Exercise training on disease control and quality of life in asthmatic children

PURPOSE: Aerobic training has been shown to be effective in improving cardiopulmonary fitness in asthmatic children. However, the actual impact of physical training on clinical indicators of disease control remains controversial. METHODS: Thirty-eight children with moderate to severe persistent asthma were randomly assigned to control (N=17) and training (N=21) groups. Spirometry, exercise challenge, and maximum incremental cardiopulmonary exercise tests were performed 16 wk apart. Daily doses of inhaled steroids and Pediatric Asthma Quality of Life Questionnaire (PAQLQ) scores were also recorded. RESULTS: Physical training was associated with significant improvements in physiological variables at peak and submaximal exercise (P<0.05); in contrast, no significant changes were found in controls. Severity of exercise-induced bronchoconstriction (EIB) and postexercise breathlessness were significantly lessened in trained patients; improvement in fitness and EIB, however, were not linearly related (P>0.05). In addition, PAQLQ scores improved only in trained children (P<0.01). Daily doses of inhaled steroids were reduced in trained patients (52%), but they remained unchanged or increased in controls (70.6%) (P=0.07). CONCLUSION: Supervised exercise training might be associated with beneficial effects on disease control and quality of life in asthmatic children. These data suggest an adjunct role of physical conditioning on clinical management of patients with more advanced disease.     

Arthroscopy of the knee in children and adolescents

A retrospective review was done of 69 children and adolescents (7-17 years old) who underwent 75 arthroscopies of the knee during a 5-year period. Girls were overrepresented (71%). Thirty-eight were children under the age of 16. Of 46 injuries, 34 (74%) happened during sports. Children and adolescents were divided into two age groups based on their presumed state of skeletal maturity (boys 9–15 and girls 7–14 in group I and boys 16–17 and girls 15–17 in group II); meniscal lesions were equally common in the two groups, whereas anterior cruciate ligament tears were more common in older children (NS). Eleven of 17 (65%) anterior cruciate ligament lesions were combined with other intra-articular pathology, most often meniscal tears (9/11). As in other studies, half of the prearthroscopic diagnoses were incorrect. A high frequency of incorrect prearthroscopic diagnoses and of combined lesions justifies arthroscopy as an important diagnostic tool in children and adolescents with a history of twisting knee injury or chronic nonspecific knee problems. Girls practising ball games seem to be especially prone to knee injuries leading to arthroscopy.     

Meeting 24-h movement guidelines and associations with health related quality of life of Australian adolescents

ObjectiveThis study determined the prevalence of adolescents meeting the individual and combinations of the Australian 24-Hour Movement Guidelines, and their associations with the health related quality of life (HRQoL).MethodsThe participants were 3096 adolescents (mean age: 12.4 years; 49% female) from wave 7 of the birth-cohort of the Longitudinal Study of Australian Children. The outcome was parent-reported HRQoL. Meeting the 24-Hour Movement Guidelines was defined as: ≥60 min/day of moderate to vigorous physical activity (MVPA), ≤2 hour/day of recreational screen time, and 9-11 hour/night of sleep. Generalised estimating equations were used to examine the associations between meeting vs. not meeting recommendations and HRQoL outcomes.ResultsThe prevalence of adolescents meeting all three recommendations was 2.4%, with 23% meeting two, and 57% meeting one recommendation. Meeting all three recommendations was associated with higher overall HRQoL score (β = 4.96, 95% CI: 2.54–7.38) as well as physical (β = 5.22, 95% CI: 2.61–7.83) and psychosocial (β = 4.76, 95% CI: 1.77–7.75) scores. Meeting combinations of screen time with MVPA or sleep recommendations were associated with higher scores for all HRQoL outcomes, while meeting MVPA and sleep recommendations was associated with overall HRQoL score. Compared to meeting no recommendation, meeting more recommendations was significantly and incrementally associated with higher scores for all HRQoL outcomes (p_trend<0.001).ConclusionsOverall, meeting more recommendations within the 24-Hour Movement Guidelines was associated with better HRQoL outcomes. However, only a small percentage of adolescents met all the recommendations, which underscores the need for promoting and supporting adherence to these behaviours.     

Meniscal injuries in children and adolescents

Meniscal tears occur in children and adolescents even though they have open physeal plates. Appropriate clinical evaluation and use of imaging studies is important because making a diagnosis can be difficult. Meniscectomy and partial meniscectomy are associated with long-term morbidity. Repair of meniscal tears in youths is the preferred treatment.     

Knee problems in children and adolescents

It is important to recognize that there are differences in the spectrum of knee injuries that occur in childhood and adolescence and to always keep these in mind when examining the younger athlete. Constant vigilance for hip pathology presenting as knee pain is also necessary in this age group. As the tendency becomes greater for practitioners to become more specialized in treatment modalities (for example, arthroscopic surgeons, knee surgeons, and so forth), the likelihood of making preventable errors in the case of young athletes increases. The comprehensive care of the athlete and his or her injury is paramount, and one should be wary of the pressure to treat the youngster as one might the college or professional athlete in order to return him or her to sports more quickly. Serious injuries require time to heal and even more time for the patient to convalesce and undergo rehabilitation.     

Anaerobic characteristics in male children and adolescents

Only sparse information has been published on the effects of growth, development, and maturation on the ability to perform high intensity, short-term "anaerobic" tasks. Cross-sectional studies on Italian, African, British, and American females and males have indicated an age-related progression in the performance of the Margaria step-running test. Children had a distinctly lower mechanical power output than adolescents and young adults, both in absolute terms and when divided by body weight, or by fat-free mass. Data are presented on some 300 10- to 45-yr-old Israeli males who performed the Wingate anaerobic test by cycling or by arm cranking. Both the peak power at any 5-s period and the mean power throughout the test were lowest in the children, whether expressed in absolute power units or corrected for body weight. Performance progressed with age and reached the highest values at the end of the third decade for cycling and at the end of the second decade for arm cranking. This pattern is unlike that described for maximal O2 uptake per kg body weight which, in males, remains virtually unchanged from childhood to young adulthood. In females, maximal O2 uptake per kg is even higher in children than among adolescents or adults. Biochemical correlates of such a low anaerobic performance in children are their lower maximal lactate concentration in muscle and blood, lower rate of anaerobic glycolysis, and lower levels of acidosis at maximal exercise. The mechanisms for the relatively deficient anaerobic characteristics of children are not clear.     

Physical activity assessment in children and adolescents

Chronic disease risk factors, including a sedentary lifestyle, may be present even in young children, suggesting that early prevention programmes may be critical to reducing the rates of chronic disease. Accurate assessment of physical activity in children is necessary to identify current levels of activity and to assess the effectiveness of intervention programmes designed to increase physical activity. This article summarises the strengths and limitations of the methods used to evaluate physical activity in children and adolescents. MEDLINE searches and journal article citations were used to locate 59 articles that validated physical activity measurement methods in children and adolescents. Only those methods that were validated against a more stringent measure were included in the review. Based on the definition of physical activity as any bodily movement resulting in energy expenditure (EE), direct observation of the individual's movement should be used as the gold standard for physical activity research. The doubly labelled water technique and indirect calorimetry can also be considered criterion measures for physical activity research, because they measure EE, a physiologic consequence closely associated with physical activity. Devices such as heart rate monitors, pedometers and accelerometers have become increasingly popular as measurement tools for physical activity. These devices reduce the subjectivity inherent in survey methods and can be used with large groups of individuals. Heart rate monitoring is sufficiently valid to use in creating broad physical activity categories (e.g. highly active, somewhat active, sedentary) but lacks the specificity needed to estimate physical activity in individuals. Laboratory and field validations of pedometers and accelerometers yield relatively high correlations using oxygen consumption (r = 0.62 to 0.93) or direct observation (r = 0.80 to 0.97) as criterion measures, although, they may not be able to capture all physical activity. Physical activity has traditionally been measured with surveys and recall instruments. These techniques must be used cautiously in a paediatric population that has difficulty recalling such information. Still, some studies have reported 73.4% to 86.3% agreement between these instruments and direct observation. Future investigations of physical activity instruments should validate the novel instrument against a higher standard. Additional studies are needed to investigate the possibility of improving the accuracy of measurement by combining 2 or more techniques. The accurate measurement of physical activity is critical for determining current levels of physical activity, monitoring compliance with physical activity guidelines, understanding the dose-response relationship between physical activity and health and determining the effectiveness of intervention programmes designed to improve physical activity.     

Giant cell tumor in children and adolescents

The radiological appearance of giant cell tumors (GCT) in the developing skeleton was retrospectively assessed in 49 (10.6%) of the 462 patients with GCTs seen in consultation by the Netherlands Committee on Bone Tumors. There were 31 female and 18 male patients, all below 19 years of age. Thirty-four tumors were located in short and long tubular bones, two in the tarsus, while the others were in the pelvis, vertebral spine, and a rib. Involvement of the epiphysis in tubular bones was closely related to the age of the patient: the average age of the 3 patients with a lesion in the metaphysis was 11 years, that in the 6 patients with metadiaphyseal lesions 13 years, average age in the 10 patients with epimetaphyseal lesions 17 years, and it was also 17 years in the 17 patients with epimetadiaphyseal lesions. In tubular bones with the epiphyseal growth plates still open, the epiphysis was never involved, with the exception of two epimetadiaphyseal lesions in which closure of the growth plate was difficult to establish. Assessing GCT characteristics in this study population demonstrated that epiphyseal involvement increased with age and showed; to some extent, a predominance of female patients.     

Downhill ski injuries in children and adolescents

Downhill skiing is considered to be an enjoyable activity for children and adolescents, but it is not without its risks and injuries. Injury rates now range between 3.9 and 9.1 injuries per 1000 skier days, and there has been a well documented increase in the number of trauma cases and fatalities associated with this sport. Head and neck injuries are considered the primary cause of fatal injuries and constitute 11-20% of total injuries among children and adolescents. Cranial trauma is responsible for up to 54% of total hospital injuries and 67% of all fatalities, whereas thoracoabdominal and spine injuries comprise 4-10% of fatalities. Furthermore, there has been an increase in the proportion of upper extremity trauma with acromioclavicular dislocations, and clavicle and humeral fractures accounting for the majority (22-79%) of the injuries. However, the most common and potentially serious injuries in children and adolescents are those to the lower extremity, with knee sprains and anterior cruciate ligament tears accounting for up to 47.7% of total injuries. Knee sprains and grade III ligament trauma associated with lower leg fractures account for 39-77% of ski injuries in this young population.Approximately 15% of downhill skiing injuries among children and adolescents are caused by musculoskeletal immaturity. Other factors include excessive fatigue, age, level of experience, and inappropriate or improperly adjusted equipment. Collisions and falls constitute a significant portion (up to 76%) of trauma, and are commonly associated with excessive speed, adverse slope conditions, overconfidence leading to carelessness, and behavioural patterns within and among gender. The type and severity of injuries are typically functions of biomechanical efficiency, skiing velocity or slope conditions; however, a multiplicative array of intrinsic and extrinsic factors may simultaneously be involved. Despite extensive efforts to provide a comprehensive picture of the aetiology of injury, limitations have hampered reporting. These limitations include age and injury awareness, data collection challenges, lack of uniformity in the definition or delineation of age classification and lack of knowledge of predisposing factors prior to injury.Since skill level is the primary impetus in minimising ski injuries, formal instruction focusing on strategies such as collision avoidance and helmet use, fall training minimising lower extremity trauma, altering ski technique and avoiding behaviours that lead to excessive risk are, therefore, highly recommended. Skiing equipment should be outfitted to match the young skier's height, weight, level of experience, boot size and slope conditions. Additionally, particular attention should be paid to slope management (i.e. overcrowding, trail and obstacle marker upkeep) and minimising any opportunity for excessive speed where children are present. Whether increases in knowledge, education and technology will reduce predisposition to injury among this population remains to be seen. As with all high-risk sports, the answer may lie in increased wisdom and responsibility of both the skier and the parent to ensure an adequate level of ability, self-control and simply common sense as they venture out on the slopes.     

Breast US in children and adolescents.

Ultrasonography (US) is of value in the evaluation and characterization of breast masses in children. Most masses represent either normal breast tissue, cysts, or fibroadenomas. Premature thelarche may be unilateral, and normal breast tissue is found at US. Cysts are commonly retroareolar; when they become infected, they appear sonographically as a complex mass. Fibroadenoma is the most frequent breast tumor in adolescent girls, and it is usually solitary, homogeneous, and hypoechoic. Malignant breast lesions are very rare in children; most are due to metastatic disease secondary to rhabdomyosarcoma, leukemia, lymphoma, and neuroblastoma, and their US appearance is nonspecific. Gynecomastia in boys can be mimicked by general obesity and pectoral hypertrophy; US is helpful in the diagnosis, especially when gynecomastia is asymmetric. Most breast lesions in children and adolescents are benign, and surgery should be avoided to prevent later deformity. US is the ideal imaging modality to evaluate breast lesions and may be used to guide a fine-needle aspiration biopsy. Color Doppler US evaluation is helpful; cysts are avascular, fibroadenomas may be avascular or hypovascular, and abscesses show peripheral increased flow. Bloody nipple discharge is more common in prepubertal patients, may occur in infants, and may be secondary to mammary ductal ectasia. Discharge commonly resolves spontaneously, and findings at US are frequently normal.