Environmental toxins; their impact on children's health

Contamination of the environment by man-made and natural toxins has a direct impact on the health of children. This review considers how toxic contamination is identified and regulated, and highlights specific hazards.     

Genetic variation and health; towards individualized medicine

BACKGROUND: Pediatric endocrine diseases and their adult consequences depend on interactions of environmental exposure factors with the genetic makeup of the individual. Much has been learned over the past two decades about the genetic component in cases of monogenic (Mendelian) disorders due to drastic disruption of a single gene. The majority of children consulting a pediatric endocrinologist, however, suffer from conditions not attributable to a single gene. The nature and mechanisms of more subtle alterations at multiple different genes that are responsible for the genetic component of most human morbidity and mortality is now only beginning to be elucidated, largely thanks to the vast amount of information that is becoming available through the human genome effort. OVERVIEW: The purpose of this review is to describe 1. the nature of the information on health-related human variation that is coming our of the genome effort; 2. how this variation can affect biology; 3. which research approaches show promise in linking DNA variation to disease; 4. how this variation is organized in genomic blocks of linkage disequilibrium; and 5. how this knowledge may, in the future, allow clinicians to individualize management of a specific patient according to his/her genetic makeup.     

The enigma of the welfare state: excellent child health prerequisites – poor subjective health

The rate of subjective health complaints among Swedish children is increasing by age and over time, and more so than among children in other Scandinavian countries. In contrast, the somatic health and prerequisites for wellbeing are excellent. This paradoxical situation, The Enigma of the Welfare State, is the focus of this viewpoint. We argue that one important background factor may be late adverse effects of the welfare society itself and some of its inherent values. We have identified several possible pathways. We have given them names of diseases – on the society level – like health obsession, stress panic, welfare apathy and hyper‐individualism. Together with other factors such as a dysfunctional school and an unsatisfactory labour market for youth, these diseases are involved in an interplay that is constantly inducing anxiety and low self‐esteem. Conclusion: The gradually deteriorating self‐reported health among Swedish youth may, to some degree, be explained as a late adverse effect of the welfare society itself and its inherent values.     

Vitamin D and child health in the 21<Superscript>st</Superscript> century

Context  

Vitamin D has emerged as a topic of great interest among researchers. Recent evidence indicates that today the world is facing vitamin D deficiency pandemic. Sensitizing pediatricians to widespread vitamin D deficiency in children and benefits accrued from it’s correction would go a long way as far as clinical practice and public health is concerned.     

The health of HIV‐exposed children after early weaning

There are potential health risks associated with the use of early weaning to prevent mother‐to‐child transmission of human immunodeficiency virus (HIV) in resource‐poor settings. Our objective was to examine growth and nutrient inadequacies among a cohort of children weaned early. Children participating in the Breastfeeding Antiretrovirals and Nutrition (BAN) Study in Lilongwe, Malawi, had HIV‐infected mothers, were weaned at 6 months and fed LNS until 12 months. 40 HIV‐negative, BAN‐exited children were compared with 40 HIV‐negative, community children matched on age, gender and local health clinic. Nutrient intake was calculated from 24‐h dietary recalls collected from BAN‐exited children. Anthropometric measurements were collected from BAN‐exited and matched community children at 15–16 months, and 2 months later. Longitudinal random effects sex‐stratified models were used to evaluate anthropometric differences between the two groups. BAN‐exited children consumed adequate energy, protein and carbohydrates but inadequate amounts of fat. The prevalence of inadequate micronutrient intakes were: 46% for vitamin A; 20% for vitamin B6; 69% for folate; 13% for vitamin C; 19% for iron; 23% for zinc. Regarding growth, BAN‐exited girls gained weight at a significantly lower rate {0.02 g kg^?1 per day [95% confidence interval (CI): 0.01, 0.03]} than their matched comparison [0.05 g kg^?1 per day (95% CI: 0.03, 0.07)]; BAN girls grew significantly slower [0.73 cm month^?1 (95% CI: 0.40,1.06)] than their matched comparison (1.55 cm month^?1[95% CI: 0.98, 2.12]). Among this sample of BAN‐exited children, early weaning was associated with dietary deficiencies and girls experienced reduced growth velocity. In resource‐poor settings, HIV prevention programmes must ensure that breastfeeding stop only once a nutritionally adequate and safe diet without breast milk can be provided.     

Measuring health professionals' beliefs about skin‐to‐skin care during a cesarean

Women and their newborns are at risk of delayed or withheld skin‐to‐skin care (SSC) during a caesarean, which is about one‐third of births, worldwide. To date, no instrument exists to assess health professionals'' (HPs) beliefs, and potential barriers and strategies for implementing SSC during a cesarean. The study aims were to (1) develop an instrument, Health Professionals'' Beliefs about Skin‐to‐Skin Care During a Cesarean (SSC_B), (2) establish its validity and reliability and (3) describe HPs'' beliefs about SSC during a caesarean. Quantitative and qualitative analyses were used to test the SSC_B and describe HPs'' beliefs. SSC_B analysis yielded a content validity of 0.83 and reliability of α = 0.9. We grouped all practice roles as either nurses or physicians. The mean rank score for nurses (n = 120, M = 90) was significantly higher (p = 0.001) than physicians (n = 46, M = 79). Despite this difference, scores for both roles reflected support for SSC. Participants identified hospital readiness to implement SSC and maintaining maternal and newborn safety as major issues. SSC_B is a valid, reliable instrument to measure HPs'' beliefs about SSC during a caesarean birth. HPs can use the SSC_B during quality improvement initiatives to improve access to immediate SSC for women who have a caesarean birth. Improved access can enhance breastfeeding outcomes and promote optimal maternal and child health.