Obesity in 4-year-old children more prevalent in girls and in municipalities with a low socioeconomic level.

AIM: To provide updated prevalence data of BMI and obesity in 4-year-old Swedish children, also exploring socioeconomic differences. SUBJECTS: A total of 4407 children born 1998-1999 (2231 boys and 2176 girls) in the county of Västerbotten, Sweden. METHODS: Overweight and obesity was estimated using the International Obesity Task Force cutoff values (ISO BMI). Information about socioeconomic level of the municipalities was collected from a health survey of the adult population. RESULTS: Of the boys, 16.7% were classified as overweight and 3.1% of these as obese. Corresponding figures for girls were 22.1% and 6%. [corrected] The P50 and P95 values for BMI were 16.2 and 18.8 for boys and 16.1 and 19.3 for girls, respectively. P50 was at the same level as in previous Swedish studies, while P95 was higher in this study. Obesity, in girls, was more prevalent in municipalities with a low socioeconomic level. CONCLUSION: Overweight and obesity in pre-school children in Sweden is more prevalent in girls than in boys, and the prevalence is as high as in school age children. A low socioeconomic level of living area seems to be related to a higher prevalence of obesity. Increased preventive efforts, both on the individual and the societal level, must be undertaken to reduce future health risks in obese children.

An incident case-control study of first unprovoked afebrile seizures in children: a population-based study of pre- and perinatal risk factors.

PURPOSE: The aim of this prospective incident community-based study was to assess the influence of pre- and perinatal risk factors in children in whom an unprovoked afebrile epileptic seizure later developed. METHODS: From November 1, 1985, until June 30, 1987, 75 children aged 0-15 years with a first unprovoked afebrile seizure were identified. After exclusion of cases with neonatal seizures (n = 14), two controls per case were selected from the same province in northern Sweden matched by age and sex. Files from maternity wards and pediatric clinics could be traced for 58 cases and 109 controls. These formed the study group. RESULTS: In the univariate analysis, the risk for an unprovoked afebrile seizure was significantly elevated for birth order (OR = 9.3; CI, 2.2-39), vaginal bleeding (OR = 17; 95% CI, 3.5-85), onset of hypertension during pregnancy (OR = 4.8; CI, 1.3-17), cesarean section (OR = 18; 95% CI, 3.7-88), short or long gestational age (OR = 6.7; 95% CI, 2.0-22), and an Apgar score < or =6 at any time (OR = 3.8; 95% CI, 1.2-12). None of these six factors was present in 48.3% of the cases and 89% in the controls. A combination of two or more risk factors found to be significant in the univariate analysis showed a pronounced increased risk for seizures (OR = 19; 95% CI, 5.6-65). In the multivariate analysis, the following characteristics remained statistically significant: vaginal bleeding, gestational age, and Cesarean section. Furthermore, smoking also was identified as a risk factor in the multivariate analysis (OR = 3.4; 95% CI, 1.1-10). CONCLUSIONS: Both pre- and perinatal factors may be associated with later development of epileptic seizures in children. However, in many of the cases, no such factors were identified.

[Measurements in child health services. Also experienced nurses obtain different results]. / Väga och mäta på BVC. Aven erfarna distriktssköterskor får olika mätvärden.

Growth reflects general health but also the nutritional and environmental health of a child. Disordered growth may be an early manifestation of disease or deficiency. In Sweden, the newly updated growth charts are highly valued at the child health services, yet measurements of height, weight and head circumference of four infants showed that even experienced nurses achieved noticeably large differences in their individual results. In several cases the plotted data also deviated concerning the exact age of the child or the registered value. Awareness of methodological problems should lead to more accurate advice and referral.

The role of the Child Health Services in the identification of children with possible attention deficit hyperactivity disorder/deficits in attention, motor control and perception (ADHD/DAMP).

Literature concerning the role of the Child Health Services in the identification of children with possible Attention Deficit Hyperactivity Disorder/Deficits in Attention, Motor Control and Perception (ADHD/DAMP) is summarized in order to establish a background for evaluation, discussion and conclusion.

Periodontal health in adopted children of Asian origin living in Sweden.

In the present study the periodontal condition of a group of adopted 6-17 year-old children of Asian origin living in Sweden was compared with that of age- and sex matched Sweden children. Thirty-one Asian children and 31 Swedish children participated. Data on general health for all the children and on age at arrival for the Asian children was collected by interview. A clinical examination included recording of presence of plaque, supragingival calculus, bleeding on probing, probing depth, and caries. Radiographs were used to determine marginal bone loss (distance between the cemento-enamel junction and the marginal bone level > 2 mm), proximal calculus, and proximal caries. In addition, previously taken and filed radiographs of the primary dentition of the older children and current radiographs of the younger children with primary teeth were analysed to determine the prevalence of bone loss and calculus. The children of Asian origin showed a significantly higher number of surfaces with plaque and bleeding on probing. No significant differences were noted in the number of individuals with probing depths > or = 4 mm, supragingival calculus, or radiographic calculus. Three of the Asian and none of the Swedish children displayed radiographic bone loss. The retrospective analysis of all available radiographs from the primary dentition showed that 9 of 29 (31%) Asian children and 2 of 29 (7%) Swedish children had experienced bone loss in primary teeth.

Glycerol kinase deficiency in two brothers with and without clinical manifestations.

We report two brothers with glycerol kinase deficiency (GKD). The older brother had serious clinical symptoms, mental and growth retardation, abnormal skeleton, spontaneous fractures and premature loss of abnormal teeth. He and his mother had low serum phosphate levels. He had elevated serum and urine glycerol levels and GKD was found in cultured fibroblasts. Prenatal diagnosis was performed in the second pregnancy. Glycerol kinase activity was considered normal in a chorionic villus sample of the foetus. After birth, it was found that the boy had elevated serum and urine glycerol levels. Enzymatic analysis in cultured fibroblasts revealed that this boy also had GKD, in spite of having no expression of the disease. Chromosomal analyses in the parents and both boys were normal. Major rearrangements or deletions were not detected in molecular studies of DNA from the two brothers. The hybridisation pattern was normal and no allelic loss was observed.

Influence of epilepsy on mortality in mental retardation: an epidemiologic study.

PURPOSE: A cohort consisting of all persons with known mental retardation (MR) and living in a Swedish province on December 31, 1985, was followed for 7 years (1987-1992) to study the mortality pattern. METHODS: A file of the cohort was linked to the cause-of-death pattern of the general population in the study area. RESULTS: One hundred twenty-four deaths (8.4%) occurred among the 1,478 persons with MR. Thirty deaths (10.1%) occurred among the 296 persons with epilepsy and MR. The standardized mortality ratio (SMR) in those with only MR was significantly increased as compared with that of the general population: 1.6 [95% confidence interval (CI) 1.3-2.0]; MR and epilepsy, 5.0 (CI 3.3-7.5); and MR, epilepsy, and cerebral palsy (CP), 5.8 (CI 3.4-9.7). Mortality was increased both in patients with partial seizures without seizures secondarily generalized (SMR 3.7, CI 1.0-13.6) and in patients with seizures secondarily generalized (5.0, CI 2.3-11.0). The highest mortality occurred in patients who had seizures that were always generalized from the onset: 8.1 (CI 5.7-11.5). Mortality increased with increasing seizure frequency during the year preceding the prevalence date. In patients with epilepsy and MR, pneumonia was the most common cause of death and a seizure was the probable cause of death in 6.7%. CONCLUSIONS: Epilepsy is associated with a significantly increased mortality in persons with MR. The increase is related to seizure type and seizure frequency. Death in persons with epilepsy and MR is seldom directly due to seizures. Other impairments associated with epilepsy and MR are important causes of death.

Hypophosphatasia affecting the permanent dentition.

Reports on dental abnormalities in connection with hypophosphatasia almost exclusively describe changes in primary teeth. A 23-year-old man with hypophosphatasia, first diagnosed at the age of 8 months, is described; histologically and radiographically verified signs of the condition were present in the permanent dentition. The findings included a reduced level of the marginal alveolar bone supporting the upper central incisors, which had to be extracted. The molars displayed large coronal pulp chambers. Histologically, the upper incisors demonstrated abnormal root cementum, with areas of dentin resorption, as well as disturbances of the mineralization of the coronal dentin. The patient also had signs of abnormal root resorption of molars. The potential involvement of permanent teeth puts children with hypophosphatasia at risk of developing oral complications during adolescent and adult life.

Mutations and phenotype in isolated glycerol kinase deficiency.

We demonstrate that isolated glycerol kinase (GK) deficiency in three families results from mutation of the Xp21 GK gene. GK mutations were detected in four patients with widely differing phenotypes. Patient 1 had a splice-site mutation causing premature termination. His general health was good despite absent GK activity, indicating that isolated GK deficiency can be silent. Patient 2 had GK deficiency and a severe phenotype involving psychomotor retardation and growth delay, bone dysplasia, and seizures, similar to the severe phenotype of one of the first described cases of GK deficiency. His younger brother, patient 3, also had GK deficiency, but so far his development has been normal. GK exon 17 was deleted in both brothers, implicating additional factors in causation of the severe phenotype of patient 2. Patient 4 had both GK deficiency with mental retardation and a GK missense mutation (D440V). Possible explanations for the phenotypic variation of these four patients include ascertainment bias; metabolic or environmental stress as a precipitating factor in revealing GK-related changes, as has previously been described in juvenile GK deficiency; and interactions with functional polymorphisms in other genes that alter the effect of GK deficiency on normal development.

Supplementary feeding in the maternity ward shortens the duration of breast feeding.

In a prospective study, feeding routines of a maternity unit and the subsequent feeding patterns of 521 newborns were analysed. During the stay in the maternity unit, 69% of newborns were exclusively breast fed and 1% received only donor's milk from the milk bank and/or formula. Nine percent received their mothers' milk by bottle at least once and 21% received one or more supplementary feedings with donor's milk from the milk bank. One-quarter of the children received supplementary feeds on the third day of life, the indications for this being birth weight less than 3.0 kg, maternal diabetes or gestational diabetes, "insufficient amounts" of milk or fussiness. At three months, 65% were being exclusively breast fed and 15% partially breast fed. In a multiple logistic regression analysis, the potential determinants (neonatal feeding, maternal characteristics, characteristics of the delivery and the child) for the duration of breast feeding were included. The adjusted relative risk (estimated as odds ratios, OR) of not being breast fed at three months was associated with maternal age (< 25 years, OR 4.2), maternal smoking (OR 4.0), neonatal feeding (supplements given, OR 3.9) and initial weight loss (10% or more, OR 2.8). Thus the administration of supplementary donor's milk or formula during the early neonatal period was associated with an increased risk of a short duration for breast feeding, even after adjustment for a number of potential confounders.

A community-based prospective incidence study of epileptic seizures in children.

During a 20-month period, an attempt was made to find all children with unprovoked non-febrile seizures. The first attendance and incidence rates were 95 and 89/100,000, respectively, in the age group 0-15 years. These figures are lower than those found 10 years earlier in the same area. The highest incidence was during the first year of life and there was a higher proportion of girls (male:female ratio 1:1.4). Generalized seizures dominated in the first year of life. The incidence of benign childhood epilepsy with centro-temporal spikes was 10.7/100,000 and was the most common epilepsy syndrome found. The incidence of partial seizures increased with age up to the age of 10 years. One in 10 children had a history of febrile convulsions.

Tay or IBIDS syndrome. A case with growth and mental retardation, congenital ichthyosis and brittle hair.

A new, Swedish case with Tay or IBIDS syndrome is presented. The boy had growth and mental retardation, congenital ichthyosis and brittle hair. He was the only child in an uncle-niece marriage. The boy suffered recurrent infections and died at the age of 3 years from pneumonia. Clinical data on 15 cases are presented from a study of the literature.

The occurrence of symptoms and the proportion treated in Swedish infants and their mothers.

Eighty-five per cent of 229 post-parturient women answered a questionnaire concerning the occurrence of symptoms in themselves and in their infants after discharge from two maternity wards up to the infant age of four months. Information about the treatment and drugs used was also requested. Although the level of maternal education differed between the two regions examined, the panorama of symptoms, the drug treatment, and the breastfeeding were reported mainly the same. Symptoms were common both in the mothers and in their infants. No symptoms were reported by six per cent of the mothers and for eight per cent of the infants. Many of the symptoms were not pharmacologically treated, but 70% of the mothers and 38% of the infants took one or more drugs besides vitamins. None of the drugs taken by the mothers was considered to have adverse effects on breastfeeding and none of the drugs given to the infants was considered to be ineligible.

Pre- and perinatal factors in febrile convulsions.

In a community based study, 110 children with febrile convulsions (FC) were identified prospectively. Pre- and perinatal risk factors were compared with 213 age and sex matched controls sampled from the community. During pregnancy, proteinuria and preeclampsia/eclampsia occurred more often in mothers of cases. Premature birth and bilirubinemia greater than 200 mumol/l were also more common in cases. There were no differences between cases and controls in occurrence of chronic illnesses in mothers, parents age at birth, birth order, and factors occurring during delivery such as type of anesthesia, occurrence of acute or elective cesarean section, use of vacuum extraction, mode of presentation, signs of fetal distress in amnion fluid, umbilical problems, abnormalities of fetal heart rate or duration of delivery. Perinatal asphyxia was uncommon and there was no difference between cases and referents. Occurrence of complications during the first neonatal week did not differ between groups.

Fragile X families in a northern Swedish county: a genealogical study of possibly affected individuals in the nineteenth century.

Most studies of fragile X [fra(X)] families are able to document mental impairment only by family history. Using Swedish historical archives and the unique parish catechetical meeting records it is possible to document qualitative phenomena such as literacy for over 100 years. In this way it was possible to identify 7 individuals with mental retardation living in the nineteenth century in an earlier published fra(X) pedigree. Four of them were female. At the present time another 4 severely mentally retarded females with the fra(X) syndrome have been diagnosed in this family. The high prevalence of mentally retarded females might indicate a variant form of the fra(X) syndrome in this family.

An incident case-referent study of febrile convulsions in children: genetical and social aspects.

In a prospective community-based study of 103 children with febrile convulsions (FC), social and genetical factors were compared with 193 age and sex matched referents sampled from the community. FC were found more often among parents of cases than referents (odds ratio 21.0; p less than 0.001). A history of FC in any type of relative was found in 39.8% of cases and 10.4% of referents (odds ratio 5.8; p less than 0.001). The familial occurrence of FC is best described by a multifactorial (polygenic) model. No difference was found between groups in the occurrence of other diseases than FC affecting the central nervous system and only one case was mentally retarded. No difference was found between cases and referents in the age of independent walking and ability to speak at age 18 months. Children with FC more often had infectious diseases than referents (odds ratio 2.84; p = 0.002). Children with FC more often lived in apartments and spent their time in day by day care institutions (odds ratio 2.91; p = 0.02). Parents' occupation did not differ between groups. Mothers of children with FC more often had compulsory education only compared with mothers of referents.

Epilepsy in a population of mentally retarded children and adults.

All mentally retarded (MR) subjects in a northern Swedish county were assessed for the occurrence of active epilepsy on a prevalence day. Active epilepsy was found in 299 subjects (20.2% of those with MR) corresponding to a crude prevalence rate of 1.2/1000 inhabitants. The age-specific prevalence for 0-9 years was higher for females than for males, while in other age groups it was slightly higher for males or showed no difference between the sexes. Epilepsy and MR were the only disorders in 129 subjects (43.1%). Cerebral palsy was the most common associated disorder and occurred in 100 (33.4%). A presumable etiology for epilepsy and MR was identified in 73.2% and 71.9%, respectively. The presumable etiological factors which caused MR occurred prenatally in 35%, perinatally in 10% and postnatally in 9%. The pathogenetic period was unknown in 31%. In 15%, the etiological events occurred during more than one of the above periods. The presumable causes were responsible for both epilepsy and MR in all except 7 cases. MR individuals with epilepsy were significantly more retarded than those without epilepsy. The first seizure occurred during the neonatal period in 11.6% and before 1 year of age in 27.7%. Generalized tonic-clonic seizures were the most common type and occurred in 204 subjects (68.2%). Seventy-one of these also had partial seizure manifestations. Daily to weekly seizures occurred in 26.8% and 32.0% had been seizure-free for the past year.

A prospective incidence study of febrile convulsions.

A prospective epidemiological study of febrile convulsions (FC) was performed during a 20-month period. 128 children with FCs were identified. The annual first attendance rate and annual incidence rate were 500/100,000 and 460/100,000 respectively, in the age group 0-4 years. The cumulative incidence was 4.1%. FCs were more common among boys, with a male to female ratio of 1.72 to 1. The median and mean age for first FC was for boys 16 and 19.9 months respectively, and for girls 18 and 19.7 months respectively. During an average follow-up period of 20 months, 18% had another FC and 10% had two or more FCs. 8.6% had an initial complicated FC. Four children had FCs within two weeks after being vaccinated by combined vaccine against morbilli, rubella and parotitis. Three of these had earlier had an FC.