Concentrations In Children Research Articles

The perioperative dialogue reduces postoperative stress in children undergoing day surgery as confirmed by salivary cortisol

To evaluate the efficacy of 'the perioperative dialogue (PD)' by analyzing salivary cortisol, in 5- to 11-year-old children undergoing day surgery. To deal with anxiety prior to investigations and/or procedures, children need to be confident and informed about what is going to happen. Therefore, intervention strategies should be initiated before admission to hospital. Children (n = 93), 79 boys and 14 girls, scheduled for elective day surgery requiring general anesthesia were randomly recruited into three groups: (i) standard perioperative care (n = 31), (ii) standard perioperative care including preoperative information (n = 31), and (iii) the PD (n = 31). Saliva was sampled for cortisol analysis at specific time points during the pre- and perioperative procedures. The children who received the PD had significantly lower (P = 0.003) salivary cortisol concentrations postoperatively. Moreover, it continuously decreased during the day of surgery compared with the other two groups (P < 0.01). Among the children who received analgesics, the PD group received significantly less morphine (P = 0.014) related to bodyweight: the mean dose was 0.1 mg·kg(-1) (n = 9) in the control group vs 0.04 mg·kg(-1) (n = 6) in the PD group. Irrespective of group, there was a positive correlation between the children's morphine consumption and salivary cortisol concentration (r = 0.56; P = 0.038). The W-B scale score was higher in the group that received morphine (median = 3 vs median=1; P = 0.001). The PD's caring, continuity, and on-going dialogues were associated with low concentrations of salivary cortisol postoperatively and reduced morphine consumption and thus appears to be a valuable complement to standard perioperative care in children undergoing day surgery.

Reference Range for Cerebrospinal Fluid Protein Concentration in Children and Adolescents

Reference Range for Cerebrospinal Fluid Protein Concentration in Children and Adolescents

HEALTH CARE UTILIZATION, SOCIOECONOMIC FACTORS AND CHILD HEALTH IN INDIA

This paper models the proximate determinants of height, weight and haemoglobin concentration of over 25,000 Indian children using data from the National Family Health Survey-3. The effects of public and private health care service utilization, food consumption patterns and maternal health status on child health were investigated in a multidisciplinary framework. Methodological issues such as potential endogeneity of explanatory variables and the appropriateness of combining height and weight as the body mass index were tackled. The results from models for children's heights and weight showed beneficial effects of child vaccinations against DPT, polio and measles, and negative effects of not utilizing government health facilities. The models for children's haemoglobin concentration indicated beneficial effects of food consumption patterns and treatment against intestinal parasites. The results provide several insights for improving child health in India.

The Effect of Multidisciplinary Lifestyle Intervention on the Pre- and Postprandial Plasma Gut Peptide Concentrations in Children with Obesity

Objective. This study aims to evaluate the effect of a multidisciplinary treatment of obesity on plasma concentrations of several gut hormones in fasting condition and in response to a mixed meal in children. Methods. Complete data were available from 36 obese children (age 13.3 ± 2.0 yr). At baseline and after the 3-month multidisciplinary treatment, fasting and postprandial blood samples were taken for glucose, insulin, ghrelin, peptide YY (PYY), and glucagon-like peptide 1 (GLP-1). Results. BMI-SDS was significantly reduced by multidisciplinary treatment (from 4.2 ± 0.7 to 4.0 ± 0.9, P < .01). The intervention significantly increased the area under the curve (AUC) of ghrelin (from 92.3 ± 18.3 to 97.9 ± 18.2 pg/L, P < .01), but no significant changes were found for PYY or GLP-1 concentrations (in fasting or postprandial condition). The insulin resistance index (HOMA-IR) remained unchanged as well. Conclusion. Intensive multidisciplinary treatment induced moderate weight loss and increased ghrelin secretion, but serum PYY and GLP-1 concentrations and insulin sensitivity remained unchanged.

Nursery Equipment: Private spaces - A place of their own

Nursery WorldVol. 2011, No. 5 FeatureNursery Equipment: Private spaces - A place of their ownAnnette RawstroneAnnette RawstroneSearch for more papers by this authorAnnette RawstronePublished Online:4 Mar 2014https://doi.org/10.12968/nuwa.2011.3.5.1096174AboutSectionsView articleView Full TextView EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View articleAbstractEnclosed spaces can foster friendship and heighten young children's concentration and involvement in their play, says Annette Rawstrone. FiguresReferencesRelatedDetails 1 May 2011Volume 2011Issue 5ISSN (print): 0029-6422ISSN (online): 2059-9358 Metrics History Published online 4 March 2014 Published in print 1 May 2011 Information© MA Education Ltd

Subcutaneous rhIGF-1 Significantly Increases Circulating IGF-1 Concentrations in Children With Crohn's Disease Induced Growth Failure

Introduction Faltering growth is a complication of paediatric Crohn9s disease, affecting up to a third of patients. There is no recognised treatment targeted at improving linear growth. These children have low circulating insulin-like growth factor-1 (IGF-1), a hormone essential for linear growth and the primary mediator of growth hormone (GH) action. Low IGF-1 concentrations occur despite normal GH response to stimulation testing – the children thus having a functional GH insensitivity. Injections with recombinant human IGF-1 (rhIGF-1) have been reported to improve growth in animal models of colitis and in children with genetic GH insensitivity syndrome using doses of 80–120 μg/kg bd. rhIGF-I therapy has never previously been used in children with Crohn9s disease. We hypothesised that subcutaneous injections of rhIGF-1 would significantly increase circulating IGF-1 concentrations in children with Crohn9s disease induced growth failure, and that twice daily injections would maintain these concentrations. Methods Eight children with active Crohn9s disease and growth failure were recruited for an open-label pharmacokinetics study of rhIGF-1 (Increlex). A subcutaneous injection of rhIGF-1 (dose 120 μg/kg) was given, and levels were measured over 24 h. Children were also studied over a second period (5 days) of repeated doses. Blood sugar levels were monitored as hypoglycaemia is a potential adverse effect. Protein losing enteropathy was measured by stool α1-antitrypsin and related to IGF-1 levels attained. Results The median age(range) of the children was 12 years(10–14). 4 were female, 4 male, mean (SD) Paediatric Crohn9s Disease Activity Index (PCDAI) was 31.25(14.08). All the children had poor growth (mean growth velocity standard deviation score(SDS) −3.34 (SD 1.13)). All the subjects completed the study. The rhIGF-1 was well tolerated, with only one patient having an (asymptomatic) hypoglycaemic episode. All patients except for one had low baseline IGF-1 levels (mean SDS -1.78 (SD 1.37)) and all showed an increase in 3-h circulating IGF-1 levels following administration of rhIGF-1 (mean SDS 2.70 (SD 3.06)). This increase was significant(p = 0.007). IGF-1 levels were maintained above 0.0 SDS by twice daily injections. This occurred without any change in PCDAI over the 5-day trial period (p = 0.77) Protein-losing enteropathy did not inhibit this response. Conclusion Subcutaneous administration of rhIGF-1 significantly increased circulating concentrations of IGF-1 in children with Crohn9s disease-related growth retardation. These results support the initiation of trials to assess the impact of long-term rhIGF replacement therapy on linear growth.

Predictors of Risperidone and 9-Hydroxyrisperidone Serum Concentration in Children and Adolescents

Little is known about risperidone metabolism in a clinical sample, where polypharmacy is common. Such knowledge is important since several of its side effects are dose dependent. Medically healthy patients aged 7 to 17 years old treated with risperidone for at least 6 months were enrolled. Trough serum risperidone and 9-hydroxyrisperidone concentrations were measured. One hundred seven participants (92% males) were recruited, representing a heterogenous clinical group with attention-deficit/hyperactivity disorder, disruptive behavior disorders, pervasive developmental disorders, anxiety disorders, mood disorders, tic disorders, or psychotic disorders. Risperidone had been used at a mean dose of 0.03 mg/kg, for a mean 2.5 years, predominantly to treat irritability and aggression. Cytochrome CYP2D6 inhibitors were divided into prominent (fluoxetine, bupropion, and lamotrigine), intermediate (sertraline), and weak inhibition groups (citalopram or escitalopram). The concentrations of risperidone and its metabolite were strongly associated with the dose of risperidone and time since the last dose and, to a lesser extent, with male sex. In addition, risperidone concentration increased with pubertal stage (p < 0.05), while body mass index z-score (p = 0.001) predicted a higher 9-hydroxyrisperidone concentration. The use of CYP2D6 inhibitors was much more strongly associated with risperidone concentration (p < 0.0001) than with its metabolite's (p = 0.06). In chronically treated youths, the metabolism of risperidone depends on the stage of sexual development, whereas that of 9-hydroxyrisperidone varies with body fat. Moreover, CYP2D6 inhibitors more strongly affect risperidone metabolism than that of its metabolite. The clinical implications of these findings, in relation to efficacy and tolerability, deserve further investigation.

The Effect of Helicobacter Pylori and Economic Status on Growth Parameters and Leptin, Ghrelin, and Insulin-Like Growth Factor (IGF)-I Concentrations in Children

It was suggested that gastric colonization with Helicobacter pylori (H. pylori) was associated with suboptimal nutrition and growth in childhood. Furthermore, several studies indicated a relationship between H. pylori colonization and alterations in the circulating levels of growth-related molecules (GRM). Accordingly, in this study, we investigate the effect of H. pylori infection on GRMs and on the growth of healthy school children, taking into consideration the effect of their economic status (ES) and anthropometric indices of their parents. To acquire sociodemographic and anthropometric nutritional parameters and to detect H. pylori-specific serum IgG antibodies and growth-related molecules, we evaluated a total of 473 children attending four different primary and secondary schools in Istanbul. Subsequently, we assessed the effect of H. pylori on growth-related parameters (weight for age SDS, height for age SDS, BMI SDS, TSF, and waist-to-hip ratio) and on GRMs (leptin, ghrelin, and insulin-like growth factor-1 (IGF-1)), controlling for age, gender, family income, household crowding (HC), breastfeeding, maternal and paternal BMI SDS, and midparental height SDS with complex statistical models. Of the 473 children (275 F/198 M, age 6-15 years; mean: 10.3 ± 0.1 years), 161 (34%) were H. pylori-positive. The prevalence of H. pylori was significantly higher in lower economic status (ES) groups, in children living in crowded houses, and in older age groups. Using simple statistical models, we did not find any significant associations between H. pylori infection and the growth parameters. However, in complex models for height for age SDS and for weight for age SDS, there was a significant interaction between H. pylori infection status and ES. Whereas in H. pylori-positive subjects, mid-income family children were both taller and heavier than the low-income group, there was no such an association in H. pylori-negative subjects. Among biochemical parameters, only ghrelin levels were associated with H. pylori infection in all models. Leptin levels were associated with HC in girls, whereas none of the parameters was significantly associated with leptin levels in boys. For IGF-1 levels, for boys, age and maternal BMI, and for girls, age and HC were significantly associated with IGF-1 levels. We suggest that H. pylori may impair growth significantly only in susceptible children where unfavorable socioeconomic conditions facilitate its action, probably through mechanisms, at least in part, involving growth-related molecules.

Development of Educational System with the Android Robot SAYA and Evaluation

This chapter describes an educational system with a tele-operated android robot, named SAYA, that can express human-like facial expressions and perform some communicative functions with its head and eye movements, and it is utilized as a role of a teacher. Two kinds of field experiments were conducted to investigate effectiveness of this educational system in actual educational fields. An experiment was conducted at both an elementary school and a university to estimate age-dependent differences of its effectiveness. The other experiment was carried out to verify whether children's interest, motivation, and concentration to the class, and science and technologies were enhanced.

Leukocyte Telomere Length and Plasma Catestatin and Myeloid-Related Protein 8/14 Concentrations in Children With Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is common in children and leads to multiple end-organ morbidities induced by the cumulative burden of oxidative stress and inflammation. Leukocyte telomere length (LTL) reflects not only chronologic age but also the burden of disease. We hypothesized that LTL would be decreased in children with OSA. Two hundred thirteen children (mean age, 7.7 +/- 1.4 years) were included after a sleep study and a morning blood sample. LTL was examined by quantitative polymerase chain reaction in a case-control setting involving 111 OSA cases and 102 controls. Myeloid-related protein (MRP) 8/14 and catestatin plasma levels also were assayed using enzyme-linked immunosorbent assay. Log LTL was significantly increased and OSA severity dependently increased in children (P = .012), was positively associated with apnea-hypopnea index (AHI) (r = 0.236; P < .01), and was inversely correlated with age (r = -0.145; P < .05). In a multivariate regression model, LTL was independently associated with AHI (beta = 0.28; P = .002) after adjusting for age, sex, BMI z score, and race. Children with OSA exhibited higher BP (P < .05), lower plasma catestatin (P = .009), and higher MRP 8/14 levels (P < .001) than controls. Of note, children with the lowest plasma catestatin levels (< 1.39 ng/mL) had 5.2-fold increased odds of moderate-to-severe OSA (95% CI, 1.19-23.4 ng/mL; P < .05) after adjusting for confounding variables. In pediatric OSA, LTL is longer rather than shorter. Children with OSA have reduced plasma catestatin levels and increased BP along with increased MRP 8/14 levels that exhibit AHI dependencies. Thus, catestatin and MRP 8/14 levels may serve as biomarkers for cardiovascular risk in the context of pediatric OSA. However, the implications of increased LTL in children with OSA remain to be defined.

Selenium Supplementation does not Decrease Thyroid Peroxidase Antibody Concentration in Children and Adolescents with Autoimmune Thyroiditis

In adults, selenium supplementation decreases thyroid peroxidase antibody (TPO Ab) concentrations in patients with autoimmune thyroiditis (AIT). Our aim in this study was to investigate if selenium supplementation decreased TPO Ab and thyroglobulin antibody (Tg Ab) concentrations in children with AIT. Forty-nine patients (33 females) with newly diagnosed AIT and hypothyroidism were randomized to daily oral therapy with levothyroxine alone (group A, n = 18), levothyroxine plus 100 µg sodium-selenite (group B, n = 13), or levothyroxine plus 200 µg sodium-selenite (group C, n = 18). Mean age at diagnosis was 12.2 ± 2.2 years. All 49 patients needed a mean levothyroxine dose of 1.6 ± 0.5 µg/kg body weight to lower TSH to the treatment goal of 1–2 µU/ml, with no significant difference between groups. At study entry and after 12 months, TPO Ab concentrations were comparable in all three groups. Tg Ab concentrations decreased significantly after 12 months in group A and group C (p = 0.03 and p = 0.01), but not in group B (p = 0.06). It is our conclusion that selenium supplementation with sodium-selenite does not decrease TPO Ab concentrations in children and adolescents, neither given in the reduced dose of 100 µg daily nor given in the “adult” supplementation dose of 200 µg daily.

Arterial Stiffness, Lipoprotein Particle Size, and Lipoprotein Particle Concentration in Children with Type 1 Diabetes

To determine if lipoprotein particle abnormalities correlate with arterial stiffness in children with type 1 diabetes (T1D). In this case-control study, we evaluated 70 children, 35 with T1D and 35 controls, ages 10-18 years, matched for age, sex, race, and BMI. Arterial stiffness was assessed by radial tonometry (AI75) and blood was collected for lipoprotein subclass analysis. T1D subjects had increased AI75, decreased small LDL particle concentration (P = 0.0067), increased large LDL particle concentration (P = 0.007), increased large HDL particle concentration (P = 0.0012), increased mean LDL particle size (P = 0.0028), and increased mean HDL particle size (P < 0.0001) compared to controls. No significant correlations were found between lipoprotein subclasses and arterial stiffness in T1D subjects. T1D subjects have increased arterial stiffness when compared to controls, despite a less pro-atherogenic lipoprotein profile, indicating the need to identify other risk factors that correlate with arterial stiffness in T1D youth.

Here and now: Yoga in Israeli schools

Context:In the aftermath of the Second Lebanon War, a project was initiated and designed to reduce tension in the children living in the area under bombardment.Aims:To assess the impact of yoga intervention in a group of Israeli school children residing in the region affected by the Second Lebanon War.Settings and Design:The study population included 122 school children aged 8–12 years in two elementary schools in Safed (n=55 and n=67, respectively) and their teachers (n=6). The children attended the third grade (n=28), fourth grade (n=42) and sixth grade (n=52).Inclusion in the study was based on the school principal’s consent to participate in the program.Materials and Methods:Assessment was conducted using three questionnaires that have been previously validated in international studies and translated to Hebrew.Statistical Analysis Used:Statistical analysis of the results included Wilcoxon Signed Ranked Tests for pre- and post-intervention comparisons and the Kruskall–Wallis test for teacher and child cross-comparisons.Results:Based on the questionnaires completed by the children and their teachers, we found that the teachers reported many statistically significant improvements in the children’s concentration, mood and ability to function under pressure, although the children themselves were unaware of any change in their behavior. Enjoyment was reported by all participants, and almost all expressed an interest in continuing to practice yoga during school hours. We conclude that participation in yoga classes may be both enjoyable and beneficial to children living in stressful conditions.Conclusions:The study indicates that yoga may be beneficial as an intervention for children in postwar stress situations.

Socioeconomic and personal behavioral factors affecting children's exposure to VOCs in urban areas in Korea

Volatile organic compounds (VOCs) are known to cause adverse health effects. We investigated the relationships between children's VOC exposure and socioeconomic and human activity factors with passive personal samplers, questionnaires, and time-activity diaries (TAD). Statistical analyses were conducted using SAS 9.1, and the results were organized using SigmaPlot 8.0 software. Chemicals such as benzene, toluene, 2-butanone, ethylbenzene, xylene, chloroform, n-hexane, heptane, and some kinds of decanes, which are known to adversely affect public health, were identified in measured samples. These were mainly emitted from outdoor sources (e.g., vehicular traffic) or indoor sources (e.g., household activities such as cooking and cleaning) or both. We concluded that region was the most important socioeconomic factor affecting children's VOC exposure, and the significant compounds were n-hexane (p = 0.006), 1,1,1-trichloroethane (p = 0.001), benzene (p = 0.003), toluene (p = 0.002), ethylbenzene (p = 0.020), m-, p-xylene (p = 0.014), dodecane (p = 0.003), and hexadecane (p = 0.001). Parental education, year of home construction and type of housing were also slightly correlated with personal VOC exposure. Only the concentration of o-xylene (p = 0.027) was significantly affected by the parental education, and the concentrations of benzene (p = 0.030) and 2-butanone (p = 0.049) by the type of housing. Also, tridecane (p = 0.049) and n-hexane (p = 0.033) were significantly associated with the year of home construction. When household activities such as cooking were performed indoors, children's VOC concentrations tended to be higher, especially for n-hexane, chloroform, heptane, toluene (p < 0.05), 1,1,1-trichloroethane, benzene, dodecane, and hexadecane (p < 0.01). However, smoking had a significant effect for only dodecane, and cleaning had no impact on any VOC concentrations. Considering both socioeconomic and personal behavioral factors simultaneously, socioeconomic factors such as region had a greater effect on children's VOC exposures than indoor activities. From this study, we can suggest that socioeconomic factors as well as environmental factors should be considered when formulating environmental policy to protect children's health.

Effects of Aircraft Noise on Children's Mental Health: Data from the Health Survey of Inhabitants in the Vicinity of Gunsan Airport

Objectives: This study was conducted to investigate the effects of aircraft noise exposure on children’s mental health problems such as depression and personality. Methods: We obtained data from the health examinations of school children in the vicinity of Gunsan airport. This survey was conducted in the rural area, Gunsan during 2009. The study population included 195 children attending 4th to 6th grade from 6 elementary schools near the airport. Based on 60 Weighted Equivalent Continuous Perceived Noise Level (WECPNL) measures of aircraft noise, participants were divided into 2 groups; the exposure group consisted of 106 children from 4 schools, and the reference group included 89 children from the 2 schools in Gunsan. All children completed questions on general characteristics, the Korean Children's Depression Inventory (KCDI) for depression, and the Korea Human Nature Inspection (KHNI) for personality. Results: Children in the exposure group were at higher risk of depression (5.62, 95% CI 1.12~28.25), and personality changes (2.08, 95% CI 1.07~4.05) than those of the reference group. In particular, children's diligence, cooperation, and concentration, subgroups of personality measure, were affected significantly and negatively, by aircraft noise level. Conclusions: Our results suggest that exposure to aircraft noise at school is associated with mental health problems in children. Requirements should be implemented to manage aircraft noise of its affect on children's health.

Interferon-gamma in suppurative otitis media: significance of otorrhoea type and disease outcome

Interferon-gamma has been reported to have an immunoregulatory role in otitis media with effusion. However, such a role remains to be determined in acute suppurative otitis media. To determine the levels of interferon-gamma in middle-ear secretion in children with acute suppurative otitis media, and to determine the significance of interferon-gamma to the nature of otorrhoea and the outcome of otitis media. Prospective, longitudinal follow up of patients selected from community and tertiary health centres. We selected children with acute suppurative otitis media, diagnosed as otorrhoea of less than three months' duration. Middle-ear secretions were collected by pipetting and stored at -80 degrees C. Interferon-gamma was assayed using enzyme-linked immunosorbent assay. The patients were treated and followed up for nine to 12 months, to separate those with resolved acute suppurative otitis media from those with chronic suppurative otitis media. The study initially included 358 cases of acute suppurative otitis media. Nine-month follow up was achieved in 304 patients (85 percent). Of these patients, acute suppurative otitis media resolved in 187 (61 percent), while chronic suppurative otitis media was evident in 117 (39 percent). The children with completed follow up comprised 173 boys and 131 girls, aged between four months and nine years (mean age 6.6 years; standard deviation 1.32). These children had purulent otorrhoea in 171 cases (56 percent) and mucoid otorrhoea in 133 cases (44 percent). The children's middle-ear secretion interferon-gamma concentrations ranged from 12 to 126 pg/ml. The mean middle-ear secretion interferon-gamma concentration was 27.2 pg/ml (standard deviation 8.8) in patients whose acute suppurative otitis media resolved, and 73.1 pg/ml (standard deviation 9.5) in those progressing to chronic suppurative otitis media. In children with purulent otitis media, the mean middle-ear secretion interferon-gamma concentration was 43.5 pg/ml (standard deviation 15.6); in those with mucoid otitis media, it was 74.3 pg/ml (standard deviation 19.1). Univariate analysis revealed significant differences in middle-ear secretion interferon-gamma concentration, comparing resolved acute suppurative otitis media and chronic suppurative otitis media cases (p = 0.00), and comparing purulent and mucoid otitis media cases (p = 0.00). Pearson correlation testing revealed significant inverse correlation between interferon-gamma concentration and middle-ear secretion immunoglobulin G concentration (p = 0.01), immunoglobulin E concentration (p = 0.03) and immunoglobulin A concentration (p = 0.00). A high concentration of interferon-gamma in middle-ear secretions promotes chronicity of suppurative otitis media. Further research in this area may lead to the development of agents which assist the control of suppurative otitis media chronicity.

Kawasaki Disease

Kawasaki disease (KD) is an acute systemic inflammatory illness that occurs predominately in children <5 years of age. The reported incidence varies widely depending on the ethnicity of the population and the method of case ascertainment. Recent reports would suggest the annual incidence is ≈20 to 25 per 100 000 children <5 years of age in North America, with the highest reported incidence of 188 being in Japan, where the disease was first described in 1967.1 The illness is self-limited and of unknown cause, but is complicated by a systemic vasculitis with a predilection for small- to medium-sized arteries, particularly the coronary arteries. The majority of patients will have either transient coronary artery dilation or no coronary artery luminal changes as noted on echocardiography. Long-term prognosis for these patients is considered to be excellent. Coronary artery aneurysms occur in 25% of patients, but the prevalence is reduced to ≈4% for patients treated with intravenous immunoglobulin infusion within 10 days of illness onset. Aneurysms are associated with an intense inflammatory cell infiltrate, destruction of the internal elastic lamina, and smooth muscle cell death. Coronary artery involvement is usually maximal within 6 to 8 weeks after the acute episode. Regression of aneurysms can occur primarily through myointimal proliferation, although the arterial structure and function remains abnormal,2 and there is an important ongoing risk of stenoses and occlusions.3 Long-term cardiology assessment and management is required, and some of these patients may require revascularization procedures or, rarely, cardiac transplantation. KD has become the most prevalent acquired cardiac disease in children in developed countries. Article see p 60 Although coronary artery complications are the predominant cause of morbidity and mortality, other cardiovascular abnormalities can occur. Valvulitis is a less prevalent complication, and there have been case reports of important long-term aortic and …

Platelet Serotonin Concentration in Children with Attention-Deficit/Hyperactivity Disorder

Background: Attention-deficit/hyperactivity disorder (ADHD) is a psychiatric disorder highly prevalent in children. The neurobiology of ADHD is still not clear, but is assumed to be related to disturbances in catecholaminergic and serotonergic (5-hydroxytryptamine, 5-HT) systems. Peripheral indices of central 5-HT function were shown in recent studies to be lower, unaltered, or increased in ADHD. Methods: The study determined platelet 5-HT concentration in 84 medication-free 9-year-old (range 4–14 years) boys and girls with DSM-IV diagnosis of ADHD, subdivided according to the different symptoms (inattention, hyperactivity, and impulsivity) and clinical ADHD subtypes (predominantly hyperactive, predominantly inattentive, and combined subtype), and in 30 age- and sex-matched healthy controls. Results: Children with ADHD had similar platelet 5-HT concentrations to control children. Platelet 5-HT concentration did not differ between boys and girls, or between children with a hyperactive, inattentive, or combined subtype of ADHD. In children with ADHD there was a significant positive correlation between platelet 5-HT concentration and impulsive symptoms, but not with symptoms of inattention or hyperactivity.Platelet 5-HT concentration wassignificantly higher in impulsive compared to non-impulsive children with ADHD. Conclusion: The data provide preliminary evidence that increased platelet 5-HT concentration might be a trait marker predictive of impulsivity in ADHD.

Learning outdoors: the Forest School approach

This paper outlines the role that Forest School can play in children's development. With over 100 Forest Schools in England, 20 in Scotland and 20 in Wales, this concept is growing across Britain. Forest School involves children having regular contact with woodland over an extended period of time; it allows them to become familiar, and have contact, with the natural environment. The recent Learning outside the classroom manifesto highlights the importance of children and young people gaining experience of the world beyond the classroom. Twenty-four children from seven schools in Oxfordshire, Shropshire and Worcestershire were observed over an eight-month period as they attended Forest School. Improvements in the children's confidence, motivation and concentration, language and communication and physical skills were recorded by teachers and Forest School leaders. Changes took time to occur, highlighting the need for repeated and regular contact with the natural environment, especially for children who do not have access to nature as part of their everyday lives.

The association of hypothalamic–pituitary–adrenal axis activity and blood pressure in an Afro-Caribbean population

Hyperactivity of the hypothalamic-pituitary-adrenal axis (HPAA) resulting from fetal programming may play a role in the development of high blood pressure (BP) in black people. We assessed the diurnal salivary cortisol profile in children with and without increased BP and evaluated their mother's HPAA. In a cross-sectional study, 20 Afro-Caribbean children (mean age 9.6 years) with higher blood pressures and 20 children with lower blood pressures were chosen from a prospective study of 569 mothers and children in Jamaica. Daytime salivary cortisol profiles were collected in the children and their mothers. The mothers were also assessed for features of the metabolic syndrome. Children with higher BP had higher mean morning salivary cortisol concentrations than those with lower BP (7.9 S.D. 1.9 vs. 4.5 S.D. 2.4nmol/l; p=0.03). Their mothers also had increased morning salivary cortisol concentrations (9.9 S.D. 1.8 vs. 5.5 S.D. 2.5nmol/l; p=0.02), but no changes in fasting glucose, insulin, lipids, BP or adiposity. Maternal and offspring cortisol concentrations correlated significantly (r=0.465, p=0.004). Maternal cortisol concentrations were significantly associated with the child's BP. We conclude that Afro-Caribbean children with higher BP have higher morning salivary cortisol concentrations. The children's cortisol concentrations correlate significantly with the mother's cortisol concentrations. These findings suggest that the HPAA may play a role in the development of raised BP in Afro-Caribbean people.