Knowledge and attitudes in multicultural health care.

Health professionals' knowledge of ethnic minority cultures and lifestyles was assessed to determine whether the respondents' cultural background and experience of working with ethnic minorities affected the health care delivered by them and to assess the need for training. Improving access to health services for ethnic minorities requires continuing education and training of all health professionals.

Second dose of MMR vaccine: health professionals' level of confidence in the vaccine and attitudes towards the second dose.

Public concerns have been raised about the safety of MMR vaccine following the publication of two studies linking the vaccine to inflammatory bowel disease and to a syndrome of Ileal-lymphoid-nodular hyperplasia, non-specific colitis and pervasive developmental disorder. Our study had two aims, to determine whether health professionals' confidence in MMR vaccine was affected and to assess professional knowledge and attitudes towards the second dose of MMR. In July 1998 we undertook a questionnaire survey of general practitioners, practice nurses and health visitors in an inner city area. A significant fall was found in professional confidence following the two publications and the subsequent media coverage (from 59.4% to 40.9%). Forty percent of respondents were unsure about the need for a second dose of MMR vaccine and more than one in ten professionals stated that it was not necessary. It is reasonable to assume that this reduced confidence in the safety of MMR and the professional uncertainty about the second dose have contributed to the observed decline in MMR uptake rates. More professional and public education appears to be needed.

Motor difficulties in children with developmental disorders of speech and language.

The motor hand function of 16 children, aged between 4 and 7 years, with developmental speech and language disorders, was compared with that of 16 control children. The children with developmental speech and language disorders were significantly slower than controls on three out of four motor tasks. They were also more likely than controls to have mixed hand preference although this results was not significant. Children with developmental speech and language disorders should be assessed to ensure that motor deficits are diagnosed and that appropriate support is given.

Ability and dependency in adolescents with severe learning disabilities.

In order to investigate the abilities and care needs of adolescents with severe learning disability, the authors conducted structured interviews with parents/carers of 42 males and 29 females aged 11 to 25 years and attending a school or adult training centres in Salford, Manchester. 56 per cent of the subjects could talk in sentences and 82 per cent could walk. The ability to walk and talk well was associated with better social behaviour. Mean onset of shaving and of menarche was earlier in subjects with than without Down syndrome. Five of the females and two of the males had been abused sexually, 24 per cent of the males and 59 per cent of the females were thought by their parents to have received sex education.

The Education Act 1993: working with health services to implement the Code of Practice.

Whereas the 1981 Education Act led to emphasis on written statements of special educational needs for 2% of pupils, the 1993 Act seeks to recruit help for all children with such needs at earlier stages in the teaching process. Such help includes that available from the health services. The organization of health services has gone through considerable change since the 1993 Act was drafted so special efforts will be required to implement the intentions of the Act.

Minor congenital anomalies, major congenital malformations and development in children conceived from cryopreserved embryos.

A total of 91 children (68 singletons, 20 twins and three triplets) who were conceived from cryopreserved embryos between 27 December 1989 and 18 January 1994, and 83 normally conceived control children (81 singletons and two twins) of a similar age, sex and social class, were assessed for minor congenital anomalies and major congenital malformations. Their development was assessed using the Griffiths Scales of Mental Development. The incidence of minor congenital anomalies (31.9% in the cryopreserved embryo group and 21.7% in the controls) and major congenital malformations (3.3 and 2.4% respectively) in our two groups of children was statistically similar. The relative risk (odds ratio and 95% confidence interval) in the cryopreserved embryo group compared with the controls was 1.7 (0.8, 3.3) for minor congenital anomalies and 1.4 (0.2, 8.5) for major congenital malformations. The minor congenital anomalies were mostly naevi and haemangiomas. The major congenital malformations included Down's syndrome, Beckwith-Wiedemann syndrome and hypophosphataemic rickets in the cryopreserved embryo group and hydronephrosis and gastroschisis in the controls. The Griffiths assessment showed that children from the cryopreserved embryo group and the controls were functioning at a similar level. The mean Griffiths quotient and subquotient values were greater than the standard 100 in children with or without congenital abnormalities. These results in the cryopreserved embryo group are reassuring in that the minor congenital anomaly and major congenital malformation rates were similar to those in normally conceived children of a similar age, sex and social class and their development was not adversely affected by cryopreservation.

Outcome in children from cryopreserved embryos.

A cohort of 91 children from cryopreserved embryos and 83 control children who were conceived normally had their development assessed using the Griffiths's scales of mental development. The controls (81 singletons and two twins) of a similar age, sex, and social class were selected from siblings, cousins, and peers of the cryopreserved embryo group (68 singleton, 20 twins, and three triplets). Children from cryopreserved embryos had a lower mean birth weight and mean gestational age and a higher proportion were born by caesarean section. One child from the cryopreserved embryo group had Down's syndrome, three had squints, and four had conductive hearing loss while in the control children, six had squints, and nine had conductive hearing loss. In both groups, including the child with Down's syndrome, the mean Griffiths's quotient was greater than the standard 100. In the children from cryopreserved embryos, the singleton and multiple birth subgroups had statistically similar assessment results. The mean (SD) Griffiths's quotient was 105.69 (13.55) in children from cryopreserved embryos and 108.18 (9.80) in controls at a chronological age of 25.08 (12.86) and 29.19 (14.65) months respectively. Overall, the development in children from cryopreserved embryos did not cause concern though formal testing had highlighted small differences compared with other children conceived normally and of a similar social class.

Handedness in children at school entry: does the 'Mesker test' provide a valid method for testing writing handedness?

The 'Mesker test', an experiment devised after the psycho-motor dominance test described by the Dutch paediatrician Mesker, was evaluated as a method for testing writing handedness in 145 children at school entry in Crewe Health Authority. Also included in the assessment was if, and how these children know their laterality. Positive outcome was measured as Mesker test result corresponding to spontaneous hand-preference in symbol copying. The correct indication of right arm or leg was evaluated in relation to the outcome by chance. The Mesker test could not confirm hand-preference in children at school entry. There was no significant relation to the child's maturity and no significant consistency in test performance. The sub-group of right-handed writers who confirmed their handedness showed an almost significant level of consistency. No more children who thought they knew the right side indicated the correct limb then could have been arrived at by chance. This was not significantly related to having been taught, writing handedness or maturity. It is concluded therefore, that at school entry age children don't have a good knowledge of their body's laterality. Although the Mesker test does not confirm writing handedness at school entry, it may be useful in older children with inconsistent laterality.

Adolescent smoking.

Most smokers start experimenting with cigarettes in early adolescence. This paper describes the factors which influence the development of the smoking habit. Methods of intervention, both in and out of the classroom, are discussed. Recommendations for further legislation and increased taxation on tobacco are supported.

Intention to treat febrile convulsions with rectal diazepam, valproate or phenobarbitone.

One hundred and eighty-six consecutive children aged between six and 72 months admitted to the Manchester Children's Hospitals with a febrile convulsion in the first year of life, a complicated febrile convulsion, or more than one febrile convulsion within two years, were allocated randomly to one of three groups who were offered rectal diazepam in the event of a subsequent prolonged febrile convulsion, or prophylactic treatment with sodium valproate or phenobarbitone. Over-all risk of recurrence was 30 per cent and adequate prophylactic treatment did not lessen this risk. Side-effects in 24 per cent of the valproate group and 61 per cent of the phenobarbitone group did not justify the use of prophylactic treatment.

Autism: the paediatric neurologist's tale.

Neurologists use the term 'autistic' to describe a quality of social behaviour and communication rather than 'autism' as a diagnosis. It has an organic basis and is commonly, and increasingly, found to be associated with specific medical diagnoses. Epilepsy is as common as in severely mentally handicapped children but whereas in the latter it is often evident in the early years it commonly emerges in adolescence in autistic children. There is a genetic component to autism and in the absence of a specific diagnosis an empirical recurrence risk of 1-2% is given. Fragile-X chromosome disorder is a relatively common explanation but the investigation is expensive and subject to restriction in spite of the enormous implications for affected families. The male preponderance and the neurological explanation for autism have not yet been explained.

Sexual maturation in girls with severe mental handicap.

It is becoming accepted that sex education of handicapped adolescents should not be neglected. For such education to be effective, it should begin before sexual maturity. In an attempt to provide a starting guideline for girls attending ESN(S) schools in the Manchester area, a cross-sectional survey was performed to determine mean age of menarche. The results showed the group as a whole to be on average 13 months later than normal. However, Down's syndrome formed a large identifiable subgroup with a mean menarcheal age 11 months earlier than normal, leaving the non-Down's group 21 months later than normal, and 2 years 8 months behind the Down's group. The implications for education are discussed.

Co-ordination screening for children with and without moderate learning difficulties: further experience with Gubbay's tests.

Modified Gubbay tests, assessing various aspects of motor performance, were administered to 885 Manchester children in mainstream primary education, and centile tables were drawn up by age. Children who had performed badly on one of the four tests were retested two years later, when they were found to have 'caught up' with controls. The primary-school children reached a ceiling in their performance by the age of nine or 10 years. A further 482 children, aged eight years to 16 years 11 months and attending schools for children with moderate learning difficulties, were assessed. These children showed continuing improvement up to the age of 14, after which little further improvement was seen. Thus this ceiling occurred some five years later than for the children in mainstream schools. On the more complex tests performance was worse than would have been predicted by general intelligence. Implications for policies of integration into mainstream schooling are discussed.