A multidisciplinary intervention programme has positive effects on quality of life in overweight and obese preschool children.

AIM: Up to 18.1% of Dutch children aged 3-5 are overweight and up to 3.3% are obese, with higher levels in girls. This study assessed the effect of a multidisciplinary intervention programme on health-related quality of life (HRQoL) in this patient group. METHODS: We randomised 75 children to a multidisciplinary intervention, comprising dietary advice, exercise sessions and psychological counselling for parents or the standard care programme, providing healthy lifestyle advice. The parents completed quality of life and child health questionnaires at baseline and after 16 weeks and 12 months. RESULTS: At 16 weeks, children in the intervention group experienced more bodily pain and less mental health than the standard care group, but at 12 months, this difference disappeared and they showed a more positive change in HRQoL than the standard care group, especially for the physical domain. When we combined both groups, a decreased BMIz-score over 12 months was associated with increased global health and reduced visceral fat correlated with increased general health. CONCLUSION: At 12 months, a multidisciplinary intervention programme for overweight and obese children aged 3-5 years had beneficial effects on HRQoL, especially for the physical domain. Reduced obesity parameters correlated with several increased HRQoL parameters.

Happiness to be gained in paediatric asthma care.

The aim of the present study was to establish the efficacy in terms of morbidity and health-related quality of life (HRQoL) of a group asthma education-exercise programme to children with low (below 10th percentile value) quality-of-life scores. A controlled, randomised, open, clinical trial was conducted. In total, 36 out of 53 unhappy children, among 204 (68%) respondents, treated in four paediatric practices, enrolled (mean age 10 yrs; range: 8-12 yrs), after random allocation in control and intervention groups (child, parent, teacher). Measurements were taken at baseline (T0) and after 3, 6 (T6) and 9 months (T9; intervention group only at 9 months). All but four controls completed the study. From T0-T6, changes (Delta) in HRQoL were clinically important and significantly greater in the intervention group than in the control group, both for generic HRQoL (effect size (ES) 0.95; Delta 16%+/-12% versus -1+/-4%) and for asthma-specific HRQoL (ES 0.58; Delta 15%+/-17% versus 1.5+/-14%). T9 measurements were consistent with T6 findings. Changes in sick days (ES 0.78), oral prednisone courses (ES 0.71) and doctor visits (ES 0.74) over a 6-month period were greater in the intervention group than in the control group. Changes could not be ascribed to change in lung function or medication. In unhappy children, quality of life and morbidity may improve with a low intensity asthma education-exercise programme, even without gains in pulmonary function or exercise tolerance.

Psychometric properties of the TACQOL-asthma, a disease-specific measure of health related quality-of-life for children with asthma and their parents.

The disease-specific-TACQOL-asthma questionnaire measures health-status and appraisal of health-status. The TACQOL-asthma evaluates the personal feelings about problems in the domains, 'complaints, situations, emotions, treatment and medication'. The TACQOL-asthma can be used alone or in combination with the generic TACQOL. Our objective was to study the psychometric properties of the TACQOL-asthma-questionnaire. Responses of 298 parents and children with asthma (age eight to 16 years) in four paediatric practices in the northern part of The Netherlands were studied. The factor-analysis and item-domain correlation analysis show a moderate to strong correlation between the different items and their hypothesised domains. For all items, the correlation of the separate item with the hypothesized domain is stronger than with any other domain. The internal consistency (Cronbach's alpha) of the domains is moderate to good. Concurrent correlation with the Paediatric-Asthma-Quality-of-Life-Questionnaire-(PAQLQ) was significant. Effect sizes of differences between asthma-severity classes in TACQOL-asthma and PAQLQ-scores were similar and of clinical importance. This study validates the TACQOL-asthma as a new disease-specific questionnaire. The TACQOL-asthma ensures a measurement of health status as well as appraisal of health problems. The TACQOL-asthma has good reliability and validity properties to serve as an evaluative and discriminate disease-specific health-related-quality-of-life questionnaire.

Perceptual skills of children with developmental coordination disorder.

The aim of this study was to investigate whether children with a Developmental Coordination Disorder (DCD) experience problems in the processing of visual, proprioceptive or tactile information. Different aspects of visual perception were tested with the Developmental Test of Visual Perception (DTVP-2), tactile perception was assessed with the Tactual Performance Test (TPT), and a manual pointing task was employed to measure the ability to use visual and proprioceptive information in goal-directed movements. Nineteen children with DCD and nineteen age and sex-matched controls participated in this study. Differences between groups were most pronounced in the subtests measuring visual-motor integration of the DTVP-2, and in two subtests measuring visual perception (visual closure and position in space). On average the children with DCD performed slightly below the norm for tactile perception, with only three children failing the norm. On the manual pointing task, children with DCD made inconsistent responses towards the targets in all three conditions (visual, visual-proprioceptive and proprioceptive condition). No significant differences between groups were found for absolute error. Inspection of the individual data revealed that only two children failed on the majority of perceptual tasks in the three modalities. Across tasks, no consistent pattern of deficits appeared, illustrating the heterogeneity of the problems of children with DCD.

[Ritalin: a stimulating drug in the treatment of children with minimal brain dysfunction (MBD)]. / Ritalin: een stimulans bij de behandeling van kinderen met minimal brain dysfunction (MBD).

Children with Minimal Brain Dysfunction (MBD) are vulnerable in society. Therapy consists of a combination of behaviour modification techniques, function training, psychotherapy, family therapy and counseling of parents and teachers. This way of treatment is not appropriate for all children with MBD. Some of them need additional therapy with a psychotropic drug e.g. methylphenidate (Ritalin). We describe a procedure to establish, whether Ritalin improves the therapeutic impact in a specific child. Eight children enrolled the program. In seven Ritalin improved the therapeutic possibilities for a longer period of time. The dose for an optimal therapeutic effect varied individually, and was relatively low (0.4-0.8 kg/kg/dg). The hypothesis concerning the effect of psychotropic drugs in MBD and the pharmacological properties of Ritalin are discussed. We believe this procedure to be applicable in any multidisciplinary setting, experienced with behavioural and learning problems in childhood.

[Primary thrombocythemia in childhood]. / Primaire trombocytemie op de kinderleeftijd.

Primary thrombocythemia is a myeloproliferative disease characterized by a sustained and marked increase in platelet count. The platelet number rises in excess of 1000 X 10(9)/l. Adult patients present with recurrent hemorrhages, thrombotic episodes and microvascular disturbances. It is a relatively benign disease and rarely reported in children. We describe two patients with a thrombocythaemia. The first, a 13 1/2 year old boy, had no complaints. A thrombocythemia (2167 X 10(9)/l) and splenomegaly were found by chance. He was treated with melfalan. Acetylsalicilic acid and dipyridamol were added as anti-coagulants. The second patient, a 12 year old girl, was submitted to a splenectomy at the age of 10, because of a traumatic rupture. Sixteen months later she was admitted to our hospital with symptoms of thrombotic as well as bleeding tendency. Periferal microvascular disturbances and symptoms on the basis of impaired cerebro-vascular bloodflow were found. The number of platelets was 5083 X 10(9)/l. She was treated in the same way as the first patient. Symptoms disappeared as soon as the number of platelets decreased. In both patients periferal blood and bonemarrow examination as well as platelet function, measured by aggregation studies, were abnormal. Consideration of the literature on children and our own case I indicate that this disease in the younger patient may exist without undue risk of complications. One might consider treatment with anti-aggregating agents only.