method to decrease health-risk behaviors and increase adherence to treatment plans by their patients. SUMMARY: Hypertension and sports-supplement use are both extremely common problems which negatively impact the lives of children and adolescents. Practitioners must acquire strategies such as motivational interviewing to aid their patients and families with behavior change in order to combat health problems related to behavior.     

Screening for childhood mental health problems: outcomes and early identification

Background: Many childhood psychiatric problems are transient. Consequently, screening procedures to accurately identify children with problems unlikely to remit and thus, in need of intervention, are of major public health concern. This study aimed to develop a universal school‐based screening procedure based on the answers to three questions: (1) What are the broad patterns of mental health problems from kindergarten to grade 5? (2) What are the grade 5 outcomes of these patterns? (3) How early in school can children likely to develop the most impairing patterns be identified accurately? Methods: Mothers and teachers reported on a community sample (N = 328) of children’s internalizing and externalizing symptoms in kindergarten and grades 1, 3, and 5. In grade 5, teachers reported on children’s school‐based functional impairments, physical health problems, and service use; mothers reported on children’s specialty mental health care. Results: Four patterns distinguished children who (1) never evidenced symptoms; (2) evidenced only isolated symptoms; or evidenced recurrent symptoms, either (3) without or (4) with comorbid internalizing and externalizing. By grade 5, children with recurrent comorbid symptoms had the greatest impairments, physical health problems, and service use. These children can be identified quite accurately by grade 1. Conclusions: Universal screening at school entry can effectively identify children likely to develop recurrent comorbid symptoms, and would provide a basis for developing optimal targeted intervention programs.     

Patienten/-innen am Rande des Gesundheitswesens

Patient groups without lobbies are those that experience most problems related to ill-balanced distribution policies concerning public health services. This particularly applies to children and adolescents with mental health problems, often living (with their families) under rather precarious conditions. This article attempts to shed some light on the scope of health care services for this group in Austria. Given the Austrian situation, which is characterised by a major lack of adequate services for mentally impaired children and adolescents, international health care standards for this young patient group have not been met by far. Hence, families with children and adolescents with special (mental) needs often face situations they cannot deal with or which they cannot afford. Against this backdrop, current distribution policies in the context of health care services need to be re-designed and politicians called to take concerted action in favour of deprived patient groups.     

CPIPS: musculoskeletal and hip surveillance for children with cerebral palsy

CPIPS (Cerebral Palsy Integrated Pathway Scotland) provides access for all children with cerebral palsy (CP) aged between 2 and 16 years in Scotland for a standardized musculoskeletal examination of the spine and lower limbs by paediatric physiotherapists. Children with more severe CP are at risk of developing a displaced hip joint which can become painful and interfere with seating and daily activities. Therefore all children also receive regular X-rays of their hips based on their age and severity of CP. CPIPS has been universally accepted and approved by the children, parents, carers and clinicians alike. It provides useful data on epidemiology, hip subluxation, physiotherapy participation and orthotic use as well as much more. It is already producing a significant improvement in hip displacement rates in Scotland. CPIPS has also greatly improved communication between community based care and hospital services. It is now fully embedded in the day to day care of these vulnerable children in Scotland and is now deemed essential in improving and maintaining their musculoskeletal health.     

Frequency, predictors, and expenditures for pediatric insurance claims for complementary and alternative medical professionals in Washington State

BACKGROUND: This study describes the frequency, predictors, and expenditures for the use of complementary and alternative medicine (CAM) in an insured pediatric population. METHODS: Washington state requires CAM-licensed medical professional coverage in private health insurance. We performed a cross-sectional analysis of services provided to children in 2002 by conventional professionals, chiropractors, naturopathic physicians, acupuncturists, and massage therapists. Both chi(2) tests and logistic regression analysis were used to identify statistically significant differences in use and explanatory factors. RESULTS: Of 187 323 children covered by 2 large insurance companies, 156 689 (83.6%) had any claims during the year. For those with claims, 6.2% of children used an alternative professional during the year, accounting for 1.3% of total expenditures and 3.6% of expenditures for all outpatient professionals. We found that CAM use was significantly less likely for males (odds ratio, 0.91; 95% confidence interval, 0.87-0.95) and more likely for children with cancer, children with low back pain, and children with adult family members who use CAM. Visits to chiropractors or massage therapists nearly always yielded diagnoses of musculoskeletal conditions. In contrast, diagnoses from naturopathic physicians and acupuncturists more closely resembled those of conventional professionals. CONCLUSIONS: Insured pediatric patients used CAM professional services, but this use was a small part of total insurance expenditures. We found that CAM use was more common among some children, depending on their sex, age, medical conditions, and whether they had an adult family member who used CAM. Although use of chiropractic and massage was almost always for musculoskeletal complaints, acupuncture and naturopathic medicine filled a broader role.     

Chest pain in children: diagnosis through history and physical examination.

INTRODUCTION: Chest pain is a common complaint in the pediatric age group and can be a physically and emotionally distressing symptom. Although chest pain in children rarely indicates serious cardiac problems, chest pain is perceived as "heart pain" to most children and their families and presents a diagnostic challenge to health care providers. METHODS: A prospective study was conducted to identify specific factors in history taking and physical examination that permit accurate diagnosis of the cause of pediatric chest pain. Fifty children (ages 5-21 years; mean, 13 years), referred to the cardiology clinic with the chief complaint of chest pain, underwent systematic history taking, physical examination, and electrocardiogram testing. RESULTS: The following diagnoses were made: 38 children (76%) had musculoskeletal/costochondral chest pain, 6 children (12%) had exercise-induced asthma, 4 children (8%) had chest pain resulting from gastrointestinal causes, and 2 children (4%) had chest pain resulting from psychogenic causes. DISCUSSION: All the children in this study had noncardiac causes of their chest pain. This finding supports previous research suggesting that chest pain in children is rarely of cardiac origin. This article reviews the causes of pediatric chest pain and suggests an approach to its evaluation and management.     

Functional imaging of infection: conventional nuclear medicine agents and the expanding role of <Superscript>18-</Superscript>F-FDG PET

A growing body of literature suggests that 18-fluorine fluorodeoxyglucose positron emission tomography (¹⁸F-FDG PET), particularly when combined with CT, is a useful tool for the detection of infectious and inflammatory disease processes. This article will briefly review the data to date on the use of FDG PET in diagnosing musculoskeletal infections and fever of unknown origin, comparing it to conventional scintigraphic techniques in both adults and, when available, in children.     

Bowel and bladder management of the child with myelomeningocele in the school setting

Children with myelomeningocele have a variety of health and psychosocial needs that must be dealt with by the family, by health care providers, and by school staff. Bowel and bladder dysfunction are problems that are common in most of these children. Bladder dysfunction can lead to renal complications and, ultimately, may threaten the child's life. Bowel problems, including constipation and incontinence, can lead to medical complications and to severe social problems. This article discusses the pathophysiology of these problems and suggests nursing interventions, especially as they apply to children in the school setting.     

Consequences of use of anabolic androgenic steroids

Whether providing anticipatory guidance to the young adolescent patient, conducting a preparticipation examination on a young athlete, or treating a sick user of anabolic androgenic steroids (AASs), the primary care physician must be familiar with the adverse consequences of the use of these compounds. This article reviews the endocrine, cardiovascular, neuropsychiatric, musculoskeletal, hematologic, hepatic, and miscellaneous effects of AASs, highlighting effects reported in children and adolescents, and relying on consequences in adults when pediatric data is unavailable.     

24-Hour postural care and use of sleep systems in cerebral palsy

The purpose of this article is to explain the impact of secondary musculoskeletal problems in cerebral palsy and the impact with growth on body posture and how postural care and use of sleep systems can help protect and preserve body shape. Successful postural care relies on a family's engagement of the programme. To engage them education staff and health care workers require the awareness of the impact of body shape distortion and the fact it can be reduced or avoided through good postural care. A failure to provide good postural care increases the risks of physical changes in the bones and muscles and joints, which can lead to severe issues on an individual's respiration, circulation and their digestion. This can lead to compromising the internal organs and has the potential to lead to premature death. It is important for everyone involved in the care of children with CP to have knowledge and understanding of the importance of postural care. The child needs a team around them empowering the family through education and support. All clinicians should be able to identify who will need it, know how they can refer on to access assessment of the child and training for the family and be aware off the postural care plan as it is developed to get the right equipment in place. The benefits of an improved posture can result in reduced muscle tone, increased comfort, improved functioning and participation, and better sleeping patterns. This leads to an improved quality of life for the child and the family.     

The impact of home computer use on children's activities and development

The increasing amount of time children are spending on computers at home and school has raised questions about how the use of computer technology may make a difference in their lives--from helping with homework to causing depression to encouraging violent behavior. This article provides an overview of the limited research on the effects of home computer use on children's physical, cognitive, and social development. Initial research suggests, for example, that access to computers increases the total amount of time children spend in front of a television or computer screen at the expense of other activities, thereby putting them at risk for obesity. At the same time, cognitive research suggests that playing computer games can be an important building block to computer literacy because it enhances children's ability to read and visualize images in three-dimensional space and track multiple images simultaneously. The limited evidence available also indicates that home computer use is linked to slightly better academic performance. The research findings are more mixed, however, regarding the effects on children's social development. Although little evidence indicates that the moderate use of computers to play games has a negative impact on children's friendships and family relationships, recent survey data show that increased use of the Internet may be linked to increases in loneliness and depression. Of most concern are the findings that playing violent computer games may increase aggressiveness and desensitize a child to suffering, and that the use of computers may blur a child's ability to distinguish real life from simulation. The authors conclude that more systematic research is needed in these areas to help parents and policymakers maximize the positive effects and to minimize the negative effects of home computers in children's lives.     

Morbidity from 5 to 10 years

The prevalence and incidence of illness was examined in a birth cohort of Christchurch children studied during the age range of 5-10 years. At this age, children had an average of 12 consultations with family doctors; 26% were admitted to hospital and 53% made one or more attendances at hospital outpatient departments. The majority of general practitioner contacts involved five groups of conditions: respiratory illness; integumental lesion; accidents; gastrointestinal conditions; and hearing problems. Hospital admissions were dominated by five types of admission: respiratory illness; accidents; gastrointestinal conditions; genito-urinary problems; musculoskeletal problems. More than two-thirds of outpatient attendances were accounted for by accidents, respiratory illness, musculoskeletal problems, vision problems, and hearing problems. Trends in rates of medical consultation for accidents and respiratory illness during the period from birth to 10 years are described and the implications of the findings are discussed.     

Computers in medicine. Augmenting medical care in pediatric patients with chronic illnesses

The use of computers to aid care for chronically ill pediatric patients is a relatively new concept. We are currently using Filemaker II software and a Macintosh Plus computer to augment overall patient care in children with chronic diseases, such as spina bifida, cerebral palsy, neuromuscular diseases, head injury, and spinal cord injury. This is a computerized medical record with a clinical database for dissemination of information to multidisciplinary team members, generating letters to private health care providers, displaying telephone messages, and assisting inpatient care. Advances in computer technology will provide future applications to aid health care providers in caring for patients with chronic illnesses.     

Psychiatric and psychosomatic symptoms are increasing problems among Swedish schoolchildren

Paediatricians and other professionals in Sweden note that the amount of children with psychiatric and psychosomatic symptoms is growing in number. Suicide attempts among the young (15-24 y) increased by more than 30% from 1998-2003. The Swedish National Board for Health and Welfare's 2004 guidelines for school healthcare shed light on this increasing problem among schoolchildren. An article in this issue of Acta Paediatrica, “Living conditions and psychosomatic complaints in Swedish schoolchildren”, analyses economic stress as a causative factor leading to psychosomatic symptoms such as headache, abdominal pain and difficulty in falling asleep. Living conditions, however, most likely include other factors related to our modern and ever-changing society that also have an impact on the growing child.

Conclusion: Psychiatric health is changing for the worse among Swedish schoolchildren. The cause is multifactorial. Economic stress is one factor, but there are also other possible causes related to modern society that correlate to the increase of psychosomatic problems among schoolchildren. Three major problems are among those suspected: impaired education and deficient working environment in Swedish schools, a general lack of adult contact and guidance, and excessive computer and TV use.