Behavioural assessment and treatment of chronic headaches in children

ABSTRACT This review explores advances in the behavioural assessment and treatment of childhood headaches. Behavioural assessment procedures are outlined including the behavioural interview, self-report questionnaires, self-monitoring and caregiver observations. We conclude that behavioural treatment strategies are effective in the management of childhood headaches, although most of the research support appears to be limited to relaxation training and biofeedback. Nonetheless, the behavioural assessment and treatment of childhood headaches appears to be a promising clinical and research direction.     

Hopelessness and suicidal ideation among adolescents in two cultures

BACKGROUND: This study examines the cross-sectional and longitudinal associations among cognitive variables, depressive symptoms and suicidal ideation in Hong Kong Chinese and Caucasian American adolescents. METHODS: Community adolescents (n = 2,044) ages 14-18 years from Hong Kong and the United States provided information regarding their suicidal ideation, depressive symptoms, and cognitions (self-efficacy, cognitive errors and hopelessness), at two surveys, six months apart. RESULTS: Self-efficacy was a weak unique predictor of suicidal ideation in both cultures. Hopelessness was the strongest of cognitive variables in concurrent associations with suicidal ideation in bivariate and multivariate models, in both cultures, and in both boys and girls. Hopelessness continued to offer unique prediction when depressive symptoms were controlled, both concurrently and prospectively. CONCLUSIONS: Our results support hopelessness theories of suicidal ideation and behavior in Hong Kong, and extend the cognitive theory of suicidality to a modernized Asian culture.     

Comparison of Parent-Referred and Doctor-Referred Patients to Child Psychiatrists in Hong Kong: a Research Note

The characteristics of 75 children referred to psychiatrists by medical practitioners in Hong Kong were compared with 56 children who were referred by their families to a community clinic. Their demographic characteristics, and the nature and severity of their illness, were quite similar. Medical practitioners tended to refer children with childhood psychosis and psychophysiological disorder. The reasons leading to different types of referral are discussed. A community child mental health clinic may be a useful model for providing psychiatric care to children in Hong Kong.     

Unintentional residential child injury surveillance in Hong Kong

OBJECTIVES: To provide an overall pattern of morbidity in unintentional residential childhood injuries (URCI) in Hong Kong. METHODOLOGY: A cross-sectional telephone survey of caregivers of children aged under 16-years and adolescents suffering from URCI and admitted to three selected local Accident and Emergency Departments. RESULTS: Falls, cuts and scalds were the most common external causes of URCI observed, while boys predominated in the sample population. Most of the observed URCI were of moderate to mild severity. Children of new immigrant mothers were more likely to receive first aid immediately after the incidents. Parents were aware of potentially injurious behaviour and intervened on occasion, but most resorted to verbal warnings only. CONCLUSIONS: Prevalence of falls among observed URCI offers evidence in support of the hypothesis that the high population density in Hong Kong plays an integral role in understanding mechanisms of morbidity. Parents show concern about URCI but often lack substantial action that modifies injury risk. Considering the local injury differentials, an active prevention effort such as behavioural intervention and education for parents may be useful.     

INHERITANCE OF CHRONIC GRANULOMATOUS DISEASE IN FEMALES Report of a Female Patient and the Leucocyte Function Studies in the Family

A case of chronic granulomatous disease in a female child is presented. Onset of symptoms seem to have been somewhat delayed compared with most male patients. The results of in vitro leucocyte function studies on the patient and her parents and siblings are presented together with the results of similar studies on 6 male patients and some of their relatives. In contrast to the male patients, no heterozygote carrier state could be detected among the family members. These results are in agreement with current views on the genetics of chronic granulomatous disease, that the large majority of male cases are inherited as an X-linked trait whereas most if not all female cases are inherited as an autosomal recessive trait. Spontaneous gene mutation cannot, however, be excluded in the present case.     

Human colostral cells: phagocytosis and killing of E. coli and C. albicans.

Cells from human colostrum, collected from mothers within 48 hours of delivery, were examined for their capacity to phagocytose and kill Eschericia coli and Candida albicans. The phagocytic power of colostral cells was comparable to that of blood leukocytes from the same individuals. In contrast, the capacity of colostral cells to kill microorganisms was significantly less than that of blood leukocytes. Preincubation of blood leukocytes with colostrum supernatant did not reduce phagocytic indices, but reduced E. coli killing by 40% and C. albicans killing by 66%. The role of colostral cells in protecting the neonate from infection is discussed in the light of these findings.     

Anaemia and thalassaemia in healthy adolescents from southern Chinese families

A study was conducted on 447 healthy high school students of southern Chinese descent to determine the prevalence of anaemia and thalassaemia. Haematological data and serum ferritin levels were determined on all venous blood samples. Haemoglobin (Hb) electrophoretic study was conducted on 43 students who had anaemia (Hb less than 12 g/dL), and/or mean corpuscular volume (MCV) less than 80 fL. They were re-assessed after 1 month of oral iron therapy. Three girls had definite iron deficient anaemia (less than 1%). Thirty-nine students had either alpha, or beta-thalassaemia, only seven of whom showed anaemia. Since the overwhelming majority of both the thalassaemic students (38 of 39) and the participants (429 of 447) were of Cantonese extraction (native of Guangdong province), the overall incidence of 8.8% (alpha-thalassaemia 5.4%, beta-thalassaemia 3.4%) reflected the high frequency of the thalassaemia gene among this group of southern Chinese. MCV measurement, rather than Hb, was more useful in its detection.     

Meningitis in Hong Kong children, with special reference to the infrequency of haemophilus and meningococcal infection

Objective: To study the epidemiologic and aetiologic features of meningitis in children in Hong Kong.
Methodology: A retrospective study of 85 children resident in the New Territory East region of Hong Kong admitted to a teaching Hospital because of meningitis during a 9 year period.
Results: Mycobacterium tuberculosis was the most common aetiological agent accounting for 13 cases (15.3%). Other bacteria accounted for 41 cases (48%); among these one fifth were caused by Haemophilus influenzae type b. The overall admission rates for tuberculous meningitis in Chinese children were 0.76/100 000 (95% CI 0.25-1.78) and 0.42/100 000 (CI 0.19-0.8) per year, respectively, for under 5 year olds and under 15 year olds. The overall annual incidence rates of bacterial meningitis other than tuberculous were 5.2/100 000 (CI 3.72-7.43) and 1.6/100 000 (CI 1.14-2.29) for Chinese children under 5 years and under 15 years, respectively. The annual incidence of H. influenzae meningitis in Chinese children under 5 years old was low at 1.1/100 000 (0.43-2.2). All five cases of meningococcal meningitis were in Vietnamese children (under 5 years of age incidence: 13.0/100 000 per year, CI 4.2-30.3). There were no cases of meningococcal meningitis in Chinese children during the 9 year period.
Conclusion: M. tuberculosis was the most common aetiological agent of meningitis in Hong Kong children. The incidence of haemophilus or meningococcal meningitis was very low.     

Weight-for-age and weight-for-height references for Hong Kong children from birth to 18 years

Objective : Childhood obesity is an emerging problem in Asia. Sequential monitoring of the growth of an individual can detect a change in body fatness, provided there are ethnically appropriate growth references.
Methodology : A territory wide cross-sectional growth survey of Hong Kong on 24 709 individuals from the age of newborn to 18 years was performed in 1993. Weight-for-age and weight-for-height percentile charts were prepared separately for boys and girls.
Results : There was an average increase of 8.5 kg and 5.1 kg in the 18 year old boys and girls, respectively, compared to those surveyed 30 years ago. The percentile curves between 6 and 18 years were similar to those of Singapore. Weight-for-height percentile curves were close to those of America in the prepubertal years.
Conclusions : These Hong Kong growth standards for weight-for-age and weight-for-height are important tools for the assessment of nutritional status of an individual and for monitoring changes in nutritional status of the population.     

Secrets to success: a qualitative study of perceptions of childhood immunisations in a highly immunised population

Aim: The aim of this study was to explore childhood immunisations with a sample of parents from a population where children have high vaccination coverage and to identify factors which might encourage uptake in other populations. Methods: This research was conducted as part of a larger study on childhood immunisations in Hong Kong. In‐depth interviews were conducted with a subsample of parents (n = 15) to further explore general perceptions and health beliefs about childhood immunisations. Interview data were analysed using content analysis techniques. Results: Three core themes emerged from the data: individual influences factors, family and social factors, and system factors. [Correction added after online publication 21/8/08: sentence corrected from “Four core themes emerged from the data: individual influences, family influences and system influences.”] Parents readily admitted knowledge deficits concerning childhood vaccines but believed that the benefits of immunisation outweighed the risks. Family members and peers were a source of pro‐immunisation advice and comprehensive public health programmes and mandatory vaccination requirements for school entry ensured that childhood immunisation recommendations were followed. Conclusions: Overall, Hong Kong parents are highly supportive of immunisation programmes and insight gained from this study could prove helpful to providers trying to improve uptake rates among other populations.     

Increasing prevalence of allergic rhinitis but not asthma among children in Hong Kong from 1995 to 2001 (Phase 3 International Study of Asthma and Allergies in Childhood)

There is a worldwide belief that the prevalence of asthma and other allergic diseases is increasing but the measures used in many studies are susceptible to systematic errors. We examined the trend of asthma, allergic rhinitis and eczema prevalence in school children aged 6–7 years in Hong Kong from 1995 to 2001 using standardized ISAAC methodology. There were 4448 and 3618 children participating in 2001 and 1995, respectively. The prevalence of life-time rhinitis (42.4% vs. 38.9%, p < 0.01), current rhinitis (37.4% vs. 35.1%, p < 0.03), current rhinoconjunctivitis (17.2 vs. 13.6%, p < 0.01) and life-time eczema (30.7% vs. 28.1%, p = 0.01) increased significantly. There was no significant change in prevalence of life-time asthma, life-time wheeze and current wheeze albeit a significant increase in severe asthma symptoms. We investigated a number of potential risk factors including sex, family history of atopy, sibship size, birth weight, respiratory tract infections, pet ownership and exposure to tobacco smoke. However, the increases in prevalence of rhinitis and eczema could not be entirely explained by the change of prevalence of these risk factors. The odds ratio OR for the study period remained significantly associated with current rhinitis (OR 1.31, 95% confidence intervals CI 1.17–1.46), current rhinoconjunctivitis (OR 1.63, 95% CI 1.41–1.87) and life-time eczema (OR 1.30, 95% CI 1.16–1.45) after adjustment for these confounding variables using logistic regression model. Further study is warranted to elucidate the factors contributing to the observable change in the prevalence of rhinitis in our population.     

Behavioural problems in children and parenting stress associated with primary nocturnal enuresis in Hong Kong

The aim of this study was to investigate the behavioural problems and parenting stress of enuretic children in the local Chinese community. The study recruited 89 children with primary nocturnal enuresis (PNE) from the paediatric clinics of 9 regional hospitals in Hong Kong, and 131 age- and gender-matched control children without PNE from the Student Health Centres. After adequate instruction, the parents completed the Child Behaviour Checklist (CBCL) and Parenting Stress Index (PSI). A trained interviewer interviewed the parents and children and rated the children on the Global Assessment of Functioning (GAF). The PNE group had worse overall scores in both the Problem and Competence scales of CBCL; in particular, they had more attention problems and aggressive behaviours, and lower social competence and school performance than the control group. Their parents demonstrated more parenting stress as shown by higher PSI scores. Conclusion: In the local Chinese population, PNE was associated with more childhood behavioural problems and greater parenting stress. Attention to the psychosocial functioning of the child and parents may be important in the management of enuresis.     

Reliability of pubertal self-assessment in Hong Kong Chinese children

Aim:   To validate a Tanner stages self-assessment questionnaire using gender-specific line drawings and brief explanatory text in Chinese.
Methods:   Design: A cross sectional study design. Setting: One primary and two secondary schools. Participants: 172 boys and 182 girls aged between 8 and 18 years. Main outcome measures: Students' self-assessments of pubertal maturation were compared with assessments made by a same gender rater using visual depiction physical examination. Raters' physical examinations were performed after the children had answered the self-assessment questionnaire individually and in private. Raters were blinded to the self-assessment results. Accuracy rates and weighted kappa statistic were used to evaluate the degree of agreement between children and raters.
Results:   Substantial to almost perfect agreement was found between self- and rater's assessments of breast development and pubic hair growth in girls [weighted kappa 0.72 ( P  < 0.0001, 95% CI 0.66, 0.79) and 0.83 ( P  < 0.0001, 95% CI 0.78, 0.87) respectively]. Moderate to substantial agreement was found between self- and rater's assessments of male genital development and pubic hair growth [weighted kappa 0.58 ( P  < 0.0001, 95% CI 0.48, 0.68) and 0.80 ( P  < 0.0001, 95% CI 0.74, 0.86) respectively]. Most agreements between self- and rater's assessments differed by only one Tanner stage. Agreement was higher for girls than boys. Girls tended to overestimate their breast stages and boys tended to underestimate their genitalia development.
Conclusion:   This study confirms that a Tanner pubertal self-assessment questionnaire with line drawings and explanatory Chinese text can reliably estimate sexual maturation status in Hong Kong Chinese children.     

Conners'' Teacher''s Rating Scale—A Validity Study in Hong Kong

The validity of the Conners' teacher's rating scale (CTRS) in Hong Kong Chinese school children was examined. It was found that CTRS could significantly differentiate a behaviorally deviant group and the normal population; that CTRS has a strong positive correlation with the teacher's decision to refer a child to a mental health professional; that the CTRS by itself is not useful as a diagnostic instrument; and finally, it cannot stand alone as a screening instrument in the epidemiological study of childhood hyperactivity.     

Neonatology in developed and developing nations

Neonatal care has made tremendous improvements in developing countries. However there are number of challenges to be met and neonatal mortality remains unacceptably high. In contrast to this neonatal care in developed nations have moved ahead of a pre-occupation to reducing the neonatal mortality only. The main reasons for this gap are poor infrastructure, resource limitations and lack of systems developed by neonatal units in the developed nations. Though this communication we explore the possibilities of application of health policies in the Australian neonatal units n developing countries.