Self-perceived quality of life of children and adolescents with physical disabilities in Hong Kong

Although illnesses and diseases are thought to adversely affect quality of life (QoL), whether children who have physical disabilities (PD) from a young age adapt to the effect of developmental disabilities has rarely been investigated. This study attempted to assess the subjective wellbeing, and examine the correlation between objective and subjective QoL, of children with PD. Using a self-reported non-disease-specific questionnaire, the QoL of 72 young persons (13.5 ± 2.0 years) with PD was contrasted with those who do not have disabilities (n = 510; age-matched). MANOVA analyses revealed that the PD group had lower objective QoL score (63.0 ± 7.4 vs. 66.8 ± 5.7, p < 0.001) but the two groups were not significantly different in subjective QoL score (70.9 ± 11.4 vs. 69.6 ± 13.6, p = 0.466). No correlation was found between objective and subjective QoL in the PD group (r ranged from 0.06 to 0.19), while weak to medium correlations (r ranged from 0.03 to 0.41) were observed for the controls. The apparent detachment of subjective feeling and objective circumstances in the PD group may reflect adjustment to developmental disabilities.

A new approach to assessing the health benefit from obesity interventions in children and adolescents: the assessing cost-effectiveness in obesity project

OBJECTIVE: To report on a new modelling approach developed for the assessing cost-effectiveness in obesity (ACE-Obesity) project and the likely population health benefit and strength of evidence for 13 potential obesity prevention interventions in children and adolescents in Australia. METHODS: We used the best available evidence, including evidence from non-traditional epidemiological study designs, to determine the health benefits as body mass index (BMI) units saved and disability-adjusted life years (DALYs) saved. We developed new methods to model the impact of behaviours on BMI post-intervention where this was not measured and the impacts on DALYs over the child's lifetime (on the assumption that changes in BMI were maintained into adulthood). A working group of stakeholders provided input into decisions on the selection of interventions, the assumptions for modelling and the strength of the evidence. RESULTS: The likely health benefit varied considerably, as did the strength of the evidence from which that health benefit was calculated. The greatest health benefit is likely to be achieved by the 'Reduction of TV advertising of high fat and/or high sugar foods and drinks to children', 'Laparoscopic adjustable gastric banding' and the 'multi-faceted school-based programme with an active physical education component' interventions. CONCLUSIONS: The use of consistent methods and common health outcome measures enables valid comparison of the potential impact of interventions, but comparisons must take into account the strength of the evidence used. Other considerations, including cost-effectiveness and acceptability to stakeholders, will be presented in future ACE-Obesity papers. Information gaps identified include the need for new and more effective initiatives for the prevention of overweight and obesity and for better evaluations of public health interventions.

Reflexivity: a concept and its meanings for practitioners working with children and families

Reflexivity is a concept that is increasingly gaining currency in professional practice literature, particularly in relation to working with uncertainty and as an important feature of professional discretion and ethical practice. This article discusses how practitioners working in child and family welfare/protection organisations understood and interpreted the concept of reflexivity for their practice, as one of the outcomes of larger, collaborative research project. This project was conducted through a series of workshops with practitioners. The overall research that aimed to expand practitioners’ practice repertoires from narrowly-defined risk assessment, to an approach that could account for the uncertainties of practice, included the concept of reflexivity as an alternative or a complement to instrumental accountability that is increasingly a feature in child welfare/protection organisations. This article discusses how the concept of reflexivity was explored in the research and how practitioners interpreted the concept for their practice. We conclude that while concepts like reflexivity are central to formal theories for professional practice, we also recognise that individual practitioners interpret concepts (in ways that are both practically and contextually relevant), thus creating practical meanings appropriate to their practice contexts.

Promoting physical activity participation among children and adolescents

With global increases in the prevalence of overweight and obesity among children and adolescents, there has never been a more urgent need for effective physical activity programs. The aim of this narrative review is to summarize the evidence of the effectiveness of interventions that report physical activity outcomes in children aged 4–12 years and adolescents aged 13–19 years. A systematic search of electronic databases identified 76 interventions. Most interventions were delivered via the school setting (57 interventions), nine through the family setting, six via primary care, and four in community- or Internet-based settings. Children's physical activity interventions that were most effective in the school setting included some focus on physical education, activity breaks, and family strategies. Interventions delivered in the family setting were not highly effective, but many were pilot studies. The use of motivationally tailored strategies and program delivery in the primary care setting showed promise among adolescents. Many studies had methodological and reporting flaws (e.g., no baseline data, poor study design, physical activity measures of unknown reliability and validity, and poor reporting of sample size, response rates, attrition/retention, compliance, year of intervention, and duration of intervention). Publications reporting the results of evaluations of intervention studies should follow the Consolidated Standards of Reporting Trials guidelines or, for nonrandomized studies, should follow the Transparent Reporting of Evaluations with Nonrandomized Designs guidelines. Further evidence of the effectiveness of interventions promoting young people's physical activity in family and community settings is needed.

Children and terraira

The authors have been involved with a group of primary school children since 1998, exploring their science learning in the first years of school. This article describes an activity run with two classes in grade 1, focussing on their ideas about plants. The activity involves constructing a terrarium and using it to challenge children's ideas about the conditions for plant growth.

Does elite competition inhibit growth and delay maturation in some gymnasts? quite possibly

Today, elite young gymnasts undertake training programs of progressive volume and intensity from an early age. For example, talented young female gymnasts often commence training at age 5 or 6 and train more than 20 to 30 hours per week year-round throughout childhood and adolescence. Despite the "normal" short stature of top-level gymnasts and the obvious health benefits of physical activity during growth, there is concern that elite level or those gymnasts involved in heavy training regimens may be at risk for adverse effects on growth and maturation. This concern has been the source of much debate in the literature and is complicated by the difficulties in distinguishing between the genetic predisposition to short stature and late or delayed maturation, and the effect of environmental factors such as nutrition and exercise that may influence growth and maturation. The effect of gymnastics training on growth and maturation is often reported as averaged data: an approach that does not identify individual growth patterns. Finding no difference between groups is not proof that there is "in fact" no difference. Accepting the null hypothesis without the appropriate critical review of both the methodological and statistical power to detect differences is a flawed endeavor. We believe there is compelling "circumstantial" evidence to build a case that preparation for advanced gymnastics competition may place some children and youth at risk of reduced growth and delayed maturation.

Emotional growth: helping children and families 'bounce back'

Background: Depression is becoming increasingly prevalent in young people and is occurring earlier. General practitioners are prescribing antidepressants more frequently for this group, yet they are usually not the answer to the problem. Objective: This article examines the increase in prevalence rates of childhood and adolescent depression. We draw on recent research into resilience and positive psychology to suggest guidelines for the GP in helping young people and their parents develop better coping skills in the short term, and greater resilience in the long term. Discussion: Resilience is the ability to bounce back after encountering difficulties, negative events, hard times or adversity and to be able to return to the original level of emotional wellbeing. It is the capacity to maintain a healthy and fulfilling life despite adversity. Young people who have the skills to be resilient have a lower likelihood of becoming depressed or suicidal and a higher likelihood of maintaining emotional wellbeing. Self efficacy, optimistic and helpful thinking, and maintaining a success orientation are all important skills in being resilient.

The epidemiology of overweight and obesity among Australian children and adolescents, 1995-97

A study attempts to determine the population prevalence of overweight and obesity among Australian children and adolescents, based on measured body mass index (BMI) to determine if overweight and obesity are distributed differentially across the population of young Australians. Data from three independent surveys were analyzed and results indicate that the population prevalence and distribution of overweight, obesity and overweight/obesity combined were 79%-81%, 14%-16%, 5% and 19%-21% (boys) respectively, and 76%-79%, 16%-18%, 5%-6% and 21%-24% (girls). There were no consistent relationships between the prevalence of overweight/obesity and sex, age or SES. It is concluded that some 19%-23% of Australian children and adolescents are either overweight or obese. Only cultural background differential warrant a targeted health promotion response.

Standardizing anthropometric measures in children and adolescents with new functions for egen

A new function for egen has been developed to allow transformation of child anthropometric data to z-scores using the LMS method and the reference data available from the 1990 British Growth Reference and the 2000 US CDC Growth Reference. An additional function allows for children to be categorized according to body mass index (weight/height ²) using international cutoff points recommended by the Childhood Obesity Working Group of the International Obesity Taskforce. Copyright 2004 by StataCorp LP.

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.