Pupils' use of school outdoor play settings across seasons and its relation to sun exposure and physical activity.

BACKGROUND: Long outdoor stay may cause hazardous exposure to ultraviolet radiation (UVR) from the sun even at high latitudes as in Sweden (Spring to Autumn). On the other hand, long outdoor stay is a strong predictor of primary school children´s free mobility involving moderate to vigorous physical activity (MVPA). UV-protective outdoor environments enable long outdoor stay. We investigated the concurrent impact of different school outdoor play settings upon pupils´ sun exposure and levels of physical activity across different ages, genders, and seasons. METHOD: During 1 week each in September, March, and May, UVR exposure and MVPA were measured in pupils aged 7-11 years. Erythemally effective UVR exposure was measured by polysulphone film dosimeters and MVPA by accelerometers. Schoolyard play was recorded on maps, and used areas defined as four play settings (fixed play equipment, paved surfaces, sport fields, and green settings), categorized by season and gender. RESULTS: During the academic year, sport fields yielded the highest UVR exposures and generated most time in MVPA. In March, time outdoors and minutes in MVPA dropped and UVR exposures were suberythemal at all play settings. In May, green settings and fixed play equipment close to greenery promoted MVPA and protected from solar overexposure during long outdoor stays. CONCLUSION: More outdoor activities in early spring are recommended. In May, greenery attractive for play could protect against overexposure to UVR and stimulate both girls and boys to vigorous play.

The Galker test of speech reception in noise; associations with background variables, middle ear status, hearing, and language in Danish preschool children.

PURPOSE: We tested "the Galker test", a speech reception in noise test developed for primary care for Danish preschool children, to explore if the children's ability to hear and understand speech was associated with gender, age, middle ear status, and the level of background noise. METHODS: The Galker test is a 35-item audio-visual, computerized word discrimination test in background noise. Included were 370 normally developed children attending day care center. The children were examined with the Galker test, tympanometry, audiometry, and the Reynell test of verbal comprehension. Parents and daycare teachers completed questionnaires on the children's ability to hear and understand speech. As most of the variables were not assessed using interval scales, non-parametric statistics (Goodman-Kruskal's gamma) were used for analyzing associations with the Galker test score. For comparisons, analysis of variance (ANOVA) was used. Interrelations were adjusted for using a non-parametric graphic model. RESULTS: In unadjusted analyses, the Galker test was associated with gender, age group, language development (Reynell revised scale), audiometry, and tympanometry. The Galker score was also associated with the parents' and day care teachers' reports on the children's vocabulary, sentence construction, and pronunciation. Type B tympanograms were associated with a mean hearing 5-6dB below that of than type A, C1, or C2. In the graphic analysis, Galker scores were closely and significantly related to Reynell test scores (Gamma (G)=0.35), the children's age group (G=0.33), and the day care teachers' assessment of the children's vocabulary (G=0.26). CONCLUSIONS: The Galker test of speech reception in noise appears promising as an easy and quick tool for evaluating preschool children's understanding of spoken words in noise, and it correlated well with the day care teachers' reports and less with the parents' reports.

Suberythemal Sun Exposures at Swedish Schools Depend on Sky Views of the Outdoor Environments - Possible Implications for Pupils' Health.

More scheduled outdoor stay is increasingly advocated for school children. This study measured 2(nd) , 5(th) and 8(th) graders' erythemal UV-exposure in September, March and May at four Swedish schools. We related those exposures, as fractions of total available ambient radiation, to the schools outdoor environments differing in amount of shade, vegetation, and peripheral city-scape quantified as percentage of free sky view calculated from fish-eye photographs. Exposures correlated with the sky views (with exceptions in May) and were suberythemal. The exposures were also below the threshold limit of the International Commission on Non-Ionizing Radiation Protection (ICNIRP) for hazard evaluation of UVR but were potentially enough for adequate vitamin D formation according to a cited model calculation - as illustrated in the results and discussed. The school environments, typical in southern and middle Sweden, offer enough shade to protect children from overexposure during seasons with potentially harmful solar UV radiation. Pupils' outdoor stay may be extended during September and March. In May extended outdoor stay of the youngest pupils requires a more UVR-protective environment.

A speech reception in noise test for preschool children (the Galker-test): Validity, reliability and acceptance.

PURPOSE: This study evaluates initial validity and reliability of the "Galker test of speech reception in noise" developed for Danish preschool children suspected to have problems with hearing or understanding speech against strict psychometric standards and assesses acceptance by the children. METHODS: The Galker test is an audio-visual, computerised, word discrimination test in background noise, originally comprised of 50 word pairs. Three hundred and eighty eight children attending ordinary day care centres and aged 3-5 years were included. With multiple regression and the Rasch item response model it was examined whether the total score of the Galker test validly reflected item responses across subgroups defined by sex, age, bilingualism, tympanometry, audiometry and verbal comprehension. RESULTS: A total of 370 children (95%) accepted testing and 339 (87%) completed all 50 items. The analysis showed that 35 items fitted the Rasch model. Reliability was 0.75 before and after exclusion of the 15 non-fitting items. In the stepwise linear regression model age group of children could explain 20% of the variation in Galker-35-score, sex 1%, second language at home 4%, tympanometry in best ear 2%, and parental education another 2%. Other variable did not reach significance. CONCLUSION: The Galker-35 was well accepted by children down to the age of 3 years and results indicate that the scale represents construct valid and reliable measurement.

Bacterial interactions in the nasopharynx - effects of host factors in children attending day-care centers.

The nasopharynges of preschool children are often colonized by potentially pathogenic bacteria. The interactions between these common pathogens and certain host factors were investigated in healthy preschool children 1-6 years of age. Nasopharynx samples were collected from all 63 children attending a day-care center that experienced an outbreak of penicillin-resistant Streptococcus pneumoniae. The samples were analyzed for S. pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Group A Streptococci. A model for the risk of carrying these bacteria was established using logistic regression. S. pneumoniae and H. influenzae antagonize each other, whereas M. catarrhalis and S. pneumoniae have a positively association. The risk of carrying M. catarrhalis decreases with age. The time spent in day care each week was not shown to influence the rate of carriage of any of these pathogens. The negative effect of H. influenzae on S. pneumoniae is discussed in relation to the carriage of penicillin-resistant S. pneumoniae, and possible mechanisms involved in this interaction are presented.

Group supervision in general practice as part of continuing professional development.

INTRODUCTION: The aim of the present study was to explore the current use of supervision groups and the value of such groups for today's Danish general practitioners (GPs). MATERIAL AND METHODS: A questionnaire was sent to a representative sample comprising 10% of GPs registered with the Organisation of General Practitioners in Denmark. RESULTS: More than 60% of Danish GPs have participated in a supervision group, more females than males (p < 0.001), at some time in their career. About a third is currently participating. The supervision activity is perceived as being formative and restorative. The main benefit from supervision was the training of communicative skills which allowed the GPs to better understand difficult patients while achieving an increase in their job satisfaction. CONCLUSION: A majority of Danish GPs have participated in a supervision group at some time. The activity is perceived as being formative and restorative. Participation is significantly more prevalent among female GPs than among male GPs. Future research is required to show how participation influences professional development; how participating in supervision groups contributes to prevention of burnout; and how the needs of males and females differ. FUNDING: This project was supported by the Committee of Multipractice Studies in General Practice and Foundation for Education and Development in General Practice (PLU). TRIAL REGISTRATION: Not relevant.

Accelerometer measured level of physical activity indoors and outdoors during preschool time in Sweden and the United States.

BACKGROUND: It is important to understand the correlates of physical activity (PA) to influence policy and create environments that promote PA among preschool children. We compared preschoolers' PA in Swedish and in US settings and objectively examined differences boys' and girls' indoor and outdoor PA regarding different intensity levels and sedentary behavior. METHODS: Accelerometer determined PA in 50 children with mean age 52 months, (range 40-67) was recorded during preschool time for 5 consecutive weekdays at 4 sites. The children wore an Actigraph GTIM Monitor. RESULTS: Raleigh preschool children, opposite to Malmö preschoolers spent significantly more time indoors than outdoors (P<.001). Significantly more moderate-to-vigorous intensity physical activity (MVPA) was observed outdoors (P<.001) in both settings. Malmö children accumulated significantly more counts/min indoors (P<.001). The percent of MVPA during outdoor time did not differ between children at Raleigh and Malmö. CONCLUSION: Physical activity counts/minutes was significantly higher outdoors vs. indoors in both Malmö and Raleigh. Malmö preschoolers spent 47% of attendance time outdoors compared with 18% for Raleigh preschoolers which could have influenced the difference in preschool activity between the 2 countries. Time spent in MVPA at preschool was very limited and predominantly adopted outdoors.

The majority of sick children receive paracetamol during the winter.

INTRODUCTION: Even though fever is a common symptom in childhood, it often worries parents and they may try to reduce discomfort by giving the child paracetamol, which is currently the most commonly sold over-the-counter medicine. The objective of this study was to investigate parent-administered paracetamol in toddlers during a winter-period in relation to symptoms, doctor contacts and severity-rated illness. MATERIAL AND METHODS: The study was conducted as a prospective diary study covering a three-month winter-period. It comprised a cohort of 183 infants born in February 2001 in a district of the capital area in Denmark. RESULTS: According to the parents, a total of 119 toddlers (65%) received paracetamol at least once during the study period; 9.3% of the toddlers received paracetamol for more than ten days. The administration of paracetamol rose as the number of symptoms increased. Paracetamol was given in 37% of days with fever. The most frequent combinations of symptoms to trigger paracetamol administration were fever and earache with a probability of 64%. For the symptoms of vomiting and earache, the probability was 60%. In the rare cases with monosymptomatic fever, some 23% used paracetamol. CONCLUSION: The majority of ill toddlers received paracetamol if they had several symptoms. However, paracetamol was administrated in 37% of days with fever. This use of paracetamol seems reasonable as the parents differentiate between degrees of illness and withhold paracetamol until the second day of the illness episode.

Infants' symptoms of illness assessed by parents: impact and implications.

OBJECTIVES. Some parents with a sick infant contact a doctor, while others do not. The reasons underlying such parental decisions have not been thoroughly studied. The purpose of this study was to explore how the actual symptoms in the infant were associated with parent-rated illness, illness severity, and the probability of the parents contacting a doctor. DESIGN. A retrospective questionnaire and a prospective diary study covering 14 months of the participating infants' lives. SETTING AND SUBJECTS. The 194 participating infants were followed for three months prospectively from the age of 11 to 14 months using diary cards, and retrospectively from birth until the age of 11 months by a questionnaire. RESULTS. During the three months of the diary card prospective follow-up, the infants had symptoms on average every second day, and the vast majority (92%) had 10 or more days with at least one symptom; 38% of the infants were reported to have had five or more symptoms for more than five days. Fever, earache, and vomiting were the symptoms most likely to cause parents to rate their infant as ill. Earache was the symptom that triggered doctor contact most immediately. The parent-rated illness severity was strongly related to the tendency to contact a doctor. However, this association was markedly weaker when adjustment was made for the infant not eating normally, having a cough, or running a fever. CONCLUSION. Specific symptoms such as fever, earache, and vomiting were strongly associated with the probability of parents rating the infant as ill. An earache would cause the parents to contact a doctor. Fever and vomiting were other symptoms triggering doctor contacts. First, these symptoms could cause the parents to want a doctor's expert evaluation of the infant's illness; second, the parents could expect medication to be necessary; or third, it could just be difficult for the parents to handle the ill infant.

Is my child sick? Parents' management of signs of illness and experiences of the medical encounter: parents of recurrently sick children urge for more cooperation.

OBJECTIVES: Parents of sick children frequently visit their general practitioners (GPs). The aim was to explore parents' interpretation of their child's incipient signs and symptoms when falling ill and their subsequent unsatisfactory experience with the GP in order to make suggestions for improvements in the medical encounter. DESIGN: Semi-structured interviews. SETTING AND SUBJECTS: Twenty strategically selected families with a child from a birth cohort in Frederiksborg County, Denmark were interviewed. RESULTS: Parents wanted to consult their GP at the right time, i.e. neither too early nor too late. Well-educated parents experienced a discrepancy between their knowledge about their child, the information they had sought about the illness and the consultation with the GP, when they were dismissed with phrases such as "it will disappear" or "it is just a virus". The parents went along with the GP's advice if the child only occasionally became sick. However, parents of children with recurrent illnesses seemed very frustrated. During the course of several consultations with their GP, they started to question the GP's competence as the child did not regain health. CONCLUSIONS: Parents want to be acknowledged as competent collaborators. The GP's failure to acknowledge the parents' knowledge of their child's current illness, and the parents' attempt to identify what is wrong with the child and make the child feel better before the encounter may have consequences for the GP's credibility. It is therefore recommended that parents of children with recurrent illnesses receive extra attention and information.

Paracetamol for feverish children: parental motives and experiences.

OBJECTIVE: The sale of paracetamol products for children is increasing, and more children are accidentally given overdoses, even though the use of paracetamol against fever is still under discussion. This study explores Danish parents' use of paracetamol for feverish children and their motives for this use. DESIGN: A cross-sectional survey using structured interviews. Setting. Four general practices located in city, suburb, and rural area. SUBJECTS: A total of 100 Danish parents with at least one child under the age of 10 years. MAIN OUTCOME MEASURES: Number of parents administering paracetamol to feverish children, situations triggering medication of a child, parental views regarding fever and effects of paracetamol, and sources of information on fever treatment. RESULTS: Three in four parents use paracetamol for feverish children, mainly to reduce temperature, to decrease pain, and to help the child fall asleep. Highly educated parents medicate more often than less educated. Parents often fear fever but this does not clearly affect their use of paracetamol. Many parents believe in perceived beneficial effects of paracetamol, such as increased appetite and well-being, better sleep, and prevention of fever seizures. These expectations of paracetamol influence parental use of the drug. Parents' main source of information on fever and paracetamol is their general practitioner (GP). CONCLUSIONS: Danish parents regularly treat feverish children with paracetamol. Although parents contact their GP for advice on fever treatment, paracetamol is sometimes given to children on vague indications. Clearer information for parents on when to give paracetamol as fever treatment may help regulate its use.

Beneficial effects of a Paleolithic diet on cardiovascular risk factors in type 2 diabetes: a randomized cross-over pilot study.

BACKGROUND: Our aim was to compare the effects of a Paleolithic ('Old Stone Age') diet and a diabetes diet as generally recommended on risk factors for cardiovascular disease in patients with type 2 diabetes not treated with insulin. METHODS: In a randomized cross-over study, 13 patients with type 2 diabetes, 3 women and 10 men, were instructed to eat a Paleolithic diet based on lean meat, fish, fruits, vegetables, root vegetables, eggs and nuts; and a Diabetes diet designed in accordance with dietary guidelines during two consecutive 3-month periods. Outcome variables included changes in weight, waist circumference, serum lipids, C-reactive protein, blood pressure, glycated haemoglobin (HbA1c), and areas under the curve for plasma glucose and plasma insulin in the 75 g oral glucose tolerance test. Dietary intake was evaluated by use of 4-day weighed food records. RESULTS: Study participants had on average a diabetes duration of 9 years, a mean HbA1c of 6,6% units by Mono-S standard and were usually treated with metformin alone (3 subjects) or metformin in combination with a sulfonylurea (3 subjects) or a thiazolidinedione (3 subjects). Mean average dose of metformin was 1031 mg per day. Compared to the diabetes diet, the Paleolithic diet resulted in lower mean values of HbA1c (-0.4% units, p = 0.01), triacylglycerol (-0.4 mmol/L, p = 0.003), diastolic blood pressure (-4 mmHg, p = 0.03), weight (-3 kg, p = 0.01), BMI (-1 kg/m2, p = 0.04) and waist circumference (-4 cm, p = 0.02), and higher mean values of high density lipoprotein cholesterol (+0.08 mmol/L, p = 0.03). The Paleolithic diet was mainly lower in cereals and dairy products, and higher in fruits, vegetables, meat and eggs, as compared with the Diabetes diet. Further, the Paleolithic diet was lower in total energy, energy density, carbohydrate, dietary glycemic load, saturated fatty acids and calcium, and higher in unsaturated fatty acids, dietary cholesterol and several vitamins. Dietary GI was slightly lower in the Paleolithic diet (GI = 50) than in the Diabetic diet (GI = 55). CONCLUSION: Over a 3-month study period, a Paleolithic diet improved glycemic control and several cardiovascular risk factors compared to a Diabetes diet in patients with type 2 diabetes.

Parents' motivation for seeing a physician.

OBJECTIVE: To explore situations in which parents with an ill child consult a physician and to identify trigger factors for consultation. DESIGN AND SETTINGS: Qualitative interviews with parents of young children. Parents were asked to describe the situation in which the decision to contact the physician was made. SUBJECTS: A total of 20 families selected from a birth cohort from Frederiksborg County. The cohort numbered 194 of 389 children born between 1 and 28 February 2001. The cohort was followed prospectively from the age of 9 to 12 months by diary (January-April), and retrospectively from birth to the age of 9 months by questionnaire. Families were chosen on the basis of information provided in a questionnaire, diary illness pattern and a telephone conversation. RESULTS: Nine trigger factors associated with physician contacts were identified. Parents' answers demonstrated how their feelings and logical reasoning while caring for an ill child led them to consult the physician. The main reasons for consultation were children's protracted or aggravated symptoms. Parents initially tried to handle the situation but when unsuccessful information and advice was sought by consulting a physician. CONCLUSIONS: Parents consult the physician when they feel overtaxed, afraid, or inadequately prepared to care for their ill child. They considered seriously whether to consult a physician or not.

Hay fever and a single intramuscular injection of corticosteroid: a systematic review.

OBJECTIVES: In severe hay fever, some patients are strongly affected despite the use of first-line therapy and are therefore treated with an intramuscular injection of systemic corticosteroid (i.m. SCS) in some countries. The aim of this paper was to explore the efficacy and side effects of a single i.m. SCS injection in hay fever in adults. DATA SOURCES: PubMed, EMBASE, Cochrane Library. METHODS: Systematic review. Criteria for inclusion: hay fever or seasonal allergic rhinitis, adults, injectable steroids, clinical trials, English language. None of the clinical trials were excluded, since an important aim of the review was to identify any possible side-effects. OUTCOME MEASURES: clinical effects, and clinical and physiological side-effects. RESULTS: 18 clinical trials met the inclusion criteria: nine double-blind RCTs (five placebo-controlled and four comparative RCTs), two single-blinded RCTs, and seven open trials. All studies were conducted before 1988. The efficacy of a single intramuscular injection of SCS was statistically significant in all five placebo-controlled trials and demonstrated considerable clinical benefit, lasting approximately from within the first day to four weeks. In the only two studies comparing i.m. SCS to nasal steroids a superior effect with i.m. SCS was demonstrated. The side-effects were few, both clinically and physiologically, with retained ability to respond to stress with hypothalamic-pituitary-adrenal activation. CONCLUSIONS: The studies in this review were sound and their findings consistent: i.m. SCS therapy was shown to be efficient and safe for the treatment of hayfever in adults. This review shows no support for any concerns regarding serious tissue atrophy or other serious side-effects, any long-lasting suppression of plasma-cortisol, or any influence on stress reaction, following a single intramuscular injection of SCS.