Health control of four-year-old children. A study of bacteriuria

Urinary tract infection in children with type I diabetes

The prevalence and incidence of bacteriuria in 304 girls and 337 boys with type I diabetes was studied by screening for bacteriuria at their regular outpatient controls. In 90 girls and 108 boys a urine specimen was sampled every third month during a year. The prevalence of bacteriuria was 3/304 in girls and 0/337 in boys. During the one year follow-up one of the 90 girls had pyelonephritis and two cystitis while none of the boys had bacteriuria. It is concluded that the rate of urinary tract infection in young diabetic persons does not differ from that present in healthy young people.

Early detection of preschool health problems--role of perinatal risk factors

To evaluate a perinatal risk-grouping system, 1 262 4-year-old children went through a comprehensive health examination. A total of 41.5% of the newborns were included in the wide criteria of risk, which were more common among boys and among children of the youngest and oldest mothers. Among the 4-year-old, the frequency of significant physical health problem was 15.8%, including 10.1% visual disturbances and 2% neurological disorders. In some combinations of risk groups and later health problems there were statistically significant correlations, e.g. regarding prematurity and cerebral irritation vs. cerebral palsy, but not sufficient to serve its purpose as a screening instrument. Even the accumulation of especially serious events in the perinatal period gave no clue to later neurological disorders. The addition of low socioeconomic status as a perinatal risk did not influence the outcome either. The reasons for the weak correlation between perinatal risk factors and later outcome of health disorders and handicaps are discussed, and it is concluded that to detect children with health problems, there seems to be no acceptable alternative to a comprehensive health surveillance as part of a general health service programme of all children, including clinical examinations and screening procedures by well trained personnel.

Screening for bacteriuria of schoolchildren by the nitrite reaction

The author is conducting systematic screening surveys for bacteriuria among the pupils in the primary schools (6-14 years) of a provincial town and environments. He applies the nitrite reaction for the detection of bacteriuria. Over the past 5 years 16,621 children, 7982 girls and 8639 boys, were screened, part of them repeatedly. Four bacteriuric cases were diagnosed among the boys and 130 among the girls. In a single screening the prevalence rate of bacteriuria proved to be 1.23% among the girls. In repeated screenings the incidence rate was 0.44% on the average per annum. Fifty-six of the 130 bacteriuric girls were subjected to general examination; radiological abnormalities were found in 26 of them. The author considers the systematic screening of schoolchildren as reasonable. The nitrite reaction is the most appropriate for mass screening, since it is simple, immediate, inexpensive, specific and sufficiently sensitive.

Diagnosis of urinary tract infection. The interpretation of colony counts

The results of 787 consecutive suprapubic specimens in children were studied. Ninety-two patients with 128 positive cultures were reviewed. Sixty-five children had documented urinary tract infection (UTI) proven by other cultures. Of these, 55 per cent had colony counts less than the traditional 100,000 colony forming units/ml., and 9 per cent had colony counts less than 10,000. Organisms usually regarded as "contaminants" (Staphylococcus epidermidis, mixed organisms) were occasionally proven to cause UTI.

The prognostic significance of fever in childhood urinary infections: observations in 350 consecutive patients

All infants and children with proven bacteriuria require urologic investigation and surveillance, but their prospects for developing chronic renal disease are variable. These differences are related to whether or not the bacteria have access to the kidneys. Such access correlates closely with the presence of an underlying congenital anomaly, particularly vesicoureteral reflux. Fever during an episode of active urinary infection is a strong indication that the patient has vesicoureteral reflux or some other significant uropathy and probably pyelonephritis.

Health screening of four-year-olds in a Swedish county. II. Effectiveness in detecting health problems

Quantitative results obtained during the first 3 years of operation of a routine health screening program for 4-year-olds are presented. From these figures it is conccluded that the effectiveness in detecting previously unknown health problems needing treatment is high enough to justify the continuation of this systematic health screening by the ordinary child health staff. However, the total prevalence of newly detected anomalies was lower in our population than in similar studies where the screening was performed by a few teams of specially trained professionals. The consequences of this observation are briefly discussed.

Screening methods for covert bacteriuria in schoolgirls

Screening tests for bacteriuria based on two different principles were evaluated in1582 schoolgirls aged 5-11 years, and in 26 girls aged 3-16 years attending hospitalwith symptomatic urinary tract infection. Tests for hypoglucosuria, performed by a semi-automated fluorometric method and with Uriglox strips on early-morning urine samples voided after overnight fasting, gave unacceptably high false-negative rates (16.7% and 20.8% respectively). Oxoid and Uricult dipslides were immersed in fresh midstreamspecimens of urine obtained at school and read overnight incubation at 37 degrees C. Both gave comparable results, with low false-positive rates and no false-negative responses. The higher cost of screening by dipslides was halved by using the "dipstream" technique, which also gave no false-negative results. Its false-positive rate of 13.5% could be reduced to 1.8% by disregarding colony counts of 10-8 non-faecal organisms and over per litre, which appear unimportant in schoolchildren. Bacteriuria was found in 2.3% of the schoolgirls; 39% of them had symptons, compared with 7.2% of the healthy girls, and 25% showed vesicoureteric reflux, which in 17% was associated with renalscarring. Since the natural history of covert bacteriuria and its relationship withreflux and scarring remain undetermined further research is required. The dipstreamtechnique offers a simple, reliable, and comparatively cheap screening method which could also be applied in general practice.

Asymptomatic bacteriuria in schoolgirls. I. Clinical and laboratory findings

Among 116 schoolgirls with asymptomatic bacteriuria detected at urinary screening, renal parenchymal reduction was found in 10.3%, while reflux was found in 20.7%. Only 30% of the 116 patients had a history referable to earlier urinary tract infection and there were remarkably few girls with an increased sedimentation rate (4.4%), C-reactive protein (9.5%), pyuria (25.8%) or lowered concentrating capacity (3.4%) at the time of detection of their bacteriuria. No method was found efficient in predicting lesions on the pyelogram and urethrocystogram, but determination of renal concentrating capacity and C-reactive protein was of some value in predicting parenchymal reduction. The girls with pyelonephritic changes on the pyelogram had a mean renal concentrating capacity significantly lower than the girls without changes. The concentrating capacity of the girls with reflux but without renal scarring and those bacteriuric patients without radiologically demonstrated defects did not differ significantly from the age-related normal values.

Health and behaviour in four-year-old children

A health control of an unselected population of 2447 4-year-old-children included a thorough somatic examination as well as an analysis of child upbringing practice and problems. The relation between the children's physical health, as defined by presence or absence or "functionally important health problems" and the children's behaviour, as reported by their mothers, was elucidated. On the whole, children with health problems were not perceived as more troublesome, although children with some special kinds of disturbances, e.g. neurological and dental, constituted problems in certain areas, e.g. toilet training and hyperactivity. The use of blame as a method of upbringing was very frequent and especially frequent in children with dental defects and visual disturbances. The perception of behaviour problems and the use of methods in upbringing were the same in children with newly detected health problems as in children with previously known health problems. The implications for the Child Health Service are to identify these risk-groups, to advise and support them in order to reduce parent-child conflicts.