General Population Of Schoolchildren Research Articles

Validation of the Weiss Functional Impairment Rating Scale (WFIRS-P) as a Functional Impairment Measure in a General Population of Schoolchildren.

Functional impairment rating scales are few in numbers and have mainly been examined in clinical populations. The Weiss Functional Impairment Rating Scale-Parent report (WFIRS-P) is a case in point. We tested the psychometric properties of the WFIRS-P in the largest general population study to date and for the first time examined the factor structure of the scale in a general population setting. Participants were 2,027 schoolchildren aged 6 to 11. Parents/caregivers completed the WFIRS-P and criterion measures of quality of life, attention-deficit/hyperactivity disorder, and behavioral/emotional symptoms. Confirmatory factor analysis and convergent/divergent validity analyses supported a six-factor structure: family, life skills, self-concept, social activities, and the separation of the school domain into two smaller domains covering school learning and school behavior. Children with and without a history of referral differed significantly on all six domains supporting the external validity. In conclusion, the WFIRS-P was found to generate valid scores in a general population sample.

Feasibility, reliability and validity of the health-related quality of life instrument Child Health Utility 9D (CHU9D) among school-aged children and adolescents in Sweden

BackgroundThis study was conducted in a general population of schoolchildren in Sweden, with the aim to assess the psychometric properties of a generic preference-based health related quality of life (HRQoL) instrument, the Swedish Child Health Utility 9D (CHU9D), among schoolchildren aged 7–15 years, and in subgroups aged 7–9, 10–12 and 13–15 years.MethodsIn total, 486 school aged children, aged 7–15 years, completed a questionnaire including the CHU9D, the Pediatric quality of life inventory 4.0 (PedsQL), KIDSCREEN-10, questions on general health, long-term illness, and sociodemographic characteristics. Psychometric testing was undertaken of feasibility, internal consistency reliability, test–retest reliability, construct validity, factorial validity, concurrent validity, convergent validity and divergent validity.ResultsThe CHU9D evidenced very few missing values, minimal ceiling, and no floor effects. The instrument achieved satisfactory internal consistency (Cronbach’s Alfa > 0.7) and strong test–retest reliability (r > 0.6). Confirmatory factor analyses supported the proposed one-factor structure of the CHU9D. For child algorithm, RMSEA = 0.05, CFI = 0.95, TLI = 0.94, and SRMR = 0.04. For adult algorithm RMSEA = 0.04, CFI = 0.96, TLI = 0.95, and SRMR = 0.04. The CHU9D utility value correlated moderately or strongly with KIDSCREEN-10 and PedsQL total scores (r > 0.5–0.7). The CHU9D discriminated as anticipated on health and on three of five sociodemographic characteristics (sex, age, and custody arrangement, but not socioeconomic status and ethnic origin).ConclusionsThis study provides evidence that the Swedish CHU9D is a feasible, reliable and valid measure of preference-based HRQoL in children. The study furthermore suggests that the CHU9D is appropriate for use among children 7–15 years of age in the general population, as well as among subgroups aged 7– 9, 10–12 and 13–15 years.

Autoantibodies against zinc transporter 8 further stratify the autoantibody-defined risk for type 1 diabetes in a general population of schoolchildren and have distinctive isoform binding patterns in different forms of autoimmune diabetes: results from the Karlsburg Type 1 Diabetes Risk Study.

To evaluate the diagnostic relevance of autoantibodies against zinc transporter 8 (ZnT8) in schoolchildren from the general population as well as in people with autoimmune diabetes. A total of 137 schoolchildren positive for at least one of the three major diabetes-associated autoantibodies, without diabetes heredity or preselection on HLA typing, from the Karlsburg Type 1 Diabetes Risk Study, as well as 102 people at type 1 diabetes onset, 88 people with latent autoimmune diabetes in adults and 119 people with type 2 diabetes, were analysed for different ZnT8 autoantibody variants. Zinc transporter 8 autoantibody positivity was found in 18% of autoantibody-positive schoolchildren, with a noticeable association with other autoantibodies associated with type 1 diabetes and disease progression. Furthermore, ZnT8 autoantibody positivity was associated with diabetes progression in schoolchildren positive for autoantibodies against insulinoma-associated antigen-2 (IA-2) and, importantly, in seven IA-2 autoantibody-negative schoolchildren. Additionally, ZnT8 autoantibodies were found in 56% of people with type 1 diabetes, predominantly directed against all three ZnT8 variants and comparable to schoolchildren with multiple autoantibodies. In contrast, ZnT8 autoantibodies were detected in 10% of people with latent autoimmune diabetes in adults, none of them with reactivity to all three isoforms. Zinc transporter 8 autoantibodies are useful markers for prediction of type 1 diabetes in a general population, further stratifying the risk of progression in autoantibody-positive children. ZnT8 autoantibodies are also important markers in adult-onset diabetes, with a completely different reaction pattern in type 1 diabetes in comparison to latent autoimmune diabetes in adults, and may therefore help to differentiate between the two forms.

Psychometric evaluation of two short versions of the Revised Child Anxiety and Depression Scale

BackgroundAnxiety and depression are common in children and adolescents, which can be detected via self-report questionnaires in non-clinical settings like the school environment. Two short versions of the Revised Child Anxiety and Depression Scale (i.e., RCADS-25 and RCADS-20) seem to be feasible for administering at schools. The present study evaluated the psychometric properties of the RCADS-25 and RCADS-20 used as screening instruments for anxiety and depression in a general population of schoolchildren and adolescents.MethodsThe RCADS-25 was completed by 69,487 schoolchildren and adolescents aged 8 to 18. The RCADS-25 and RCADS-20 broad anxiety scales are equal (15 items), but there are two versions of the major depressive disorder (MDD) scale: the RCADS-25 MDD scale (10 items) and the RCADS-20 MDD scale (5 items). The three scales were assessed on structural validity, internal consistency, test-retest reliability, criterion validity, and hypotheses for construct validity.ResultsThe RCADS-25/RCADS-20 broad anxiety scale demonstrated a sufficient structural validity (CFI = 0.98, TLI = 0.99, RMSEA = 0.03, SRMR = 0.03), internal consistency (alpha = 0.82), test-retest reliability (ICC = 0.73), criterion validity (AUC = 0.79), and all four hypotheses concerning construct validity were confirmed. The RCADS-25 MDD scale demonstrated a sufficient test-retest reliability (ICC = 0.70) and three out of four hypotheses concerning construct validity were confirmed, but its structural validity was suspect (CFI = 0.89, TLI = 0.94, RMSEA = 0.09, SRMR = 0.06). The RCADS-20 MDD scale demonstrated a sufficient structural validity (CFI = 0.97, TLI = 0.97, RMSEA = 0.08, SRMR = 0.04) and internal consistency (alpha = 0.72). Two out of four hypotheses concerning construct validity were confirmed. The test-retest reliability (ICC = 0.60) was insufficient. Since both MDD scales showed shortcomings, the shortening of the RCADS-25 MDD scale was re-examined post hoc by principal component and reliability analyses. The result was an MDD scale with seven items.ConclusionsThe RCADS-25/RCADS-20 broad anxiety scale is valid and reliable for screening schoolchildren and adolescents, but the RCADS-25 and RCADS-20 MDD scales showed shortcomings. An MDD scale of seven items showed acceptable psychometric properties.

Long-term exposure to ozone and children's respiratory health: Results from the RESPOZE study

BackgroundAlthough there is evidence on the effects of short-term ozone (O3) exposures on children's respiratory health, few studies have reported results on the effects of long-term exposures. We report the effects of long-term exposure to O3 on respiratory health outcomes in 10–11-year old children. MethodsWe conducted a panel study in a sample of the general population of school children in two cities with high average O3 concentrations, Athens and Thessaloniki, Greece. All 186 participating students were followed up intensively for 5 weeks spreading across a school year. Data was collected through questionnaires, weekly personal O3 measurements, spirometry, FeNO and time-activity diaries. Long-term O3 exposure was assessed using fixed site measurements and modeling, calibrated for personal exposures. The associations between measured lung function parameters and lung function growth over the study period, as well as FeNO and the occurrence of symptoms with long-term O3 exposure were assessed through the application of multiple mixed effects 2-level regression models, adjusting for confounders and for short-term exposures. ResultsA 10 μg/m3 increase in calibrated long-term O3exposure, using measurements from fixed site monitors was associated with lower FVC and FEV1 by 17 mL (95% Confidence Interval: 5–28) and 13 mL (3–21) respectively and small decreases in lung growth: 0.008% (0.002–0.014%) for FVC and 0.006% (0.000–0.012%) in FEV1 over the study period. No association was observed with PEF, FeNO or the occurrence of symptoms. A similar pattern was observed when the exposure estimates from the dispersion models were employed. ConclusionsOur study provides evidence that long-term O3 exposure is associated with reduced lung volumes and growth.

Treating High-Caries Risk Occlusal Surfaces in First Permanent Molars through Sealants and Supervised Toothbrushing: A 3-Year Cost-Effective Analysis

We conducted a 3-year cost-effectiveness analysis on the cavitated dentine carious lesion preventive capabilities of composite resin (CR) (reference group) and atraumatic restorative treatment (ART) high-viscosity glass-ionomer cement (HVGIC) sealants compared to supervised toothbrushing (STB) in high-risk first permanent molars. School children aged 6-7 years in 6 schools (2 per group) received CR and ART/HVGIC sealants or STB daily for 180 days each school year. Data were collected prospectively and cost estimates were made for sample data and a projection of 1,000 sealants/STB high-risk permanent molars. Although STB had the best outcome, its high implementation cost (95% of cost for supervisors visiting schools 180 days/school year) affected the results. ART/HVGIC was cost-effective compared to CR for the sample data (savings of USD 37 per cavitated dentine carious lesion prevented), while CR was cost-effective compared to ART/HVGIC for the projection (savings of USD 17 per cavitated dentine carious lesion prevented), and both were cost-saving compared to STB. Two STB scenarios were tested in sensitivity analyses with variations in caries incidence and number of supervision days; results showed STB had lower costs and higher savings per cavitated dentine carious lesion prevented than CR and ART/HVGIC. A major assumption is that both scenarios have the same high effectiveness rate experienced by STB under study conditions; however, they point to the value of further research on the benefits of adopting STB as a long-term venture in a general population of school children.

Leisure-time sport and overuse injuries of extremities in children age 6–13, a 2.5 years prospective cohort study: the CHAMPS-study DK

ObjectivesIt is not known which sports are most likely to cause overuse injuries of the extremities in children. In this study, we report on the incidence of overuse injuries of...

Exhaled nitric oxide in school children: Searching for the lost variability

ObjectiveThe factors – including asthma and rhinoconjunctivitis – which influence FeNO values in a general population of school children have been studied in order to know to what extent the variability of those values can be explained. MethodsFeNO was measured in a population of 240 school children aged 6–12 years by means of a Niox-Mino™ device in a standardised way. Parents filled in an ISAAC-validated questionnaire of symptoms and environmental factors. Diagnoses were checked against clinical records. Height and weight were measured. A multivariate regression analysis including all variables in the questionnaire was performed, which was followed by two Xi stepwise tests in order to build a predictive model which included the main variables influencing FeNO values. ResultsAmong the 240 children, 10 suffered from asthma, 16 from rhinoconjunctivitis and 15 from both conditions. FeNO values (GM±GSD) in children with rhinoconjunctivitis (19.61±1.20ppb), with asthma (18.62±1.32ppb), and with both conditions (17.62±1.19ppb) tended to be significantly higher than control children (11.42±1.04ppb), p=0.0016, p=0.08 and p=0.01, respectively. The different predictive models were able to explain only 20–27% of FeNO variability. ConclusionsThe proportion of FeNO inter-individual variability which can be explained by individual (including suffering from asthma or rhinoconjunctivitis), family, and environmental factors is very low (20–27%). This could have implications on the usefulness of FeNO as a diagnostic tool in asthma.

Autoantibody-defined risk for Type 1 diabetes mellitus in a general population of schoolchildren: results of the Karlsburg Type 1 Diabetes Risk Study after 18 years.

To investigate the occurrence of diabetes-associated autoantibodies and cumulative Type 1 diabetes risk over 18 years in a general population of schoolchildren. In the Karlsburg Type 1 Diabetes Risk Study, 11 986 schoolchildren from north-eastern Germany without a family history of diabetes were screened for glutamic acid decarboxylase antibodies, insulinoma-associated antigen-2 antibodies and insulin autoantibodies by radioligand binding assay. Those children found to be autoantibody-positive were invited to follow-up examinations and HLA-DQB1 genotyping, and were followed for progression to Type 1 diabetes. At first follow-up, 119 children had single and 36 children had multiple autoantibodies. Of the multiple autoantibody-positive children, 33 had at least one diabetes-associated HLA-DQB1 allele (*02 and/or *0302). A total of 26 children progressed to Type 1 diabetes, of whom 22 had multiple autoantibodies. The male-to-female ratio of those who progressed to Type 1 diabetes was 1.6. The positive predictive value of multiple autoantibodies was 61.1% compared with only 23.7% for diabetes-associated HLA-DQB1 genotypes among all those who were autoantibody-positive. The cumulative risk was 59.7% after 10 years and 75.1% after 18 years for children with multiple autoantibodies compared with 1.2 and 22.6%, respectively, for children with single autoantibodies (P<0.001). Among the three examined autoantibodies, insulinoma-associated antigen-2 antibodies conferred the highest risk. The diabetes risk in schoolchildren with multiple autoantibodies was similar to the risk reported in other studies for genetically preselected probands; thus, a combined autoantibody-based screening could effectively identify at-risk individuals from the general population for future intervention trials.

Impact Of Allergic Rhinitis On Physical Activity In Children

Prevalence of allergic rhinitis (AR) in children is reported to be increasing worldwide. Although AR can significantly impair quality of life of the affected children, it is often ignored or left untreated because of its non-life threatening nature. To reveal a possible impact of AR on daily life of children, we investigated the relationship between physical activity assessed by an accelerometer and questionnaire-based AR symptoms in general population of school children.

Secular Trends of Adiposity and Motor Abilities in Preschool Children

Height, weight, BMI and triceps, subscapular and suprailiac skinfold thicknesses and of motor performance (20 m run, broad jump from the spot, and ball throw by right hand) were repeatedly measured over six decades in several age groups of Czech preschool children (4-6 years). The first study compared results of the measurements in the 1950s (n=268) and in 2009 (n=188), and then further measurements of height, weight, and skinfolds were conducted in two kindergartens with different physical activity programs in the 1970s (n=151) and in 2011 (n=79). When comparing the last century’s results and recent measurements, the average height and weight increased slightly in both studies, and BMI values fluctuated insignificantly around the 50th percentile of the present Czech growth grids for BMI. A significant increase of the values of skinfold thickness was mostly found; along with that results of the broad jump and ball throw (abilities which need some experience and adaptation) decreased significantly, and performance in the 20 m run did not change. The increase of adiposity was lower in the kindergarten with a program of increased physical activity. Gender differences in preschoolers were always found at the occasion of all measurements: adiposity in girls was slightly higher, and motor performance was always lower. A secular change of lifestyle with prevailing sedentarism worsened motor abilities along with increasing adiposity, and a positive effect of increased physical activity had a significant impact on adiposity already during the preschool age. What is already known about this subject: The prevalence of obesity has been increasing in the industrially developed and transitional countries, and also in selected groups of developing countries since the middle of the last century resulting, inter alia, from increasing sedentarism. Adiposity has been enhanced in the general population of school children and adolescents, along with a decreasing level of physical fitness and motor abilities. What this study adds: This study adds original information on secular changes during the last sixty years on adiposity and motor abilities in preschool children; this age group has been less studied up to the present, as more difficult to be followed up by complex programs of adiposity and motor abilities measurements.

Epidemiology of Atopy Patch Tests With Food and Inhalant Allergens in an Unselected Population of Children

Ronchetti R, Jesenak M, Trubacova D, Pohanka V, Villa MP. Pediatr Allergy Immunol. 2008;19(7):599–604PURPOSE OF THE STUDY. The atopy patch test (APT) has been used as a diagnostic tool for patients with suspected food or inhalant allergy. The authors of this study assessed the prevalence of positive APT results with food or inhalant allergens in an unselected population of schoolchildren. The authors also evaluated the link between positive APT reactions and skin-prick tests (SPTs) for food and inhalant allergens, circulating eosinophils, and histamine skin reactivity.STUDY POPULATION. The study included an unselected population of 380 children 9 or 13 years of age living in Rome, Italy.METHODS. APTs were carried out with food (native or standardized) and inhalant allergens. All children also underwent SPTs with 5 common inhalant and 4 food allergens.RESULTS. The prevalence of positive APT reactions for foods in unselected children ranged between 4% and 11% for hen's egg, tomato, and wheat flour and was similar for the 2 age groups studied. The prevalence of positive APT reactions for milk was significantly lower in children of age 13 than in children of age 9 (P = .013). No concordance emerged between positive APT and SPT results for foods. Conversely, APT and SPT results for inhalant allergens yielded statistically significant concordance (P < .001).CONCLUSIONS. The APT produces positive reactions for food or inhalant allergens in a significant number of subjects in the general population of schoolchildren. Inhalant allergens probably induce a positive APT reaction through an immunoglobulin E–linked process, whereas food allergens probably do not.REVIEWER COMMENTS. The APT has been investigated as a new diagnostic tool for patients with food or inhalant allergies when non–immunoglobulin E–mediated reactions are considered, such as in identifying triggers for atopic dermatitis, allergic eosinophilic esophagitis, and food protein-induced enterocolitis syndrome. However, studies have demonstrated conflicting results for the utility of this test. Here, the authors investigated the prevalence of positive results of APT in an unselected population of schoolchildren and found that APTs produced positive reactions for foods in 4% to 11% of cases and for inhalant allergens in 4% to 30%, depending on the allergen used. This is important information to consider when investigating the APT as a potential diagnostic tool.

Obesity rates in special populations of children and potential interventions

AbstractChildhood obesity has become a problem of epidemic proportions in the United States, but much of the research has focused on prevention and intervention programs, which target the general population of school children. Overlooked in the literature are children with special needs (including autism, genetic disorders, Down syndrome, and Prader‐Willi syndrome), who on average have higher rates of obesity than do their typically functioning peers. Specifically, some clinical populations of children have genetic predispositions that make intervention more difficult to accomplish. General intervention considerations are discussed and applied to these groups of children. © 2009 Wiley Periodicals, Inc.

Epidemiology of atopy patch tests with food and inhalant allergens in an unselected population of children

Atopy patch test (APT) has been used as a diagnostic tool in patients with suspected food or inhalant allergy. This study assessed the prevalence of positive APT with food or inhalant allergens in an unselected population of schoolchildren. We also evaluated the link between positive APT reactions and skin-prick tests (SPT) for food and inhalant allergens, circulating eosinophils and histamine skin reactivity. We studied an unselected population of 380 children aged 9 or 13 yr living in Rome, Italy. APTs were carried out with food (native or standardized) and inhalant allergens. All the children also underwent skin-prick testing with five common inhalant and four food allergens. We also measured eosinophil cell counts and histamine skin reactivity. The prevalence of positive APT reactions for foods in unselected children ranged between 4% and 11% for hen's egg, tomato, and wheat flour and was similar for both age groups studied. The prevalence of positive APT for milk was significantly lower in children aged 13 than in children aged 9 (p = 0.013). No concordance emerged between positive APT and SPT for foods. Conversely, APT and SPT for inhalant allergens yielded statistically significant concordance (p < 0.001). APT produces positive reactions for food or inhalant allergens in a significant number of subjects in the general population of schoolchildren. Age influences the prevalence of positive APTs with cow's milk to some extent. Inhalant allergens probably induce a positive APT reaction through an immunoglobulin E-linked process, while food allergens probably do not.

Height and Social Adjustment

To the Editor .— There continues to be debate about whether short children suffer psychological stress from their short stature. Sandberg et al1 have reported that extremes of stature have minimally detectable impact on peer perceptions of social behavior, friendship, or acceptance in a general population of school children. This research was supported in part by a grant from the Human Growth Foundation, a nonprofit organization dedicated to research, education, advocacy, and support for people with growth disorders. We believe that this research is important, because most reported studies on the psychological effect of short stature have been conducted in the population of children who have been referred for medical evaluation of their short stature. We hope to be able to support similar studies in the future. It is of interest that these observations differ from what is seen in patients referred to growth …

Cloning and Characterization of Islet Cell Antigen-related Protein-tyrosine Phosphatase (PTP), a Novel Receptor-like PTP and Autoantigen in Insulin-dependent Diabetes

Cloning of the cDNA encoding a novel human protein- tyrosine phosphatase (PTP) called islet cell antigen-related PTP (IAR) predicts a receptor-like molecule with an extracellular domain of 614 amino acids containing a hydrophobic signal peptide, one potential N-glycosylation site, and an RGDS peptide which is a possible adhesive recognition sequence. The 376-amino acid intracellular region contains a single catalytic domain. Recombinant IAR polypeptide has phosphatase activity. Northern blot analysis shows tissue-specific expression of two IAR transcripts of 5.5 and 3. 7 kilobases, which are most abundant in brain and pancreas. The IAR PTP is homologous in its intracellular region to IA-2, a putative PTP that is an insulin-dependent diabetes mellitus (IDDM) autoantigen. IAR is also reactive with IDDM patient sera. IAR and IA-2 may distinguish different populations of IDDM autoantibodies since they identify overlapping but nonidentical sets of IDDM patients. Thus IAR is likely to be an islet cell antigen useful in the preclinical screening of individuals for risk of IDDM.