Universal Screening Of Children Research Articles

Development and Validation of a Language Screening for Implementation in Pre-School Settings.

BackgroundTo prevent or mitigate long-lasting learning problems and emotional, behavioral, and social-adaption difficulties associated with language disorders, age-appropriate German language competence at school entry level is essential. Therefore, universal screening of children in their penultimate year of pre-school has been established in Upper Austria. So far, the screenings administered by speech and language pathologists to identify risk of language disorder (LD) were not based on standardized materials.ObjectiveTo develop a screening instrument to identify increased risk of LD and to evaluate its validity and feasibility within the constraints of regular universal pre-school language screening.DesignA two-component screening instrument including direct assessment of expressive and receptive grammar was used in a sample of 374 children with German as their dominant language attending a public pre-school in their penultimate year (age 4-5 ½ years) in the state of Upper Austria. Assessment by use of standardized German language tests including a variety of linguistic domains was considered reference standard for diagnosing LD. Feasibility was assessed by a self-developed questionnaire completed by the administrators of the screening.ResultsThe combination of the expressive and receptive grammar scales demonstrated excellent accuracy (area under the curve score 0.928). A cut-off of 18 resulted in a failing rate of 21.8% and showed good sensitivity (84.2%) and specificity (85.3%). Acceptance by children and testers, time-economy and sustainability of the screening were mostly rated as high.

1165. Seroprevalence of Chagas Disease among Latin American Children Living in New York

BackgroundApproximately 300,00 individuals in the United States are estimated to have Chagas disease. To date, only one seroprevalence study in the US has included children. Diagnosis during childhood prevents irreversible sequelae and is better tolerated than during adulthood. Seropositive children may be difficult to identify, as those infected vertically may have never visited an endemic region. We sought to identify children with Chagas disease through a pilot study of serology and risk factors.MethodsParticipants were recruited from Stony Brook University Hospital (SBUH) or an ambulatory pediatric office, both in Suffolk County, New York (population: 1,476,000; 20.2% Hispanic or Latino). Study participants were 1 - 25 years old, resided in Suffolk County, and either the child and/or the child’s mother was born in or had long-term residence (≥ 3 years) in Latin America. T. cruzi serum IgG was determined with a Chagatest ELISA (Weiner Lab) or a Chagas Detect Plus Rapid Test (InBios). Positive screens were confirmed with a second serologic test at the CDC. Participants completed a survey of demographics and Chagas disease knowledge and risk factors, in English or Spanish. Descriptive statistics were applied. SBUH IRB provided study approval.ResultsWe enrolled 93 children (Table 1). Three (3.2%) had a positive IgG screen, of which only one had a confirmed infection (1.1%). This was a 17-year-old who had lived in a rural adobe home and moved to the US at 8 years old. No children or their mothers recalled being bitten by or seeing triatomine insects in their Latin American homes. Of 27 children whose mothers had been screened for infection, 13 were born to 3 mothers with confirmed Chagas disease; all 13 children were seronegative. Of 8 participants reporting other family members with Chagas disease, all were seronegative.Demographics of 93 participants screened for Chagas disease SDstandard deviation; US: United StatesConclusionWithout reliable tools for identifying those at greatest risk of Chagas disease, universal screening of children born in high-risk Latin American regions remains a reasonable strategy. In addition, screening mothers born in Latin America is likely a more cost-efficient means to evaluate second-generation children. A tremendous knowledge gap of pediatric Chagas disease in the US remains.Disclosures All Authors: No reported disclosures

Lipid Screening in Children and Adolescents

Despite enormous advances in research supporting lipid screening among adults, there are critical research gaps in our understanding of the potential benefit and harm of routine screening of young children and adults. Although clear clinical opportunities exist to test and treat individual children from high risk backgrounds, building the case for systematically screening all children as part of a comprehensive cardiovascular disease prevention program requires more convincing evidence that this type of screening will yield true net positive clinical and public health outcomes. This should not prevent the pediatric community from aggressive promotion of healthy lifestyles, both in the office and through effective public policy.

To screen or not to screen: the hepatitis C question

In this issue of The Journal, El-Kamary, et al report results of a study in which more than 1000 children living in the Baltimore, Maryland area were screened for hepatitis C (HCV)–0.1% were infected (anti-HCV positive). Several years ago, Miriam Alter and colleagues at the Centers for Disease Control and Prevention (CDC) used serum samples obtained during the NHANES III Survey to determine the prevalence of HCV infection in children and adults living in the United States (N Engl J Med 341:556). They found that 0.2% of the 6- to 11-year-olds in the sample were HCV-positive; the prevalence doubled to 0.4% among 12- to 19-year-olds. Among adults, the prevalence progressively rose, peaking at 3.9% in the 30- to 39-year-olds in the sample. This data, combined with the data of El-Kamary et al, indicates that universal screening of children in the population is probably not warranted. However, the CDC/NHANES data suggests that women of child-bearing age might be a reasonable target of screening during pregnancy. What would be the benefit? Antiviral therapy for HCV in adults is, at best, moderately successful, and there are no clear recommendations for the treatment of HCV-infected children. Therefore, the current best management strategy is prevention. Perinatal transmission is the major cause of new cases of HCV in children. Because obstetrical factors may be important determinants of transmission, identification of HCV infected women might lead to changes in care that could decrease the risk of HCV transmission from mother to child.

Primary Prevention of Cardiovascular Disease in Childhood: Recent Knowledge and Unanswered Questions

Efforts at prevention of chronic disease in adult life must include investigation of causal pathogenetic clues in early life. There is adequate rationale for identification of children who are at risk of developing cardiovascular disease (CVD) in later years. At the present time, practical considerations would favor a selective rather than universal screening of children. If the latter is instituted, then it is ideal to test children 4-7 years of age. In either case, total cholesterol greater than 200 mg/dl warrants a complete lipid-lipoprotein profile. Those with confirmed abnormal values of total cholesterol, low-density lipoprotein cholesterol, and apolipoproteins A1 and B should be offered dietary advice and encouraged to participate in regular exercise. In a few cases, drug therapy would be required. Limited data suggest that an integrated approach will result in a reduction of cardiovascular risk factors. Perinatal nutrition also may influence the risk of CVD among adults; a reduction in the prevalence of low birth weight and prevention of failure to thrive in early infancy may be additional useful strategies for prevention of CVD.