Serum immunoreactive pancreatic lipase and cationic trypsinogen for the assessment of exocrine pancreatic function in older patients with cystic fibrosis

Indirect and qualitative tests of pancreatic function are commonly used to screen patients with cystic fibrosis for pancreatic insufficiency. In an attempt to develop a more quantitative assessment, we compared the usefulness of measuring serum pancreatic lipase using a newly developed enzyme-linked immunosorbent immunoassay with that of cationic trypsinogen using a radioimmunoassay in the assessment of exocrine pancreatic function in patients with cystic fibrosis. Previously, we have shown neither lipase nor trypsinogen to be of use in assessing pancreatic function prior to 5 years of age because the majority of patients with cystic fibrosis in early infancy have elevated serum levels regardless of pancreatic function. Therefore, we studied 77 patients with cystic fibrosis older than 5 years of age, 41 with steatorrhea and 36 without steatorrhea. In addition, 28 of 77 patients consented to undergo a quantitative pancreatic stimulation test. There was a significant difference between the steatorrheic and nonsteatorrheic patients with the steatorrheic group having lower lipase and trypsinogen values than the nonsteatorrheic group (P < .001). Sensitivities and specificities in detecting steatorrhea were 95% and 86%, respectively, for lipase and 93% and 92%, respectively, for trypsinogen. No correlations were found between the serum levels of lipase and trypsinogen and their respective duodenal concentrations because of abnormally high serum levels of both enzymes found in some nonsteatorrheic patients. We conclude from this study that both serum lipase and trypsinogen levels accurately detect steatorrhea in patients with cystic fibrosis who are older than 5 years but are imprecise indicators of specific pancreatic exocrine function above the level needed for normal fat absorption.

Age-related alterations in immunoreactive pancreatic lipase and cationic trypsinogen in young children with cystic fibrosis

Serum immunoreactive pancreatic lipase and cationic trypsinogen are elevated in young infants with cystic fibrosis (CF) and may be useful neonatal screening tests for CF. We compared lipase measured by a recently developed ELISA immunoassay with trypsinogen measured by radioimmunoassay in 70 children (ages 0.1 to 9.9 years) with CF who had various degrees of pancreatic dysfunction and in 79 similarly aged children without CF (controls). In the control children, lipase activity increased with advancing age, whereas trypsinogen showed no age-related trend. Lipase and trypsinogen were significantly elevated in the infants with CF who were younger than 1 year, irrespective of pancreatic function (trypsinogen, P<0.001; lipase, P<0.05). Sensitivities in detecting CF were 76% and 90% for lipase and trypsinogen, respectively. After the first year of life, lipase and trypsinogen values declined toward normal, the rate of decline of lipase being greater than that of trypsinogen; 67% of lipase values were within or below the normal range by 3 years, whereas 67% of trypsinogen values continued to be elevated. We conclude that trypsinogen is an excellent screening test for CF in young infants regardless of pancreatic function, and that the addition of a serum pancreatic lipase determination does not improve the accuracy of trypsinogen as a screening test for cystic fibrosis.

Physostigmine for promethazine poisoning

Experience suggests that the central anticholinergic action of promethazine is a major element in the toxic effects following overdosage. Physostigmine seems to be a direct antidote at doses within the safe therapeutic range; side-effects, if they become a problem, can be treated with intravenous atropine.

Marked increase in proton pump inhibitors use in Australia

Objectives: To examine the trends in the prescribing of subsidised proton pump inhibitors (PPIs) and histamine receptor antagonists (H2RAs), in the Australian population from 1995 to 2006 to encourage discussion regarding appropriate clinical use. PPIs and H2RAs are the second highest drug cost to the publicly subsidised Pharmaceutical Benefits Scheme (PBS). Design: Government data on numbers of subsidised scripts, quantity and doses for PPIs and H2RAs were analysed by gender and age, dose and indication. Main outcome measure: Drug utilisation as DDD [defined daily dose]/1000 population/day. Results: The use of combined PPIs increased by 1318%. Utilisation increased substantially after the relaxation of the subsidised indications for PPIs in 2001. Omeprazole had the largest market share but was substituted by its S-enantiomer esomeprazole after its introduction in 2002. There was considerable use in the elderly with the peak use being in those aged 80 years and over. The utilisation of H2RAs declined 72% over 12 years. Conclusions: PPI use has increased substantially, not only due to substitution of H2RAs but to expansion in the overall market. Utilisation does not appear to be commensurate with prevalence of gastro-oesophageal reflux disease (GORD) nor with prescribing guidelines for PPIs, with significant financial costs to patients and PBS. This study encourages clinical discussion regarding quality use of these medicines. © 2010 John Wiley & Sons, Ltd.

Parents' reported use and views of strategies for managing the behaviour of their preschool child

The aim of the research was two-fold: firstly, to investigate strategies used by Australian parents to encourage desirable child behaviours and to decrease undesirable behaviours; secondly, to determine the acceptability and perceived usefulness to parents of various strategies. The research encompassed two studies. In the first study, 152 parents of children aged under six years completed questionnaires to identify their disciplinary practices. In Study 2, 129 parents reported on the acceptability and perceived effectiveness of various parenting strategies (modelling, ignoring, rewarding and physical punishment) for influencing child behaviour. Most parents in Study 1 reported using techniques consistent with positive parenting strategies. The use of physical punishment was also reported, but predominantly as a secondary method of discipline. In Study 2, the techniques of modelling and rewarding were found to be more acceptable to parents than were ignoring and smacking. The findings highlight the need to raise parental awareness and acceptance of a broader range of positive ways to manage child behaviour.

Learning about and taking action for the environment : child and teacher experiences in a preschool water education program

Water education and conservation programs have grown exponentially in Australian primary and secondary schools and, although early childhood services have been slower to respond to the challenges of sustainability, they are catching up fast. One early program targeted at preschools was the Water Aware Centre Program in northern New South Wales developed by the local water supply authority. This paper reports on a qualitative study of children’s and teachers’ experiences of the program in three preschools. The study’s aim was to identify program attributes and pedagogies that supported learning and action taking for water conservation, and to investigate if and how the program influenced children’s and teachers’practices. Data were collected through an interview with the program designer, conversations with child participants of the program, and a qualitative survey with early childhood staff. A three-step thematic analysis was conducted on the children’s and teachers’ data. Findings revealed that the program expanded children and teachers’ ideas about water conservation and increased their water conservation practices. The children were found to influence the water conservation practices of the adults around them, thus changing practices at school and at home.

What parents want: Parent preference regarding sleep for their preschool child when attending Early Care and Education

Background While most children cease napping between the ages of 2 and 5 years, across a range of international settings the allocation of a mandatory naptime is a common feature of the daily routine in Early Care and Education (ECE) programs for children of this age. Evidence regarding the developmental effects of napping is limited but, beyond age 2, is consistently associated with delayed night sleep onset and increased number of awakenings. Objectives The present study examined parent preferences towards napping in ECE. Methods Participants were 750 parents of preschool-aged children attending a representative sample of Australian ECE programs across metropolitan, regional and rural sites in 2011. We analysed quantitative and open-ended questionnaire data from a large, longitudinal study of the effectiveness of Australian early education programs (E4Kids). Statistical analyses examined prevalence of parent preference for sleep and demographic correlates. Thematic analyses were employed to identify parents' rationale for this preference. Results The majority of parents (78.7%) preferred that their children did not regularly sleep while attending ECE. The dominant explanation provided by parents was that regular naps were no longer appropriate and adversely impacted their children's health and development. Parents of younger children were more likely to support regular naps. Conclusions The results highlight a disjuncture between parent preferences and current sleep policy and practices in ECE. Further research is needed to establish evidence-based guidelines to support healthy sleep-rest practices in ECE. Such evidence will guide appropriate practice and support parent-educator communication regarding sleep and rest.

Locating child protection in preservice teacher education

A recent report delivered by the Australian Centre for Child Protection has highlighted the need for empirical evidence of effective pedagogies for supporting teaching and learning of child protection content in Australian teacher education programs (Arnold & Maio-Taddeo, 2007). This paper advances this call by presenting case study accounts of different approaches to teaching child protection content in University-based teacher education programs across three Australian States. These different cases provide a basis for understanding existing strategies as an important precursor to improving practice. Although preschool, primary and secondary schools have been involved in efforts to protect children from abuse and neglect since the 1970s, teacher education programs, including preservice and inservice programs, have been slow to align their work with child protection agendas. This paper opens a long-overdue discussion about the extent and nature of child protection content in teacher education and proposes strategies for translating research into practice.

The development of an observation tool for use with parents with psychiatric disability and their preschool children

Community-based treatment and care of people with psychiatric disabilities has meant that they are now more likely to engage in the parenting role. This has led to the development of programs designed to enhance the parenting skills of people with psychiatric disabilities. Evaluation of these programs has been hampered by a paucity of evaluation tools. This study's aim was to develop and trial a tool that examined the parent-child interaction within a group setting, was functional and easy to use, required minimum training and equipment, and had acceptable levels of reliability and validity. The revised tool yielded a single scale with acceptable reliability. It had discriminative validity and concurrent validity with non-independent global ratings of parenting. Sensitivity to change was not investigated. The findings suggest that this method of evaluating parenting is likely to have both clinical and research utility and further investigation of the psychometric properties of the tool is warranted.

Maternal correlates of maternal child feeding practices : a systematic review

Establishing healthy eating habits early in life is one important strategy to combat childhood obesity. Given that early maternal child feeding practices have been linked to child food intake and weight, identifying the maternal correlates of maternal child feeding practices is important in order to understand the determinants of childhood obesity; this was the overall aim of the current review. Academic databases were searched for studies examining the relationship between maternal child feeding practices and parenting, personal characteristics and psychopathology of mothers with preschoolers. Papers were limited to those published in English, between January 2000 - June 2012. Only studies with mothers of normally developing children between the ages of 2 - 6 years were included. There were no restrictions regarding the inclusion of maternal nationality or SES. Seventeen eligible studies were sourced. Information on the aim, sample, measures and findings of these was summarised into tables. The findings of this review support a relationship between maternal controlling parenting, general and eating psychopathology, and socioeconomic status and maternal child feeding practices. The main methodological issues of the studies reviewed included inconsistency in measures of maternal variables across studies and cross-sectional designs. We conclude that the maternal correlates associated with maternal child feeding practices are complex, and the pathways by which maternal correlates impact these feeding practices require further investigation.

Concurrent and longitudinal links between children’s and their friends’ antisocial and prosocial behavior in preschool

Concurrent and longitudinal links between children’s own and their nominated best friends’ antisocial and prosocial behavior were studied in a normative sample of 3–5-year-olds (N = 203). Moderating effects of age and gender were also explored. Subscales of the Strength and Difficulties Questionnaire (SDQ) were used to obtain teacher ratings of behavior for each target child and his/her nominated best friends. Nomination of best friends with higher levels of antisocial behavior and lower levels of prosocial behavior was concurrently linked to more antisocial behavior in boys. Nomination of highly prosocial best friends was concurrently linked to more prosocial behavior in both boys and girls. However, the study found no longitudinal effects of best friends’ behavior on target child’s behavior over a one-year period. A group of children who nominated no best friends at T1 were generally perceived as less prosocial, but not more antisocial, than other children. © 2011 Elsevier Inc. All rights reserved.

Early life predictors of preschool overweight and obesity : a case–control study in Sri Lanka

Background Childhood obesity increases the risk of obesity in adulthood and is associated with cardiovascular disease risk factors. Our aim was to assess the early life risk factors associated with overweight and obesity among preschool children. Methods In this case–control study, from the 1087 preschool children measured, age, sex and ethnicity matched 71 cases and 71 controls were recruited. Cases and controls were defined according to the WHO 2006 growth standards. The birth and growth characteristics were extracted from the child health development records. Infant feeding practices and maternal factors were obtained from the mother. Rapid weight gain was defined as an increase in weight-for-age Z score (WHO standards) above 0.67 SD from birth to 2 years. The magnitude and significant difference in mean values of the variables associated with overweight and obesity were evaluated using logistic regressions and paired t-test, respectively. Results Cases had significantly shorter duration (months) of breastfeeding (19.4, 24.6, p = 0.003), and smaller duration (months) of exclusive breastfeeding (3.7, 5.1, p = 0.001) compared to controls. Rapid weight gain (OR = 6.3, 95% CI = 2.04–19.49), first born status (OR = 3.6, 95% CI = 1.17-10.91) and pre-pregnancy obesity (OR = 4.0, 95% CI = 1.46-10.76) were positively associated with overweight and obesity. Breastfeeding more than 2 years (OR = 0.2, 95% CI = 0.06-0.57) was negatively associated with overweight and obesity. Conclusion Rapid weight gain within first two years, first–born status and pre-pregnancy obesity of the mother contributed for preschool obesity. Our results suggest that intervention may be indicated earlier in infancy and during the toddler and preschool years to tackle the increasing prevalence of obesity.

The prevention of childhood anxiety and promotion of resilience among preschool-aged children : a universal school based trial

This study is the first to examine the effectiveness of the Fun FRIENDS programme, a school-based, universal preventive intervention for early childhood anxiety and promotion of resilience delivered by classroom teachers. Participants (N = 488) included children aged 4–7 years attending 1 of 14 Catholic Education schools in Brisbane, Australia. The schools were randomly allocated to one of three groups, the intervention, active comparison and waitlist control group. Parents completed standardized measures of anxiety and behavioural inhibition (BI), resilience, social and emotional functioning and behaviour difficulties in addition to parental stress and anxiety, at pre- and post- and 12-month follow-up. Teachers also completed a parallel measure of social and emotional strength at the three time points. Comparable results were obtained for the intervention and comparison groups; however, the intervention group (IG) achieved greater reductions in BI, child behavioural difficulties and improvements in social and emotional competence. In addition, significant improvements in parenting distress and parent–child interactions were found for the IG, with gains maintained at 12-month follow-up. Teacher reports revealed more significant improvement in social and emotional competence for the IG. Clinical implications of the findings are discussed, along with limitations and directions for future research.

Correlates of sedentary behaviours in preschool children : a review

Background Sedentary behaviour has been linked with a number of health outcomes. Preschool-aged children spend significant proportions of their day engaged in sedentary behaviours. Research into the correlates of sedentary behaviours in the preschool population is an emerging field, with most research being published since 2002. Reviews on correlates of sedentary behaviours which include preschool children have previously been published; however, none have reported results specific to the preschool population. This paper reviews articles reporting on correlates of sedentary behaviour in preschool children published between 1993 and 2009. Methods A literature search was undertaken to identify articles which examined correlates of sedentary behaviours in preschool children. Articles were retrieved and evaluated in 2008 and 2009. Results Twenty-nine studies were identified which met the inclusion criteria. From those studies, 63 potential correlates were identified. Television viewing was the most commonly examined sedentary behaviour. Findings from the review suggest that child's sex was not associated with television viewing and had an indeterminate association with sedentary behaviour as measured by accelerometry. Age, body mass index, parental education and race had an indeterminate association with television viewing, and outdoor playtime had no association with television viewing. The remaining 57 potential correlates had been investigated too infrequently to be able to draw robust conclusions about associations. Conclusions The correlates of preschool children's sedentary behaviours are multi-dimensional and not well established. Further research is required to provide a more comprehensive understanding of the influences on preschool children's sedentary behaviours to better inform the development of interventions.