The influence of ICT on the activity patterns of children with physical disabilities outside school.

AIM: To investigate the outside school activity patterns of children with physical disabilities, and specifically their information and communication technology (ICT) usage compared with that of non-disabled children. In addition, the aim was to investigate the children's opinions on computer use and the associations between their use of the Internet and their interaction with peers. METHODS: Questionnaire on activities outside school, answered by 215 children and youths with physical disabilities, mean age 12 years 10 months, attending mainstream schools. For group comparisons with non-disabled children, data from the survey 'Kids and Media' were used. RESULTS: In the analysis, two sets of activity patterns were identified, depending on whether the child was disabled or not and on the gender of the child. A higher proportion of children with physical disabilities were engaged in ICT activities, while non-disabled children tended to be engaged in a broader range of activities outside school. The activity pattern was more uniform for boys and girls with disabilities than for their non-disabled peers. Use of the Internet was positively associated with peer interaction. CONCLUSION: Outside school, the activity patterns of children and youths with physical disabilities seem to be characterized by a focus on ICT activities, which enable children to compensate for their impairment because it suits all. In addition, digital skills developed outside school engage children with physical disabilities, giving them increased access to society and for educational purposes.

Routine ultrasound screening in pregnancy and the children's subsequent neurologic development.

OBJECTIVE: To test the null hypothesis of no association between ultrasound exposure in early fetal life and impaired neurologic development in childhood. METHODS: Study of children age 8-9 years whose mothers participated in a randomized controlled trial of ultrasound screening during pregnancy in Sweden during 1985-1987. Of 4637 eligible singletons, 3265 (70%) were studied through a questionnaire to their mothers. Assessment of neurologic development was based on parents' report of their child's speech and motor development. Behavioral disorders were assessed by a ten-item parent scale. Analyses were performed according to both assignment and ultrasound exposure. With a sample size of 1600 children in each group, a two-sided alpha of .05 and beta of .10, a risk ratio of less than 1.4 for the studied variables could not be detected. RESULTS: Delayed speech development was reported by 2.9% in the screening group compared with 2.4% in the nonscreening group (odds ratio [OR] 1.21; 95% confidence interval [CI] 0.79, 1.88). Similar prevalences were found when analysis was according to ultrasound exposure (OR 1.19, 95% CI 0.78, 1.83). Delayed motor development was reported by 7.6% in the screening group compared with 7.2% in the nonscreening group (OR 1.05; 95% CI 0.81, 1.37). Corresponding figures for ultrasound-exposed and -unexposed were 7.7% and 7.2%, respectively (OR 1.08; 95% CI 0.83, 1.40). There also were no significant differences in behavioral disorders between screened and unscreened children or between exposed and unexposed children, respectively, according to parents' ratings. CONCLUSION: No significant difference in impaired neurologic development between ultrasound-exposed and -unexposed children was found in this study.

Morbidity during the first year of life in small for gestational age infants.

Postneonatal morbidity during infancy was studied in 284 small for gestational age (SGA) and 359 non-SGA term infants. None of these babies had congenital malformations and they were born to para 1 and para 2 mothers. SGA infants had an increased risk (OR: 1.7, 95% confidence interval: 1.1-2.6) of being admitted to hospital compared with non-SGA infants. The principal cause was respiratory tract infections. Increased hospitalisation among SGA infants was a factor only if the mother was a smoker-that is, smoked cigarettes at the time of conception. Among subgroups of SGA babies, there was an increased risk for infants of non-repeaters (women without a previous SGA child) (OR: 2.4, 95% CI: 1.4-3.8) and for infants with symmetric (OR: 2.0, 95% CI: 1.2-3.3) body proportions compared with non-SGA infants. The results suggest that, beginning in early pregnancy, growth retardation may have long term consequences for subsequent infant morbidity, particularly if the mother is smoker.

Friedreich's ataxia in 13 children: presentation and evolution with neurophysiologic, electrocardiographic, and echocardiographic features.

Thirteen children with Friedreich's ataxia were reviewed. The clinical presentation and evolution of the disease was compared to that observed in large series--based mainly on adult patients--and the few studies in children. The mean age of onset (5.3 +/- 2.7 years) was lower than that reported in the former studies. Progressive unremitting ataxia of all four limbs was the earliest and most consistent finding, whereas dysarthria and loss of joint or vibration sense occurred with less frequency than that reported in adult series. The tendon jerks were absent or reduced in the lower limbs in almost all children. The universal absence of lower limb reflexes was shown to be too rigid to be obligatory for the diagnosis of early cases of Friedreich's ataxia. Electrophysiologic investigations revealed typical findings, ie, normal or low-normal motor conduction velocities and absent sensory responses. Electromyography showed more features of denervation in the lower limbs than in the upper limbs. Cardiac symptoms and signs were minimal, whereas electrocardiographic abnormalities occurred in 92% of patients, presenting mostly as significant T-wave changes. Concentric symmetric thickening of both the interventricular and left ventricular posterior walls was the major echocardiographic finding.

Follow-up study of muscle function in children of mothers with myasthenia gravis during pregnancy.

Most infants whose mothers have myasthenia gravis are healthy at birth, but 10% to 15% have a transient neonatal form of myasthenia gravis. In this study, the muscular function and neuromuscular transmission were examined in 31 children, aged 3 months to 31 years (median, 10 years), of 15 myasthenic mothers. Eleven of these children had had the neonatal form of myasthenia gravis. The children were examined clinically and with neurophysiologic methods. Blood samples were taken for HLA typing, creatine kinase levels, and myoglobin and acetylcholine receptor antibody studies. Twenty-nine of the 31 children had no signs of neuromuscular disease. Two children (who had had neonatal myasthenia gravis) had a moderate stationary myopathy, probably unrelated to the myasthenia gravis of their mother. Creatine kinase levels were normal for all subjects. Acetylcholine receptor antibody levels were similar to those of a control population. The HLA type B8 antigen was not significantly more prevalent in the children who had had neonatal myasthenia gravis than in the healthy children. Neonatal myasthenia gravis in a previous sibling was the only factor in the material that predicted the occurrence of myasthenic symptoms in the neonatal period.

Behavior in term, small for gestational age preschoolers.

AIMS: To evaluate whether being born small for gestational age (SGA) was associated with an increased frequency of preschool behavioral problems. STUDY DESIGN: Follow-up study at 5 years of age. SUBJECTS: A population based cohort of 318 term infants who were SGA, defined as having a birthweight less than the 15th percentile for gestational age, and without major handicap such as cerebral palsy or mental retardation, and a random control sample of 307 appropriate for gestational age (AGA) infants. OUTCOME MEASURES: The Personality Inventory for Children and the Yale Children's Inventory (completed by the mothers), and child behavior during psychometric testing. RESULTS: Behavior problems was not more common among the SGA children. The results were not confounded by a wide range of parental demographic and child rearing factors, including maternal non-verbal problem solving abilities, child rearing style, and maternal psychological distress. However, the parental factors explained 13% of the variance in a summary score of child behavior compared to 1% explained by SGA vs. AGA status. The SGA children were not more sensitive to the negative impacts of parental risk factors than AGA controls. The study does not address the outcome of severely growth-retarded SGA infants. CONCLUSION: Being born moderately SGA is not a significant risk factor for preschool behavior problems.

Hyperkalemic periodic paralysis caused by recurring mutation in the adult muscle sodium channel alpha-subunit gene.

Linkage studies and mutation analysis were performed in two Swedish families with hyperkalemic periodic paralysis (HYPP), an autosomal dominant inherited disorder characterized by episodic muscle weakness associated with increasing or high levels of serum potassium. The gene for HYPP is the gene encoding the alpha-subunit of the sodium channel of adult human skeletal muscle (SCN4A). SCN4A has been localized on chromosome 17 q closely linked to the human growth hormone gene. Linkage between a microsatellite polymorphism in the SCN4A gene and the disease was shown in two Swedish families (Z = 12.10 theta = 0). Sequence analysis revealed that the two Swedish families have got a C to T transition at position 2188 in the cDNA. At the protein level this Thr 704 to Met mutation is located in the fifth membrane spanning segment of domain II of the protein, as previously described (28). The mutation was linked to different microsatellite alleles regarding both a (GT)n and a (GA)n repeat in the gene. Either the families are related and new mutations have occurred in both microsatellites when the pedigrees were separated or the mutation has arisen independently in the two families analysed. From the mutant alleles characterized so far it seems as if a limited number of mutations is present in this gene.

Cord blood platelet aggregation; quality control by a two-sample technique.

Two blood samples were taken from the cords at 17 normal deliveries 2-4 min and 5-8 min after birth, respectively. The difference in platelet count between early and late samples in platelet-rich plasma was less than 5% in nine cords (Group A), and greater in eight cords (Group B). Platelet aggregation studies on the early and the late blood samples showed consistent results within each cord in Group A but not in Group B. The correlations between the responses were high for Group A. The aggregation responses were also slightly but significantly higher in the late samples in this group (p less than 0.01 in Group A; n.s. in Group B). The differences between responses in early and late blood samples could not be explained by acid-base dissimilarities. The variability in cord blood platelet aggregation results can be greatly reduced by platelet counting in PRP of two independent blood samples, accepting only samples with concordant platelet counts (less than 5% difference).

Induction of male puberty by long-term pulsatile subcutaneous LH-RH therapy.

Prolonged low dose LH-RH treatment was given to induce puberty in a 17.8-year-old male with hypogonadotrophic hypogonadism. The patient had developed panhypopituitarism after transcranial surgery of a craniopharyngioma at the age of 16.8 years. One year after the operation he had no signs of pubertal development and was of short stature. A small portable automatically-timed infusion pump, connected to a subcutaneous (s.c.) catheter, was used for the 328-day-long treatment, which was given in periods of between 16 to 185 days. Twenty micrograms of LH-RH s.c. was given every 90 min. Growth hormone therapy, 8 IU intramuscularly (i.m.) twice weekly, was instituted at the same time. During the prolonged LH-RH treatment the gonadotrophin secretion normalized. The serum concentration of testosterone increased to the normal range of adult males. Rapid pubertal progression occurred with development of pubic hair to adult type and increase in size of the penis. Testicular volume increased from 2 to 12 ml. Nocturnal emissions occurred after 30 weeks of pulsatile LH-RH treatment and sperms were found in the ejaculate after 43 weeks. The height of the patient increased from 162 to 176 cm. Thus, chronic pulsatile low dose LH-RH treatment can induce normal pituitary - gonadal function with pubertal maturation and spermatogenesis in primary male hypogonadotrophic hypogonadism.

Maternal child-rearing attitudes, IQ, and socioeconomic status as related to cognitive abilities of five-year-old children.

The effects of maternal child-rearing attitudes, as measured by the Child Rearing Practices Report, on 5-yr.-old children's Verbal IQ and Performance IQ were investigated in a Scandinavian sample of 108 boys and 126 girls. The maternal child-rearing attitude of Restrictiveness, as defined by scores on the Report, showed negative relations to the cognitive measures. However, the significant negative relation between Restrictiveness and Verbal IQ, obtained for both sexes, disappeared when the effects of maternal IQ and socioeconomic status were controlled. The maternal child-rearing attitude of Nurturance, as defined by scores on the Report, was significantly related to Verbal IQ and Performance IQ for boys only. Significant relationships between scores on Nurturance and cognitive abilities of boys remained when the effects of maternal IQ and socioeconomic status were controlled.

Arachidonic acid-induced aggregation of platelets from human cord blood compared with platelets from adults.

Using a double-sample technique, platelet aggregation induced by arachidonic acid (AA) was studied in cord blood samples from 29 newborns and 20 adults, all healthy and drug-free. Of the platelets from adults (10 males, 10 females), all aggregated after 1.0 mM AA. After 0.5 mM AA, all platelets aggregated except those from 4 males which did not respond at all. The great majority of cord blood samples aggregated similarly to samples from adults. Platelets from all 15 newborn females and 11 of 14 newborn males aggregated irreversibly after 1.0 mM AA, while those from 3 of the 14 male newborns showed a reversible aggregation. All 11 newborn samples aggregated irreversibly after 0.5 mM AA. These results prove that the cyclo-oxygenase pathway for platelet aggregation operates satisfactorily in newborn infants. The double-sample technique is of value for cord blood samples. Late cord blood samples showed more marked aggregation than samples taken earlier.

Arachidonic-acid-induced platelet aggregation is increased in male but not in female smokers.

Arachidonic-acid-induced platelet aggregation was studied in 40 healthy drug-free subjects aged 18-43 years. Aggregation was elicited by lower concentrations of arachidonic acid in smoking men (n = 10) than in non-smoking men (n = 10)(p less than 0.05). No significant difference was found between smoking and nonsmoking females. Adenosine-diphosphate-induced platelet aggregation was not increased in smokers. There was no difference between smokers and non-smokers with respect to mean platelet volume and count within each sex. Females and males differed regarding platelet count in whole blood and platelet sensitivity to arachidonic acid; both differences were secondary to the difference in hematocrit. The parallelism between an increased tendency to aggregation after arachidonic acid stimulation and an increased rate of myocardial infarction in male smokers, and the absence of both these phenomena in female smokers, might be of pathophysiological significance.

Maternal smoking reduces prostacyclin formation in human umbilical arteries. A study on strictly selected pregnancies.

Production of prostacyclin (PGI2)-like activity in umbilical arteries in vitro was evaluated in 38 selected newborn infants. Nineteen of the mothers of these infants were habitual smokers and the remaining 19 were non-smokers. To rule out the possibility of disturbing effects of drugs or other factors, the newborn infants and their mothers fulfilled strict criteria regarding normality and control of drug intake. The infants of habitual smokers (greater than 5 cigarettes/day) (n=19) were compared with a control group (n = 19) with non-smoking mothers. Smokers' babies had lower birth weights than the controls (3,500 +/- 440 vs 3,900 +/- 420 g, p less than 0.001). Production of PGI2-like activity was estimated by a bioassay technique. Umbilical arteries of smokers' infants produced significantly less PGI2-like activity (139 +/- 78 ng/g arterial tissue) than those of the controls (201 +/- 87 ng/g) (p less than 0.05). As expected, the two groups differed highly significantly regarding serum levels of markers for exposure to cigarette smoke, but these levels did not correlate to formation of PGI2. Decreased production of PGI2-like activity in umbilical vessels might have an impact on nutritive blood flow and oxygen transport, especially in situations of asphyxia.