Quantifying thumb opposition kinematics using dynamic computed tomography.

Current motion capture techniques all have shortcomings when applied to the 3D quantitative evaluation of thumb base motion. Dynamic CT might overcome these shortcomings but, so far, robustness of this technique in more than one specimen has not yet been demonstrated. The aim of the current study is to further evaluate the use of dynamic CT for quantification of thumb motion in a larger cadaveric study using a protocol which is feasible in a clinical context. A dynamic CT scan was acquired from six cadaveric human forearms, while a motion simulator imposed thumb opposition. After image acquisition and segmentation, carpal bone motion was quantified using helical axes. To enable comparisons between specimens, intersection points of the instantaneous helical axis with an anatomically defined plane were determined. Precision of the dynamic CT method, measured as variation in distances between silicon nitride beads between frames of a dynamic scan, was 0.43mm (+/-0.09mm) when fixed to the skin and 0.13mm (+/-0.04mm) when embedded into the bone. Absolute deviation between known and measured distances were not larger than 0.34mm. We could demonstrate and quantify that thumb opposition is associated with motion at the trapeziometacarpal and scaphotrapezotrapezoidal joints. High consistency in motion patterns between specimen were found, while the radiation dose was limited. We conclude that dynamic CT can be used to visualize and quantify 3D thumb kinematics, making it a promising method to explore kinematics in vivo.

Quantitative p retreatment VOI analysis of liver metastases. (99m)Tc-MAA SPECT/CT and FDG PET/CT in relation with treatment response to SIRT.

UNLABELLED: Using quantitive VOI analysis, the percentage (99m)Tc-MAA uptake and SUVmax and mean values of liver metastases obtained prior to SIRT were related to treatment response using both a lesion-based and clinical dichotomous approach. Based on the VOI % of (99m)Tc-MAA activity, the estimated (90)Y-microspheres activity/cc (MBq/cc) was calculated from the effective dose injected. Baseline VOI FDG PET SUVmean and max values and estimated MBq/cc values were related to treatment response using a lesion-based approach (% change in SUVmean ≥ 50%) and a clinical dichotomous approach. Fifteen treatment sessions were analyzed (13 patients). Using the lesion-based approach (12 treatment sessions) 40 lesions responded and 37 did not. SUVmax and mean values proved significantly different between non-responding and responding lesions; 18.6 (SD 10.8) versus 13.5 (SD 8.4 ) for SUVmax (p = 0.02) and 11.4 (SD 3.8) versus 6.3 (SD 4.5) for SUVmean (p = 0.002). Using the clinical dichotomous approach (15 treatment sessions / 11 responding), 91 lesions were analyzed; 57 responded. VOI volumes and estimated (90)Y-loaded glass microspheres activity (MBq/cc) did not differ between responders and non responders; 24 cc (SD 27) versus 21 cc (SD 21 cc) (p = 0.4) and 1.95 MBq/cc (SD 1.1 MBq/cc) versus 1.90 MB/cc (SD 2.7 MBq/cc) (p = 0.92). On the contrary, SUVmax and mean values proved significantly different between responders and non-responders; 23.7 (SD 9.8) versus 9.4 (SD 3.8 ) for SUVmax (p = 0.0001) and 13.1 (SD 8.1) versus 4.9 (SD 1.4) for SUVmean. CONCLUSION: These findings suggest that in patients presenting with high baseline SUVmax and mean values, the administration of higher activities or alternatively, other potentially more useful treatment options might be considered.

A tennis ball and music as a patients solution for pulsatile tinnitus.

We present the case of a 74-year-old man with a pulsatile somatosound causing insomnia and day-time irritation. Given the lack of salvation after medical therapy the patient went in search for a solution and found it in a tennis ball and radio. In this case, the somatosound was due to an extracranial arteriovenous malformation, but the differential diagnosis of pulsatile somatosounds is quit extended, ranging form vascular disorders to tumoral processes. This makes these cases challenging for all caretakers.

Psychosocial problems among immigrant and non-immigrant children--ethnicity plays a role in their occurrence and identification.

BACKGROUND: This study aims to examine a) the prevalence of psychosocial problems and b) the association between parent-reported problems and the identification by doctors and nurses (child health professionals, CHP) working in preventive child health care, among immigrant and non-immigrant children. METHODS: CHPs examined 4,098 children aged 5 through 15 years (response: 90.1%) and interviewed parents and children during their routine health assessments in 19 Child Healthcare Services across the Netherlands, serving nearly all school-aged children routinely. The Child Behavior Checklist (CBCL) was completed by the parents. We compared five ethnic groups: indigenous Dutch, economic immigrants, immigrants from (former) Dutch colonies, from other non-industrialised, and from other industrialised countries. RESULTS: The prevalence of parent-reported problems on the CBCL is higher among children from former Dutch colonies and economic immigrant children than among indigenous children, especially regarding internalizing problems (odds ratios (OR); 95% confidence interval: 1.84; 1.03 to 3.29, and 2.52; 1.46 to 4.34). CHPs identified more problems among economic immigrant children (OR: 1.62; 1.01 to 2.60). Regarding associations, rates of CHP-identified problems were higher among indigenous children with clinical compared with normal CBCL Total Problems scores (OR: 6.90; 5.27 to 9.03), but not among economic immigrant children (OR: 0.73; 0.16 to 3.21). CONCLUSIONS: Psychosocial problems occur more frequently among some immigrant groups. CHP identification of psychosocial problems is poorly associated with parent report regarding economic immigrant children. This needs to be improved in order to provide better care.

[Prevalence of parental behaviour to diminish the crying of infants that may lead to abuse]. / Prevalentie van gedragingen van ouders om het huilen van zuigelingen te verminderen die kunnen leiden tot mishandeling.

OBJECTIVE: To estimate the prevalence of parental actions to stop infant crying that may threaten infant health, and to determine specific risk groups regarding these actions. DESIGN: Descriptive. METHOD: Before their visit to a well-baby clinic in the Netherlands, parents of 3345 infants aged 1-6 months (96.5% response) filled out an anonymous questionnaire on actions that they undertook to stop their child crying. RESULTS: At 6 months, 5.6% (95% confidence interval: 4.2-7.0%) of all the parents reported having smothered, slapped, or shaken their infant at least once because of its crying. The highest risks for detrimental parental actions were run by infants of parents from non-industrialised countries, of parents with no or only a part-time job, and of parents who had judged their infant's crying as excessive. CONCLUSION: Clinicians should be aware of the observed risk factors for abuse of young children known to cry a lot, in order to help parents to cope with this crying.

Early detection of psychosocial problems in adolescents: how useful is the Dutch short indicative questionnaire (KIVPA)?

BACKGROUND: Psychosocial problems, such as behavioural, emotional, and educational problems, are highly prevalent among children and adolescents. Early treatment may reduce these problems, if accurately identified. Validated questionnaires may support identification. The aim of this study is to assess the psychometric qualities of such a questionnaire, the Short Indicative Questionnaire for Psychosocial problems among Adolescents (KIVPA,) and to determine whether it is suitable for and adds to the early detection of psychosocial problems among adolescents. METHODS: Data came from a national sample of 1,440 Dutch adolescents, using the KIVPA, the Child Behavior Checklist (CBCL), and the Youth Self-Report (YSR). Of these, 1,248 provided data on all questionnaires (77.8%). The scale structure of the KIVPA was assessed; its sensitivity and specificity using CBCL, YSR and referral for psychosocial problems as criteria; and its contribution to detecting CBCL and YSR problems. RESULTS: The KIVPA is mostly uni-dimensional but the variance explained by its main factor is relatively low. The total KIVPA score discriminates between adolescents with and without problems on the three criteria. Using a clinical YSR total problem score as criterion, sensitivity and specificity are 0.82 and 0.85, respectively, at the proposed cut-off (area under the ROC curve: 0.92; 95% confidence interval (CI) 0.90-0.95). The odds ratio of a clinical YSR score for an elevated KIVPA score is 29.1 (95% CI: 14.4-59.1), although the KIVPA mainly covers internalizing problems. CONCLUSION: The KIVPA has added value in the early detection of internalizing psychosocial problems, but is not sufficiently efficient.

Detecting psychosocial problems among 5-6-year-old children in preventive Child Health Care: the validity of a short questionnaire used in an assessment procedure for detecting psychosocial problems among children.

BACKGROUND: An extended re-assessment of the psychometric properties of the LSPPK, an instrument aimed at identifying children with emotional and behavioural problems. METHODS: Data came from a national sample in The Netherlands of parents of 1248 children (aged 5-6 years) interviewed by child health professionals (CHP). Data were obtained regarding psychosocial problems, treatment status and scores on the LSPPK (Parent and CHP Index), and on the Child Behavior Checklist (CBCL). The scale structure, reliability, criterion and content validity and added value of the LSPPK were assessed using the CBCL and treatment status as criteria. RESULTS: The scale structure corresponded with that found originally; the LSPPK improved the prediction of problems according to the CBCL, compared to predictions using readily available risk indicators alone. Reliability varied between 0.55 and 0.69. For the LSPPK Parent Index, sensitivity varied between 0.42 and 0.50. For the CHP Index sensitivity varied between 0.60 and 0.96, but specificity varied between 0.76 and 0.79. Both indices were very sensitive for attention and social problems, but less so for other problems. CONCLUSION: The LSPPK Parent Index cannot distinguish sufficiently between children with or without serious problems. Either too many children with problems remain unnoticed or too many children without problems are labelled as a case. The LSPPK CHP Index, reflecting the CHP's interpretation of the Parent Index after interviewing the parents does not compensate adequately for the weaknesses of the Parent Index. Better assessment procedures and strategies need to be developed.

Family factors and life events as risk factors for behavioural and emotional problems in children.

The aim of this study was to identify groups of children at increased risk of behavioural or emotional problems on the basis of socio-demographic characteristics, family characteristics, and recent life events with a focus on unemployment and divorce or separation. We obtained data on the Child Behavior Checklist (CBCL) from a community-based national sample of 4480 parents of school-aged children and interviewed them about their demographic and family characteristics and about the child's recent life events. Results showed that family characteristics and recent life events were more strongly associated with children's risks of behavioural and emotional problems as measured by the CBCL than other demographic characteristics. Risks were somewhat higher for children who had experienced parental unemployment and divorce or separation recently, as compared to those who had experienced these events in the more distant past. We conclude that children with recent experience of parental unemployment or parental divorce or separation are at a relatively high risk of behavioural and emotional problems as reported by parents. Although relatively high, the risks that were found do not justify restriction of screening for behavioural and emotional problems to these children.

Excessive infant crying: definitions determine risk groups.

We assessed risk groups for excessive infant crying using 10 published definitions, in 3179 children aged 1-6 months (response: 96.5%). Risk groups regarding parental employment, living area, lifestyle, and obstetric history varied by definition. This may explain the existence of conflicting evidence on the occurrence and cause of excessive crying.

Excessive infant crying: the impact of varying definitions.

OBJECTIVE: To assess the impact of varying definitions of excessive crying and infantile colic on prevalence estimates and to assess to what extent these definitions comprise the same children. METHODS: Parents of 3345 infants aged 1, 3, and 6 months (response: 96.5%) were interviewed on the crying behavior of their infant in a Dutch cross-sectional national population-based study. We computed the prevalence of excessive crying according to 10 published definitions regarding parent-reported duration of infant crying and the parents' experience. We measured concordance between pairs of definitions by Cohen's kappa (agreement adjusted for chance agreement). RESULTS: Overall prevalence rates of excessive crying varied strongly between definitions, from 1.5% to 11.9%. They were always highest in 1-month-old infants. Concordance between definitions was only excellent (kappa > 0.75) if they were closely related, such as crying for >3 hours/day for >3 days/week for the preceding 2 or 3 weeks. Concordance between less closely related definitions was much weaker. Concordance between definitions that were based on duration and on parental experience was mostly poor (kappa: 0.17-0.53 for infants aged 1 and 3 months). CONCLUSIONS: Different definitions of excessive crying lead to the inclusion of very dissimilar groups of infants. We recommend presenting study results using clearly described definitions, preferably concerning both duration of crying and parental distress. This may improve the comparability of studies on the cause and treatment of excessive infant crying. The impact of the method of data collection on this comparability needs additional study.colic, preventive child health care, prevention, infancy.

Quality of life in preschool children born preterm.

The relationship of preterm birth to health-related quality of life (HRQoL) was examined for children aged 1 to 4 years. Three gestational age groups with a NICU history were selected, <32 weeks (n=65), 32 to 36 weeks (n=41), 237 weeks (n=54), and a reference group from the open population (n=50). The main instrument was the TNO-AZL Preschool Quality Of Life (TAPQOL) questionnaire, which was completed by the parents. In addition, other outcome measures obtained from parents or neonatologists were investigated. Children born <32 weeks had significantly lower HRQoL than the reference group in the scales for lungs, stomach, eating disorders, motor functioning, communication, and anxiety. Parental feelings towards the child were related to the child's HRQoL. We found differences between the neonatologists' and parents' perceptions of the children's situation, which can have clinical consequences (e.g. different opinions about what needed treatment). Neonatal intensive care after birth has HRQoL implications for all children, particularly in children born at <32 weeks of gestation.

Identification and management of psychosocial problems by preventive child health care.

OBJECTIVES: To assess the degree to which physicians and nurses working in preventive child health care (child health professionals [CHPs]) identify and manage psychosocial problems in children, and to determine its association with parent-reported behavioral and emotional problems, sociodemographic factors, and general and mental health history of children. DESIGN: The CHPs examined the child and interviewed parents and child during their routine health assessments. The parents completed the Child Behavior Checklist. SETTING: Nineteen child health care services across the Netherlands, serving nearly all school-aged children routinely. SUBJECTS: Of 4970 children aged 5 through 15 years, eligible for a routine health assessment, 4480 (90.1%) participated. MAIN OUTCOME MEASURES: Identification and management of psychosocial problems by CHPs. RESULTS: In 25% of all children, CHPs identified 1 or more psychosocial problems. One in 5 identified children were referred for further diagnosis and treatment. Identification of psychosocial problems and subsequent referral were 6 times more likely in children with serious parent-reported problem behavior according to the Child Behavior Checklist total problem score (8% of total sample). However, CHPs identified no psychosocial problems in 43% of these children and therefore undertook no action. Other child factors associated with CHPs' identification and referral were past treatment for psychosocial problems, life events, and academic problems. After adjustment for these, sociodemographic characteristics did not predict referral. CONCLUSIONS: The CHPs identify psychosocial problems in school-aged children frequently and undertake actions for most of them. Screening for psychosocial problems may be a promising option to reduce these problems, but accurate identification should be enhanced.

Infantile colic: maternal smoking as potential risk factor.

The association of maternal smoking and type of feeding with colic was assessed in 3345 children aged 1-6 months (96% response). The prevalence of colic was twofold higher among infants of smoking mothers, but less among breastfed infants. Maternal smoking as a potential risk factor for infantile crying needs further study.

Continuing positive secular growth change in The Netherlands 1955-1997.

Since 1858, an increase of mean stature has been observed in the Netherlands, reflecting the improving nutritional, hygienic, and health status of the population. In this study, stature, weight, and pubertal development of Dutch youth, derived from four consecutive nationwide cross-sectional growth studies during the past 42 y, are compared to assess the size and rate of the secular growth change. Data on length, height, weight, head circumference, sexual maturation, and demographics of 14,500 boys and girls of Dutch origin in the age range 0-20 y were collected in 1996 and 1997. Growth references for height and weight were constructed with a method that summarizes the distribution by three smooth curves representing skewness (L curve), the median (M curve), and coefficient of variation (S curve). The relationship between height and demographic variables was assessed by multivariate analysis. Reference curves for menarche and secondary sex characteristics were estimated by a generalized additive model using a logit transformation. A positive secular growth change has been present in the past 42 y for children, adolescents, and young adults of Dutch origin, although at a slower rate in the last 17 y. Height differences according to region, educational level of child and parents, and family size have remained. In girls, median age at menarche has decreased by 6 mo during the past four decades to 13.15 y. Environmental conditions have been favorable for many decades in the Netherlands, and the positive secular change in height has not yet come to a halt, in contrast to Scandinavian countries. Main contributors to the increase in height may be improved nutrition, child health, and hygiene, and a reduction of family size.

Development and psychometric evaluation of the TAPQOL: a health-related quality of life instrument for 1-5-year-old children.

The 43-item TNO-AZL Preschool Children Quality of Life (TAPQOL) questionnaire was developed to meet the need for a reliable and valid instrument for measuring parent's perceptions of health-related quality of life (HRQoL) in preschool children. HRQoL was defined as health status in 12 domains weighted by the impact of the health status problems on well-being. The aim of this study was to evaluate the psychometric performance of the TAPQOL. A sample of 121 parents of preterm children completed the TAPQOL questionnaire (response rate 88%) as well as 362 parents of children from the general population (response rate 60%). On the base of Cronbach's alpha, item-rest correlation, and principal component analysis, the TAPQOL scales were constructed from the data for the preterm children sample. The psychometric performance of these scales was evaluated for both the preterm children sample and the general population sample. Cronbach's alpha ranged from 0.66 to 0.88 for the preterm children sample and from 0.43 to 0.84 for the general population sample. The unidimensionality of the separate scales was confirmed by principal component analysis for both the preterm children sample and the general population sample. Spearman's correlation coefficients between scales were, on average, low. T-tests showed that the very preterm children, the children with chronic diseases, the less healthy and the less happy children had lower mean scores on the TAPQOL scales than healthy children, indicating a worse quality of life. This study shows that the TAPQOL is a reliable and valid parent's perception of HRQoL in preschool children. More research is needed to evaluate the psychometric performance of the TAPQOL in different clinical populations.

AIDS-related knowledge, attitudes, and behavior: a comparison of Dutch students and dropouts.

School dropouts are considered an important target group for AIDS prevention. They are expected to be less knowledgeable about AIDS and to show a higher degree of risky behavior as compared with their school-attending peers. Several small-scale studies among specific groups of dropouts seem to confirm such expectations. However, due to differences in methodology, it is often difficult to compare the results of such studies with findings for youths who have not dropped out of school. The present study sought to remedy this by examining AIDS-related knowledge, attitudes, and behavior among comparable samples of Dutch secondary school students and dropouts (excluding homeless and drug-addicted adolescents). The two groups were compared with regard to knowledge about AIDS prevention, attitude toward condom use, intention to use condoms, sexual history, and condom use. Contrary to expectations, few differences were found. It was concluded that, in most respects, dropouts are similar to those who have remained in school.

Dental prevention among Turkish and Moroccan parents in The Hague.

OBJECTIVE: The aim of this study was to determine the extent to which dental prevention among Turkish parents differs from that among Moroccan parents in one of the large cities in the Netherlands. DESIGN: Turkish and Moroccan mothers with a child of approximately six months old, who visited the well baby clinics in the Schilderswijk area of The Hague, were asked to participate in a dental care project. As part of the initial data collection in this project, 170 Turkish and 153 Moroccan mothers were interviewed at home by a woman who spoke their native languages. The interview contained questions about dental prevention, such as fluoride use, feeding bottle use, visits to the dentist, brushing, information about oral care, and about relevant background characteristics. RESULTS: More Moroccan than Turkish mother reported that they did not use a feeding bottle for the baby, went to the dentist twice a year, brushed their own teeth at least twice a day and started to brush their children's teeth at an early age. The Moroccan mothers were more committed to dental prevention than Turkish mothers, even after correction for background characteristics such as education, language skills and the number of years spent in the Netherlands. CONCLUSIONS: Ethnic groups should not be seen as a single group for dental prevention. It is recommended that Turkish parents in particular be encouraged to go to the dentist twice a year, to start brushing their children's teeth at an early age and to wean their children off use of a feeding bottle in bed.

Prevalence of self-reported food hypersensitivity among school children in The Netherlands.

OBJECTIVES: To provide national figures on the prevalence of self-reported food hypersensitivity (S-FH), and the association with socio-demographic variables and some health indicators in schoolchildren in The Netherlands. DESIGN: As part of the Child Health Monitoring System, data were collected from 4450 children, who were invited for a routine health assessment (response 97%). A questionnaire on food hypersensitivity was completed by the parents of the children in primary school and by the children in secondary school themselves. The measurements on health status were taken by the school physician or nurse during the school health assessment. SUBJECTS: Children aged 4-15 y in The Netherlands in three groups in primary school, and in the second year of secondary school. RESULTS: The prevalence of S-FH was 7.2%. Food additives and chocolate were most frequently avoided. Of the children with S-FH, 40% avoided food exclusively either on their own accord or on advice of relatives. School absence due to illness, use of medication, and medical treatment were more prevalent in children with S-FH, and their health status was more often considered moderate or poor by the school physician or nurse. CONCLUSION: Seven percent of school-aged children avoid certain types of food or ingredients because of S-FH. The prevalence of food allergy or food intolerance is probably lower, since many children with S-FH had not undergone any diagnostic tests. To prevent unnecessary food restriction, more information for parents is needed about the possible effects of food restriction on the health of their children, and they should be encouraged to seek further diagnosis.