Child Health - Science topic

INTRODUCTION

Childhood cancer has been increasing in

Scotland. A published report estimates that

its incidence has risen from an age standardised rate of 120 cases per million population in the time period 1983–1987 to 161

cases per million in the period 2003–2007.1

The reason for this increasing trend remains

unexplained as the aetiopathogenesis of

childhood cancer is poorly understood. As

most of the children present with cancer in

the first few years of life, epidemiologists

hypothesise that prenatal and perinatal exposures may have a part to play in its pathogenesis. The evidence surrounding this is,

however, conflicting. While some researchers

have found associations of younger maternal

age at delivery2 maternal anaemia,3 4 history

of miscarriage,256 maternal overweight7 and

smoking8 with some childhood cancers,

others have found no such associations.9–11

Fetal growth is perhaps the most investigated

perinatal risk factor for childhood

cancer7 12 13; but the authors report conflicting results. While specific central nervous

system tumours have been found to be associated with intrauterine growth restriction

(IUGR), the overall risk was small.12

Therefore, apart from the associations with

Down’s syndrome and in utero exposure to

radiation, research into the maternal and

perinatal risk factors has remained inconsistent, the results limited by small sample sizes

and recall or reporting bias.

Our objective was, therefore, to investigate

the maternal and perinatal risk factors for

childhood cancer, specifically to examine the

effects of IUGR, preterm birth and birth

asphyxia on the development of childhoodcancer in the offspring, taking advantage of the opportunities offered by record linkage of a cancer registry

with a local birth register.

odel.

Conclusions: Younger maternal age, maternal

smoking, delivery by caesarean section and low Apgar

score at 5 min were independently associated with

increased risk of childhood cancer. These general

findings should be interpreted with caution as this

study did not have the power to detect any association

with individual diagnostic categories of childhood

cancer.

Hi,

There are a few references on this topic:

The scale is given in the article.

Hi Indresh Kumar

I suggest checking the following book chapter. You may find them helpful.

Good luck!

Hello Muhammad Maaz Arif

I know of Journal of Paediatrics and Child Health. It generates PMID for its articles and has not got any charges the last time I tried to publish with them about two years ago.

The length of time for review, as Miriam Erick suggests, depends on availability of appropriate reviewer(s). I guess I must have been lucky because it was quite fast for me.

Good water quality reduces incidences of water borne diseases. The money that would have been used to treat diseases can be used for other economic purposes.

So far, there is none. However, probiotics action are mostly strain and pathogen specific

Think so dear Solaiman Elsheikh

The growing bodies of children absorb more lead. At high levels of exposure, lead attacks the brain and central nervous system to cause coma, convulsions and even death. Children who survive severe lead poisoning may be left with mental retardation and behavioural disorders.

https://www.who.int/news-room/fact-sheets/detail/lead-poisoning-and-health

I a gree with Dr Mohamed

It may be helpful to create these questionnaires and their interpretation? I have the technology in full open access for free. Since you will develop them yourself, you will be able to adapt and localize them when you need to, as well as use them in adaptive mode. http://lc.kubagro.ru/

Obedience and politeness to all

Please take a look at the following RG links.

For me the most important influence - reduced physical activity.

Dear Heather Soistmann,

I have used The PedsQL™ Multidimensional Fatigue Scale (version self and proxy) in my Ph.D Thesis in Brazil, entitle: "Neuroimmunoendocrine trajectories and the response to stress and fatigue in pediatric cancer patients under chemotherapy submitted to clown intervention". I agree with Bomfim, with regarding the use of two versions of this instrument in order to obtained more data as well as more accuracy in your results.

Please, check out one of our recent open access publication in the journal "Integrative Cancer Therapies":

Regards,

Lopes-Júnior

I use it everyday in my daily practice and it helps a lot to monitor my babies asymmetries.

of course it does not allow a volume assesment but it gives us a great idea of what is going on.

Thank you.

There are plenty of literature available in online sources. I'm just naming some; 

Hi Daniele, 

I understand the PEDro summary differently: "Blind subjects: No; Blind therapists: No" - so neither the study subjects nor the therapists/providers were considered to be blinded. 

Best, 

Helena

Thanks for the Information Hassan

Thank you both for your replies.

There is also an example in the Centre for Children with Autism in Athens, by SynThesis architects and the use of light to minimise the disruption of the melatonin mehechanism at children with Autism. There is a paper from a Cambridge conference but unfortunately most of the material was in the ppt presentation. However, I could sent you more details and pictures if you are interested.

Also a leading example of natural light is the case of Evelyna in London (which is very interesting as lately has negative press for sustainability). But from therapeutic perspective, it has an amazing ambience. You have also to look at the work of Catherine Zeliotis (former Avanti Architects now stantec) for cancer centres for children. 

Let me know if you need something. Filia sti Fani, apo Lia!

You have to view this against the background of the times.  I am 75 years old and have had (still having) a productive professional career.  I was an obese child and I could write a book about it!

There was no meaningful health education then.  Sweet rationing had just ended so my waistline swelled and my teeth rotted.  I was one of two 'fatties' in my peer group and we were known as 'Tweedledum & Tweedledee'  It was only the onset of puberty and a poor self-image that prompted me to put myself in order.  I crash dieted and had my buck teeth extracted (they were too far gone for orthodontics) but I carried an obese and generally poor self-image for almost my whole life even though I am actually slim, healthier and more active than many of my age.  Being happily married has contributed enormously, of course.

I was completely useless at sporting activities but I have a good scientific mind and I hid behind that 'geeky' image to a large extent.  I was in my twenties when I discovered potholing and I am to this day Hon. President of the Westminster Spelaeological Group.  Activities such as long-distance hiking, caving, climbing etc. are cooperative and not competitive and those who participate generally have a similar mindset to my own.

I can only point towards todays obvious differences.  My genetic family are all tending towards obesity however my wife's (2nd marriage) are not at all.  so yes, nature and nurture both play an equal part.

But one thing I will say most emphatically.  "Don't let your children become obese.!" As a parent it is one of your highest duties to see that they live a healthy physically active life and develop the vital life-skills to achieve it

These are just general comments and might be useful. 

1. Importance of Maternal Health and how its link with child health?

Ans: WHO, UN and INGO's has numerous documents on this. Very easy to find. It has latest updates and critical reviews. 

2. Maternal Health in developed and developing countries.

Ans: World bank data can be used for comparative analysis among developed and developing countries (P.S. this terminology is being replaced with low-income, middle income economic countries). 

3. Spatial Distribution of Maternal Health in slums, international slums and Pakistan slums.

Ans: In my opinion, it would be difficult to map distribution in slums (esp in case of Pakistan) where you don't have boundaries and cannot have a visual representation. Secondary Data would be (if available) for whole of slums. When collecting primary data, even with GPS locations you can't generalize for whole neighborhood because of unplanned settlements and variable densities. 

4. what research gap do we see in Pakistan for the above points.

Ans: Download MICS survey data to know about current women health and child care. Also see old reports for analyzing improvement (or deterioration) in health sector in Punjab Province. Identify sector on which needs improvement based on this data. Assess health policy success and failures, and reasons and potential for further improvement. 

Best of luck for you research. 

Hello Adam,

Have you moved forward with your study?  I am interested to hear more if you have.

Dear Vankar

please check pdf  it helps you

 Thankyou.

We are not using any such devices. But will be happy to know about.

Dear Ella,

These resources may interest you:

I would assume the 50th percentile as a good average - it may do. And as I understand, you have no other data to rely on - so it seems the only possibility

Among the physical determinants do not forget the sound environment of children in the school, at home and in the community, where the child lives

doi:10.1016/S0140-6736(05)66660-3

doi: 10.1093/aje/kwj001

doi:10.1136/oem.59.6.380

doi: 10.1177/0013916503256260

doi:10.1016/j.envres.2015.08.003

doi:10.1016/j.envint.2011.03.017

doi:10.1136/oem.2006.026831

as per national sleep foundation it is about

"School age children (6-13): Sleep range widened by one hour to 9-11 hours (previously it was 10-11)"

see this web page

We have a limited clinical experience of use of HFOV in NICU. There were no obvious additional benefits over conventional modes. 

Thank you Anthony G Gordon. Just you have given a clear answer for my question and i will disaggregate the concept respective of the data.

Sonia Lorente, pediatric nurse and psychologist.

Here is a scale for children anxiety...It is not exactly stress, but related to. The scale is

The State Anxiety Inventory for Children (SAIC).  Is a self-report questionnaire designed to measure anxiety in children. It consists of 20 items which ask children how they feel at the time, and is intended to measure transitory anxiety that varies in intensity and changes over time. This measure of anxiety was used only with the 8- to ll-year-old

children. The psychometric characteristics are in:

Tiedeman, M. E. (1997). Anxiety responses of parents during and after the hospitalization of their 5- to 11-year-old children. Journal of Pediatric Nursing, 12(2), 110–119.

Sorry for the late reply. Thank you for your suggestion.

Thank you Brenda! I'll try

Thank you sir. I am happy, I have included most of what is suggested by you in my questionnaire.

Hi Lisandra, I agree with Ronald - young people's responses are biased by the way the questions is posed and  by any response format. You might want to look at the article David Mellor and I wrote on the use of Likert scales with children. cheers, Kate

look into this publication, please read both: reply and our original article.

have fun.

don't forget to vote our response. appreciated. thanks CF

I've attached a link to a general overview related to the extensive work done by Gary Evans and his colleagues. Other authors to check out on the relationship between household chaos and child outcomes are Coldwell et al (2006), Deater-Deckard (2005), and Hanscombe et al (2011). Regarding the effects of the home's location and noise as related to children's outcomes, there's work out of the UK by Stansfeld & Matheson (2003) on general noise, and Clark, Head & Stansfeld (2013) specific to schools near airports. Good luck with your work.

you could look at the recently published Global Nutrition Report. see: http://globalnutritionreport.org/files/2014/12/gnr14_cp_spain.pdf

The report does contain trend data.

The main observed adverse effects of probiotics were sepsis, fungemia and GI ischemia. Generally, critically ill patients in intensive care units, critically sick infants, postoperative and hospitalized patients and patients with immune-compromised complexity were the most at-risk populations. While the overwhelming existing evidence suggests that probiotics are safe, complete consideration of risk-benefit ratio before prescribing is recommended. (Didari T, Solki S, Mozaffari S, Nikfar S, Abdollahi M.A systematic review of the safety of probiotics.Expert Opin Drug Saf. 2014 Feb;13(2):227-39. ).

Crying stimulates milk production in mothers and milk contains chemical that promote sleep?

Dear Atta,

Please send your research details/proposal to my e-mail address: ebenezer2k2@gmail.com

Hi Llinos,

There is a systematic review by Rees et al (2013) on The views of young people in the UK about obesity, body size, shape and weight. 

I hope this helps.

Itodo.

You can use humanoid robots as a tool that can intact with children easily, it is like a human being and also can talk and also listen if it is programmed well. Now days a wide researches have been devoted to the use of this kind of robots to health care. One interesting topic is using humanoid ones in helping autistic kids. Some commercial robots have been used recently that look interesting for kids. Some scientific surveys have been done to show the research improvement and also achievements.

This depends on age, fitness and other factors, however I would suggest two key considerations that are not methodological: affinity (how much the kid enjoys the activity) and relationship (how much they enjoy being with the person guiding them). As with affinity, they are more likely to build capacity towards something they want to do (e.g. kick a ball) rather than just for its own sake.

Yes why not malaria parasites attack white blood cells and at schizont stage the induce paroxysms of fever that takes away a lot of energy which physiologically is interpreted by use of a lot mitochondria. Please read my publication with Anoka entitled The Analgesic Antiplasmodial Activity and Toxicology of Vernonia species  in Journal of medicinal food

Dear Beatrice

In particular, the publication of Heubeck and Alfons et al. will be helpful for me. The others are known to me.

Greetings Egon

1. We should create awareness and importance of the vaccine in community through mass media,FGDS and there must be clear messages that how they can prevent their child to get sick from many diseases which can impact the   child growth, school performance along with financial burden on the family.

2.There should provision of vaccines to the nearest health facility, for extreme remote areas we should develop a team who can give the vaccines at household level for those  who are unable to reach the facility.

Dear Bibian

Thanks for the reference, I will check it out.

Best wishes

Llinos

I am very glad to hear all these different perspectives on the subject. It is a very useful input. I will try to reply to as many of the newly emerged questions as possible. The past 10 years there is a growing evidence that children in the autistic spectrum are facing problems with their eating http://journals.lww.com/topicsinclinicalnutrition/Abstract/2010/01000/Eating_Problems_in_Children_With_Autism_Spectrum.6.aspx

Therefore, the reason for this question is, that since we know that there are some difficulties in children of the spectrum, it would be nice to know how back these problems go.

Regarding the breastfeeding, what we would expect is infants later diagnosed with an autism spectrum condition (ASC) to either have a very brief period of breastfeeding, or being very difficult to be breastfed as a result of any sensory sensitivity to touch around the face area (as Anthony G Gordon similarly mentioned).

Although there is some literature relating the lack of breast feeding with a higher frequency of health problems or even with a later ASC diagnosis, we do not have enough evidence regarding their feeding behaviour during infancy in terms of feeding. And that was the main focus of my question.

I agree with Jennifer Jill Hocking, breastfeeding is difficult to be measured because there are so many factors involved into this. Having said that, there is a controversy in research on whether children with ASC face more problems in terms of eating early in life. One of the factors affecting breastfeeding the oral development of the infant. For example whether they have an effective. As for example this study http://europepmc.org/abstract/MED/12026389 , suggests that 80% present of the children with ASC presented with sucking problems when they were infants. Also there was statistical significant association between 78% of the children with ASC having sucking problems and insistence in routines later in life.

However, in another longitudinal study http://pediatrics.aappublications.org/content/126/2/e337.short

the research team started testing infants from the age of 6 months and found that between infants later diagnosed with an ASC and the controls there were found “no apparent differences between the two groups in terms of the maternal diet during pregnancy, breastfeeding rates, or infant food variety score at 6 months. Differences in the variety of diet and the eating behaviour is noticed only after 15 months old”.

My point is, that if there is a problem with the sucking rate according the first study then they will be having early withdraw from breastfeeding, or they might be very slowly fed. However, in one of our studies (not a longitudinal study), we found that it is only after the completion of the first year of life that children with ASC present with significant differences in terms of eating behaviour in comparison to their controls.

Finally, I have found no information regarding whether the ASC infants might be able to use crying effectively in order to communicate feelings of hunger or discomfort. I am also wondering if they have developed any skills on letting the carer know when they are still hungry or whether they had enough food, might be present during infancy in this population. I am wondering if anyone have more information regarding these.

Estimate Dr. José Garcia-Erce, I used the same traetment with sucrosa and carboximaltosa, 7 years ago, is excelent. With precaución ( infusion velocity) Dr. Khurshdil will can realize the research.

In 14 papers between 2002 and  2013

CECA-Q is used. Here are some examples:

 

Adverse childhood experiences and their impact on frequency, severity, and the individual function of nonsuicidal self-injury in youth.        Kaess, Michael; Parzer, Peter; Mattern, Margarete; Plener, Paul L.; Bifulco, Antonia; et al. Psychiatry Research206.2-3 (Apr 30, 2013): 265-272.

 

Is there a link between childhood trauma, cognition, and amygdala and hippocampus volume in first-episode psychosis?      Aas, Monica; Navari, Serena; Gibbs, Ayana; Mondelli, Valeria; Fisher, Helen L.; et al. Schizophrenia Research137.1-3 (May 2012): 73-79

 

Adverse childhood experiences (ACEs), genetic polymorphisms and neurochemical correlates in experimentation with psychotropic drugs among adolescents.    Somaini, L.; Donnini, C.; Manfredini, M.; Raggi, M. A.; Saracino, M. A.; et al. Neuroscience and Biobehavioral Reviews35.8 (Aug 2011): 1771-1778.

 

Effect of childhood psychological abuse on the personality of undergraduates with alexithymia.           Jia, Yuan-yuan; Du, Ai-ling; Yao, Gui-ying; Yang, Shi-chang. Chinese Journal of Clinical Psychology20.4 (Aug 2012): 518-519

 

Childhood Experience of Care and Abuse questionnaire (CECA.Q): Validation of a screening instrument for childhood adversity in clinical populations.             Smith, N.; Lam, D.; Bifulco, A.; Checkley, S.. Social Psychiatry and Psychiatric Epidemiology37.12 (Dec 2002): 572-579

 

Best regards Béatrice

Daer Beatrice

Thank you for your contributions. The publication of Rubin A. (2012) will be of interest.

Greetings

Egon

Dr Mamuda

I’ve known about some very interesting experiences with sustainable sanitation in Haiti, after the 2010 earthquake. (see SuSan Lessons Learned, v11, 12.08.2012 - AK & TF.docx)

In countries with low sanitation coverage, the improvement of sanitation coverage the prodution of biogas for cooking and lighting purposes are welcome. Even sometimes in addition to this lack of access to toilets, urban centres have dilapidated rainwater drainage systems which often flood and spread waterborne diseases, including cholera. With this figure, my answer is yes this could be the future for developing countries.

Not that Wikipedia is a peer-reviewed publication, but I recognized the name Paul Cameron. This is copied from the site (please note Cameron was expelled from the APA regarding an ethics inquiry):

[from Wikipedia] "Paul Drummond Cameron (born November 9, 1939) is an American psychologist and sex researcher. While employed at various institutions including the University of Nebraska he conducted research on passive smoking, but he is best known today for his claims about homosexuality. After a successful 1982 campaign against a gay rights proposal in Lincoln, Nebraska, he established the Institute for the Scientific Investigation of Sexuality (ISIS), now known as the Family Research Institute (FRI). As FRI's chairman, Cameron has written papers associating homosexuality with perpetration of child sexual abuse and reduced life expectancy.

In 1983, the American Psychological Association expelled Cameron for non-cooperation with an ethics investigation. Position statements issued by the American Sociological Association, Canadian Psychological Association and the Nebraska Psychological Association have accused Cameron of misrepresenting social science research."

No, I don't use metoclopramide in chikldren. In fact, in Spain is a contraindicated drug in infants under 12 monts and it's recommended avoit it until adult age..

In the cases we need to give an antiemetic (vomiting postchemotherapy or in some gastroenteritis with much vomiting), we use ondansetron.

I'm a pediatrician.

There is no $M question in pre or post op H Enterocolitis. It is commonly encountered if u work in any major regional centre with high HD turnover. Patients should be treated for their sepsis ASAP ideally with amoxicillin metronidazole gentamycin, initially and ivi fluids NBM and plain radiography to estimate bowel dilatation and rule out perforation (simple things). Even on suspicion only until proven otherwise! Antbx could be readjusted or chosen according to local guidelines and clinical microbiology advice.

Any further work up is tailored to individual circumstances. One should be extremely cautious on how they treat further the child.

Out with and after the acute phase kids at high risk could be offered vancomycin prophylaxis orally which reduces the bug load in the bowel as it is not absorbed into the systemic circulation and remains in the bowel environment. This would reduce the chance of further recurrence. This cannot be done as long as the child remains NBM.

Thank you, Mary. I will check these sources later today. Do you know if you need to use the entire profile or if you can use parts and still maintain the validity/reliability of the measure?

Hello,

As you probably noticed, there are a great deal of articles that, given your question was phrased fairly loosely, are out there and may help you. But the best reference you received so far IMO is the one about gene expression. Overall, its been a difficult and uphill climb to see empirical, sound studies done by psychologists either trained in biology, genetics, etc. in addition to psych; or are part of a team of interdisciplinary scientists. Essentially questions similar to yours, that involve trajectories, resilience, developmental factors, interventions--typically found in dev. psych--have to be given up in order for psychology as a field to ever come close to knowing under what conditions individuals act, think, feel...develop, in short; and how is that development probably going to go? What will be the probable outcome, and what are our limits, whether we are diagnosing, treating or predicting? We seem, as a sub discipline, to be VERY attached to applying this type of question to almost every aspect of human development, always on the border of nature/nurture.

At this point, developmental epigenesis (the psychology phrase or view of epigenetics) is at the stage to warrant real attention and effort when discussing development, outcomes, etc. We as (possible) scientists need to be trained differently, and if that began tomorrow, it wouldn't be soon enough, so that we could begin to ask the questions in a manner that reflected the importance of gene expression in attempting to find answers, to get close to the truth. Most of us cannot honestly read and understand a genetics article on the topic, most of us are not trained in both areas (but I have heard numerous Ph.D.'s claim an interdisciplinary background because of one graduate biology course....out of 103 credits). Epigenetics is so new, and from the hard sciences, findings are being produced at an astounding rate (some scrutiny would be nice give the rate of growth and publication), and in psychology, I have begun to see some articles that reference epigenetics, incorporate it at will, or use it as a possible mediator/moderater. Very few of the authors are well trained enough to understand the basic results, the implications, the methodology, and what are the important, future questions. As a field, to accept human development has a biological component, a genetic component, in addition to a psychological (and I would add, a more universal, human component as the Sufi mystics describe) component. It is my opinion that given our very real deficit in methodology, esp., it seems too hard, too complicated to alter the basic structure of our approach. Truly even the articles that have made attempts (with a few exceptions, Gottlieb and Lickliter being two of them; but both men were very well trained with strong interdisciplinary backgrounds as well as having developed and used teams, then consortiums of fellow scientists. Their work is primarily at the stage of "look, we do have evidence but as a field we'll need to do X in order to take this any further ACCURATELY), have made them in ignorance of language, methods, purpose, and current state of epigenetics.

Unfortunately your question, esp. the second one where you introduced an additional level/factor, is based on this outdated structure, assuming you accept humans as beings that function based on multiple processes and inputs, from neuro, to repression, gene switches, the role of the environment and how even that is highly individual as conditioning is tied tightly to the CNS and variability in how a person is conditioned is well established, to biology, everything (ok, yes, everything as in everything different fields have 'discovered' over decades and named; a name, like "resilience" is the

ticket into garnering attention, but we shouldn't forget the name isn't the thing, and there are many more things yet to be uncovered and named, but they exist). So at this point, if you or your colleagues are unable to begin to explore the effects of gene expression and how switches can be 'environmental' OR 'from within the body', and accept even genetics can't offer any definitive material to answer a question about prediction (in fact, it appears that as much work as they are producing, it is mostly directed towards the detection, understanding and possible prevention of genetic disorders. It is going to be up to psychologists to educate themselves to the point they can consider developmental epigenesis when looking at child to adult trajectories.

"Anthony. What is a genetic predisposition to ADHD?"

From Wikipedia:

"Twin studies indicate that the disorder is often inherited from one's parents with genetics determining about 75% of cases.[14][55][56] Siblings of children with ADHD are three to four times more likely to develop the disorder than siblings of children without the disorder.[57] Genetic factors are also believed to be involved in determining whether or not ADHD persists into adulthood.[58]. Typically a number of genes are involved.."

Incidentally, it is no kindness to deny a genetic component to ADHD, as otherwise the kids are punished for disobedience by teachers, and as if it were not bad enough having to deal with an uncontrollable child, the parents are then blamed for causing the condition.

"children born of Chinese parents and adopted at birth by American foster parents show no genetic predisposition to speak Chinese"

No, but they have higher mean IQ than non-Chinese adopted in the USA.

"There has never been any conclusive evidence that behaviour is genetically determined"

What, theoretically, would you regard as conclusive evidence?

"ADHD was not established by discoveries at a cellular, genetic or molecular level"

Neither were cancer, diabetes, cholera, polio, smallpox, epilepsy, Huntington's chorea, etc, etc.

In the U.S.A.: Child-Parent Psychotherapy which is within a psychodynamic framework is a manualized, evidence-based treatment for multi-problem families with violence exposure (see Lieberman AF et al.,. 2005). The David Olds homevisiting model was also designed for high-risk teen moms and infants.

Poetically, "a rose by any other name or label would smell the same." When I was growing up there were a few kids that were overweight. None in my public school were obese. I cannot recall one classmate or for that matter anyone I heard of or saw that was autistic. Why, temporally speaking, would that be? Kids then were more active. We walked to school or rode our bikes. (Like the Dutch where it is uncommon to see obesity). Our food tasted like food; it was healthier; fruit and vegetables were not picked before they were ripe and had nutrient value. Tomatoes tasted like tomatoes. Fish was not farm fed, nor beef grain fed. (In many parts of the world where food has not become "lifeless", obesity is uncommon." Perhaps, just a thought, obesity and overweight are the body's response to not getting the nutritional value that is needed i.e., a compensatory mechanism like up-regulation of receptors in the setting of a deficiency (soluble transferring receptor ↑ in the setting of iron deficiency".

Now add in the propensity to feed many families with the high carb composition of fast foods. Toss in television and the contribution of sitting on one's duff and stuffing our mouths while watching high anxiety episodes of serial killers, etc. Think about the brain-washing of our society's media where everything is oriented towards buy this, eat that, drive this i.e., it's all about getting, taking in, possessing. We now live in a world where TV shows about diners, drive-ins, cooking high caloric meals flourish. We even have TV shows that highlight obese characters. News programs interview one obese person after another. America, the land of the free and the home of the brave has become the land of entitlements, what's in it for me, and a meal of burgers, fries, and soft drink for only $5.

So what do you think? Labeling obesity as a disease will change anything? Perhaps when healthcare premiums are dramatically less with ideal weight, BMI or waist circumference that will change. Perhaps when are city planners make every third street a bicycle only or a shared bicycle-pedestrian street that will change. Perhaps when we move water from areas that flood every year and create a new great lakes system in the SouthWest and grow organic crops, and mandate grass-fed beef that will change; and when citizens demand less brutality and violence-oriented TV (note second-hand stress now in the news) that will change.

The chances of the above happening are next to nothing. Sadly, our American society and elsewhere are "emulating" the decadence that characterized the fall of the Roman empire. But who knows, the story is not over until the "fat lady sings."

Essential book for you to read is An Epidemic Of Absence by Moishe Velasques-Manoff. It will open your eyes

The natural history of the prepuce is one thing we do know about, thanks to a number of (much cited) papers. The one most often used is Gairdner's 1949 paper - the fate of the foreskin. He used a probe to separate adhesions around the age of three - thus his figures are not a true reflection of the natural history. This is perhaps where the expectation of a fully retractable foreskin at age 3 comes from.

The studies below show gradual and variable figures. We must also remember that full retractability is a function of two things - a preputial opening large enough for the glans, and a lack of glanular adhesions to the inner prepuce. Thorvaldsen has a mean age of 10.4 years, Oster's cohort had a 48% chance of some preputial adhesions at this age.

Perhaps more accurate are the figures of authors such as Oster (1969 - Danish schoolboys), Thorvaldsen (2005 - Danish again, this article in Danish), Ko (2007 - Taiwanese boys), Kayaba (1996 - Japanese boys), Agarwal (2005 - Indian boys), and Morales Concepcion (2002 Spanish article).

The simple answer is to perform a linear regression analysis. This is very easy to do in SPSS through the drop down menus - click "analyse", "regression", "linear", or something like that. Set BMI as your outcome / dependent variable, and the other variables as your predictors/independent variables. But how many variables you put in the model, and whether you can fit interaction terms, depends on your sample size. A rough rule of thumb is 10 observations per parameter in your model. With regards to interactions, I don´t believe in fitting interactions unless you have a large enough dataset and you have a theoretical reason for believing in the interaction. Otherwise it´s just data mining and your model will give imprecise results if your dataset is too small. Also, be careful that you don´t put variables into the model that are very strongly correlated with each other.

You will have to obtain a measurement of how much an individual is inbred (for example, by genetic markers or by reliable lineage or marriage data several generations backwards) and then mesaure the outcomes of interest (for example, IQ) in each individual. With these measures you could conduct simple regression analysis to see whether (and how much) inbreeding is associated with IQ. I would, however, make sure to look for curvelinear associations, because strong outbreeding could, at least, teoretically have negative effects as well.

Our paper "Could nursery rhymes cause violent behaviour? A comparison with television viewing" takes a slightly humorous angle at this question. Although there is likely to be a causal association, i would caution against the temptation to blame such a complex societal problem on to a single item. Why are those children being allowed to watch such violent television? Which is the cause then of the violent behaviour? Is this more a marker of poor boundary setting and the level of parental norms?

1) You should at first be sure about your interest/research question. Very often, the main interest isn't actually directed to coping but rather to its counterpart, defense and problems (emotional, behavioral) occuring as a consequence of being challenged by major stressors/chronic disease. If so, these should be assessed directly.

2) If you are really interested in coping, you should better use different instruments since the age range that you outlined is difficult (lower age group definitely ill-equipped with an adult version of coping instruments, upper age group definitely ill-equipped with a pediatric scale),

3) Apart from scales, mind some of the major traps and difficulties related to coping and its aqssessment: http://userpage.fu-berlin.de/~health/materials/s_knoll_coping.pdf

Catherine has made a valid point. Before venturing to a biostatistician for help I would suggest the following.

1) Decide on the timeframe of your study- how many months/ years?

2) Any cost factors involved?, any incentives offered to the study participants?- what is the amount you are willing to bear out of your own pocket in case the study is not funded.

3) How much time can you realistically afford to spend on the study?

4) What is the purpose of your study?, do you have an assumption in mind? Do you think your study can throw significant light on the problem?

5) What is the protocol going to be?- have a flowchart ready

6) How many patients with nephrotic syndrome do you hope to encounter?

7) Realistically - how many nephrotic syndrome cases come to the hospital in which you are doing your study?

8) Is any follow up required? Are you planning any interventional behaviour therapy?

9) The sample size depends partly on the end goal, prevalence of NS in your area/ no. of cases frequenting your hospital. Usually the more common the condition- the greater the sample size required for validating your findings.

10) If it is just going to be a questionnaire based - cross sectional study- then the work might actually be easier rather than a prospective intervention based study- so you do have to be careful there. An intervention based study with follow up will always have more value than a simple cross sectional study.

The Eurofit Physical Fitness Test Battery.

Yes, it is feasible at acute onset of seizure without available intravenous line.

Hey Edward, what in the gamut of "childhood obesity" are you looking at? The variables would differ based on your primary end point - like is it prevalence, or prevention/intervention or looking at cause and effect of parent lifestyle patterns or behaviour or child behaviour on their present weight status or predicting future disease conditions..so it depends on many things. And very importantly what is the age group you plan to study?

Sir,

If you own a smart phone , the options are plenty; be it an Android device or an I phone. In android devices there are plenty of calculators available in the Play Store. Qx calculate is a very handy application with a wide array of equations from all medical topics. Medscape with its exhaustive resources also contain many of these equations.

Thank you Dr Saad for the insightful response

I have already given my views.I agree with the explanation given by Khaled Saad