Joint range of motion limitations in children and young adults with spinal muscular atrophy

Objectives
To elicit descriptive data about limited joint range of motion (ROM) in subjects with type II or III spinal muscular atrophy (SMA) and to examine the relation between the number of motions with limited range and both age and functional ability.
Design
Descriptive cross-sectional study.
Setting
Neurologic pediatric outpatient clinic at a hospital in Taiwan.
Participants
Twenty-seven subjects with SMA type II (mean age, 9.8±6.5y) and 17 with SMA type III (mean age, 12.2±8.7y).
Intervention
Measurement with transparent goniometers of joint ROM bilaterally of the shoulder, elbow, wrist, hip, knee, and ankle.
Main outcome measures
The proportion of participants with each ROM limitation compared with all participants with the same SMA type, age distribution of the participants with each ROM limitation, mean range loss of each motion limitation, and the contracture index (risk index of joint contracture).
Results
Eighty-nine percent of the participants with SMA type II experienced knee extension limitation. Approximately 50% of the participants with both types of SMA had ankle dorsiflexion limitation. The motions of knee and hip extension and ankle dorsiflexion also had a relatively high contracture index. The number of motions with limited range positively correlated (P<.001) with age and upper-extremity functional grade (the higher the functional grade, the poorer the functional ability) for SMA type II.
Conclusions
We found varying degrees of joint ROM limitation. Certain motions were noted to be high risks for the development of contractures. This risk was higher mostly in younger children.

Cost-effectiveness of cognitive behavioural therapy and selective serotonin reuptake inhibitors for major depression in children and adolescents

Objective:
To assess from a health sector perspective the incremental cost-effectiveness of cognitive behavioural therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) for the treatment of major depressive disorder (MDD) in children and adolescents, compared to ‘current practice’.
Method:
The health benefit is measured as a reduction in disability-adjusted life years (DALYs), based on effect size calculations from meta-analysis of randomised controlled trials. An assessment on second stage filter criteria (‘equity’; ‘strength of evidence’, ‘feasibility’ and ‘acceptability to stakeholders’) is also undertaken to incorporate additional factors that impact on resource allocation decisions. Costs and benefits are tracked for the duration of a new episode of MDD arising in eligible children (age 6–17 years) in the Australian population in the year 2000. Simulation-modelling techniques are used to present a 95% uncertainty interval (UI) around the cost-effectiveness ratios.
Results:
Compared to current practice, CBT by public psychologists is the most costeffective intervention for MDD in children and adolescents at A$9000 per DALY saved (95% UI A$3900 to A$24 000). SSRIs and CBT by other providers are less cost-effective but likely to be less than A$50 000 per DALY saved (> 80% chance). CBT is more effective than SSRIs in children and adolescents, resulting in a greater total health benefit (DALYs saved) than could be achieved with SSRIs. Issues that require attention for the CBT intervention include equity concerns, ensuring an adequate workforce, funding arrangements and acceptability to various stakeholders.
Conclusions:
Cognitive behavioural therapy provided by a public psychologist is the most
effective and cost-effective option for the first-line treatment of MDD in children and adolescents. However, this option is not currently accessible by all patients and will require change in policy to allow more widespread uptake. It will also require ‘start-up’ costs and attention to ensuring an adequate workforce.

"Sins of their fathers" : culturally at risk children and the colonial state in Asia

In contact with their foreign surroundings, European enclaves throughout imperial Asia and Africa formed new cultural communities. Nevertheless, over time as Cooper and Stoler (1997) have argued, such colonial communities became subject to the same bourgeois project as experienced in the metropolitan centres to which they remained connected. If, in terms of that project, metropolitan European society was deemed vulnerable from a brutish and unruly working class, these colonial outposts of Western society were even more vulnerable to what was deemed to be the more insidious dangers of miscegenation and cultural hybridity. Where nineteenth century educators typically suggested that working class children were “at risk” of not being able to benefit from, and simultaneously representing “a risk to”, the emerging opportunities of bourgeois capitalist society, this “risk” was accentuated in the colonies by the additional category of race. Focussing on the question of children of mixed parentage as a category of “children at risk”, this paper examines the way educationists and politicians responded to what was perceived as “civilisational decline” in four such communities - the Dutch East Indies, British India, (British) Australia and French Indo-China - to demonstrate the universality of these concerns in Imperial Asia.

Peripheral quantitative computed tomography in children and adolescents : the 2007 ISCD pediatric official positions

Peripheral quantitative computed tomography (pQCT) has mainly been used as a research tool in children. To evaluate the clinical utility of pQCT and formulate recommendations for its use in children, the International Society
of Clinical Densitometry (ISCD) convened a task force to review the literature and propose areas of consensus and future research. The types of pQCT technology available, the clinical application of pQCT for bone health assessment in children, the important elements to be included in a pQCT report, and quality control monitoring techniques were evaluated. The review revealed a lack of standardization of pQCT techniques, and a paucity of data regarding differences between pQCT manufacturers, models and software versions and their impact in pediatric assessment. Measurement sites varied across studies. Adequate reference data, a critical element for interpretation of pQCT results, were entirely lacking, although some comparative data on healthy children were available. The elements of the
pQCT clinical report and quality control procedures are similar to those recommended for dual-energy X-ray absorptiometry. Future research is needed to establish evidence-based criteria for the selection of the measurement site, scan acquisition and analysis parameters, and outcome measures. Reference data that sufficiently characterize the normal range of variability in the population also need to be established.

Is dog ownership or dog walking associated with weight status in children and their parents?

Issue addressed: Several studies have shown that dog owners do more physical activity than non-owners; however, associations with weight status are unknown. This study examined associations between dog ownership, frequency of dog walking and weight status among children and their parents. Methods: Height and weight were measured for 281 children aged 5-6 years and 864 children aged 10-12 years. One parent reported their own and their partner's height and weight (n=1,108), dog ownership, usual frequency their child walks a dog, and usual frequency of walking the dog as a family. Logistic regression analyses were adjusted for sex (children only), physical activity, education, neighbourhood SES, parental weight status (children only) and clustering by school. Results: Dog ownership ranged from 45-57% in the two age groups. Nearly one in four 5-6 year-olds and 37% of 10-12 year- olds walked a dog at least once/week. Weekly dog walking as a family was reported by 24-28% of respondents. The odds of being overweight or obese were lower among younger children who owned a dog (OR=0.5, 95% CI 0.3-0.8) and higher among mothers whose family walked the dog together (OR--1.3, 95% CI 1.0-1.7). Conclusions: Dog ownership may offer some protection from overweight among young children. It is important that families with a dog are encouraged to walk or play with it regularly. Associations with weight status may depend on the type of dog owned, length of ownership and the nature of walks or interaction.

Preschool children and physical activity : a review of correlates

Background
Several reviews have summarized the research on correlates of older children's and adolescents' physical activity behaviors, but none have been published on preschool children. Over the past 27 years, a number of studies have investigated the correlates of preschool children's physical activity behaviors. It is timely and necessary to review the extant literature in this area. This paper reviews articles investigating correlates of preschool children's physical activity behaviors published in peer-reviewed journals between 1980 and March 2007.

Methods
A literature search was conducted to identify studies that investigated correlates of preschool children's physical activity. Data were collected and analyzed in 2007.

Results
Twenty-four articles were identified that met the inclusion criteria. From those articles, 39 variables were identified across five domains. Results showed that boys were more active than girls, that children with active parents tended to be more active, and that children who spent more time outdoors were more active than children who spent less time outdoors. Age and BMI were consistently shown to have no association with preschool children's physical activity. Other variables produced largely inconclusive results.

Conclusions
The influences on the physical activity behaviors of preschool children are multidimensional. Further research is required to enhance an understanding of these influences.

Neighbourhood fast food outlets and obesity in children and adults : the CLAN study

Objective : We examined associations between density of and proximity to fast food outlets and body weight in a sample of children (137 aged 8-9 years and 243 aged 13-15 years) and their parents (322 fathers and 362 mothers).
Methods : Children's measured and parents' self-reported heights and weights were used to calculate body mass index (BMI). Locations of major fast food outlets were geocoded. Bivariate linear regression analyses examined associations between the presence of any fast food outlet within a 2 km buffer around participants' homes, fast food outlet density within the 2 km buffer, and distance to the nearest outlet and BMI. Each independent variable was also entered into separate bivariate logistic regression analyses to predict the odds of being overweight or obese.
Results : Among older children, those with at least one outlet within 2 km had lower BMI z-scores. The further that fathers lived from an outlet, the higher their BMI. Among 13-15-year-old girls and their fathers, the likelihood of overweight/obesity was reduced by 80% and 50%, respectively, if they had at least one fast food outlet within 2 km of their home. Among older girls, the likelihood of being overweight/obese was reduced by 14% with each additional outlet within 2 km. Fathers' odds of being overweight/obese increased by 13% for each additional kilometre to the nearest outlet.
Conclusions : While consumption of fast food has been shown to be associated with obesity, this study provides little support for the concept that exposure to fast food outlets in the local neighbourhood increases risk of obesity.

Walking and cycling to school : predictors of increases among children and adolescents

Background
Little is known about what happens to active commuting as children get older, and less is known about influences on changes in this behavior. This study examined predictors of increases in children's and adolescents' active commuting (walking or cycling) to/from school over a 2-year period.
Methods
Participants were initially recruited and assessed in 2001. Follow-up data were collected in 2004 and 2006 and analyzed in 2008. Participants were 121 children (aged 9.1±0.34 years in 2004) and 188 adolescents (aged 14.5±0.65 years in 2004) from Melbourne, Australia. Parents and adolescents reported their perceptions of individual-level factors and of the neighborhood social and physical environment. Weekly active commuting (walking or cycling) to/from school, ranging from 0 to 10 trips/week was also proxy- or self-reported at the initial measurement and again 2 years later. Logistic regression analyses examined predictors of increases in active commuting over time.
Results
Children whose parents knew many people in their neighborhood were more likely to increase their active commuting (OR=2.6; CI=1.2, 5.9; p=0.02) compared with other children. Adolescents whose parents perceived there to be insufficient traffic lights and pedestrian crossings in their neighborhood were less likely to increase their active commuting over 2 years (OR=0.4; CI=0.2, 0.8; p=0.01), whereas adolescents of parents who were satisfied with the number of pedestrian crossings were more likely to increase their active commuting (OR=2.4; CI=1.1, 5.4; p=0.03) compared with other adolescents.
Conclusions
Social factors and physical environmental characteristics were the most important predictors of active commuting in children and adolescents, respectively.