Physiologic increase and tracking of blood pressure in schoolchildren.

4343 blood pressure (BP) recordings were obtained in 1575 schoolchildren during 5 years. Systolic BP rose proportionally to upper arm muscle area (MA) in both sexes. In contrast, upper arm fat area (FA) was considerably lower in boys than in girls, and the rise of systolic BP in boys during puberty was not accompanied by any increase of FA. At repeat examination of 900 children after 1 to 5 years, between 35% and 53% of those with initial systolic BP in the highest quintile had again values in the same quintile, thus twice as often as expected. Tracking in the highest decile was even stronger: 37% of 82 children had again systolic BP in the highest decile at 2 years, and 29% at 4 to 5 years. We conclude that the physiologic increase of systolic BP is primarily determined by rising muscle mass, and tracking still remains detectable in children after 4 to 5 years and is strongest in those with highest values.

[Swiss continuing education meetings for school physicians. An evaluation of preferences for selected subjects]. / Schweizerische Fortbildungsveranstaltungen für Schulärzte.

The group "school health physicians" of the Swiss Society for Social- and Preventive Medicine has organized since its foundation in 1981 two meetings; Basle in 1982, and Zurich in 1983. Questionnaires were handed out on both occasions on source and extent of experience as school health doctors. The questions included views on the meetings in general and on the various topics discussed. Participants were also asked to write down suggestions for future meetings. The following subjects discussed were voted to be "important" or "very important" by at least two thirds of the participants: ophtalmologic mass examinations; health education as an important new factor for school health physicians as evidenced by the anti-smoke-campaign in Baselstadt schools; round-table-discussion on the currant importance of school-health medicine; certification of fitness for schooling by the school doctor; growth and development of the child on startin school; psychomotor disorders and their effects on children starting school. The third meeting, scheduled for September 27th 1984 in Lausanne, which will include for the first time a morning session, will deal with topics selected by the participants of the Basle and Zurich meetings: orthopedic problems at school age and their prevention; a report on school sports and high-performance sports.

[School health tasks and activities yesterday and today]. / Schulärztliche Aufgaben und Tätigkeit gestern und heute.

In the time between 1882 and 1928 the school doctor was engaged in checking the sensory organs, in controlling infectious diseases and in judging the general state of health of his pupils. Apart from these occupations, health education took an important part. After World War I, goitre prophylaxis was introduced in health services. Between 1928 and World War II we can observe a strong development of medical services for schools. The medical examinations are extended to include kindergarten, high school, and professional schools. Tuberculosis control is expanded. Pupils' insurance is created. From the end of World War II onwards and today there is a further perfection of tuberculosis control through fluorography and BCG inoculation. The peak of preventive medicine is reached with vaccinations for polio and German measles. Because of the radiation load, fluorography has soon got to be abandoned. During the same time psychiatry, psychology, and medical pedagogics are included in the services or developped side by side. Apart from the traditional duties it is sensible for a school doctor to try to coordinate the above mentioned branches of service.

[Blood pressure study in school-children of Zurich. I. Results in the age group 7 to 12 years]. / Blutdruckstudie bei Zürcher Schulkindern. I. Ergebnisse in der Altersgruppe 7 bis 12 Jahre.

A longitudinal blood pressure study of 1575 children aged 7-11 years was started in 1977. 308 12-year-old children were rescreened one year later. The blood pressure was recorded at school in the sitting position using random-zero-sphygmomanometers and the largest cuff to fit the upper arm easily (10 cm and 12 cm wide). Systolic and diastolic II (disappearance of sounds) pressures were measured, and the mean of two readings (1st/2nd, or 3rd/4th if indicated) was used. The blood pressure values were remarkably low, with mean systolic pressures of 98 mm Hg or less and diastolic pressures of 55 mm Hg or less. The highest readings observed were 140 mm Hg systolic and 95 mm Hg diastolic in two 11-year-old children. The systolic blood pressure correlated best with weight (r = 0.38 in boys and 0.45 in girls), and, in decreasing order, with height (r = 0.32/0.40), age (r = 0.28/0.32) and triceps skinfold thickness (r = 0.24/0.26). Correlation with pulse rate was poor (r = 0.09/0.06). However, a multiple regression analysis showed that weight and pulse rate are the only variables which contribute significantly to explaining the variance of systolic blood pressure (17% in boys and 24% in girls). At constant height levels there was no correlation between systolic blood pressure and age, but the correlation with weight remained good and with skinfold thickness fair. Thus, the blood pressure in children aged 7-12 years correlates better with indices of body size (weight and Quetelet index) than with fatness, except in clearly obese children. Repeated blood pressure recordings correlated significantly with values obtained one year earlier: in boys, r = 0.49 for systolic and 0.34 for diastolic pressures, in girls, r = 0.58 (systolic) and 0.41 (diastolic). Repeatedly elevated systolic blood pressures, i.e. values within the upper decile, were observed four times more frequently than could have been expected by chance alone (in 14 of 36 children = 39%). Positive tracking correlations of blood pressure are therefore demonstrable in childhood.