Epidemiology of iodine deficiency in the middle Ob regions

AIM: Epidemiological rvaluation of goiter endemia and iodine deficiency in population of the Middle Ob region. MATERIALS AND METHODS: Thyroid palpation and ultrasonic investigations, iodine measurements in the urine were made in 6256 children and adolescents aged 8-17 years. RESULTS: Euthyroid condition was clinically stated in all the examinees. Palpation discovered thyroid enlargement in 36.78% of the examinees. Age prevalence was: 27.3, 33.28, 42.8, 46.18% in children and adolescents aged 8-10, 11-12, 13-14 and 15-17 years, respectively. Ultrasound detected goiter in 30.6% of the examinees. The occurrence was 34.78, 31.68, 28.2, 19.8% in the above age groups, respectively. No significant differences by thyroid size existed in girls versus boys. Urinary iodine was low in all the age groups. CONCLUSION: The Middle Ob regions belong to zone of goiter endemia with mild to moderate iodine deficiency. This dictates the necessity of introduction of special programs of iodine deficiency control and prevention.     

Will genetics revolutionize psychiatry?

After a declining period by the mid-1980s and its stabilization in 1985-1995, the morbidity rates of tuberculosis in Uzbekistan increased in 1996 by 20.7% as compared to 1995, by 24% among children in the past decade, and 2 times among adolescents and young individuals aged under 30 years within 5 years. The rise of mortality rates is accompanied by aggravation of the clinical forms of the tuberculosis cases detected. The goal-oriented examinations of populations at risk of the disease in 14 districts of the Republic indicated a 1.5-fold increase in total mortality rates, followed by an upward tendency.     

The course of pulmonary tuberculosis in adolescents

The authors summarize data obtained at the examinations of 178 tuberculous adolescents aged 15-17. Primary forms of the disease were diagnosed in 52% of new-onset cases, while infiltrative tuberculosis prevailed among secondary forms (48%). The tuberculosis was detected at prophylactic fluorography in 63.5% of the examinees. Late disease diagnosis was mostly consequent to poor symptoms of tuberculosis.     

Life after cancer

Medium-weight molecules (MWM) were measured in the plasma of 67 children and adolescents aged 11 to 17 years who were infected with and suffered from various types of tuberculosis. The highest values of MWM were found in patients with tuberculous exudative pleuritis and infiltrative pulmonary tuberculosis. During treatment, there was a significant reduction in the mean levels of MWM in 20 follow-up patients. It is concluded that it is expedient to employ this test to detect insidious tuberculosis activity during sanatorium treatment and to use it as a criterion for therapeutical efficiency.     

Risk of infection and estimated incidence of tuberculosis in northern Uganda

The main goals of our study were to evaluate: 1) the annual risk of tuberculosis infection (ARTI) and its annual decrease in Uganda; 2) the expected incidence of new tuberculosis cases and the notification rate; and 3) the role of incentives given to children tested in increasing compliance with the survey procedures. The methodology is based on performing the standard World Health Organization (WHO) tuberculin test on children of the same age groups at intervals of 10-15 yrs, identifying infected persons by induration distribution analysis, and converting the prevalence rates detected into risk rates according to the ARTI model. Two thousand six hundred and twenty one school children aged 10 yrs old and bacilli Calmette-Guérin (BCG) nonvaccinated, in six study areas, were injected with two tuberculin units (TU) of purified protein derivative (PPD) RT 23 Copenhagen. The detected prevalence was 14 +/- 1.4% (prevalence +/- 95% confidence interval (95% CI)) and the ARTI value 1.2 +/- 0.9%, with an estimated annual decrease of 0.83% from 1958 to 1970 and 2.9% in the 1970-1987 period. The estimated expected incidence of new cases in Uganda was 59 smear positive and 75 smear negative/extrapulmonary cases per 100,000 population in 1987, and 53 and 65, respectively, in 1990, with an overall 68% notification coverage. No significant improvement in children returning for reading was observed in the group receiving incentives. We conclude that the average decrease (2.9%) probably represents the natural decline of tuberculosis in Uganda. The coverage appears encouraging, although the ARTI detected could be underestimated, since the existing ARTI model was developed and validated before the human immunodeficiency virus (HIV) era.(ABSTRACT TRUNCATED AT 250 WORDS)     

Short-term administration of tall oil phytosterols improves plasma lipid profiles in subjects with different cholesterol levels

OBJECTIVE: To determine the accuracy of antigliadin and antiendomysium antibodies for the diagnosis of celiac disease in diabetic children and adolescents with and without digestive symptoms. STUDY DESIGN: 177 children and adolescents with IDDM aged 15.4 +/- 5.4 years (mean +/- SD). Antigliadin (ELISA) and antiendomysium (IFI) antibodies were measured in 177 and 35 patients, respectively. RESULTS: Seven of 177 patients (3.9%; 95% confidence interval: 1.1-6.7) had celiac disease. The specificities of antiendomysium antibodies test (83%), IgA-antigliadin antibodies test (80%) and IgG-antigliadin antibodies test (90%) and the positive predictive values of these antibodies (55-75%) were lower than those obtained with the combined determination of these antibodies (100%). Negative antibodies and normal mucosa in one determination did not rule out the development of celiac disease later. CONCLUSIONS: The combined determination of antigliadin and antiendomysium antibodies is the test of choice in screening for celiac disease in diabetic patients. The yearly investigation of these antibodies is a reliable method for detecting silent celiac disease in this population.     

Familial aggregation of emotional and behavioral problems of childhood in the general population

OBJECTIVE: This study sought to evaluate the existence and implications of familial aggregation of emotional and behavioral problems of childhood in a general population sample. METHOD: The children included in the study were chosen with the use of a sampling technique that identified households in which there were two or more children aged 4-16 years living at home at the time of the survey. Ratings on checklists of emotional and behavioral problems were obtained from parents, teachers of children in elementary school, and the children themselves if they were adolescents aged 12-16. Children were classified as having problems if their scores on scales of conduct, attention deficit, or emotional problems were in the top 10% of the distribution of scores from any informant. RESULTS: There was evidence for familial aggregation of these problems, particularly conduct and emotional problems. However, this was largely derived from the parents' reports of symptoms, not the teachers' or adolescents' reports. The degree of familial aggregation varied according to certain sibship characteristics and patterns of comorbidity. CONCLUSIONS: Familial aggregation of emotional and behavioral problems does exist in a community population and is not simply an artifact of clinic attendance.     

Nutrient intakes of adolescents with phenylketonuria and infants and children with maple syrup urine disease on semisynthetic diets

Adequacy of nutrient intakes of adolescents with and without phenylketonuria (PKU) and infants and children with and without maple syrup urine disease (MSUD) were assessed using 3-day diet records sorted by disease and by age of the subject. Mean intakes of all nutrients were greater than two-thirds of the Recommended Dietary Allowances (RDA) or Estimated Safe and Adequate Daily Dietary Intakes (ESADDI) for all adolescents studied, with the exception of selenium (Se) in PKU adolescents, which averaged 27.8 micrograms. For adolescents with PKU, > 50% of the RDA or ESADDI for all nutrients was provided by elemental or modified protein hydrolysate medical foods, except for vitamin A in children aged 11-15 years and Se in children 11-18 years. Mean nutrient intakes of all infants and children were greater than two-thirds of the RDA or ESADDI for all nutrients except Se in MSUD children aged 1-11 years, where intakes ranged from 6.4 to 13.2 micrograms (21-66% of the RDA). The medical foods provided for most of the RDA and ESADDI recommendations, with the exception of Se in MSUD children.     

Syncope in children and adolescents

OBJECTIVES: The objectives of this study were to 1) define the incidence of syncope coming to medical attention among children and adolescents, 2) determine the outcome of syncope in these patients, and 3) determine changes over time in the evaluation and charges for evaluating this problem. BACKGROUND: Syncope occurs commonly in children and adolescents. However, the mid- and long-term outcome of children and adolescents who experience syncope is unknown. METHODS: Utilizing the Rochester Epidemiology Project, we determined the incidence, outcome and charges for medical evaluation for patients seeking medical attention for syncope during an early 5-year period (1950 to 1954) and a more recent 5-year period (1987 to 1991). RESULTS: The incidence of syncope coming to medical attention was 71.9 and 125.8/100,000 population for the early and more recent cohort, respectively. The incidence was higher for female than for male patients. The incidence peaked in 15- to 19-year old patients. Acute illness and noxious stimuli were associated with 24% and 23% of the episodes, respectively. Although long-term survival was not different from that of the general population, one child died suddenly, and another had hereditary prolonged QT interval syndrome. These were two of only six patients who had exertional syncope. Total charges for evaluation of syncope were similar in the two time periods. However, charges for testing procedures were greater for the more recent cohort. CONCLUSIONS: In general, syncope in children and adolescents is a benign event. Syncope occurring during exercise may identify patients with a potentially fatal condition. Detailed evaluation should be considered for patients who have syncope during exercise or who have a family history of syncope, sudden death, myocardial disease or arrhythmias. It may be prudent to obtain an electrocardiogram for all patients who seek medical attention for syncope.     

Stability of plasma-polymerized allylamine films with sterilization by autoclaving

BACKGROUND: Survey data on the prevalence of use of oral snuff (toombak) and cigarette consumption according to various demographic factors are needed in the Sudan. METHODS: A house to house cross-sectional survey of a random population sample of 4,535 households was performed. Of the 23,367 household members identified, 21,648 (92.6%) eligible individuals were questioned about tobacco use. RESULTS: Among children and adolescents (4-17 years) prevalence of tobacco use was quite low (2%, range 1-2%), but there was an abrupt increase up to 25% in late adolescence. Among the adult population aged 18 years and older the prevalences of toombak use (34%) and cigarette smoking (12%) among males were significantly higher than among females (2.5 and 0.9%, respectively). The prevalence of toombak use among the male population aged 18 years and older was significantly higher in the rural than in the urban areas (35% vs 24%), while cigarette smoking had a higher prevalence in urban areas (18% vs 12%). The highest rates of toombak use were found in rural areas among the male population ages 30 years and older (mean 46.6%, range 45-47%). CONCLUSIONS: In view of the high prevalence of tobacco use, especially of toombak, among the population surveyed, there is an urgent need to educate the public on the health consequences of these habits.     

Fractures of the hip in children and adolescents

Long-term results of 52 fractures of the hip in 51 children and adolescents are discussed. A distinction was made between fractures in children (aged 1 to 11 years) and those in adolescents (aged 12 to 18 years). Irrespective of the type of fracture it was found that immediate operative treatment leads to the best results. In children as well as in adolescents the risk of avascular necrosis, premature closure of the epiphysis and non-union is less following immediate operative treatment than following delayed operative treatment or conservative treatment. The prognosis of these fractures depends on the amount of damage to the vascularization. Treatment of children consisted of open reduction and fixation with K-wires followed by postoperative immobilization in a hip-spica for 6 weeks. Adolescents were treated with three-flanged nails usually without postoperative plaster immobilization. In both children and adolescents internal fixation may also be carried out with screws, in which case these must not cross an open epiphyseal plate. In both groups a non-weight-bearing period of 6 to 12 months is advisable. The results in adolescents were definitely poorer than in children. Seemingly completely destroyed hips can reintegrate even to a nearly "restitutio ad integrum" state after a period of years.     

Correlation of dermatoglyphic and cellular immunity parameters in children with early stage of primary tuberculosis

Immunological status and dermatoglyphic characteristics were compared in 55 children aged 4-14 with a turn in tuberculin reactions. A correlation was established between genetic and immunological factors, this pointing to the fact that dermatoglyphics is a component of genotype indicative of natural resistance of children to tuberculosis. Synchronization between immunological and genetic values is less intensive in children with immunological disorders against those without them. The findings support the hypophysis on an evolutional role of M. tuberculosis as natural selection factors as well as setting up genetically determined mechanisms of natural resistance to tuberculosis.     

Insulin management and metabolic control of type 1 diabetes mellitus in childhood and adolescence in 18 countries. Hvid?re Study Group on Childhood Diabetes

Insulin regimens and metabolic control in children and adolescents with Type 1 diabetes mellitus were evaluated in a cross-sectional, non-population-based investigation, involving 22 paediatric departments, from 18 countries in Europe, Japan, and North America. Blood samples and information were collected from 2873 children from March to August 1995. HbA1c was determined once and analysed centrally (normal range 4.4-6.3%, mean 5.4%). Year of birth, sex, duration of diabetes, height, body weight, number of daily insulin injections, types and doses of insulin were recorded. Average HbA1c in children under 11 years was 8.3 +/- 1.3% (mean +/- SD) compared with 8.9 +/- 1.8% in those aged 12-18 years. The average insulin dose per kg body weight was almost constant (0.65 U kg(-1) 24 h(-1)) in children aged 2-9 years for both sexes, but there was a sharp increase during the pubertal years, particularly in girls. The increase in BMI of children with diabetes was much faster during adolescence compared to healthy children, especially in females. Sixty per cent of the children (n = 1707) used two daily insulin injections while 37% (n = 1071) used three or more. Of those on two or three injections daily, 37% used pre-mixed insulins, either alone or in combination with short- and intermediate-acting insulin. Pre-adolescent children on pre-mixed insulin showed similar HbA1c levels to those on a combination of short- and long-acting insulins, whereas in adolescents significantly better HbA1c values were achieved with individual combinations. Very young children were treated with a higher proportion of long-acting insulin. Among adolescent boys, lower HbA1c was related to use of more short-acting insulin. This association was not found in girls. We conclude that numerous insulin injection regimens are currently used in paediatric diabetes centres around the world, with an increasing tendency towards intensive diabetes management, particularly in older adolescents. Nevertheless, the goal of near normoglycaemia is achieved in only a few.     

Clinical studies of patients with spinal cord metastases

Despite unfavorable socioepidemiological conditions, there are potentials of reducing tuberculosis morbidity in the epidemic foci of children and adolescents (by more than 3.5 times). For this, all the children and adolescents from the foci of infection should be thoroughly examined and followed up and educational and preventive measures including intensified antituberculosis propaganda should be made in these foci.     

Relationship between dental status and salivary microbiology in adolescents

The authors studied caries prevalence in connection with salivary caries related findings, in 349, 14-16 years old Hungarian adolescents, living in two different cities. DMF.T, DMF-S means, stimulated salivary flow, buffer capacity, Streptococcus mutans, Lactobacillus and Candida albicans counts in saliva were determined. The ratio of cariesfrre adolescents was 4.6% in the total population sample, DMF-T mean values were 7.24 +/- 4.86, DMF-S means 10.50 +/- 8.35. Mean secretion rate of stimulated saliva was 0.84 +/- 0.50, a low buffer capacity was found in 6.3% of the examined children. Ratio of carriers of Streptococcus mutans, Lactobacilli and yeasts in saliva was 89.7%, 73.9% and 47.7% respectively. DMF-T and DMF-S values, as well as S. mutans counts were lower in the capital than in the other city. Statistically significant correlations were found between DMF-S, DMF mean values and salivary microbiological counts.     

Idiopathic intracranial hypertension in children and adolescents

PURPOSE: To investigate sex distribution, frequency of obesity, and other associated conditions among children and adolescents with idiopathic intracranial hypertension. METHODS: We conducted a retrospective chart review of patients aged 18 years or younger diagnosed with idiopathic intracranial hypertension between 1988 and 1995 at two medical centers. Meta-analyses were performed using our data pooled with published information. RESULTS: Of 374 patients, 175 (46.8%) were male and 199 (53.2%) were female. Obesity was noted in 50 (29.6%) of the 169 patients for whom relevant data are available, and other associated conditions were noted in 185 (53.2%) of the 348 patients. CONCLUSIONS: Idiopathic intracranial hypertension among children and adolescents affects boys and girls equally; concurrent obesity occurs less frequently than in adults; and other associated conditions or secondary causes are common.     

Characteristics of typhoid fever in children and adolescents in a major metropolitan area in the United States

To examine the epidemiology of typhoid fever in children in an area that was not endemic, we analyzed 55 cases of typhoid fever in children and adolescents who were < or = 18 years and whose cases were reported to the Chicago and suburban Cook County Health Departments over 7 years. Cases had positive blood and/or stool cultures for Salmonella typhi. The ethnic distribution of the patients was as follows: 25% Asian, 22% Hispanic, 15% African American, 9% Caucasian, 18% other, and 11% unknown. Of the 55 cases, 35% were aged 0-5 years, 25% were aged 6-10 years, 31% were aged 11-15 years, and 9% were aged 16-18 years. Twelve patients did not have a history of travel. All patients recovered; none became carriers. Symptoms in 41 patients whose charts were available for review included fever (100%), diarrhea (77%), vomiting (50%), and dehydration (30%). Bacteremia was documented in 27 (66%) of 41 cases. In 17 of 41 cases, the household contacts were food handlers or health care workers. Eight (31%) of 26 isolates were resistant to both ampicillin and trimethoprim-sulfamethoxazole. The findings in our study were as follows: typhoid fever occurred frequently in children aged 0-5 years (in contrast with reports from areas of endemicity), approximately 20% of patients did not have a history of travel, and multidrug-resistant strains were prevalent.     

Age dependence of coping strategies in children and adolescents with diabetes mellitus

In this cross-sectional study the age-dependency of coping behaviours of 43 children and adolescents with IDDM aged 8 to 18 years has been assessed by means of the German version of the Kidcope (Rathner u. Zangerle 1996). Everyday stressors as well as disease-related stressors were used. Significant age-dependent differences in the frequency of coping behaviours could be found in all strategies except self-criticism. Especially distraction and wishful thinking were significantly more often used by children than by adolescents, whereas adolescent used significantly more often resignation. The more frequent use of resignation by adolescents is not due to a longer duration of illness, but to their developmental stage. Thus, in chronically ill children and adolescents developmental aspects showed a stronger influence on coping than duration of illness. Self-criticism, blaming of others and social withdrawal are as rarely used by children as by adolescents. Self-rated efficacy of coping strategies showed almost no age differences; social support was rated as the most efficient coping strategy by both age groups. Resignation, in the sense of a cognitive acceptance of the illness, seems to be more efficient for adolescents than for children. It is concluded that the developmental process of children and adolescents with chronic illnesses such as IDDM may lead to a better cognitive acceptance of the disease.     

Topographical analysis of cortical neuronal loss associated with disseminated selective neuronal necrosis and infarction after repeated ischemia

Hepatitis A virus (HAV) is a health problem in countries where seroepidemiology shows changes from hyperendemicity to intermediate endemicity. Throughout the last decade, we studied, in Bangkok, the seroprevalence of hepatitis A virus antibody (anti-HAV) among adolescents of different age groups. In 1996, 245 serum specimens from children aged between 10 and 19 were tested for anti-HAV by ELISA method. The results were compared to those obtained in 1987 and 1993 from students of the same age and attending the same school. Anti-HAV was detected in 31.4%, 14.6% and 12.7% of school children in the years 1987, 1993 and 1996, respectively. Each year, it was found that an increasing prevalence of anti-HAV was related to an increasing age. From 1987 to 1996, the age specific prevalence of anti-HAV was markedly decreased in younger children. The surveillance of the epidemiological trend of HAV infection is important for implementing preventive measures and for controlling the disease.