Diet in a group of 18-month-old children in South West England, and comparison with the results of a national survey

Objective To investigate the normal range of nutrient intakes and food consumption patterns in 18-month-old children.
Subjects 1026 children resident in South West England, forming part of the Children in Focus (CIF) research cohort.
Methods Diet was assessed using a 3-day unweighed dietary record. Nutrient and food intakes were compared with the dietary reference values and with the results of a British survey of preschool children – the National Diet and Nutrition Survey (NDNS).
Results Intakes of energy and nearly all nutrients were significantly higher in boys than in girls. Intakes of energy were slightly above the estimated average requirements. For most nutrients the mean and median intakes were well above the Reference Nutrient Intakes (RNI). The exceptions were vitamin D, iron and zinc. Nutrient intakes in CIF were very similar to those in the NDNS except for carotene, calcium, vitamin D and iodine, where intakes were considerably higher in CIF, and sugar intake which was lower in CIF. Intakes of most foods were similar in the two surveys. However, consumption of milk, yoghurt and fromage frais and baby foods was higher in CIF, intakes of most fruit and vegetables was somewhat higher, and intakes of savoury snacks and sugar confectionery were lower. In addition, there were differences between the two groups in the types of meat and meat products consumed.
Conclusions These children are unlikely to be deficient in any nutrients, with the possible exceptions of iron, zinc and vitamin D. The use of vitamin D supplements and the inclusion of iron- and zinc-rich foods in the diets of preschool children should be encouraged. These data will be important in assessing the influence of early diet on subsequent health and development.     

Administration of medicines to children using sports and leisure facilities: a survey of the South West of England

Background It is widely recognized that a healthy diet and regular exercise are important for general health. Sports and leisure centres are providing many opportunities for children to participate in various activities. Methods A pre‐piloted questionnaire was sent to the manager of sports and leisure centres throughout the South West of England to look at provision for the administration and storage of medication. Results Response rate is 66%. While 91% of centres have sessions for children without a parent present, only 57% had a policy for administration of medication. Conclusion Despite clear guidance on administration of medicine being available, relatively few sports and leisure facilities we surveyed are currently operating within this framework. At present, the current practice regarding administration of medicine in many leisure facilities seems to be suboptimal.     

Neuroborreliosis in the South West of England

Although Lyme borreliosis is increasingly diagnosed in the United Kingdom, few systematic studies have been performed there. UK data suggest that the commonest complications are neurological, but inadequate information exists about their nature and the incidence of late neuroborreliosis. Local data are necessary because clinical presentations may show geographical variation. This study aimed to provide data on clinical manifestations in an area of South West England and to estimate treatment delay. We reviewed clinical records of 88 patients in the Royal Devon and Exeter Hospital catchment area who had positive Borrelia antibody tests during a 5-year period. Fifty-six (64%) reported tick bites. The commonest presentations were erythema migrans (65%) and arthralgia/myalgia (27%). However, 22 patients (25%) had neurological symptoms other than headache alone. Fourteen had facial palsy, eight had confusion/drowsiness, four had meningism, five had radiculopathy, two had sixth nerve palsies, and two had peripheral neuropathies. No late, progressive or atypical neurological syndromes were found. Neurological manifestations were generally predictable and usually included either (or all) of meningoencephalitis, facial palsy or radiculopathy.     

Household fertility decisions in West Africa: a comparison of male and female survey results

This study compares the responses of matched husbands and wives in monogamous and polygynous unions, in the Yoruba village of Bolorunduro in Ondo State, Nigeria, with respect to a variety of family planning and fertility-related attitudes and behaviors. The results suggest that, although the husband and wife responses on the family planning and achieved fertility items were generally similar, responses relating to prospective fertility intentions were very different between husbands and wives. The results are consistent with the notion that fertility intention orientations in this particular culture operate essentially on an individual and not a family level. Women, whether in monogamous or polygynous unions, have fertility preferences that, while normatively bound, are clearly individual preferences and not necessarily related to their husbands' desires.     

Lead testing of children and homes: results of a national telephone survey.

OBJECTIVES. This study was designed to estimate the percentage of young children in the United States who have been tested for lead and the percentage of dwellings in the United States in which the paint has been tested for lead. METHODS. A national random digit dial telephone survey of 5238 households was conducted in 1994. Weighted national estimates and 95% confidence intervals for outcomes of interest were calculated. RESULTS. About 24% of U.S. children ages 0 to 6 years were estimated to have been tested for lead. Higher rates of testing were reported for children living in homes constructed prior to 1960, those living in homes with low household income, those living in rental units, and those living in the Northeast. Lead paint testing was performed for only an estimated 9% of U.S. housing units. Older homes were not more likely to have been tested than newer ones. CONCLUSION. A high proportion of pre-school children have apparently not been screened for lead exposure, even among subgroups at increased risk. Most dwellings of pre-school children have not been tested for lead paint. These data suggest that most at-risk children are not being reached by current approaches to lead poisoning prevention.     

Moving towards better health: a survey of transport authorities and primary care trusts in South West England

OBJECTIVE: Transport, the way we travel and our ability to access amenities, is an important determinant of health. A survey was conducted to: (1) identify past and present joint working arrangements between transport authorities and health authorities; (2) understand the role and impact of transport themes in health improvement programmes (HIMPs) and health themes in local transport plans (LTPs); and (3) raise awareness of transport and health issues. STUDY DESIGN: A questionnaire survey of directors of public health of primary care trusts (PCTs) and local authority transport managers was undertaken in the South West of England, a region of 5 million people with 32 PCTs and 15 transport authorities. RESULTS: All the transport authorities and 66% of PCTs responded. Consultation with the health authority on the LTP had been full in 67% of transport authority areas and more limited in the remainder. Common targets in the LTP and HIMP had been agreed in 33% of transport authority areas, shared programmes or themes in 40%, and a single shared theme in 13%. LTP and HIMP shared themes included walking and cycling initiatives, road safety, school travel and rural access. LTP themes identified as best practice to deliver health gain included walking initiatives, rural access, school travel and road safety. Ongoing links with PCTs were in place in 73% of the transport areas. Of the PCTs that responded, 33% reported that they were working on a travel plan. CONCLUSIONS: The responses in this survey identified strengths and concerns in the way that health and transport issues are handled locally and are reflected in the LTPs and HIMPs. Recommendations were produced by public health and transport managers in government office South West to improve partnership working.     

Outbreak of Cryptosporidium parvum among children after a school excursion to an adventure farm, South West England

We present the results of an outbreak investigation on a Cryptosporidium parvum outbreak among 35 people, (27 students and 8 teachers), who participated in a school excursion to an outdoor adventure farm in South West England, from 22 to 26 May 2006. A cohort study was implemented to investigate possible sources of infection during the farm visit. The most likely transmission route was contact with faecally contaminated surface water following heavy rainfall, or consumption of water from the private well. Disinfection of the water reservoir was by chlorination, to which cryptosporidium is resistant. Supplemental disinfection or filtration methods of private water supplies on livestock farms may be needed. This study highlights the fact that epidemiological investigations of outbreaks as a result of environmental exposures are complex but important to inform the public and health professionals of the risks posed by private water supplies and outdoor activities. This is particularly so after heavy rainfall, as this may result in an increased effluent from faecally contaminated land, causing a wide variety of pathogens to wash into surface water and potentially, private wells. This poses risks for public health.     

Physical ill health, disability, dependence and depression: results from the 2007 national survey of psychiatric morbidity among adults in England

BackgroundThe relationship between physical ill health, disability, and depression is not straightforward. Both cross-sectional and longitudinal studies have clearly shown that medical illness and physical disability are strongly associated with depression.ObjectiveTo test the hypothesis that disability is associated with an increased prevalence of depression irrespective of physical health problems and that this is proportionate to the severity of disability (measured in terms of the number of difficulties in daily activities and the degree of dependence on others).MethodsUsing a random probability sample design, 7460 respondents were interviewed for the third national survey of psychiatric morbidity of adults in the private household population in England. Fieldwork was carried out throughout 2007. The prevalence of depression was established by the administration of the revised Clinical Interview Schedule (CIS-R), while disability was measured by reported difficulties in activities of daily living (ADL) and instrumental activities of daily living (IADL).ResultsDisability was associated with depression even after adjustment for physical ill health. The number of ADL/IADL difficulties was directly related to the likelihood of respondents having depression. Dependence on others was not associated with depression once severity of disability had been accounted for.ConclusionAll ADL/IADL limitations are significantly associated with depression and there seems to be a cumulative effect irrespective of whether the limitation is in personal care or in instrumental activities such as mobility problems.     

Invasive pneumococcal infection in South and West England.

Variation in the incidence of invasive pneumococcal disease across South and West England, in 1995, was measured through a survey of microbiology laboratories. A 100% response rate was achieved. The incidence by laboratory varied between 5.2 and 20.4 per 100,000 catchment population (P < 0.001). Adjusting for pneumococcal vaccine uptake rate in over 65 year olds, hospital admission rates, blood culture system used and for the age and sex structure of the population, did not account for this variation. When blood culture sampling rates were included in a logistic regression model, the variation between laboratories was much less and of lower statistical significance (P = 0.019). Higher rates of blood culture sampling were associated with a higher incidence of invasive pneumococcal disease. Consistently high sampling should be encouraged because a higher diagnostic rate should result in more selective prescribing of antibiotics, and secondly because improved ascertainment of severe pneumococcal infections is a prerequisite for the evaluation of new pneumococcal conjugate vaccines.     

Frequency of consumption of cariogenic food items by 4-month-old to 24-month-old children: comparison between two rural communities in KwaZulu-Natal, South Africa

The objective of the study was to compare the frequency of consumption of cariogenic food items among 4-month-old to 24-month-old children in two neighbouring rural areas in KwaZulu-Natal Province, South Africa: Nyuswa/Embo (Area A) (n = 127) and Ndunakazi (Area B) (n = 105). Dietary intake was assessed using a food frequency questionnaire. Mothers or caregivers were interviewed by a team of Zulu-speaking fieldworkers. The percentage of children consuming the individual food items (consumers) and the weekly consumption for consumers were calculated for the two areas separately. The food items were ranked in descending order according to the combined group of children and reported for each area within five selected food groups (carbohydrates, sugars, fruit and vegetables, milk and milk products, and other foods and snacks). Food items were 'flagged' according to their cariogenic potential. Fisher's exact test on absolute numbers tested for significant differences in the frequency of intake between individual food items between the two groups. Significance was set at P < 0.05. The frequency of consumption of certain listed cariogenic food items showed significant differences between the two areas. A higher percentage of children in Area A than in Area B consumed most of the food items and also more frequently. Children mainly consumed foods with a cariogenic score of 2, solid foods with 8-20% sugars as well as foods high in starch with less than 10% sugars. This knowledge is essential to gain insight into the eating pattern among rural communities and will provide a baseline for developing and adapting dietary advice specifically for young rural South African children with particular emphasis on the prevention of dental caries.     

Maternity services for drug misusers in England and Wales: a national survey

A postal questionnaire was sent to the 213 National Health Service maternity units in England and Wales to identify their current involvement with drug misusers. The response rate was 89.5%. Data indicated that only 29% had formal links with their local drug agency. Child protection case conferences were automatically convened in 52%, and 57% routinely admitted babies to high dependency areas. Twenty-seven per cent of the units did not offer hepatitis B screening to pregnant women, and 32% did not offer hepatitis B prophylaxis to babies whose mothers were infected. Local Health purchasing authorities should ensure that their providers are offering appropriate services to pregnant drug misusers in order to encourage such women to seek help without fear of discrimination. Liaison between health care agencies should be encouraged and areas with low levels of drug misuse should receive help with formulating policies, and training, from units with more experience.     

Wellbeing,alcohol use and sexual activity in young teenagers: findings from a cross-sectional survey in school children in North West England

Background  

Adolescent health is a growing concern. High rates of binge drinking and teenage pregnancies, documented in the UK, are two measures defining poor wellbeing. Improving wellbeing through schools is a priority but information on the impact of wellbeing on alcohol use, and on sexual activity among schoolchildren is limited.     

Hospital disclosure practices: results of a national survey

New patient safety standards from JCAHO that require hospitals to disclose to patients all unexpected outcomes of care took effect 1 July 2001. In an early 2002 survey of risk managers at a nationally representative sample of hospitals, the vast majority reported that their hospital's practice was to disclose harm at least some of the time, although only one-third of hospitals actually had board-approved policies in place. More than half of respondents reported that they would always disclose a death or serious injury, but when presented with actual clinical scenarios, respondents were much less likely to disclose preventable harms than to disclose nonpreventable harms of comparable severity. Reluctance to disclose preventable harms was twice as likely to occur at hospitals having major concerns about the malpractice implications of disclosure.     

Comparison of Haitian children in a nutrition intervention programme with children in the Haitian national nutrition survey

Weight-for-height and height-for-age data were compared for preschool-age Haitian children enrolled in a community health and nutrition intervention program and children measured in the Haiti national nutrition survey of 1978. Cross-sections of the longitudinal data of the intervention program corresponding to the season when the national survey was conducted (May-September) were chosen for the 3 years of available program data (1969-71). Significantly less stunting was found in children in the 1970 and 1971 intervention group than in the children covered by the national survey. Tests of trend also showed that the height (or length) status of the children in the intervention program improved from 1969-71. Wasting, or low weight status, was in general not significantly different in any of the comparisons. Nevertheless, the data were more favorable to children in the intervention groups, even in 1970, a year of food shortages. The results of the comparison are consistent with a positive program effect. (author's)     

Radon in Irish schools: the results of a national survey.

This paper presents the results of a survey of radon concentrations in Irish primary and post-primary schools. The objective of this survey was to assess the distribution of radon in Irish schools and to identify those requiring remedial work to reduce radon exposure to children and staff. All primary and post-primary schools were invited to participate in the survey. Indoor radon concentrations were measured during the academic year using integrating passive alpha track-etch detectors with a measurement period from three to nine months. The survey was carried out on a phased basis from 1998 to 2004 and is one of the most comprehensive of its kind undertaken in Europe. Measurements were completed in 38 531 ground floor classrooms and offices in 3826 schools, representing over 95% of the approximate 4000 primary and post-primary schools in Ireland. Of these, 984 schools had radon concentrations greater than 200 Bq m(-3) in 3028 rooms and 329 schools had radon concentrations in excess of 400 Bq m(-3) in 800 rooms. The average radon concentration in schools was 93 Bq m(-3). This results in an annual average effective dose to an Irish child from exposure to radon of 0.3 mSv per year, assuming that the long-term radon concentration is equal to the radon concentration present during the working hours and that the annual average occupancy is 1000 h per year. A programme of remediation of schools with radon concentrations above 200 Bq m(-3) has been put in place.