DRUG USAGE AND ADVERSE DRUG REACTIONS IN PAEDIATRIC PATIENTS

Abstract. The development of epidemiological methods for the study of adverse drug reactions is reviewed in connection with the presentation of data obtained by intensive monitoring of 1000 admissions to a medical paediatric unit. Compared with adults and American children, the patients received fewer drugs and experienced fewer reactions while in hospital. The drug usage pattern was different from that of American paediatric practice and general practice in the United Kingdom. Fifty-one (6%) patients experienced 119 adverse drug reactions. These occurred more frequently in children suffering from serious disorders and in the majority of cases the basic therapy was continued regardless of the severity of the drug side–effects. Treatment was required for the effects of 66 (55 %) adverse reactions. It appears that drug monitoring in paediatric practice may be of greater value if surveillance programmes are designed to provide a "therapeutic audit" and extended to include children receiving drugs in the community.     

THE DIETING AND BODY SHAPE CONCERNS OE ADOLESCENT FEMALES

This study set out to examine dietary and body shape concerns of four age groups (12-18 yr) of British female adolescents in order to compare current findings with previous results. Although less than 4% were overweight as measured by standard tables, over 10 times this number considered themselves overweight. Approximately half desired to alter their weight and considered various ways of doing so. The subjects' shape related directly to the subjects' desire to alter body shape, particularly in the oldest group. These results are discussed in terms on the literature on the development of an idea of ideal body shape, increasing interest in exercise and previous research in the area.     

POSITIVE AND NEGATIVE SYMPTOMS IN PSYCHOTIC AND OTHER PSYCHIATRICALLY DISTURBED CHILDREN

The positive and negative symptom distinction has been found to be valid in research on schizophrenia in adulthood. The present study examined age-related changes in the occurrence of positive and negative symptoms in psychiatrically disturbed children who were receiving psychiatric treatment for the first time. The effect of age on the manifestation of positive and negative symptoms was significant; positive symptoms increased linearly with age, while negative symptoms were most frequent in early childhood and late adolescence. This finding held for the entire sample of children, as well as the subsample of children with psychotic diagnoses. There were few sex differences in the rate of symptoms, although age trends varied somewhat by sex. Examination of the relation between symptomatology and IQ revealed that high-IQ children showed greater positive and fewer negative symptoms than low-IQ children. Results are discussed in terms of the importance of examining developmental differences in positive and negative symptoms.     

27. THE ADOLESCENT WITH A LEARNING PROBLEM. EXPERIENCE AND INSIGHT WITH DELINQUENT BOYS

ABSTRACT
Twelve teenaged boys referred by a juvenile court clinic because of delinquent behavior and academic failure were examined by an experienced team of pediatricians, neurologists, psychologists, social workers, nurses, and occupational, physical, recreational, speech and hearing therapists. Two boys came from troubled families with long histories of legal problems, had behavior problems antedating their school difficulties and had no evidence of perceptual handicaps. The remaining ten were the family blacksheep whose academic problems began early and whose behavior decompensated later. They all had perceptual handicaps and both groups of boys had intense psychological reactions to their school difficulties. The learning disabled require a flexible team approach in school together with individual, group and family therapy in order to achieve success.     

DIETARY COMPOSITSION AND DENTAL DISEASE IN ADOLESCENT DIABETICS

In a group of adolescent diabetics there was a probable lower frequency of caries but a higher frequency of supragingival calculus than in the control group. The diabetics consumed relatively more protein and less refined carbohydrates, taken less frequently than nondia-betics. The 24-hour recalls showed good reproducibility but an unsatisfactory correspond-ance to a 7-day record among diabetics.     

MULTIPLE CONGENITAL ABNORMALITIES IN A NEWBORN BOY ASSOCIATED WITH MATERNAL USE OF FLUPHENAZINE ENANTHATE AND OTHER DRUGS DURING PREGNANCY

ABSTRACT. A boy was born with a short sloping forehead, wide metopic suture, persistent metopic fontanelle, telecanthus, ocular hypertelorism, nystagmoid eye movements, bilateral cleft lip and palate, imperforate anus, rectourethral fistula, bind scrotum and an unusual penis with hypospadias. The neutrophil polymorphs had numerous nuclear projections. The pregnancy was complicated by chronic maternal schizophrenia, severe toxaemia and maternal use of fluphenazine enanthate, dicyclomine hydrochloride, doxylamine succinate, pyridoxine hydrochloride and other drugs. Details of mother's illness, pregnancy and drug usage are presented with the clinical findings and investigations.     

DIABETES MELLITUS AND ADDISON'S DISEASE IN AN ADOLESCENT FEMALE

Abstract. Matsaniotis, N., Tzortzatou-Stathopoulou, F., Thomaidis, Th., Karakatsani-Kerasioti, Z., Theodoridis, Ch. and Dacou-Voutetakis, C. (First Department of Paediatrics of Athens University, "Aghia Sophia" Children's Hospital, Athens, Greece). Diabetes mellitus and Addison's disease in an adolescent female. Acta Paediatr Scand, 70: 949, 1981.-This short report describes a 16-year-old female who presented with Addison's disease 6 years after diabetes mellitus had been diagnosed. The possibility of both conditions being present should be borne in mind whenever an unexplained reduction of insulin requirements is noted, especially if this is accompanied by cutaneous pigmentation. The metabolic interrelationships of the two conditions are briefly discussed.     

HEIGHT AND WEIGHT OF SCHOOL CHILDREN AND ADOLESCENT GIRLS AND BOYS IN OSLO 1970

ABSTRACT: Brundtland, G. H., Liestö1, K. and Wallöe, L. (Oslo City Health Department and Departments of Physics and Physiology, University of Oslo). Height and weight of school children and adolescent girls and boys in Oslo 1970. Acta Paediatr Scand, 64:565, 1975.–Height and weight measurements of the school children of Oslo in 1970 (aged 7 to 19 years) are reported. Weights show considerably skewed distributions with long tails towards higher weights. Weight percentiles are calculated by interpolation in the empirical distributions. Percentiles and tables for both sexes, showing height for age, weight for height and weight for age, are presented. A comparison with existing Norwegian data from Sundal, 1956, Bergen shows that the application of statistics based on normal distribution for weight, has introduced considerable error in these percentiles. Oslo children in 1970 are taller by 5–6 cm at age eighteen, than USA (Iowa) standards and 4–5 cm taller compared to Tanner's English percentiles. Oslo children are also taller than Swedish children, and have reached a stature higher than found in any other comparable study.     

DEVELOPMENTAL ASPECTS OF ADOLESCENT PROBLEM DISCLOSURE IN ENGLAND AND IRELAND

Adolescents in England and Ireland completed a problem checklist and results showed that problem experience varied systematically with age, sex and culture. Boys were less mature than girls in their problem experience, and were more concerned with authority, self-image and behavioural problems. Girls showed more worries in personal and emotional areas. In both sexes concern about unemployment and feelings of self inadequacy increased with age, while concerns in in other areas showed a general decrease. Irish adolescents had a less mature problem pattern than English, and they admitted to more worries. Cultural differences were specifically reflected in the adolescents' problem experience.     

SERUM CHOLESTEROL AND TRIGLYCERIDE LEVELS IN NORWEGIAN ADOLESCENT SCHOOL CHILDREN

ABSTRACT. The frequency distribution of serum cholesterol and triglycerides in 172 boys and 232 girls, 13–16 years, from four elementary schools in Oslo has been determined. The cholesterol values were significantly higher for girls 15–16 years than for boys of the same age group. In the case of triglycerides boys 15–16 years had significantly higher values than boys 13–14 years. Otherwise no statistically significant differences with regard to sex and age were observed. The 85th percentiles have been suggested as appropriate upper normal limits. In all groups the 85th percentile for plasma cholesterol was slightly below 6 mmol/l. The corresponding plasma triglyceride value was below 2 mmol/l.     

IN VITRO DRUG SENSITIVITY AND APOPTOSIS INDUCTION IN NEWLY DIAGNOSED PEDIATRIC ACUTE LYMPHOBLASTIC LEUKEMIA: Correlation with Overall Survival

The present study looked for any associations between in vitro drug sensitivity and clinical outcome in pediatric acute lymphoblastic leukemia (ALL) with the standard drugs used for leukemia therapy. A total of 72 samples were analyzed. In vitro sensitivity to drugs was tested by a methyl-thiazol-tetrazolium assay in 6 serial fold dilutions. Apoptosis was determined by TUNEL assay and apoptotic index was calculated for each sample. Patients sensitive to prednisone, asparginase, vincristine, and 6-mercapto purine had higher overall survival compared to patients whose tumor cells were resistant to these drugs (p <. 01). For the other drugs tested, overall survival did not vary from that of the resistant patients. For doxorubicin, asparginase, vincristine, prednisone combination sensitivity, there was a significant worsening of prognosis from the extremely sensitive patients through an intermediate sensitive group to a most resistant group. The present study thus shows that in vitro drug-sensitivity testing provides significant prognostic information in childhood ALL.     

COMMUNICATION BEHAVIORS IN AUTISM AND DEVELOPMENTAL LANGUAGE DELAY

The communicative behavior of autistic and developmental language delay (DLD) children matched for nonverbal mental age and mean length of utterance (MLU) was compared to that of normally-developing (ND) 2-yr-olds. Autistic children were less able than other children to respond correctly to language or gestures used to direct their attention, used attention directing (pointing, showing) less frequently, and produced more echolalic speech when making requests. DLD and ND children differed only in number of pronouns used while requesting. Attention-directing gestures were associated with receptive and expressive language abilities for autistic, DLD and normal children.     

GROWTH HORMONE AND SOMATOMEDIN A IN GIRLS WITH ADOLESCENT IDIOPATHIC SCOLIOSIS

Abstract. Girls with adolescent idiopathic scoliosis are taller than nonscoliotic girls of the same age. This observation may be related to factors regulating longitudinal growth. Plasma growth hormone was determined in a group of scoliotic girls by double antibody radioimmunoassay under the following conditions: 1) Insulin induced hypoglycemia, 2) glucose tolerance test, 3) exercise. Somatomedin A was determined by a method based on the ability of serum to stimulate the incorporation of radioactive sulphate in embryonic chick cartilage. The results were compared with those obtained in a control group of healthy nonscoliotic girls of comparable age. After overnight fasting and after at least one hour's rest the basal growth hormone level was 9.8 ± 11.1 (±S.D.) ng/ml in the scoliotic girls ( n =48) and 2.2 ± 1.1 ng/ml in the controls ( n =15). This difference is significant. In the hypoglycemia test the peak growth hormone level tended to be higher in the scoliotic girls but the difference is not significant. In the exercise test the maximal value was reached at different times in the two groups: at 20 min after start of the exercise in the scoliotic girls ( n =14, 17.3±11.8 ng/ml) and at 40 min in the controls (n=9, 16.0±6.6 ng/ml). In the glucose tolerance test the growth hormone level was suppressed in both groups but the mean values tended to be higher during the first 120 min in the scoliotic girls. The serum somatomedin levels were higher in the group of scoliotic girls ( n =19, 1.13±0.17 U/ml) than in the controls ( n =14, 0.88±0.16 U/ml) and the difference is significant. The results obtained are difficult to interpret but suggest that growth hormone secretion is higher in girls with adolescent idiopathic scoliosis than in healthy girls of comparable age.     

OSTEITIS AND OTHER COMPLICATIONS CAUSED BY GENERALIZED BCG-ITIS

ABSTRACT. In 1973 an increase in the number of osteitis caused by BCG vaccination in the neonatal period was observed in Sweden. A high incidence of this complication, i. e. 1 case per 3000 vaccinated newborn children continued until this vaccination was interrupted in 1975. In the years 1972 to 1980 a total of 90 cases were reported to the Adverse Drug Reaction Committee. Earlier retrospective studies had disclosed 36 cases born between 1949-1968 and an active search for unreported cases in the 1970s revealed an additional 26 cases. Of the total of 152 known cases in Sweden, 82 were boys and 70 girls. The mean incubation period was 14 months for boys and 23 for girls. Extremely long incubation periods were seen, i. e. 6 years in two children and 12 years in one. Eleven children had multiple osteitis lesions. The epiphyses of the long bones of the extremities were the most frequent sites of the affection (109 lesions). Only in 6 patients the spine, which is the common site of osteitis caused by tuberculosis, was affected. Relapses occurred in two patients.     

Alcohol and drug usage in parents soon after stillbirth, neonatal death or SIDS

The behaviour of bereaved parents with respect to their drug and alcohol ingestion was examined 2 months following the loss of an infant from stillbirth (SB) neonatal death (NND) or sudden infant death syndrome (SIDS). Responses from bereaved families (99 SB, 109 NND, 52 SIDS) were compared with 252 control families (who had a liveborn infant). There was no difference in self-medication using aspirin as the example. The use of sedative drugs was significantly higher in all bereaved mothers (but especially the SIDS group). Use of sedatives by fathers was significantly higher only in the SIDS group. There was also a greater frequency of heavy drinking of mothers in all the bereaved groups and fathers in the SIDS group. These results have implications for the understanding and care of families following infant loss.     

HEREDITARY CHOLESTASIS COMBINED WITH PERIPHERAL PULMONARY STENOSIS AND OTHER ANOMALIES

Abstract A syndrome consisting of chronic intrahepatic cholestasis with retention of bile acids but with normalization of bile pigment excretion and blood lipids, peripheral pulmonary stenosis, vertebral anomalies and a characteristic facies is described in six patients, including a father and his daughter. An autosomal dominant mode of inheritance is suggested.