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Auxology has developed from mere describing child and adolescent growth into a vivid and interdisciplinary research area encompassing human biologists, physicians, social scientists, economists and biostatisticians. The meeting illustrated the diversity in auxology, with the various social, medical, biological and biostatistical aspects in studies on child growth and development.

Background: To assess the criterion and construct validity of the KIDSCREEN-10 well-being and health-related quality of life (HRQoL) score, a short version of the KIDSCREEN-52 and KIDSCREEN-27 instruments. Methods: The child self-report and parent report versions of the KIDSCREEN-10 were tested in a sample of 22,830 European children and adolescents aged 8-18 and their parents (n = 16,237). Correlation with the KIDSCREEN-52 and associations with other generic HRQoL measures, physical and mental health, and socioeconomic status were examined. Score differences by age, gender, and country were investigated. Results: Correlations between the 10-item KIDSCREEN score and KIDSCREEN-52 scales ranged from r = 0.24 to 0.72 (r = 0.27-0.72) for the self-report version (proxy-report version). Coefficients below r = 0.5 were observed for the KIDSCREEN-52 dimensions Financial Resources and Being Bullied only. Cronbach alpha was 0.82 (0.78), test-retest reliability was ICC = 0.70 (0.67) for the self- (proxy-)report version. Correlations between other children self-completed HRQoL questionnaires and KIDSCREEN-10 ranged from r = 0.43 to r = 0.63 for the KIDSCREEN children self-report and r = 0.22-0.40 for the KIDSCREEN parent proxy report. Known group differences in HRQoL between physically/mentally healthy and ill children were observed in the KIDSCREEN-10 self and proxy scores. Associations with self-reported psychosomatic complaints were r = -0.52 (-0.36) for the KIDSCREEN-10 self-report (proxy-report). Statistically significant differences in KIDSCREEN-10 self and proxy scores were found by socioeconomic status, age, and gender. Conclusions: Our results indicate that the KIDSCREEN-10 provides a valid measure of a general HRQoL factor in children and adolescents, but the instrument does not represent well most of the single dimensions of the original KIDSCREEN-52. Test-retest reliability was slightly below a priori defined thresholds. © 2010 The Author(s).

Background: Until recently, external cephalic version to prevent breech presentation at birth was not widely accepted. The objective of our study was to assess the prevalence, outcomes, and women's experiences of external cephalic version to improve the implementation of the procedure in the Netherlands. Methods: A prospective cohort study was conducted of 167 women under the care of a midwife with confirmed breech presentation at a gestational age of 33 completed weeks or more. Results: Between June 2007 and January 2008, 167 women with a confirmed breech presentation were offered an external cephalic version. Of this group, 123 women (73.7%, 95% CI: 65.5-80.5) subsequently received the version. These women had about a ninefold increased probability of a cephalic presentation at birth compared with women who did not undergo a version (relative risk [RR]: 8.8, 95% CI: 2.2-34.8). The chance of a vaginal birth after an external cephalic version was almost threefold (RR: 2.7, 95% CI: 1.5-5.0). The success rate was 39 percent, although considerable differences existed associated with region and parity. Ninety-four percent of women with a successful version rated it as a good experience compared with 71 percent of women who had a failed version (p = 0.015). Significant pain during the version was experienced by 34 percent of women, of whom 18 percent also experienced fear during the version, compared with no women who reported little or no pain (p = 0.006). Women who reported significant pain or fear during the version experienced the version more negatively (OR: 6.0, 95% CI: 3.3-12.2 and OR: 2.7, 95% CI: 1.1-6.0, respectively). Conclusions: One in every four women with a breech presentation in independent midwifery care did not receive an external cephalic version. Of the women who received a version one third experienced significant pain during the procedure. Considerable regional variation in success rate existed. © 2010, Wiley Periodicals, Inc.

Objective: To examine the association between use of health care services and health status, sociodemographic, and health care system characteristics in children and adolescents from 11 European countries. Research Design: Cross-sectional surveys in representative samples included using phone or school-based sampling. Subjects: Children and adolescents aged 8-18 years and their parents. Questionnaires were administered in households or at schools in Austria, Czech Republic, France, Germany, Greece, Hungary, Poland, Spain, Switzerland, the Netherlands, and the United Kingdom. Main Outcome Measures: Any visit to ("access") and number of visits ("intensity of use") to health care professionals during the previous 12 months. Results: The study included 16,210 parent-child pairs. In a multivariate analysis, variables statistically associated with access included the following: health status (more disability days, more chronic conditions), sociodemographic characteristics (being younger, being female, having a higher socioeconomic status, or higher parental educational level), and health system variables (higher percentage of public health expenditure, widespread private health care coverage, pediatrician-led system). The strongest association was with disability days [odds ratio (OR) = 6.92; 95% confidence interval (CI) = 5.24-9.14 for 5-15 days]. In the "intensity of use" model, sociodemographic (being younger, strong social support) and health status (chronic conditions, disability days, psychiatric disorders, psychosomatic complaints, poor health-related quality of life) characteristics were associated with greater intensity of use. Health system variables were not significant in this model. Conclusions: The likelihood of contacting the health services is a function of health status, socioeconomic factors, and health system characteristics. Intensity of use among those having made contact is associated with health status and sociodemographic characteristics but not with health system characteristics. Copyright © 2009 by Lippincott Williams & Wilkins.

OBJECTIVE. To identify parties involved in the prevention of MP3-induced hearing loss among adolescents and potentially effective prevention strategies and interventions. METHODS. Thirty experts in fields such as scientific research, medical practice, community health professions, education, youth work, music entertainment, and enforcement authorities participated in a qualitative, electronic, 3-round, Web-based Delphi study. RESULTS. Multiple parties involved in the prevention of MP3-induced hearing loss among adolescents were identified; the most relevant are the adolescents themselves, their parents, manufacturers of MP3 players and earphones, and the authorities. The experts did not expect that adolescents in general would perform the necessary protective behaviors to prevent MP3-induced hearing loss. Two environmental health protection measures were identified as both relevant and feasible to be implemented (ie, authorities encourage manufacturers to produce safer products, and public health campaigns will be held to improve knowledge of the risks of high-volume music, possible protective measures, and consequences of hearing loss). CONCLUSIONS. Authorities, the music industry in general, and especially manufacturers of MP3 players and earphones should recognize their responsibility and create a safer MP3-listening environment by taking measures to protect today's youth from the dangers of listening to high-volume music on MP3 players.

In het verlengde hiervan is ook de vraag toegenomen naar valide en betrouwbare methoden voor het meten van sport en bewegen op verschillende niveaus, voor verschillende doelen en doelgroepen. Voor het formuleren en evalueren van beleidsdoelen is het van belang dat informatie over de ontwikkelingen met betrekkng tot sport en bewegen zo eenduidig mogelijk is. In de huidige situatie komen echter verschillende, schijnbaar tegenstrijdige cijfers met betrekking tot sport en bewegen naar voren. In dit artikel wordt aan de hand van een aantal voorbeelden nader ingegaan op verklaringen voor verschillen in cijfers over bewegen, toegespitst op de NNGB. Tevens wordt een voorstel gedaan voor het adresseren van lacunes en knelpunten op dit gebied.

This study explores the opportunities for and barriers to improving environmental conditions in order to reduce the risk for music-induced hearing loss in people who attend music venues. Individual semi-structured interviews were held with 20 representatives of music venues and of governmental organizations, according to a semi-structured interview guide. The interviews were audiotaped, transcribed, and systematically coded using a content-analysis technique. Reported opportunities to reduce music volume included improving the acoustics and installing advanced speaker systems. The most important barrier reported was the lack of clear definitions of what levels of high-volume music are hazardous. Other barriers mentioned included economic considerations, and the beliefs that visitors demand high-volume music in music venues and are personally responsible for their own hearing. Before measures to improve environmental conditions are implemented, the exact dangers of exposure to high-volume music have to be established. Evidence-based guidelines and safety standards for leisure-time noise exposure should therefore be developed. © 2009 Informa UK Ltd All rights reserved.

Contains fulltext : 73300.pdf (Publisher’s version ) (Closed access) Aim. This paper is a report of a study to explore the views of midwives on women's positions during the second stage of labour. Background. Many authors recommend encouraging women to use positions that are most comfortable to them. Others advocate encouragement of non-supine positions, because offering 'choice' is not enough to reverse the strong cultural norm of giving birth in the supine position. Midwives' views on women's positions have rarely been explored. Method. Six focus groups were conducted in 2006–2007 with a purposive sample of 31 midwives. The data were interpreted using Thachuk's models of informed consent and informed choice. Findings. The models were useful in distinguishing between two different approaches of midwives to women's positions during labour. When giving informed consent, midwives implicitly or explicitly ask a woman's consent for what they themselves prefer. When offering informed choice, a woman's preference is the starting point, but midwives will suggest other options if this is in the woman's interest. Obstetric factors and working conditions are reasons to deviate from women's preferences. Conclusions. To give women an informed choice about birthing positions, midwives need to give them information during pregnancy and discuss their position preferences. Women should be prepared for the unpredictability of their feelings in labour and for obstetric factors that may interfere with their choice of position. Equipment for non-supine births should be more midwife-friendly. In addition, midwives and students need to be able to gain experience in assisting births in non-supine positions. 10 p.

Background: to evaluate the effectiveness of external cephalic version (ECV) without tocolysis or epidural analgesia, the complications associated with the procedure and the association between the number of ECV attempts and cephalic presentation at birth and caesarean section. Methods: retrospective cohort study of all (n = 924) ECVs carried out between 1996 and 2000 in a specialised midwifery centre in the Netherlands. After bivariate analysis, those variables with a p value under 0.05 were considered statistically significant and were tested in a logistic regression model using backward stepwise selection. Analyses were carried out separately for first ECV attempts and second ECV attempts. Findings: in total, 958 ECVs were analysed, 889 first attempts and 69 repeat attempts. Seventy per cent of all first ECVs were carried out before 37 weeks, but half of those were carried out between 36 and 37 weeks. The success rate for first ECV was 41% and for the second ECV 29%. Bivariate analysis showed that the success of the first ECV was positively influenced by parity, non-Dutch origin, higher birth weight, higher age and longer duration of pregnancy. After logistic regression, parity (odds ratio [OR] 2.8, 95% CI 2.1 to 3.7), non-Dutch origin (OR 1.8, 95% CI 1.2 to 2.8) and birth weight (OR 1.7, 95% CI 1.4 to 2.0) remained factors that independently influenced the success of ECV. The odds ratio for duration of pregnancy at first ECV was borderline significant: OR 1.2 (1.0 to 1.4). After an unsuccessful first ECV, only 13% of the women received a second ECV. The prevalence of cephalic presentation at birth increased with 3% after a second ECV. Three cases of complications were reported during or very shortly after the first ECV, and these did not result in serious complications. No complications were reported after a second ECV. Conclusion: ECV without tocolysis is a safe procedure for pregnant women and their babies. Repeat ECV increases the number of cephalic presentations at birth and should be considered after an unsuccessful ECV. © 2006 Elsevier Ltd. All rights reserved.

Objective: To explore adolescents' behaviors and opinions about exposure to loud music from MP3 players. Study design: We conducted a qualitative analysis of focus-group discussions with adolescents aged 12 to 18 years from 2 large secondary schools (1 urban and 1 rural) for pre-vocational and pre-university education. The semi-structured question route was theoretically framed within the protection motivation theory. Results: Most adolescents-especially male students and students from pre-vocational schools-indicated that they often played their MP3 players at maximum volume. Although they appeared to be generally aware of the risks of exposure to loud music, they expressed low personal vulnerability to music-induced hearing loss. Most adolescents said that they would not accept any interference with their music-exposure habits. Conclusions: Interventions should target students from pre-vocational schools and should focus on increasing adolescents' knowledge of the risks of loud music and how to protect themselves. Besides hearing education for adolescents and technical modifications of MP3 players, volume-level regulations for MP3 players may be warranted. © 2008 Mosby, Inc. All rights reserved.

Background: Advances in genomics will open up opportunities in the fields of genetic testing, early diagnosis and disease treatment. While neonatal screening is the field of application par excellencefor these developments, the debate on its potential benefits and drawbacks is mainly theoretically driven and based on the opinions of professionals. Methods: We conducted a qualitative study of the perceptions, preferences and needs of parents (and parents to be) with respect to expansion of the neonatal screening programme. Seven focus group discussions were conducted. Using disease scenarios, 4 examples of conditions amenable to neonatal screening were discussed in depth. All focus group discussions were audio taped and content analysed. Results: Participants thought that the medical benefits of screening were very important for the child. Assuming the availability of effective early medical treatment, almost 100% would be willing to participate in a screening programme. If such treatment were absent, their potential willingness would be much lower. Conclusions: The divergence in attitudes and preferences we found in this study reflected the complexity inherent in any consideration of screening for additional conditions. To implement such options successfully and to direct applied research in genomics, it is important to develop a better understanding of the thinking of target groups, namely parents.

Objective: To determine the prevalence, neonatal characteristics, and first-year mortality in Down syndrome (DS) among children in the Netherlands. Study design: The number of DS births registered by the Dutch Paediatric Surveillance Unit (DPSU) in 2003 was compared with total live births (reference population) and perinatal registrations. Results: The prevalence of DS was 16 per 10,000 live births. Compared with the reference population, the 182 children with trisomy 21 had a gestational age of 38 weeks versus 39.1 weeks (P < .001), a birth weight of 3119 g versus 3525 g in males (P < .001) and 2901 g versus 3389 g in females (P < .001), and mothers with a parity of ≥4.17% versus 5% (P < .001) and a mean age of 33.6 years versus 31 years (P < .001) and 33% (n = 54) ≥36 years). The mean age of DS diagnosis was 10.2 days in nonhospital deliveries and 1.8 days in hospital deliveries (P < .001). Children with DS were less often breast-fed (P < .05), and 86% (n = 156) were hospitalized after birth. Neonatal and infant mortality were higher in DS, 1.65% versus 0.36% (P < .02) and 4% versus 0.48% (P < 0.001), respectively. Conclusions: The prevalence of DS in the Netherlands exceeds previously reported levels and is influenced by the mother's age. Neonatal and infant DS mortality have declined, but still exceed those in the reference population. © 2008 Mosby, Inc. All rights reserved.

Background and Objective: We examined the reliability and validity of self-reported limitations encountered in the activities of daily living (ADL) as measure of functional performance, for Turkish, Moroccan, and indigenous Dutch elderly in the Netherlands.Methods: We obtained data on self-reported ADL measured by Katz' ADL index and on five related health outcomes among a general population sample of 304 Dutch, 330 Turkish, and 299 Moroccan respondents aged 55-74 years, in Amsterdam, the Netherlands (response: 60%).Results: Katz' ADL index demonstrated good internal consistencies for each ethnic group (Cronbach's alphas: 0.84-0.94). Regarding validity, the ADL index showed relatively strong associations with related outcomes, that is, long-term limitations in mobility and SF-36 physical functioning (rank correlations: 0.64 and -0.60, respectively). Associations with more general health outcomes, number of chronic disorders, Center for Epidemiologic Studies-Depression scale symptoms, and SF-36 role performance were weaker, as expected. Associations were stronger for Moroccans than for indigenous Dutch elderly regarding both SF-36 outcomes and depressive symptoms.Conclusion: Katz' ADL index is valid to assess functional performance of Turkish, Moroccan, and Dutch elderly, but comparisons with Moroccan elderly should be handled with caution. The explanation of these findings and their generalizability to other ethnic groups deserve further study. (C) 2007 Elsevier Inc. All rights reserved.

AIMS: Little is known about ethnic differences in the timely diagnosis of Type 1 diabetes mellitus (Type 1 DM). This study aimed to assess ethnic inequalities in the timely diagnosis of Type 1 DM, as indicated by a more adverse clinical condition at onset. In addition, we assessed whether these differences could be explained by differences in socio-economic status. METHODS: From a national register, we selected 3128 children aged < 15 years with newly diagnosed Type 1 DM. Ethnic differences in serum glucose, blood pH, bicarbonate, presence of ketonuria, level of consciousness, hydration status,and diabetic ketoacidosis were assessed by logistic regression. A measure of socioeconomic status based on postal codes was used as an explanatory variable. RESULTS: The risk of adverse clinical presentation was 1.5-2 times higher in non-Western immigrants than Dutch children, while Western immigrant children did not differ from Dutch children. Blood pH, bicarbonate level, and level of consciousness were lower in Turkish and Antillean children in particular. The adverse socio-economic position of immigrant children contributed very little to these differences in clinical presentation. CONCLUSIONS: Non-Western children were likely to be sicker at first presentation of Type 1 DM, and thus diagnosis may have been delayed. These disparities were not accounted for by differences in socio-economic status. Possible explanations may be difficulties in recognition of symptoms, failure of GPs to take symptom reporting seriously and lack of awareness of the fact that Type 1 DM occurs more often in certain ethnic groups

To identify factors associated with asthma control in a multi-ethnic paediatric population. We interviewed 278 children with paediatrician diagnosed asthma (aged 7-17 years) and one of their parents. Asthma control was assessed with the Asthma Control Questionnaire (ACQ). Detailed information about sociodemographic variables, asthma medication, knowledge of asthma, inhalation technique and environmental factors were collected. Turkish and Moroccan parents were interviewed in their language of choice. Logistic regression analyses were used to identify correlates of asthma control. Of the 278 children, 85 (30.6%) were Dutch, 84 (30.2%) were Moroccan, 58 (20.9%) were Turkish and 51 (18.3%) were Surinamese. Overall, almost 60% had a status of well-controlled asthma, as indicated by the ACQ. Only 51 of the 142 (35.9%) Moroccan and Turkish parents had a good comprehension of the Dutch language. In logistic regression analyses the risk of having uncontrolled asthma was significantly higher among Surinamese children (OR 2.3; 95% CI 1.06-4.83), respondents with insufficient comprehension of the Dutch language (OR 2.3; 95% CI 1.08-4.78), children using woollen blankets (OR 9.8; 95% CI 1.52-63.42), and significantly lower among male (OR 0.5; 95% CI 0.31-0.91) and non-daily users of inhaled corticosteroids (OR 0.6; 95% CI 0.38-1.07). In conclusion, ethnicity as well as insufficient comprehension of the Dutch language appeared to be independent risk factors for uncontrolled asthma. Special attention should be given to children from immigrants groups for example by calling in an interpreter by physicians when comprehension is insufficient. © 2006 Elsevier Ltd. All rights reserved.

Due to ever-improving medical technology over the course of the last century, the limit of viability has been lowered from around 32 weeks of gestation, first to 28 weeks and, in recent decades, to as low as less than 24 weeks. Long-term follow-up studies (Project on Preterm and Small-for- Gestational-Age Infants, Leiden Follow-up Project on Prematurity, Epidemiological Project for ICU Research and Evaluation, Étude Epidémiologique sur les Petits Ages Gestationnels, Extremely Preterm Infants in Belgium), however, have shown high percentages of deaths and/or disabilities at lower gestational ages in surviving children. Many parents and children are burdened with lifelong iatrogenic disabilities. As a result, the Dutch Paediatric Association and the Dutch Society of Obstetrics and Gynaecology have laid down joint rules for the management of expected/threatened preterm delivery. © RCOG 2006 BJOG An International Journal of Obstetrics and Gynaecology.

Ultrasound (US) physiotherapy as a clinical treatment is extremely common in the Western world. Internationally, regulation to ensure safe application of US physiotherapy by regular calibration ranges from nil to mandatory. The need for a portable power standard (PPS) has been addressed within a European Community (EC)-funded project. This PPS consists of an electrical driver, a set of US transducers and a cavitation detector (CD). Each component has been extensively tested for stability and travel robustness. Transducer output power has been determined with an uncertainty of 100%). The PPS is now ready to be used to underpin traceable calibration of physiotherapy devices. (E-mail: rt.hekkenberg@pg.tno.nl). © 2006 World Federation for Ultrasound in Medicine & Biology.

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Recently, it has been proposed that abnormalities in coagulation and fibrinolysis contribute to the development of preeclampsia by increasing the thrombotic tendency. This hypothesis was tested in women who have had preeclampsia (cases) compared with matched controls. Polymorphisms in the thrombophilia genes {plasminogen activator inhibitor type 1 [PAI-1 -675(4G/5G)], thrombin activatable fibrinolysis inhibitor (TAFI-438G/A and 1040C/T), methylenetetrahydrofolate reductase (MTHFR 677C/T), factor V (FV Leiden R/Q506), prothrombin (FII 20210G/A) and factor XIIIA (FXIIIA V/L34)} were determined in 157 women with preeclampsia and 157 women with uncomplicated pregnancy. The associated risk of preeclampsia was analyzed using logistic regression methods. The frequency distributions of the genotypes of these six polymorphisms in thrombophilia genes were similar in the case and control groups. We found no differences in the prevalence of genetic risk factors of thrombosis in women with preeclampsia compared with controls, which makes it unlikely that these polymorphisms are risk factors for preeclampsia. © 2004 International Society on Thrombosis and Haemostasis.

Healthy participation in society. The value of social work in health promotion An important condition for health and well-being is an active role in society. Most people feel much better and actually have a better health when they participate in (voluntary) work, sports, clubs, et cetera. This is the case for healthy people but probably even more so for less able people. Therefore the focus in health promotion is moving from the individual to the (social) environment. Especially social support systems get a lot of attention. Surprisingly, social work professionals are not a natural partner in health promotion. While their focus and competences lie with building, supporting and maintaining social support systems. In this article we show how social work can play it’s part in modern health promotion.

Objective. To evaluate whether congenital adrenal hyperplasia (CAH) patients can be detected by newborn screening before the occurrence of life-threatening salt wasting and whether the prevalence, specificity, and sensitivity are adequate enough for a routine screening procedure. Design. From 1998, a 2-year regional pilot screening for CAH was performed. In 1998, cutoff levels for 17OHP were primarily based on birth weight, and in 1999 on gestational age. In addition, nationwide, all newly diagnosed patients with CAH were reported to the Dutch Pediatric Surveillance Unit to compare screened CAH patients with CAH patients in the area without screening. Results. In 2 years, 176 684 newborns were screened and 15 CAH patients (7 males/8 females) were detected. Therapy was started at the median age of 7 days. In the area without screening, 223 307 infants were born and 19 CAH patients (10 males/9 females) were reported to the Dutch Pediatric Surveillance Unit. Therapy was started at the median age of 14 days. The mean (standard deviation) serum sodium concentration was 134.5 (3.4) mmol/L in the area of screening versus 124.5 (10.8) mmol/L in the area without screening. The overall prevalence was 1:11 764. In 1998 and 1999, the specificity was 99.76% and 99.97%, respectively. The positive predictive value was 4.5% and 16%, respectively. To date, no false-negative cases have been detected. Conclusion. Severe salt wasting can be prevented by neonatal screening. The prevalence, specificity, and sensitivity allowed addition of screening for CAH to the routinely performed national neonatal screening program.

Het uniforme deel van het Basistakenpakket Jeugdgezondheidszorg (het deel dat aan alle kinderen in Nederland op dezelfde manier wordt aangeboden) bevatte voorheen een combinatie van 18 bewezen effectieve programmaonderdelen, te weten negen vaccinaties, zes screeningsprogramma’s en drie vormen van preventieve advisering. Daarnaast werd een groot aantal programmaonderdelen aangeboden waarvan de werkzaamheid (nog) niet bewezen was. Van deze laatste werden een aantal alsnog onderzocht, om in een later stadium te kunnen besluiten over al dan niet handhaving in het uniforme Basistakenpakket JGZ. Sommige onderdelen lenen zich niet voor evaluatieonderzoek, maar worden door ouders of overheid dermate op prijs gesteld dat ze deel blijven uitmaken van het pakket. Mede dank zij dit gemengde aanbod is het bereik met gemiddeld rond 95% hoog in vergelijking met de ons omringende landen. De afgelopen jaren is het Basistakenpakket JGZ uitgebreid, en is een aantal bestaande onderdelen wetenschappelijk beter onderbouwd. In dit artikel wordt de actuele stand van zaken per juni 2007 weergegeven, voortbouwend op een eerdere analyse uit 2003.

Background: The aim of the present study on the occurrence of Henoch-Schonlein Purpura ( HSP) in Dutch children is to give some insight into the epidemiology of HSP in the Netherlands, to record the diagnostic criteria used by Dutch paediatricians and to evaluate the accuracy of the latter using the presence of IgA in the skin when biopsies are available. Methods: Each month in 2004, all Dutch paediatricians received an electronic card asking them to mention new diagnosed HSP. Paediatricians reporting one or more new patients with HSP were sent a list of questions concerning various parameters. Results: 232 patients from 0 to 18 years of age ( 6.1/10(5)) were reported as having contracted HSP in 2004. 29% presented renal symptoms. In accordance with the classification criteria of the American College of Rheumatology, 80% of paediatricians consider that isolated purpura ( without haematological abnormalities) is sufficient to allow the diagnosis of HSP in children. From the 17 skin biopsies performed, only 9 ( 53%) presented IgA deposits. The follow-up duration, considered as necessary, was longer in case of renal symptoms at presentation. However, 45% of patients without renal symptoms would be followed for more than 1 year. Conclusion: Considering the recent ( 2006) EULAR/PReS endorsed consensus criteria for the classification of childhood vasculitides, HSP should have been diagnosed in only 160 of the 179 patients of our study. The use of isolated non-thrombocytopenic purpura as the only criterion to diagnose HSP in children might therefore lead to over diagnosis and unnecessary follow-up

The association between poverty, malnutrition, illness and poor socioeconomic conditions on the one side, and poor growth and short adult stature on the other side, is well recognized. Yet, the simple assumption by implication that poor growth and short stature result from poor living conditions, should be questioned. Recent evidence on the impact of the social network on adolescent growth and adult height further challenges the traditional concept of growth being a mirror of health. Twenty-nine scientists met at Glücksburg castle, Northern Germany, November 15th - 17th 2013, to discuss genetic, endocrine, mathematical and psychological aspects and related issues, of child and adolescent growth and final height.

We assessed the effects of a stringent reception policy on the mental health of unaccompanied adolescent asylum seekers by comparing the mental health of adolescents in a restricted campus reception setting and in a setting offering more autonomy (numbers [response rates]: 69 [93%] and 53 [69%], respectively; mean age, 16 years). Unaccompanied adolescent asylum seekers in a restricted reception setting reported more emotional problems on the Hopkins Symptom Checklist than their counterparts in the more autonomy group (mean scores [SD]: restricted, 59.3 [13.1]; other, 53.4 [10.5]; p = 0.033, F test). Main effects concerned a rise in anxiety. Girls showed larger differences than boys. A restrictive reception may therefore affect the mental health of minor asylum seekers. Health care workers and policy makers should be aware of this adverse effect. Copyright © 2005 by Lippincott Williams & Wilkins.

Auxology has developed from mere describing child and adolescent growth into a vivid and interdisciplinary research area encompassing human biologists, physicians, social scientists, economists and biostatisticians. The meeting illustrated the diversity in auxology, with the various social, medical, biological and biostatistical aspects in studies on child growth and development.

Auxology has developed from mere describing child and adolescent growth into a vivid and interdisciplinary research area encompassing human biologists, physicians, social scientists, economists and biostatisticians. The meeting illustrated the diversity in auxology, with the various social, medical, biological and biostatistical aspects in studies on child growth and development.

Background Emotional and behavioural problems are a risk factor for the initiation of smoking. In this study, we aimed to assess this relationship beyond clinical cut-off values of problem behaviour. Methods Cross-sectional national survey among 9-13 year old children with data on smoking and Childhood Behaviour Checklist (CBCL) (N = 960). Relationships between smoking and tertiles of CBCL-scores were assessed. Results Smoking was reported by 5.9% of the children (7.1% boys and 5.0% girls, P > 0.100). Relationships between smoking and problem behaviour were present in girls, but ot in boys. Among girls, smoking was associated with attention problems, thought problems, and delinquent behaviour. For attention problems and delinquent behaviour the associations were limited to the CBCL-scores in the uppermost 16% which agrees with the subclinical cut-off value. Conclusion Pre-adolescent girls more frequently smoke if having attention problems, delinquent behaviour, or thought problems.

Growth and body height have always been topics interesting to the public. In particular, the stupendous increase of some 15-19. cm in final adult height during the last 150 years in most European countries (the " secular trend" ), the concomitant changes in body and head proportions, the tendency towards early onset of sexual maturation, the changes in the age when final height is being reached, and the very recent trend in body mass index, have generated much scientific literature. The marked plasticity of growth in height and weight over time causes problems. Child growth references differ between nations, they tend to quickly become out of date, and raise a number of questions regarding fitting methods, effects caused by selective drop-out, etc. New findings contradict common beliefs about the primary importance of nutritional and health related factors for secular changes in growth. There appears to be a broad age span from mid-childhood to early adolescence that is characterised by a peculiar insusceptibility. Environmental factors that are known to influence growth during this age span appear to have only little or no impact on final height. Major re-arrangements in height occur at an age when puberty has almost been completed and final height has almost been reached, implying that factors, which drive the secular trend in height, are limited to early childhood and late adolescence. © 2010 Elsevier GmbH.

Introduction: In the Dutch maternity care system, the role division between independently practising midwives (who take care of normal pregnancy and childbirth) and obstetricians (who care for pathologic pregnancy and childbirth) has been established in the so-called " List of Obstetric Indications" (LOI). The LOI designates the most appropriate care provider for women with defined medical or obstetric conditions. Methods: This descriptive study analysed the evolution of the concept of " normality" by comparing the development and the contents of the consecutive versions of the LOI from 1958 onwards. The results were related to data from available Dutch national databases concerning maternity care. Results: The number of conditions defined in the successive lists increased from 39 in 1958 to 143 in 2003. In the course of time, the nature and the content of many indications changed, as did the assignment to the most appropriate care provider. The basic assumptions of the Dutch maternity care system remained stable: the conviction that pregnancy and childbirth fundamentally are physiologic processes, the strong position of the independently practising midwife, and the choice between home or hospital birth for low-risk women. Nevertheless, the odds of the obstetrician being involved in the birth process increased from 24.7% in 1964 to 59.4% in 2002, whereas the role of the primary care provider decreased correspondingly. Discussion: Multidisciplinary research is urgently needed to better determine the risk status and the optimal type of care and care provider for each individual woman in her specific situation, taking into account the risk of both under- and over-treatment. Safely keeping women in primary care could be considered one of a midwife's interventions, just as a referral to secondary care may be. The art of midwifery and risk selection is to balance both interventions, in order to end up with the optimal result for mother and child. © 2010 American College of Nurse-Midwives.

The main goal of this guideline for preventive child health care (PCHC) is to improve early detection of disorders that induce short stature. Based on research, evidence-based referral criteria for children aged 0-10 years with a short stature were formulated. These criteria are important for all professionals working with children, such as PCHC, general practitioners and paediatricians. Previous referral criteria dated 1997 and titled 'Diagnostics of short stature in children' had a very low specificity and were therefore considerably revised. They should no longer be applied. The guideline also provides information on the cause of short stature, psychosocial aspects and the use of growth hormone.

There is an increasing population at risk of hearing loss and tinnitus due to increasing high-volume music listening. To inform prevention strategies and interventions, this study aimed to identify important protection motivation theory-based constructs as well as the constructs 'consideration of future consequences' and 'habit strength' as correlates of adolescents' unsafe discotheque-visiting behavior. We invited 1687 adolescents (12-19 years old) at Dutch secondary schools to complete questionnaires about music-listening behaviors, sociodemographic characteristics and psychosocial determinants of behavior. Over 70% of participants reported to have visited discotheques; 24.6% of them were categorized as visitors at risk for hearing loss due to estimated exposure of 100 dBA for 1.25 hours per week or more without the use of hearing protection. Compared with visitors not at risk for hearing loss, those at risk were more likely not to live with both parents and less likely to consider future consequences and for them visiting high-volume music discotheques was more habitual. Risky exposure to high-volume music in discotheques is associated with several sociodemographic and psychosocial factors, with habit strength being the strongest correlate. Voluntary behavior change among adolescents might be difficult to achieve, because visiting discotheques seems to be strongly linked to current adolescent lifestyle. © The Author 2010. Published by Oxford University Press. All rights reserved.

Objective: Since 1997 the Dutch Association for Cleft Palate and Craniofacial Anomalies (NVSCA) has maintained a national registry of congenital craniofacial anomalies. This study validates data on three common oral cleft categories (cleft lip/alveolus = CL/A; cleft lip/alveolus and palate = CL/AP; and cleft palate = CP) and general items. Design: Retrospective observational study. Setting: All 15 Dutch cleft palate teams registered presurgery patients with common oral clefts (n = 2553) from 1997 to 2003. Patients: A random sample of 250 cases was used; 13 cases were excluded. Main Outcome Measures: The corresponding medical data were reviewed; these medical data served to validate the NVSCA registry data. Prevalence comparisons, 2 X 2 tables and validity measures were performed. Results: The cleft categories most accurately recorded were CL/A and CP. Both categories had an observed agreement of 98%, kappa of 0.94, and a sensitivity and specificity of 97%. Cleft lip/alveolus and palate had an observed agreement of 95%, kappa of 0.89, a sensitivity of 90%, and a specificity of 99%. Regarding the general items, observed agreement and kappa were highest for adoption/foster child (99%; 0.76) and lowest for remarks about pregnancy (63%; 0.20). Sensitivity ranged from 25% (consanguinity) to 97% (white mother) and specificity was high for all items (>93%) except for white father and mother (approximately 35%). Conclusions: The NVSCA registry is a valuable tool for quality improvement and research because validity on all three common oral cleft categories is very good. Validity on the general items is reasonable to satisfying and appears to be related to the type of information.

In 2010 mocht gezondheidsbevordering zich verheugen in extra aandacht in de VTV en het inspectierapport. Zowel het belang van dit werkveld als de uitdagingen tot verbetering werden geschetst. We zien schuivende panelen: wat we gisteren nog als vooruitgang begroetten is vandaag een normaal startpunt. We willen allemaal verder, beter. Diverse kwaliteitsimpulsen proberen de interactie te bevorderen in de driehoek beleid, onderzoek en praktijk en de werkzaamheden op ieder van die velden te verbeteren. Op grond van die rapporten, de hier voorafgaande artikelen en de gesprekken waarop ze gebaseerd zijn, heeft de redactie van dit themanummer een eigen diagnose gesteld. In deel 1 stellen wij deze diagnose aan de hand van vijf verbeterpunten: (1) doelkeuze, (2) strategie, (3) randvoorwaarden, (4) ondersteuning van en (5) feedback op gezondheidsbevordering. In deel 2 geven we mogelijke werklijnen aan en wie daarbij in het veld naar ons oordeel het initiatief zou moeten nemen. We bepleiten onder meer een breder opvatting van gezondheid, het opzetten van een doelenboom, het combineren van de evidence- en de draagvlakroute, meer andersoortig onderzoek. Voorts ook het investeren in kwaliteit en, met nadruk, een beter oog voor capaciteit: de zakelijke en logistieke kant van het werk. We streven in het werkveld naar een verdere ontwikkeling van duurzaam en degelijk werk, dat tegelijk creatief en dynamisch is.

Purpose: As part of a larger nationwide enquiry into severe maternal morbidity, our aim was to assess the incidence and possible risk factors of obstetric intensive care unit (ICU) admission in the Netherlands. Methods: In a 2-year nationwide prospective population-based cohort study, all ICU admissions during pregnancy, delivery and puerperium (up to 42 days postpartum) were prospectively collected. Incidence, case fatality rate and possible risk factors were assessed, with special attention to the ethnic background of women. Results: All 98 Dutch maternity units participated in the study. There were 847 obstetric ICU admissions in 358,874 deliveries, the incidence being 2.4 per 1,000 deliveries. Twenty-nine maternal deaths occurred, resulting in a case fatality rate of 1 in 29 (3.5%). Incidence of ICU admission varied largely across the country. Thirty-three percent of all cases of severe maternal morbidity were admitted to an ICU. Most frequent reasons for ICU admission were major obstetric haemorrhage (48.6%), hypertensive disorders of pregnancy (29.3%) and sepsis (8.1%). Assisted ventilation was needed in 34.8%, inotropic support in 8.8%. In univariable analysis, non-Western immigrant women had a 1.4-fold (95% CI 1.2-1.7) increased risk of ICU admission as compared to Western women. Initial antenatal care by an obstetrician was associated with a higher risk and home delivery with a lower risk of ICU admission. Conclusions: Population-based incidence of obstetric ICU admission in the Netherlands was 2.4 per 1,000 deliveries. Obstetric ICU admission accounts for only one-third of all cases of severe maternal morbidity in the Netherlands. © 2009 The Author(s).