Childhood obesity: should primary school children be routinely screened? A systematic review and discussion of the evidence

Background: Population monitoring has been introduced in UK primary schools in an effort to track the growing obesity epidemic. It has been argued that parents should be informed of their child's results, but is there evidence that moving from monitoring to screening would be effective? We describe what is known about the effectiveness of monitoring and screening for overweight and obesity in primary school children and highlight areas where evidence is lacking and research should be prioritised. Design: Systematic review with discussion of evidence gaps and future research. Data sources: Published and unpublished studies ( any language) from electronic databases ( inception to July 2005), clinical experts, Primary Care Trusts and Strategic Health Authorities, and reference lists of retrieved studies. Review methods: We included any study that evaluated measures of overweight and obesity as part of a population-level assessment and excluded studies whose primary outcome measure was prevalence. Results: There were no trials assessing the effectiveness of monitoring or screening for overweight and obesity. Studies focussed on the diagnostic accuracy of measurements. Information on the attitudes of children, parents and health professionals to monitoring was extremely sparse. Conclusions: Our review found a lack of data on the potential impact of population monitoring or screening for obesity and more research is indicated. Identification of effective weight reduction strategies for children and clarification of the role of preventative measures are priorities. It is difficult to see how screening to identify individual children can be justified without effective interventions.

The aetiology and treatment of developmental stammering in childhood

Developmental stammering (DS, also known as idiopathic stammering or stuttering) is a disorder of speech fluency that affects approximately 0.75% to 1% of the populations of Great Britain, Australia and America,(1-4) although a recent study puts the point prevalence figure at between 1% and 3% in the UK.(5) Prevalence is generally thought to be similar amongst communities worldwide, although there have been occasional suggestions that this figure might be lower in countries where there is less pressure on verbal acuity.(6) DS may be distinguished from neurogenic stammering, which can occur subsequent to neurological damage of various aetiologies (for example, stroke, tumour, degenerative disease) and psychogenic stammering, whose onset can be related to a significant psychological event such as bereavement. While a diagnosis of neurogenic stammering might be made in early childhood and adolescence, both neurogenic and psychogenic types are typically associated with an adult onset. DS is by far the most common form of stammering and usually develops in the pre-school years. The mean age at onset is 4 2, with 75% of cases beginning before the age of 6.(1) However, occasionally, stammering onset may be seen as late as 12 or 13 years of age.