Child sex rings.

Details of 11 child sex rings identified in one working class community were obtained by interviewing investigating police officers and examining health and social services records. The rings contained 14 adult male perpetrators and 175 children aged 6-15 years. Most perpetrators used child ringleaders to recruit victims; others became a "family friend" or obtained a position of authority over children. Secrecy was encouraged and bribery, threats, and peer pressure used to induce participation in sexual activities. Offences reported included fondling, masturbation, pornography, and oral, vaginal, and anal intercourse. Eleven perpetrators were successfully prosecuted; all but one received a sentence of three years or less. Behavioural problems were common among those children who had participated for a long time. Child sex rings are difficult to detect and may be common. Many children are seriously abused as a consequence of them.     

The first 10 years of the dialysis-transplantation program at The Hospital for Sick Children,Toronto. 1: Predialysis and dialysis.

Renal dialysis and transplantation have been used for many years for adults with kidney failure but only recently for children. In May 1967 a renal-dialysis-transplantation program was established at The Hospital for Sick Children, Toronto for patients aged 6 to 18 years living within 240 km of Toronto. In 1973, children aged 1 to 5 years began to be accepted into the program, and by August 1977, 90 children (mean age 11 years) from all parts of Canada had been admitted to the program. The creation of vascular access in very small patients is difficult; the most successful types of access have been central shunts (established above the knee or the elbow) and bovine grafts. Specially made dialysis equipment is necessary for young patients. Young children should only be accepted in a dialysis-transplantation program that has a medical staff expert in meeting the specific needs of such children.     

Tennis elbow and the cervical spine.

The exact cause of tennis elbow, a common condition, is still obscure. While the condition may well be entirely due to a local disorder at the elbow, the results of a study of 50 patients whose condition was resistant to 4 weeks of treatment directed to the elbow suggest that the underlying condition may have been (at least in these patients) a reflex localization of pain from radiculopathy at the cervical spine. Clinical, radiologic and electromyographic findings supported this suggestion. The pain was demonstrated to be muscular tenderness, which was maximal and specific at motor points. Treatment directed to the cervical spine appeared to give relief in the majority of patients. The more resistant the condition, the more severe were the radiologic and electromyographic findings in the cervical spine.     

Peptic ulcer disease: a clinical study in 73 children

Seventy-three children with peptic ulcer have been admitted to The Montreal Children''s Hospital and l''Hôpital Sainte-Justine over the past 11 years. The primary ulcer group comprised 39 duodenal and nine gastric ulcers; repeat contrast studies were necessary to demonstrate a crater in 25%. Vomiting was especially prominent in the younger patients (1 month to 6 years). Pain was present in the majority of older patients (6 to 18 years) but was considered “typical” in no more than one third. Bleeding occurred more commonly in the older children but five had occult bleeding only. There was a positive family history in 11 children with primary duodenal ulcers but in none of those with gastric ulcers. Follow-up in 34 cases with primary ulcers showed that close to two thirds of the older children have had recurrent problems. Bleeding and/or perforation was the most common mode of presentation in 25 cases of secondary ulcers. Corticosteroids and increased intracranial pressure were the most frequently associated factors, the younger age group being at greater risk.     

Mucocutaneous lymph node syndrome in Canada.

Two Edmonton children recently had a disease seemingly new to North America but a common problem in young children in Japan in the last few years. Named "mucocutaneous lymph node syndrome", it is an acute febrile condition with massive focal cervical lymphadenopathy, conjunctivitis and indurative edema of the hands and feet progressing to desquamation. It may have an infectious basis and therefore may become common in Canada.     

Acquired myopia in 11-year-old children.

Children who had acquired myopia by the age of 11 years were identified from a nationally representative sample. There were no overall sex differences in its occurrence but myopia was more common in children from non-manual families than in those from manual families. Short-sighted children were more likely to come from small families and to be of higher birth order than children with normal vision, and these associations held within each social class. At 11 years myopic children showed striking advantages in educational performance over their normal-sighted peers, as judged by tests of reading, arithmetic, and general ability. After adjustments had been made for social background, this age gain still amounted to over one year. Findings obtained at 7 years of age showed that superior educational attainments were already apparent before the onset of myopia. Children with myopia read in their leisure time more often than normally sighted children, but despite the visual impairment, they participated in outdoor sports as often as other children.     

Humoral imunity to pertussis in children with diabetes of type 1

To determine the state of humoral immunity to pertussis in children with insulin-dependent diabetes, IgG antibodies to pertussis toxin (PT) were determined in blood serum samples by means of EIA. In a group of children aged up to 6 years the highest percentage (100%) received the complete course of vaccination against pertussis with Russian adsorbed DPT vaccine, containing whole-cell pertussis monovaccine, while in a group over 6 years the complete vaccination course (3 vaccinations and 1 revaccination) had 53.4% of children. Pertussis morbidity was considerably higher in nonvaccinated subjects than in children with 4-fold vaccination (p < 0.001). The coefficient of association (Q) was 0.84. Children of all age groups were found to have low and average titers of antibodies to PT. The regressive analysis showed a decrease in antibodies in persons completely immunized against pertussis by the age of 6 years old. The presence of antibodies in nonimmunized persons showed that cases of pertussis or carrier state took place among the population. High titers of antibodies, indicative of recent cases of pertussis, were registered in all age groups, but high titers of antibodies were registered mostly in the group of children over 13 years old (p < 0.05), which confirmed an increase in pertussis morbidity in adolescents. Thus, vaccination against pertussis effectively protected children with diabetes of type 1, aged up to 6 years. For more prolonged protection the vaccination and revaccination of children aged over 4 years old is necessary.     

Does the Majority Always Know Best? Young Children's Flexible Trust in Majority Opinion

Copying the majority is generally an adaptive social learning strategy but the majority does not always know best. Previous work has demonstrated young children''s selective uptake of information from a consensus over a lone dissenter. The current study examined children''s flexibility in following the majority: do they overextend their reliance on this heuristic to situations where the dissenting individual has privileged knowledge and should be trusted instead? Four- to six- year-olds (N = 103) heard conflicting claims about the identity of hidden drawings from a majority and a dissenter in two between-subject conditions: in one, the dissenter had privileged knowledge over the majority (he drew the pictures); in the other he did not (they were drawn by an absent third party). Overall, children were less likely to trust the majority in the Privileged Dissenter condition. Moreover, 5- and 6- year-olds made majority-based inferences when the dissenter had no privileged knowledge but systematically endorsed the dissenter when he drew the pictures. The current findings suggest that by 5 years, children are able to make an epistemic-based judgment to decide whether or not to follow the majority rather than automatically following the most common view.     

Serum Alkaline Phosphatase and Rickets in Urban Schoolchildren

Among 569 schoolchildren (386 boys and 183 girls) aged 14-17 years, 233 had serum alkaline phosphatase values of 30 K.A. units or greater. There was no significant difference in the results in Asian, white, or West Indian children. The mean values were significantly greater in boys than girls and both showed a fall in mean values with increasing age. Radiological rickets occurred in at least 4% of the survey, and was more common in Asians. Low calcium and high hydroxyproline excretion in most of those investigated and the response to vitamin D therapy suggests that most children with alkaline phosphatase levels above 30 K.A. units have rickets.Since the decline of the widespread supplementation of the diet with vitamin D, the demands of the physiological growth spurt for extra vitamin D in adolescents already on a borderline intake may be responsible for the great increase in “biochemical” rickets. Once the growth spurt is over the condition subsides but the results of impaired growth or permanent pelvic deformity will not necessarily be eradicated.     

Severe obstetric brachial plexus palsies can be identified at one month of age

Objective

To establish whether severe obstetric brachial plexus palsy (OBPP) can be identified reliably at or before three months of age.

Methods

Severe OBPP was defined as neurotmesis or avulsion of spinal nerves C5 and C6 irrespective of additional C7-T1 lesions, assessed during surgery and confirmed by histopathological examination. We first prospectively studied a derivation group of 48 infants with OBPP with a minimal follow-up of two years. Ten dichotomous items concerning active clinical joint movement and needle electromyography of the deltoid, biceps and triceps muscles were gathered at one week, one month and three months of age. Predictors for a severe lesion were identified using a two-step forward logistic regression analysis. The results were validated in two independent cohorts of OBPP infants of 60 and 13 infants.

Results

Prediction of severe OBPP at one month of age was better than at one week and at three months. The presence of elbow extension, elbow flexion and of motor unit potentials in the biceps muscle correctly predicted whether lesions were mild or severe in 93.6% of infants in the derivation group (sensitivity 1.0, specificity 0.88), in 88.3% in the first validation group (sensitivity 0.97, specificity 0.76) and in 84.6% in the second group (sensitivity of 1.0, specificity 0.66).

Interpretation

Infants with OBPP with severe lesions can be identified at one month of age by testing elbow extension, elbow flexion and recording motor unit potentials (MUPs) in the biceps muscle. The decision rule implies that children without active elbow extension at one month should be referred to a specialized center, while children with active elbow extension as well as active flexion should not. When there is active elbow extension, but no active elbow flexion an EMG is needed; absence of MUPs in the biceps muscle is an indication for referral.     

Glucose-6-Phosphate Dehydrogenase Deficiency in Nigerian Children

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common human enzymopathy and in Sub-Saharan Africa, is a significant cause of infection- and drug-induced hemolysis and neonatal jaundice. Our goals were to determine the prevalence of G6PD deficiency among Nigerian children of different ethnic backgrounds and to identify predictors of G6PD deficiency by analyzing vital signs and hematocrit and by asking screening questions about symptoms of hemolysis. We studied 1,122 children (561 males and 561 females) aged 1 month to 15 years. The mean age was 7.4±3.2 years. Children of Yoruba ethnicity made up the largest group (77.5%) followed by those Igbo descent (10.6%) and those of Igede (10.2%) and Tiv (1.8%) ethnicity. G6PD status was determined using the fluorescent spot method. We found that the overall prevalence of G6PD deficiency was 15.3% (24.1% in males, 6.6% in females). Yoruba children had a higher prevalence (16.9%) than Igede (10.5%), Igbo (10.1%) and Tiv (5.0%) children. The odds of G6PD deficiency were 0.38 times as high in Igbo children compared to Yoruba children (p = 0.0500). The odds for Igede and Tiv children were not significantly different from Yoruba children (p = 0.7528 and 0.9789 respectively). Mean oxygen saturation, heart rate and hematocrit were not significantly different in G6PD deficient and G6PD sufficient children. The odds of being G6PD deficient were 2.1 times higher in children with scleral icterus than those without (p = 0.0351). In conclusion, we determined the prevalence of G6PD deficiency in Nigerian sub-populations. The odds of G6PD deficiency were decreased in Igbo children compared to Yoruba children. There was no association between vital parameters or hematocrit and G6PD deficiency. We found that a history of scleral icterus may increase the odds of G6PD deficiency, but we did not exclude other common causes of icterus such as sickle cell disease or malarial infection.     

Relationships between muscle power output using the stretch-shortening cycle and eccentric maximum strength

This study aimed to examine the relationships between muscle power output using the stretch-shortening cycle (SSC) and eccentric maximum strength under elbow flexion. Eighteen young adult males pulled up a constant light load (2 kg) by ballistic elbow flexion under the following two preliminary conditions: 1) the static relaxed muscle state (SR condition), and 2) using the SSC with countermovement (SSC condition).Muscle power was determined from the product of the pulling velocity and the load mass by a power measurement instrument that adopted the weight-loading method. We assumed the pulling velocity to be the subject's muscle power parameters as a matter of convenience, because we used a constant load. The following two parameters were selected in reference to a previous study: 1) peak velocity (m x s(-1)) (peak power) and 2) 0.1-second velocity during concentric contraction (m x s(-1)) (initial power). Eccentric maximum strength by elbow flexion was measured by a handheld dynamometer.Initial power produced in the SSC condition was significantly larger than that in the SR condition. Eccentric maximum strength showed a significant and high correlation (r = 0.70) with peak power in the SSC condition but not in the SR condition. Eccentric maximum strength showed insignificant correlations with initial power in both conditions. In conclusion, it was suggested that eccentric maximum strength is associated with peak power in the SSC condition, but the contribution of the eccentric maximum strength to the SSC potentiation (initial power) may be low.     

Campylobacter enteritis: a "new" disease.

By selective culture campylobacters (C jejuni and C coli) were isolated from the faeces of 57 (7-1%) out of 803 unselected patients with diarrhoea; none were isolated from 194 people who had not got diarrhoea. Specific agglutinins were found in the sera of 31 out of 38 patients with campylobacter enteritis and 10 of them had a rising titre. Half the patients were aged 15 to 44 years, but the incidence was highest in young children. All the patients with campylobacters had a distinctive clinical illness with severe abdominal pain. Campylobacters are a relatively unrecognised cause of acute enteritis, but these findings suggest that they may be a common cause. Spread of infection was observed within 12 out of 29 households, and in these cases children were usually implicated. Several patients were apparently infected from chickens, both live and dressed, and poultry may be the primary source of the organism. In two cases dogs with diarrhoea were found to be infected with strains indistinguishable from their human contacts. Ten patients acquired their infections while travelling abroad.     

Dogs in Schools: The Impact of Specific Human–Dog Interactions on Reading Ability in Children Aged 6 to 8 Years

Dog-assisted educational programs, including reading programs, are becoming an area of research focus, based on claims of various advantages for children. However, while available findings typically indicate benefits for the children involved, the low quality of evidence makes it difficult to draw valid inferences. In the current study three dog-assisted programs with clearly defined parameters were developed and evaluated. Sixty-three children, aged 6 to 8 years, were matched on age and gender and pseudo-randomly allocated to one of the three conditions. In one condition the children participated in eight 15–20 minute sessions over a four-week period, in which they worked in pairs to train a dog to complete obstacle course tasks. In a second condition the children spent the same amount of time reading out loud, in pairs, to a stationary dog. In the third condition children participated in normal classroom activities with a dog present in the classroom. This intervention ran for up to four hours per week over the four-week period. Validated measures were used to assess reading abilities pre- and post-intervention. From the results it appeared that children showed significant improvements across time for reading ability for all three conditions, including the condition with minimal dog contact, with no significant group or interaction effects. Exploratory analyses unexpectedly indicated that children who had lower starting abilities displayed the greatest levels of reading improvement. While it cannot be determined that these findings are the result of the presence of the dog alone, they nonetheless may indicate that dog-assisted reading programs are an effective means of benefitting those children who most need help to become fluent readers.     

The development of rhythm regularity, neuromuscular strategies, and movement smoothness during repetitive reaching in typically developing children

IntroductionThis study examined the development of paced coordinated reaching characterized by the successful entrainment of the movement to an external pacer, synchronous muscle activations and movement smoothness.MethodsThirty children, 5–10 years of age, and ten adults were instructed to repeatedly reach for and move an object from a lower shelf to an upper shelf in time to a metronome. Surface electromyography data were recorded. Amplitude and cross-correlations were calculated on three muscle pairs crossing the shoulder and elbow. A motion capture system captured the space curve accelerations of hand, forearm and upper arm segments to quantify movement smoothness.ResultsThe 5–6 year old children showed the greatest amount of temporal variability, followed by 7–10 year olds and then the adults. Correlations between muscle pairs stabilizing the shoulder girdle were higher in each group as compared to the other two muscle pairs but the correlations for all pairs were consistently higher for adults. Movement smoothness for children 9–10 years of age was closer to an adult-like pattern with respect to control of the upper arm, but the hand segment had the greatest variability across groups.ConclusionsThe increased temporal variability and decreased movement smoothness of the hand and forearm segments suggest that control of more distal musculature may be more difficult in children. The neuromuscular strategies adopted by adults were more optimal than those adopted by children as reflected by smoother and more consistent reaching.     

The outcome of Erb's palsy when the decision to operate is made at 4 months of age

Since the establishment of the obstetrical brachial plexus clinic in Saudi Arabia, the author has designed a prospective study in which the indication for brachial plexus surgery in infants with Erb's palsy was the lack of active elbow flexion against gravity at 4 months of age. Forty-three infants were included in the study and were distributed among four groups: group A (n = 20) included infants who had active elbow flexion at the initial assessment or at 2 months of age; group B (n = 9) included infants who had active elbow flexion at 3 months of age; group C (n = 11) included infants who had active elbow flexion at 4 months of age; and group D (n = 3) included infants who did not have active elbow flexion at 4 months of age. At the final follow-up, all children in group A demonstrated complete spontaneous recovery of the motor power of the limb. All children in group B also had satisfactory spontaneous recoveries, and none required secondary corrective procedures. Five of the 11 patients in group C had satisfactory spontaneous recoveries. The remaining six children in group C had good recovery of elbow flexion but a poor recovers of shoulder function. Finally, all three patients who did not have elbow flexion at 4 months of age (group D) underwent surgical exploration and reconstruction of the brachial plexus, using nerve grafts. The results of this prospective study are discussed, along with the controversial issue regarding the timing of primary plexus surgery in Erb's palsy.     

Precocious puberty secondary to cranial irradiation for tumors distant from the hypothalamo-pituitary area

This retrospective study is the first report of the occurrence of central precocious puberty in 6 children having received cranial irradiation. Pubertal development took place at a mean age of 7 5/12 years (6 10/12-7 10/12 years in 5 girls and at 9 years in 1 boy). They had received 2,400-4,500 rad at a mean age of 5 2/12 years. In addition, 5 children had GH deficiency so that their growth spurt was blunted and 3 of them were left with an extremely short stature. This condition would require a therapeutic approach combining the use of an LHRH analogue and hGH therapy when necessary in order to protect from too rapidly progressing bone maturation.     

Investigation on Hyperuricemia in Children with Obesity or Various Pediatric Disorders

The present study aims at investigating the frequency and characteristics of hyperuricemia in both obese and sick children. First, we established our own reference values for serum uric acid (UA), since UA values are highly dependent upon age. In the analysis of 328 samples consisting of six different age groups: <1, 1–3, 4–6, 7–9, 10–12, and 13–15 years, the mean values for UA were found to increase significantly with an increase of age. A significant sex difference was observed only in the age group of 13–15 years. Hyperuricemia was defined as the values over the mean value plus 2 standard deviations for each age group. Next, we examined the frequency of hyperuricemia in 1,687 obese children aged 6–15 years and its relation to metabolic syndrome (MetS). A total of 328 children (19.4%) were found to have hyperuricemia. Among them, 98 children (29.9%) had MetS, whereas 197 (14.5%) out of 1,359 children without hyperuricemia had MetS. Finally, the frequency of hyperuricemia in sick patients was investigated using 13,675 samples from 9,405 patients. Hyperuricemia was seen in 348 (3.7%) patients after excluding redundant samples. The number of patients with hyperuricemia was higher in males than in females. The most common disorder causing hyperuricemia was gastroenteritis, followed by respiratory tract infection and cardiac diseases. This first comprehensive study of childhood hyperuricemia is useful for considering its relationship with hyperuricemia and life-style-related disorders occurring in adulthood.     

Investigation on hyperuricemia in children with obesity or various pediatric disorders

The present study aims at investigating the frequency and characteristics of hyperuricemia in both obese and sick children. First, we established our own reference values for serum uric acid (UA), since UA values are highly dependent upon age. In the analysis of 328 samples consisting of six different age groups: <1, 1-3, 4-6, 7-9, 10-12, and 13-15 years, the mean values for UA were found to increase significantly with an increase of age. A significant sex difference was observed only in the age group of 13-15 years. Hyperuricemia was defined as the values over the mean value plus 2 standard deviations for each age group. Next, we examined the frequency of hyperuricemia in 1,687 obese children aged 6-15 years and its relation to metabolic syndrome (MetS). A total of 328 children (19.4%) were found to have hyperuricemia. Among them, 98 children (29.9%) had MetS, whereas 197 (14.5%) out of 1,359 children without hyperuricemia had MetS. Finally, the frequency of hyperuricemia in sick patients was investigated using 13,675 samples from 9,405 patients. Hyperuricemia was seen in 348 (3.7%) patients after excluding redundant samples. The number of patients with hyperuricemia was higher in males than in females. The most common disorder causing hyperuricemia was gastroenteritis, followed by respiratory tract infection and cardiac diseases. This first comprehensive study of childhood hyperuricemia is useful for considering its relationship with hyperuricemia and life-style-related disorders occurring in adulthood.     

Diagnosing familial hypercholesterolaemia in childhood by measuring serum cholesterol.

The serum cholesterol concentrations of 134 children aged 1-16 years who had at least one first-degree relative with presumed familial hypercholesterolaemia showed a bimodal distribution, and, using the maximum likelihood technique, two overlapping curves could be fitted. The mean value of the affected children (heterozygotes) was 8-9 mmol/l and that of the unaffected 4-9 mmol/l. The two curves intersected at 6-77 mmol/l, and at this point 5% of the unaffected children had values over 6-77 mmol/l and 3-5% of the heterozygotes had values under 6-77 mmol/l. If this cholesterol concentration is used as a cut-off point 4-25% of cases would be misdiagnosed.