PHYSICAL HEALTH OF TEN-YEAR-OLD CHILDREN An Epidemiological Study of School Children and a Follow-up of Previous Health Care

ABSTRACT. At 10 years of age, all 223 children in a school district underwent a physical examination and a screening for vision and hearing defects within the school health services. The purpose of the study was to detect health problems of importance for the day-to-day functioning of the child. In 26.1% significant deviations were found. Physical disorders comprised 11.7%, visual defects 11.7% and auditory impairment 2.7%. The vast majority of significant health problems were previously known and in only 4.4% of the 223 children newly detected, 0.9% by the physical examination, 2.7% by the vision screening and 0.9% by the auditory screening. The most frequent health problem of all was allergy in 13.5%, in 5.4% regarded as functionally important. Minor orthopaedic deviations and motor disturbances were common but not often considered to affect the functioning of the child significantly. As a whole, the children's health was very good and the outcome of the physical examination at this age was not impressive. It is evident that the physician's role in the school health system needs to be reconsidered.     

PHYSICAL HEALTH SCREENING OF SCHOOL-CHILDREN Extended Health Care Responsibilities for School-nurses

Abstract. All 410 ten- and twelve-year-old children of a school district underwent two repeated physical examinations within the school services, the first by the school nurse, the second by the school doctor. The aim was to compare their assessments to see if physical class examinations could be delegated to the nurse in future in order to release doctor's time. More than half of the children were found to have slight deviations from normal, most common of the spine and in the skin. The nurse detected many more deviations than the doctor but their assessments showed good agreement concerning functionally important deviations. Newly detected functionally important deviations were noted in 8 children (2%).
The routine physical examination could perfectly well be delegated to the school nurse who has the necessary prerequisites to take this responsibility and screen out those children in need of a doctor's assessment, in this study 20%. She would release valuable time for the doctor who could then apply himself to the real health problems of the children of today: chronic diseases, behavioural and school problems, many of which frequently are concerns beyond the boundaries of traditional medical care.     

GENERAL HEALTH SCREENING OF FOUR-YEAR-OLDS IN A SWEDISH COUNTY IV. An Analysis of the Effectiveness of the Psychological Examination Program

Abstract. Since 1969, 4-year-olds in the County of Uppsala have been offered extensive health screening at the Child Health Centres. In 1969 and 1970 a total of 3810 children underwent the screening procedure. The psychological screening instrument consisted of a questionnaire (to be answered by the parents), an interview of the parents, a psychomotor examination and an observation of the child's behaviour. 156 (4.1%) 4-year-olds were referred to a specialist team for investigation and decision concerning treatment. In the present study the effectiveness of the psychological screening instrument was assessed by its sensitivity, specificity and predictive value. The sensitivity was found to amount to a maximum of 0.73. The specificity was estimated to be 0.98–0.99, and the positive predictive value to 0.67. The authors consider the effectiveness to be sufficiently high to motivate continuation of the screening procedure for detection of psychological problems in pre-school age. Efforts should be made, however, to further improve the effectiveness.     

Early identification of children with communication disabilities— evaluation of a screening programme in a Swedish county

Objective : The aim was to evaluate the effectiveness of an early screening programme for communicative disturbances in relation to the health status of the child at the age of 4 years. Materials and methods : A case-control study including 705 cases and 2451 controls was performed. Results : Cases with communication disorders as well as other types of disabilities at 4 years of age showed a higher frequency of deviant screening results on each screening occasion. The sensitivity for the screening programme amounted to 24.8%, the specificity was 95.5% and the positive predictive value was 61.2%.     

Health Promotion in a Low-income Primary School: Children with and Without DCD Benefit,but Differently

ABSTRACT

Poor motor performance and reduced physical fitness are characteristic of children with Developmental Coordination Disorder (DCD). These features have also been identified more frequently among children living in low socio-economic circumstances. Aims: To evaluate the outcomes of a nine-week health promotion program (HPP) on the motor performance and fitness levels of children (6–10 years) with and without DCD attending a low-income primary school. Methods: The HPP was designed and implemented by undergraduate physiotherapy students using guidelines from the World Health Organization School Health Initiative and their physiotherapy curriculum. Children with DCD (n = 22) and a control group without DCD (n = 19) participated in the evaluation. Motor skill, functional strength, aerobic capacity, and anaerobic power were measured at baseline and after nine weeks. Results: Both groups of children improved on all measures at the conclusion of the HPP. Children with DCD showed greater improvement than the control group in motor performance and the control group showed greater improvement on one of the anaerobic fitness outcomes. Conclusions: A school-based HPP that focuses on increasing opportunities for physical activity may be effective in improving motor performance in children with DCD and can increase fitness levels in general.     

EVALUATION OF SINGLE ORAL DOSE METYRAPONE TESTS IN CHILDREN WITH HYPOPITUITARISM Comparison with the Prolonged Metyrapone and Insulin Induced Hypoglycaemia Tests and Their Relationship with the Etiology of Hypopituitarism

ABSTRACT. Pituitary-adrenal reserve was evaluated in control and hypopituitary subjects by comparing the 8 a.m. plasma 11-deoxycorticoid response (11-DOCS) to a single midnight oral dose of metyrapone (short test) with 1) the 8 a.m. 11-DOCS increase under repeated oral doses of metyrapone (prolonged test) and 2) with the plasma corticoid response during arginine-insulin test. In the short and the prolonged metyrapone tests, the same response was obtained in 25 out of 27 patients. The short test was repeated in 22 patients and the 11-DOCS response did not show a significant difference. In 34 of 40 patients, the response to the short test was comparable to the response during the arginine-insulin test; only 3 patients with a normal 11-DOCS rise to the short test had a low response to insulin and vice versa. Among the low responders to the short test, the mean 11-DOCS value was significantly lower in subjects with operated craniopharyngiomas than in idiopathic hypopituitary patients ( p <0.001). In the short test, the 8 a.m. baseline cortisol value was positively correlated with the 8 a.m. 11-DOCS response ( p <0.001), the cortisol level allowing to predict the 11-DOCS response in 28 out of 53 patients. Thus, the short oral metyrapone stimulation was found to be a reliable test in hypopituitary children.     

Children with malignant disorders: the health and life situation of their parents examined over a 7-year interval

The parents of 31 children with malignant disorders were clinically examined and interviewed to characterize their life situation and somatic health during treatment of their child. The follow-up was for 7 years. Comparison groups were from the mean Finnish population matched for age, sex and occupation. The parents were generally healthy. Hypertension, headache and abdominal pain were the main symptoms. Sick leave and contact with a physician were less common than in the control population. The frequency of paramedical drug use was high but tranquilizers were used rarely. At the beginning the mothers had many symptoms indicating stress. Their attitude about their own state of health improved during the follow-up in spite of ageing. The spare-time physical activities of the parents increased during follow-up. Few marital conflicts and problems with the siblings were reported. The increment in economic burden caused by the child's disease was not regarded as essentially changing the family life.     

Comparison of percentile tables and algorithm-based calculators for classification of blood pressures in children and adolescents with obesity: A secondary analysis of a clinical trial

Aim

Obesity as a major risk factor for childhood hypertension necessitates careful blood pressure (BP) monitoring of those affected. This study aimed to compare BP classification in a cohort of children affected by obesity using tables versus digital calculations in two sets of guidelines.

Methods

This study was a secondary analysis of data collected from a randomised clinical trial of a multidisciplinary life-style assessment and intervention program. Baseline data from 237 children with a body mass index >99th percentile or >91st percentile with weight-related comorbidities and available BP measurements were analysed. We assessed agreement between tables and algorithms in classification of elevated BP/pre-hypertension and hypertension based on the American Academy of Paediatrics (AAP) clinical practice guidelines (CPG) and the older Fourth Report using Cohen's weighted kappa. The prevalence of hypertensive diagnoses was also compared between the two guidelines.

Results

Agreement between BP tables and algorithmic calculation of percentiles was discordant, though improved in the AAP CPG compared to the Fourth Report (Cohen's kappa = 0.70 vs. 0.57, respectively). None (0%) were missed diagnoses, and 59 (24.9%) were false positives for the Fourth Report, and 0 (0%) were missed diagnoses, and 49 (20.9%) were false positives for the AAP CPG. Under the recent guidelines, there was an increase in prevalence of 6.0% (95% confidence interval (CI) 2.5–9.4%; P = 0.0001) for BP ≥90th percentile, and of 3.0% (95% CI 0.4–5.6%; p = 0.016) for hypertension (BP ≥ 95th percentile) in the cohort (18.0% and 6.8%, respectively, increased from 12.0% and 3.8%).

Conclusions

Digital calculators over tables in clinical practice are recommended where possible to improve the accuracy of paediatric BP classification. Substantial rates of elevated BP/Hypertension were found in this cohort of children and adolescents with overweight and obesity.     

Comparison of characteristics of children and adolescents with and without a history of abuse assessed in an urgent psychiatric clinic

PurposeThe objective was 1) to describe the clinical characteristics of children referred for an urgent psychiatric consult with and without, a history of abuse; 2) to study differences in demographic and clinical variables between the groups; and 3) to examine the relationship between different types of abuse and disposition after assessment.MethodsThis is a 2-year retrospective cohort study of all patients aged 12 to 17 years referred to a hospital urgent psychiatric clinic. Patients were divided into two groups, those with a history of abuse and those without. Study variables included demographics, reason for referral, history of emotional, physical, sexual abuse, substance use, bullying victimization, DSM-5 diagnoses, and disposition. The study population was described using means, frequencies, and percentages, while relationships between types of abuse and clinical and demographic variables were assessed using Mann–Whitney U statistics, Spearman correlations, and logistic regression.ResultsThe prevalence of any type of abuse was 30.4% (227 of 746 referrals). The abused group were older, more likely to be female, to have a history of substance use, bullying victimization, diagnosis of an externalizing disorder, and more likely to be admitted. Among the abused group, males were significantly more likely to report physical/emotional abuse, and female sexual abuse. There was no difference between different kinds of abuse and final diagnoses.ConclusionsAlmost one-third of children and adolescents referred for urgent psychiatric consultation reported a history of abuse. Awareness of the association between abuse and emergency visits may assist physicians in triaging for urgent psychiatric assessment.     

Psychosocial Factors and Physical Health during the First Year of Life Children in a New Stockholm Suburb. A Prospective Longitudinal Study. III

The study is part of a longitudinal research project of a cohort of 501 children in a Stockholm suburb. The aim of the project is to clarify the relation between the children's health and development and their home environment. The present work deals with the children's physical health during their first year of life and comparisons were made between infants in families suffering or not suffering from psychosocial stress. Indications of psychosocial stress in the homes include reports of alcohol abuse, mental disease or criminality in one or both of the parents. Judging by reports from child welfare centres and hospital records, children from homes with psychosocial stress do not have a higher rate of somatic illnesses, retarded psychomotor development and psychosomatic problems than the control children.     

NATURAL HISTORY OF JUVENILE RHEUMATOID ARTHRITIS A Follow-up Study of a Case with Special Reference to Clinical, Electroencephalographic and Neuropathological Findings

ABSTRACT. A detailed comparison between the clinical and EEG findings is made in a case of a boy with juvenile rheumatoid arthritis (JRA) who died at 15 years, 6.5 years after the beginning of the follow-up period. In the course of the disease, seven EEG recordings were made, showing a progressive diffuse slowing and disorganization with some improvement during short remissions. In relapses, diffuse slowing was associated with grave asymmetries in the EEG which, however, fluctuated and later disappeared without accompanying clinical or neuroradiological abnormalities. An abundancy of different residual findings, however, remained in the EEG after relapses. There were spike-and-wave paroxysms in every record except at the terminal stage. A stepwise slowing and disorganization was also seen in these paroxysms as background activity. The final cause of death was an intraventricular haemorrhage. No cerebral amyloidosis was found at autopsy. In conclusion, it is suggested that JRA is also a brain disease manifested as a cerebral vasculitis.