Ultrasonographic length of morphologically-normal kidneys in children presented to a premier tertiary healthcare setting of Sri Lanka.

BACKGROUND: Accurate prediction of reference ranges of renal lengths facilitates clinical decision making. Currently a single renal-length-reference chart is used for both kidneys, which is solely based on the age of the child without adjusting for anthropometrics. Objective of the study is to assess the length of morphologically-normal kidneys ultrasonically and to build models to predict the renal lengths of children presenting at the Radiology Department of Lady Ridgeway Hospital for Children. METHODS: A descriptive cross sectional study was done among 424 children with 233 males and 191 females at the study setting. Study population included children undergoing abdominal ultrasound scans for indications not related to renal disease. Children with a family history of renal diseases or with morphologically-abnormal kidneys were excluded. Bipolar-lengths of kidneys, gender and anthropometrics were documented. Having tested for assumptions, Wilcoxon-signed rank test, Mann-Whitney U test and multiple linear regression were used. RESULTS: The mean (SD) bipor-length of right and left kidneys were 6.83 (1.43) and 7.05 (1.36) respectively (p < 0.001). Age, height and weight were significantly correlated with the renal lengths (p < 0.05). Until 16 months, there was a significant difference between the renal lengths between males and females (P < 0.05). Yet the association with gender was not significant from 17 months and in overall. Until 16 months, the best linear-regression equation (p < 0.001) for the left kidney was; 3.827 +  0.019(length in centimeters) +  0.141(weight in kilograms) - 0.023(age in months) - 0.347(for male sex). For the right kidney, it was; 3.888 + 0.020(length or height) + 0.121(weight) - 0.037(age) - 0.372 (for male sex). The respective R squares were 59.2 and 53.5% with VIF (Variance-Inflation-Factor) ranging from 1.06 to 2.08. From 17 months, best equation for left kidney (p < 0.001) was; 5.651+ 0.022(age) + 0.01(BMI). For right kidney it was; 5.336 + 0.022(age) + 0.012(BMI). The R squares were 62.5 and 66.1% with VIF being 1. CONCLUSIONS: The established models explain more variability for children above 17 months. Both renal lengths are affected significant by the body's' anthropometric parameters. For each kidney, separate normograms of renal lengths which are local-context-specific must be prepared. Further research must be promoted.

Predictors of developmental surveillance completion at six months of age in south western Sydney.

BACKGROUND: While developmental surveillance programs promote early identification of child developmental problems, evidence has indicated suboptimal uptake. This study aimed to identify predictors of developmental surveillance completion at 6 months postpartum. METHODS: Questionnaires were administered to the parents of 510 infants who were born in south western Sydney, Australia over a 22-month period. Attendance for developmental screening and completion of the Parents' Evaluation of Developmental Status (PEDS) at 6 months postpartum were modelled separately using multivariable logistic regression. RESULTS: Developmental surveillance attendance was predicted by higher levels of maternal education, annual income and being informed about checks. PEDS completion at 6 months of age was predicted by higher income and being informed, as well as being married, employed, speaking English at home, full-term birth and the professional status of the practitioner completing the check. CONCLUSIONS: Barriers to developmental surveillance included low socioeconomic status, linguistic diversity and possible gaps in parental knowledge and professional education. Developmental surveillance rates may be increased by the addition of targeted parental and professional support within current universal frameworks.

Metal release from serpentine soils in Sri Lanka.

Ultramafic rocks and their related soils (i.e., serpentine soils) are non-anthropogenic sources of metal contamination. Elevated concentrations of metals released from these soils into the surrounding areas and groundwater have ecological-, agricultural-, and human health-related consequences. Here we report the geochemistry of four different serpentine soil localities in Sri Lanka by coupling interpretations garnered from physicochemical properties and chemical extractions. Both Ni and Mn demonstrate appreciable release in water from the Ussangoda soils compared to the other three localities, with Ni and Mn metal release increasing with increasing ionic strengths at all sites. Sequential extraction experiments, utilized to identify "elemental pools," indicate that Mn is mainly associated with oxides/(oxy)hydroxides, whereas Ni and Cr are bound in silicates and spinels. Nickel was the most bioavailable metal compared to Mn and Cr in all four soils, with the highest value observed in the Ussangoda soil at 168 ± 6.40 mg kg(-1) via the 0.01-M CaCl2 extraction. Although Mn is dominantly bound in oxides/(oxy)hydroxides, Mn is widely dispersed with concentrations reaching as high as 391 mg kg(-1) (Yudhaganawa) in the organic fraction and 49 mg kg(-1) (Ussangoda) in the exchangeable fraction. Despite Cr being primarily retained in the residual fraction, the second largest pool of Cr was in the organic matter fraction (693 mg kg(-1) in the Yudhaganawa soil). Overall, our results support that serpentine soils in Sri Lanka offer a highly labile source of metals to the critical zone.

Chronic kidney diseases of uncertain etiology (CKDue) in Sri Lanka: geographic distribution and environmental implications.

The increase in the number of chronic kidney disease (CKD) patients from the north central region of Sri Lanka has become a environmental health issue of national concern. Unlike in other countries where long-standing diabetes and hypertension are the leading causes of renal diseases, the majority of CKD patients from this part of Sri Lanka do not show any identifiable cause. As the disease is restricted to a remarkably specific geographical terrain, particularly in the north central dry zone of the country, multidisciplinary in-depth research studies are required to identify possible etiologies and risk factors. During this study, population screening in the prevalent region and outside the region, analysis of geoenvironmental and biochemical samples were carried out. Population screening that was carried out using a multistage sampling technique indicated that the point prevalence of CKD with uncertain etiology is about 2-3% among those above 18 years of age. Drinking water collected from high-prevalent and non-endemic regions was analyzed for their trace and ultratrace element contents, including the nephrotoxic heavy metals Cd and U using ICP-MS. The results indicate that the affected regions contain moderate to high levels of fluoride. The Cd contents in drinking water, rice from affected regions and urine from symptomatic and non-symptomatic patients were much lower indicating that Cd is not a contributing factor for CKD with uncertain etiology in Sri Lanka. Although no single geochemical parameter could be clearly and directly related to the CKD etiology on the basis of the elements determined during this study, it is very likely that the unique hydrogeochemistry of the drinking water is closely associated with the incidence of the disease.

Dose-dependent Na and Ca in fluoride-rich drinking water--another major cause of chronic renal failure in tropical arid regions.

Endemic occurrence of chronic kidney disease with unknown etiology is reported in certain parts of the north central dry zone of Sri Lanka and has become a new and emerging health issue. The disease exclusively occurs in settlements where groundwater is the main source of drinking water and is more common among low socio-economic groups, particularly among the farming community. Due to its remarkable geographic distribution and histopathological evidence, the disease is believed to be an environmentally induced problem. This paper describes a detailed hydrogeochemical study that has been carried out covering endemic and non-endemic regions. Higher fluoride levels are common in drinking water from both affected and non-affected regions, whereas Ca-bicarbonate type water is more common in the affected regions. In terms of the geochemical composition of drinking water, affected households were rather similar to control regions, but there is a large variation in the Na/Ca ratio within each of the two groups. Fluoride as shown in this study causes renal tubular damage. However it does not act alone and in certain instances it is even cytoprotective. The fine dividing line between cytotoxicity and cytoprotectivity of fluoride appears to be the effect of Ca(2+) and Na(+) of the ingested water on the F(-) metabolism. This study illustrates a third major cause (the other two being hypertension and diabetes) of chronic kidney diseases notably in tropical arid regions such as the dry zone of Sri Lanka.

Geochemical and mineralogical characteristics of elephant geophagic soils in Udawalawe National Park, Sri Lanka.

Geophagy or deliberate ingestion of soils was observed among Asian elephants (Elephas maximus) in the Udawalwe National Park, Sri Lanka, for several years. The geochemical and mineralogical composition of the clayey soil layers which are purposefully selected and eaten by elephants in the park were studied, in order to identify the possible reasons for elephant geophagy. The concentrations of major and trace elements were determined by means of X-ray fluorescence spectrometry in 21 soil samples from eight geophagic sites and six soil samples collected from four non-geophagic sites. The mineralogical composition of selected soil samples was investigated using X-ray diffractometry (XRD). These geochemical analyses revealed that geophagic soils in the study areas are deeply weathered and that most of the elements are leached from the soil layers under extreme weathering conditions. The XRD data showed that the soils of the area consisted mainly quartz, feldspar, and the clay minerals kaolinite, Fe-rich illite, and smectite. Although no significant geochemical differences were identified between geophagic and non-geophagic soils, a clear difference was observed in their clay mineralogical content. Soils eaten by elephants are richer in kaolinite and illite than non-geophagic soils, which contain a higher amount of smectite. It is suggested that elephants in Udawalawe National Park ingest soils mainly not to supplement the mineral contents of their forage but to detoxify unpalatable compounds in their diet.

Fluoride in Ceylon tea and its implications to dental health.

The purpose of this study was to assess the fluoride content of Ceylon Tea, which is a popular beverage throughout the world. The fluoride content of tea infusions prepared from different grades of tea leaves collected from different parts of the tea-growing regions (25 samples) of Sri Lanka was measured using a fluoride-selective electrode. Fluoride leaching was found to vary from 0.32 to 1.69 mg F/l, but there were no significant differences in terms of fluoride leaching between tea from different tea-growing regions or between tea of different grades. Dental fluorosis is widespread throughout the dry zone of Sri Lanka, and drinking water has traditionally been considered to be the main contributory factor to the development of fluorosis. However, diet, the consumption of tea in particular, may also contribute to the manifestation of dental diseases.

Medical geology in tropical countries with special reference to Sri Lanka.

Sri Lanka provides an ideal opportunity for the study of the effect of geology on human health. The vast majority of the people of Sri Lanka still live in rural areas within areas termed geochemical provinces. Very broadly, one could say that a geochemical province has characteristic chemical composition in soil, water stream sediments and rocks, enabling their delineation from others. The chemical composition is presumed to be have an impact on the health of the inhabitants of the particular geochemical province, particularly because of the fact that their food and water are obtained mostly from the terrain itself. This leads to the concept of "diseases of geochemical origin". Among these are dental fluorosis, iodine deficiency disorders (IDDs) and selenium-based diseases. The Dry Zone of Sri Lanka has several areas rich in groundwater fluoride, the ingestion of which leads to dental fluorosis. Iodine deficiency diseases are more common in the Wet Zone, though their aetiologies are more complicated. Interestingly, it has also been observed that significant proportions of the female population of Sri Lanka are selenium-deficient, which could well be related to the geological environment. Chronic renal failure (CRF) has been observed in some areas of the Dry Zone of Sri Lanka, where there is a relationship of CRF with the mineral content of drinking water. This subject matter falls under the auspices of Medical Geology, a scientific discipline still in its infancy, and much more concerted studies are needed to attract the attention of medical research.

Biomineralogy of human urinary calculi (kidney stones) from some geographic regions of Sri Lanka.

Kidney stones (urinary calculi) have become a global scourge since it has been recognized as one of the most painful medical problems. Primary causative factors for the formation of these stones are not clearly understood, though they are suspected to have a direct relationship to the composition of urine, which is mainly governed by diet and drinking water. Sixty nine urinary calculi samples which were collected from stone removal surgeries were analyzed chemically for their Na, K, Ca, Mg, Cu, Zn, Pb, Fe and phosphate contents. Structural and mineralogical properties of stones were studied by XRD and FT-IR methods. The mean contents of trace elements were 1348 mg kg(-1) (Na); 294 mg kg(-1) (K); 32% (Ca); 1426 mg kg(-1) (Mg); 8.39 mg kg(-1) (Mn); 258 mg kg(-1) (Fe); 67 mg kg(-1) (Cu); 675 mg kg(-1) (Zn); 69 mg kg(-1) (Pb); and 1.93% (PO (4) (3-) ). The major crystalline constituent in the calculi of Sri Lanka is calcium oxalate monohydrate. Principal component analysis was used to identify the multi element relationships in kidney stones. Three components were extracted and the first component represents positively correlated Na-K-Mg-PO (4) (3-) whereas the second components represent the larger positively weighted Fe-Cu-Pb. Ca-Zn correlated positively in the third component in which Mn-Cu correlated negatively. This study indicates that during the crystallization of human urinary stones, Ca shows more affinity towards oxalates whereas other alkali and alkaline earths precipitate with phosphates.

What are you like?: A personality profile of cancer and palliative care nurses in the United kingdom.

Occupational psychology has long been concerned with the proposed link between personality and occupational success or stress. The role of the cancer and palliative care nurse can be challenging and stressful, and the aim of the current study was to explore the existence of a personality profile for nurses working in this area. For this study, 178 nurses undertaking degree and diploma studies in cancer and palliative care at a specialist palliative care unit in northwest England completed the 16PF personality inventory and a demographic questionnaire. The mean age of these nurses was 38 years, and 95% were women. Approximately half (52%) were staff nurses, and the majority (77%) worked in hospital or community environments. The profile suggested that the nurses were extraverted, empathic, trusting, open, expressive, insightful, and group oriented. They were likely to be cautious when facing new ideas, potentially naïve in dealings with more astute others, and somewhat lacking in objectivity. Positive aspects of the profile suggested that they would thrive in a stressful occupation wherein caring for others and multidisciplinary team working are important. However, less positive elements may affect their ability to be influential members of the multidisciplinary team. The potential for using personality profiling for effective targeting of personnel, education, training, and improvement of self-awareness is explored.

Selenium and iodine in soil, rice and drinking water in relation to endemic goitre in Sri Lanka.

Endemic goitre has been reported in the climatic wet zone of south-west Sri Lanka for the past 50 years, but rarely occurs in the northern dry zone. Despite government-sponsored iodised salt programmes, endemic goitre is still prevalent. In recent years, it has been suggested that Se deficiency may be an important factor in the onset of goitre and other iodine deficiency disorders (IDD). Prior to the present study, environmental concentrations of Se in Sri Lanka and the possible relationships between Se deficiency and endemic goitre had not been investigated. During the present study, chemical differences in the environment (measured in soil, rice and drinking water) and the Se-status of the human population (demonstrated by hair samples from women) were determined for 15 villages. The villages were characterised by low (< 10%), moderate (10-25%) and high (> 25%) goitre incidence (NIDD, MIDD and HIDD, respectively). Results show that concentrations of soil total Se and iodine are highest in the HIDD villages, however, the soil clay and organic matter content appear to inhibit the bioavailability of these elements. Concentrations of iodine in rice are low (< or = 58 ng/g) and rice does not provide a significant source of iodine in the Sri Lankan diet. High concentrations of iodine (up to 84 microg/l) in drinking water in the dry zone may, in part, explain why goitre is uncommon in this area. This study has shown for the first time that significant proportions of the Sri Lankan female population may be Se deficient (24, 24 and 40% in the NIDD, MIDD and HIDD villages, respectively). Although Se deficiency is not restricted to areas where goitre is prevalent, a combination of iodine and Se deficiency could be involved in the pathogenesis of goitre in Sri Lanka. The distribution of red rice cultivation in Sri Lanka is coincident with the HIDD villages. Varieties of red rice grown in other countries contain anthocyanins and procyanidins, compounds which in other foodstuffs are known goitrogens. The potential goitrogenic properties of red rice in Sri Lanka are presently unknown and require further investigation. It is likely that the incidence of goitre in Sri Lanka is multi-factorial, involving trace element deficiencies and other factors such as poor nutrition and goitrogens in foodstuffs.

Continuity and change in the social competence of children with autism, Down syndrome, and developmental delays.

The aims of this longitudinal study were: (1) to assess the continuity and change in diagnosis, intelligence, and language skills in children with autism, Down syndrome, and other developmental delays, (2) to specify the deficits in social competence and language skills in these children, and (3) to identify precursors in the preschool period of gains in language skills and of peer engagement in the mid-school years. The initial sample consisted of 70 children with autism, 93 children with Down syndrome, 59 children with developmental delays, and 108 typically developing children, with the first three groups of children studied when they were between 2 and 6 years of age. At follow-up, 51 children with autism, 71 children with Down syndrome, and 33 children with developmental delays were assessed at mean ages around 10-13 years. The long-term follow-up showed little change in the diagnosis of autism but sizeable improvements in intellectual and language abilities within the autistic group, a pattern that was not seen in the children with Down syndrome. Unique deficits in joint attention, some forms of representational play, responsiveness to the emotions of others, and initiation of peer engagement were identified in the autistic children, whereas the children with Down syndrome seemed to have a specific deficit only in language. Joint attention skills were concurrently associated with language abilities in all groups and predicted long-term gains in expressive language for the children with autism. Children with autism, regardless of their level of functioning, were less socially engaged with classmates than the other developmentally disabled children because they infrequently initiated and accepted play bids, not because they were rebuffed by peers. Early nonverbal communication and play skills were predictors of the frequency of initiations of peer play for the children with Down syndrome as well as the extent of peer engagement of the children with autism. These results suggest that improvements in early communication and play skills may have long-term consequences for later language and social competence in these groups of children.

Is affect aversive to young children with autism? Behavioral and cardiac responses to experimenter distress.

The aim of this study was to determine whether displays of negative emotions are more aversive to young children with autism than displays of neutral emotions. The attention, behavioral reactions, facial affect, and cardiac responses of 22 autistic and 22 mentally retarded 3-5-year-old children were compared when an experimenter pretended to hurt herself and showed strong distress in contrast to when the experimenter pretended to hurt herself but showed only neutral affect. The children in both diagnostic groups looked more at the experimenter and appeared more interested and concerned when she displayed strong distress than when she showed neutral affect. The heart rate of the mentally retarded children decreased during the distress condition relative to a baseline condition, but the heart rate of the children with autism did not change across conditions. In summary, the children with autism gave no evidence of being overly aroused by or avoiding the distressed experimenter.

Autistic children's responses to separation and reunion with their mothers.

Observed 16 autistic, 16 normal, and 16 Down syndrome children (age 3-6 years during separation and reunion with their mother in a laboratory playroom over three sessions. Children's responses to separation and reunion were assigned to one of five behavioral patterns that were weighted for intensity or level of response. No differences were found between groups in their behavioral responses during separation or reunion. Moreover, children in each group altered their responses according to the environmental setting which was varied over the three sessions. However, the autistic and Down syndrome groups did differ from the normal group in their consistency of behavioral patterns over the three observation sessions; both the former groups showed more individual variation in their separation and reunion patterns indicating that the expression of these patterns may be influenced by their associated developmental delay.

Long-term stability of individual differences in the emotional responsiveness of children with autism.

The results of two studies designed to investigate the short- and long-term stability of autistic children's responsiveness to displays of negative emotions in others are reported here. In the first study we measured the attention and behavioural responses of 22 autistic children to another's distress about a year and a half after initial assessments in a similar situation. In the second study, the children were re-assessed in two affective contexts over 5 years after initial testing. Individual differences in early responses to affect predicted affective responsiveness at each follow-up. Emotional responsiveness was positively associated with concurrent cognitive skills at each point of assessment. Furthermore, autistic children discriminated between affective and non-affective contexts when this discrimination was tested at the second follow-up.

Proximity and sociable behaviours in autism: evidence for attachment.

Sixteen autistic, 16 normal and 16 Down syndrome children (aged 3-6 years) were observed with their mother and a female stranger in a laboratory playroom. Proximity and sociable behaviours were recorded continuously during three observation sessions. The autistic children showed behaviours indicating that they were clearly attached to their mothers: like the normal and Down syndrome children, they showed all behaviours preferentially to the mother and directed proximity behaviours almost exclusively to her. These attachments were functionally similar to those of the comparison children. The deficits identified in the autistic group were restricted to a set of behaviours which have to do with social interaction such as Show, Give and Mutual Play. Descriptions of the aloof, unattached autistic child were not confirmed.

Current research findings on childhood autism.

OBJECTIVE: To review the main areas of current research findings regarding the core deficits in autism and the implications of these findings for the practicing clinician. METHOD: Behavioural, cognitive, emotional and neurophysiological aspects are covered with an emphasis on the importance of methodology. RESULTS: The implication of these findings for the treatment of autism is discussed. CONCLUSION: Autism can teach us how we learn about emotions and the possibility of sensitive periods of development.

Autism: fifty years on from Kanner.

It is now 50 years since Leo Kanner first described autism as a distinctive pattern of symptoms in some children with severe developmental problems. Since then the assessment and diagnosis of children with pervasive disorders of development has been refined and much is known about the phenomenology and epidemiology. Autism is a biological disorder of the central nervous system (CNS) of unknown cause. It is associated with a number of organic disorders such as epilepsy and has comorbidity with other psychiatric disorders such as tic disorder. Cognitive abnormalities in social interactions, affect and language are present but there is still debate regarding which of these, if any, is the primary cognitive deficit. Special education and behavioral management has led to modest but important developmental improvement in many children with autism. Autism remains a life-long condition but patterns of symptoms change and skills develop from childhood into adult life.

The effect of selenium on fluoride - clay interactions: Possible environmental health implications.

Previous epidemiological studies have shown that dental fluorosis is endemic in the lowland, dry zone of Sri Lanka, which is considered to be an area in which excessive quantities of fluorides are present in the drinking water supplies. It has been found that kaolinitic clay forms a suitable raw material in the defluoridation of water.It is shown that there is a noticeable effect of selenium and media pH on the reactions involved in the interaction of fluoride with clay. In this study, 1 mM fluoride solutions containing SeO 3 (2-) (selenite) concentrations of 0 mM, 0.1 mM, 0.5 mM and 1 mM were used in the reactions with kaolinitic clay. The effect of pH was monitored in the range 4 to 8. It was observed that fluoride adsorption was maximum at a pH of 5.6 without either SeO 3 (2-) or SeO 4 (2-) , the adsorption capacity being 15.2 µmol F(-) g(-1) clay. However, when the SeO 3 (2-) concentration was increased up to 0.5 mM at this optimum pH, the adsorption capacity reduced to 12.8 µmol F(-) g(-1) clay. Monitoring of the effect of SeO 4 (2-) and media pH on fluoride adsorption showed that when the SeO 4 (2-) concentration increases from zero to 0.1 mM, there is a reduction of fluoride adsorption capacity. However, when the SeO 4 (2-) concentration is further increased from 0.1 mM to 1.0 mM, there was an increase in the fluoride adsorption capacity, indicating a more consistent effect of SeO 3 (2-) on fluoride-kaolinitic clay interaction than SeO 4 (2-) .Fluoride concentrations in drinking water supplies have a marked effect on dental health and the geochemistry of selenium appears to play an important role in the geochemical mobility of fluoride ions.