Psychosocial adversities underestimated in hyperkinetic children

Abnormal psychosocial factors, assessed both clinically and by raters blind to clinical presentation, were examined in 21 hyperkinetic and 26 conduct disordered children. Blind raters found the frequency of psychosocial adversities to be similar in the two disorders. By contrast the clinical rater, who did know the diagnosis of patients, rated adverse psychosocial situations as much lower in hyperkinetic children than in children with conduct disorder. Logistic regression showed, particularly in the category of abnormal intrafamilial relationships (Lack of warmth in parent child relationship, Hostility or scapegoating of the child, Intrafamilial discord among adults), effects of the interaction between rater and knowledge of diagnosis. Clinical raters should be aware of abnormal psychosocial situations in hyperkinetic children and assess possible adverse effects on parents and children. Researchers should be aware of a possible bias in research interviews.     

Neuroimaging in hyperkinetic children and adults: an overview

The application of brain imaging techniques to children with Attention Deficit/Hyperactivity Disorders is reviewed, stressing methodological aspects. Findings are still provisional, but suggest minor structural changes in frontal and candate areas, especially on the right side. Functional studies suggest reduced activation in these and other areas. The techniques do not yet contribute to individual diagnosis.     

Impaired growth in hyperkinetic children receiving pemoline.

Decreased longitudinal growth was observed in 24 hyperkinetic children receiving pemoline therapy. Mean height velocity was 3.67 +/- 0.25 cm/year during therapy but 5.35 +/- 0.42 cm/year after treatment had been discontinued (P less than 0.01). There appeared to be an inverse relationship between growth velocity and drug dosage. All patients receiving less than the median dose of 3.72 mg/kg grew 4 cm/year or more, while seven of 12 patients receiving more than this dose grew at a slower rate. Body weight, basal and stimulated growth hormone values, and plasma somatomedin concentrations were not significantly altered by pemoline treatment, suggesting that this drug may have a direct effect on cartilage metabolism.     

广西南宁儿童青少年高血压现状及其与肥胖关系的研究

目的 了解广西南宁地区6~18 岁儿童青少年高血压现状及超重/ 肥胖与高血压发生的关系。方法 采用随机整群抽样方法对南宁地区7 893 名 6~18 岁儿童青少年进行问卷调查并测量血压、身高、体重等生长发育指标。结果 男女生收缩压（SBP）和舒张压（DBP）均随着年龄的增长呈递增趋势。高血压、高收缩压（HSBP）、高舒张压（HDBP）检出率分别为6.58%、4.02%、3.81%,其中男生高血压、HSBP 检出率明显高于女生（P<0.05）。正常组、超重组、肥胖组高血压检出率分别为3.87%、9.84%、19.23%。高血压、HSBP 及HDBP 检出率均表现为肥胖组> 超重组> 正常组 （P<0.05）。与正常组相比,超重组、肥胖组高血压发生的相对危险度（95%CI）分别为2.71（1.69~5.96）和5.91（3.46~7.63）。血压与年龄、身高、体重及体重指数均呈正相关（P<0.01）。结论 广西南宁6~18 岁儿童青少年血压的分布特征为：血压值与儿童青少年的性别、年龄、身高、体重和体重指数相关; 肥胖与高血压患病率密切相关,随着体重的增加,儿童青少年患高血压的危险亦增加。     

Decisional procedure in school-age children with hyperkinetic syndrome]

Hyperkinetic syndrome may be either secondary to an organic disease or a psycho-effective disorder (mood and/or anxiety disorder), or primary as part of an attention deficit hyperactivity disorder. Precise diagnosis is essential before any therapeutic decision; this requires a complete anamnestic, behavioural, psychological, sensorial, and neurological evaluation. It is only when a reliable diagnosis has been made that a relevant therapeutic project can be proposed. An evaluation procedure and a decisional tree are presented.     

Atrial natriuretic peptide concentrations in children with pulmonary hypertension: Correlation with hemodynamic measurements

Summary To define the relation between atrial natriuretic peptide (ANP) and hemodynamic parameters in children with pulmonary artery hypertension, we measured the ANP concentrations of the femoral vein, right atrium, pulmonary artery, left atrium and left ventricle, or femoral artery in 32 patients during right or left heart catheterization. There is a strong correlation among the ANP levels obtained from different locations (p<0.001), and these ANP levels are positively correlated with pulmonary arterial pressures and pulmonary resistance. Patients were divided into two groups according to their pulmonary arterial pressure. The group with pulmonary arterial systolic pressure higher than 31 mmHg had higher ANP levels than the group with pulmonary arterial systolic pressure lower than 31 mmHg. When patients were grouped according to their pulmonary resistance, ANP levels in the group with pulmonary resistance over 2 U/m² were higher than those in the group with pulmonary resistance lower than 2 U/m². In this study ANP levels showed a correlation with the right ventricular systolic pressure. A correlation was not seen between ANP levels and the flow ratios or the presence of shunt. The results of our study suggest that ANP should be considered an important factor in pulmonary hypertension, independent of other factors.     

Prognostic value of hyperkinetic syndrome in children with epilepsy

In a retrospective study the data of 43 children suffering from epilepsy were analysed. The first epileptic seizure was observed in all patients before the age of 6 years. The relationship between behavioral disturbances with hyperactivity, developmental respectively intellectual test scores, and efficiency of antileptic drug therapy have been investigated. Psychological testings were performed two times, at first after the start of drug therapy, and a second time after a period of 1 year 11 months in average. There were behavioral disturbances with hyperactivity in 20 patients. The epileptic seizures were intractable in 26 patients. The developmental respectively intellectual test scores have decreased to values below 85 in 7 patients with and 3 patients without hyperactivity. There was a decline by more than 10 points of the IQ score between first and second psychological testings in 16 patients with and 4 patients without hyperactivity, respectively in 17 patients with intractable seizures, but in one child only with prompt cessation of epileptic seizures. An increasing retardation of mental development was seen in children with hyperactivity at the start of seizures, in children with intractable seizures, but especially in patients with a combination of intractable seizures and hyperactivity.     

Left atrial size in children with hypertension: the influence of obesity,blood pressure,and left ventricular mass

OBJECTIVE: To evaluate the prevalence of left atrial enlargement and the correlates of left atrial size in children and adolescents with essential hypertension. BACKGROUND: Left atrial enlargement has been associated with increased risk of cardiovascular disease, including stroke in adults. Risk factors for left atrial size in adults with hypertension include age, race, and obesity. METHODS AND RESULTS: Patients (n =112; average age, 14.2 years) with essential hypertension were studied with echocardiography. The average left atrial dimension was 2.8 (+/- 0.5) cm; 51% patients had left atrial dimension >95% upper confidence limit. The patients with left atrial enlargement had greater body mass index (P <.05) than those without left atrial enlargement. In multiple regression analysis, height, body mass index, systolic blood pressure, and left ventricular geometry were significant independent correlates of left atrial size. Children with eccentric left ventricular hypertrophy were more likely to have a larger left atrial dimension. CONCLUSIONS: Left atrial enlargement is prevalent in children and adolescents with essential hypertension. This may indicate an increased risk of cardiovascular disease morbidity and mortality. Control of obesity and blood pressure elevation offer two approaches for treatment that may prevent left atrial enlargement.     

Energy expenditure, physical activity, and obesity in children

Although there are physiologic and genetic influences on the various components of energy metabolism and body weight regulation, and a major portion of individual differences in body weight can be explained by genetic differences, it seems unlikely that the increased global prevalence of obesity has been driven by a dramatic change in the gene pool. It is more likely and more reasonable that acute changes in behavior and environment have contributed to the rapid increase in obesity and that genetic factors may be important in the deferring individual susceptibilities to these changes. The most striking behavioral changes that have occurred have been an increased reliance on high-fat and energy-dense "fast foods," with larger portion sizes, coupled with an ever-increasing sedentary lifestyle. The more sedentary lifestyle is caused by an increased reliance on technology and labor-saving devices, which has reduced the need for physical exertion for everyday activities. Examples of energy-saving devices that have resulted in a secular decline in physical activity include: Increased use of automated transport rather than walking or biking Central heating and use of automated equipment, such as washing machines, in the household. Reduction in physical activity in the workplace because of computers, automated equipment, and electronic mail. Increased use of television and computers for entertainment and leisure activities. Use of elevators and escalators rather than stairs. Increased concern for crime, which has reduced the likelihood of outdoor playing. Poor urban planning that does not provide adequate biking paths or even sidewalks in some communities. Thus, the increasing prevalence, numerous health risks, and astounding economic costs of obesity clearly justify widespread efforts toward prevention efforts. These prevention efforts should begin in childhood because the behaviors are learned and continue through the lifetime.     

Asthma and obesity in children

PURPOSE OF REVIEW: Childhood asthma and obesity are significant public health problems. The prevalence of both disorders has increased considerably in the past decade. This review will highlight recent publications regarding the nature of the relationship between asthma and obesity and the clinical effects of obesity in children with asthma. RECENT FINDINGS: Most prospective studies suggest that obesity increases the risk of subsequent asthma. Possible mechanisms for the relationship between asthma and obesity include airway inflammation, mechanical changes associated with obesity, changes in airway hyper-responsiveness, and changes in physical activity and diet. Most studies suggest that obesity increases the clinical severity of asthma and decreases quality of life in children with asthma. More research is required to further define and clarify the relationship between asthma and obesity in children. SUMMARY: There are many questions and few answers regarding the relationship between asthma and obesity in children. Additional studies are needed to clarify the relationship between the two epidemics so that effective interventions can be developed to improve the health and lives of children with both asthma and obesity.