A national prospective study on childhood celiac disease in the Netherlands 1993-2000: an increasing recognition and a changing clinical picture.

OBJECTIVES: To investigate prospectively whether the incidence of diagnosed celiac disease (CD) is increasing in the Netherlands and whether the clinical presentation is changing. STUDY DESIGN: All newly diagnosed cases of CD throughout the Netherlands were registered prospectively from 1993 to 2000. The clinical picture was compared with that noted in our former study (1975-1990). RESULTS: The overall incidence rate of CD was 0.81/1000 live births, with a linear increase from 1993 to 2000. There was a significant increase in the number of subjects with partial villous atrophy of the small bowel mucosa. The clinical presentation has changed significantly: abdominal distention, chronic diarrhea, and failure to thrive are less common, and more children presented with weight < P10, abdominal pain, and lassitude. The median age at diagnosis also increased. CONCLUSION: The recognition of childhood CD in the Netherlands has increased significantly during the last few years, and the clinical picture has changed as well. Our data may indicate an increasing awareness of the Dutch doctors working in Child Public Health, general practitioners, and pediatricians to recognize more subtle expressions of the disease.

The weight of schoolbags and the occurrence of neck, shoulder, and back pain in young adolescents.

STUDY DESIGN: A cross-sectional study of 745 young adolescents in the area of two Regional Health Centers in the Netherlands. OBJECTIVES: To assess the occurrence of neck and/or shoulder and back complaints in young adolescents and examine relationships with type and weight of schoolbags and other physical and psychologic risk factors. SUMMARY OF BACKGROUND DATA: The occurrence of back pain in children and adolescents varies from 8% to 74% in the literature. Age, gender, and certain psychological factors appear to be important risk factors. An association with heavy schoolbags has been presumed but without clear scientific evidence. METHODS: A questionnaire was used, asking about complaints of back, neck, and/or shoulders and about potential risk factors including psychosomatic factors. Length and weight of the children were determined. Schoolbags were weighed, and the relative weight of the schoolbag was calculated. RESULTS: Neck and/or shoulder complaints and also back complaints were reported by about 45% of young adolescents. Severe complaints of neck and/or shoulder were reported by 6%, and severe back complaints by 7% of the schoolchildren. The (relative) weight of schoolbags was not related to complaints of neck and/or shoulder and back. Psychosomatic factors showed the strongest association with the occurrence of neck and/or shoulder and back complaints. CONCLUSION: Psychosomatic factors appear to be more strongly related to the occurrence of neck and/or shoulder and back complaints than the type and weight of the schoolbag and other physical factors. The role of psychosomatic factors should be further explored in future longitudinal research.