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.

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.

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.

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.

What kind of thing is 'being clumsy'?

The term 'clumsy' is used both as a colloquial pejorative and as a specific diagnostic entity. The meaning of the word and the possible means by which a child may come to be regarded as clumsy are discussed. The implications for management are considered.

Transient acute myositis in childhood.

Eight cases of transient acute polymyalgia with weakness are described. All had abnormal serum creatine phosphokinase levels and most had minor haematological abnormalities at the time of diagnosis. Virological studies were performed with negative findings.