Prospective survey of childhood inflammatory bowel disease in the British Isles

The incidence of inflammatory bowel disease in children in western countries may be rising. Since there is no prospective national data on the incidence of inflammatory bowel disease in the UK and Republic of Ireland (ROI), we undertook a prospective survey to determine this incidence. The incidence during 1998 and 1999 was 5.2/100,000 per year in children aged younger than 16 years. Those from an Asian background were over-represented and more likely to have ulcerative colitis.

Childhood eating disorders: British national surveillance study

BACKGROUND

The incidence of eating disorders appears stable overall, but may be increasing in younger age groups. Data on incidence, clinical features and outcome of early-onset eating disorders are sparse.

AIMS

To identify new cases of early-onset eating disorders (<13 years) presenting to secondary care over 1 year and to describe clinical features, management and 1-year outcomes.

METHOD

Surveillance over 14 months through the established British Paediatric Surveillance System, and a novel child and adolescent psychiatry surveillance system set up for this purpose.

RESULTS

Overall incidence was 3.01/100,000 (208 individuals). In total, 37% met criteria for anorexia nervosa; 1.4% for bulimia nervosa; and 43% for eating disorder not otherwise specified. Nineteen per cent showed determined food avoidance and underweight without weight/shape concerns. Rates of comorbidity were 41%; family history of psychiatric disorder 44%; and early feeding difficulties 21%. Time to presentation was >8 months. A total of 50% were admitted to hospital, typically soon after diagnosis. Outcome data were available for 76% of individuals. At 1 year, 73% were reported improved, 6% worse and 10% unchanged (11% unknown). Most were still in treatment, and seven were hospital in-patients for most of the year.

CONCLUSIONS

Childhood eating disorders represent a significant clinical burden to paediatric and mental health services. Efforts to improve early detection are needed. These data provide a baseline to monitor changing trends in incidence.

Decline running produces more sarcomeres in rat vastus intermedius muscle fibers than does incline running

Unaccustomed eccentric exercise, in which a muscle is lengthened while generating tension, is well known to cause injury and pain. A rapid training effect has been demonstrated in a number of eccentric exercises. The mechanism for both the damage and the training has been unknown. Morgan proposed that the damage is caused by sarcomere length instabilities during operation on the descending limb of the sarcomere length-tension curve and that the training effect is an increase in the number of sarcomeres connected in series in a muscle fiber, thus avoiding the descending limb (Biophys. J. 57: 209-221, 1990). We tested this proposal by exercising rats on a treadmill set at either an incline or a decline of 16 degrees, an exercise that has previously been shown to cause damage in untrained rats and a training effect. The vastus intermedius muscles were fixed and were digested in acid, and the fiber and sarcomere lengths of representative fibers were measured. From these measurements, the mean number of sarcomeres per fiber was found for the different training regimes. A clear and repeatable difference was found, supporting Morgan's prediction of more sarcomeres after decline running, although with some differences in response that depended on the age of the rats.

Rising incidence of type 2 diabetes in children in the U.K

OBJECTIVE

To estimate the incidence of type 2 diabetes in children <17 years of age and to investigate the relationship of diabetes with increasing childhood obesity in the U.K. and the Republic of Ireland (ROI).

RESEARCH DESIGN AND METHODS

Active monthly reporting of cases by consultant pediatricians occurred through the framework of the British Pediatric Surveillance Unit, with additional reports from specialist diabetes nurses. All children <17 years of age and diagnosed by their clinician as having non-type 1 diabetes from 1 October 2004 to 31 October 2005 were included.

RESULTS

A total of 168 confirmed cases of non-type 1 diabetes were reported, resulting in a national incidence (excluding the ROI) of 1.3 x 100,000(-1) x year(-1). Of these, 40% were diagnosed with type 2 diabetes giving a minimum incidence of 0.53 x 100,000(-1) x year(-1). Children of ethnic minorities were greatly overrepresented, with those of black and South-Asian origin (England data only) having an incidence of 3.9 and 1.25 x 100,000(-1) x year(-1), respectively, compared with 0.35 x 100,000(-1) x year(-1) in those defined as white. Of those diagnosed with type 2 diabetes, 95% were overweight and 83% obese according to International Obesity Task Force guidelines. Eighty-four percent had a family history of type 2 diabetes.

CONCLUSIONS

Type 2 diabetes is still less common than type 1 diabetes in U.K. children. However, compared with previous prevalence data, the frequency of type 2 diabetes appears to be increasing. Incidence among ethnic minorities is far higher than in whites, as previously described in the U.S. Increased adiposity and family history of type 2 diabetes were strongly associated with the diagnosis of type 2 diabetes in U.K. children.

Gender differences in extraversion, neuroticism, and psychoticism in 37 nations

Mean gender differences on Eysenck's three personality traits of extraversion, neuroticism, and psychoticism were collated for 37 nations. Women obtained higher means than men on neuroticism in all countries, and men obtained higher means than women on psychoticism in 34 countries and on extraversion in 30 countries. The relation between the magnitude of the gender differences and per capita incomes was not significant for any of the three traits.

Differences in rat skeletal muscles after incline and decline running

Rats were trained for 5 days by running on either an inclined or declined treadmill. Three days later, the rats were anesthetized, and angle-torque curves were plotted for the vastus intermedius muscles. The maximum active torque was generated at significantly greater muscle lengths for muscles from decline-trained rats compared with incline-trained rats. Sixteen muscles were then fixed and acid digested, and fiber lengths and sarcomere lengths were measured. The estimated average number of sarcomeres in series was greater in muscle fibers from decline-trained animals. Fourteen other muscles underwent a test series of lengthening contractions, all from the same knee angle. Torque fell less and the optimum angle shifted less for muscles from decline-trained animals, showing that the decline-trained muscles were more resistant to changes in mechanical parameters that indicate damage. These results support but do not prove the proposal that the lesser damage from a series of eccentric contractions seen in muscles trained by prior eccentric contractions is due to a greater number of sarcomeres in series.

Incidence and clinical features of Langerhans cell histiocytosis in the UK and Ireland

OBJECTIVES

There are few published studies on the epidemiology of Langerhans cell histiocytosis (LCH). We undertook a survey to ascertain all newly diagnosed cases aged 0-16 years in the UK and Republic of Ireland.

DESIGN

Three methods of ascertainment were used: the British Paediatric Surveillance Unit (BPSU) system, a survey by Newcastle University, and the Children's Cancer and Leukaemia Group (CCLG) registry. Deaths data were obtained from the UK Office for National Statistics and the Central Statistics Office in Ireland. Clinicians who reported cases were sent a questionnaire to obtain demographic and clinical details.

RESULTS

Over the 2-year period, 94 cases were identified. The age-standardised incidence rate of LCH in children aged 0-14 years was 4.1 per million per year. The sex ratio (M:F) was 1.5:1 and the median age at diagnosis was 5.9 years. Single system disease (predominantly bony involvement) accounted for 73% of cases and 27% had multisystem disease of whom 7% had involvement of "risk organs" (liver, lung, spleen and bone marrow). Three children died, two of whom were diagnosed after death.

CONCLUSIONS

This is the first study of LCH to use an active surveillance method with additional sources of ascertainment. Our incidence is comparable with those in other national reports, although it is likely to be an underestimate as each method may have missed some cases, either diagnosed or undiagnosed.

Tandem regions of yeast DNA topoisomerase II share homology with different subunits of bacterial gyrase

The nucleotide sequence for the Saccharomyces cerevisiae gene TOP2, which encodes DNA topoisomerase II, was compared with the sequence for bacterial DNA gyrase. The amino and carboxyl terminal halves of the single-subunit yeast enzyme showed homologies with the B and A subunits of bacterial gyrase, respectively, at corresponding positions along the polypeptide chains. Although the two enzymes differ in both quaternary structure and activity, the homology between the two proteins indicates mechanistic as well as structural similarities, and a probable evolutionary relationship.

Sex differences in means and variability on the progressive matrices in university students: A meta-analysis

A meta-analysis is presented of 22 studies of sex differences in university students of means and variances on the Progressive Matrices. The results disconfirm the frequent assertion that there is no sex difference in the mean but that males have greater variability. To the contrary, the results showed that males obtained a higher mean than females by between .22d and .33d, the equivalent of 3.3 and 5.0 IQ conventional points, respectively. In the 8 studies of the SPM for which standard deviations were available, females showed significantly greater variability (F(882,656) = 1.20, p < .02), whilst in the 10 studies of the APM there was no significant difference in variability (F(3344,5660) = 1.00, p > .05).

Incidence and 12-month outcome of non-transient childhood conversion disorder in the U.K. and Ireland

BACKGROUND

Little is known about conversion disorder in childhood.

AIMS

To document clinical incidence, features, management and 12-month outcome of non-transient conversion disorder in under 16-year-olds in the U.K. and Ireland.

METHOD

Surveillance through the British Paediatric Surveillance Unit and Child and Adolescent Psychiatry Surveillance System.

RESULTS

In total, 204 cases (age range 7-15 years) were reported, giving a 12-month incidence of 1.30/100 000 (95% CI 1.11-1.52). The most common symptoms were motor weakness and abnormal movements. Presentation with multiple symptoms was the norm. Antecedent stressors were reported for 80.8%, most commonly bullying in school. Most children required in-patient admission with frequent medical investigations. Follow-up at 12 months was available for 147 children, when all conversion disorder symptoms were reported as improved. Most families (91%) accepted a non-medical explanation of the symptoms either fully or partially.

CONCLUSIONS

Childhood conversion disorder represents an infrequent but significant clinical burden in the UK and Ireland.

Consequences of frequent nocturnal gastro-oesophageal reflux disease among employed adults: symptom severity, quality of life and work productivity

BACKGROUND

Effects of frequent nocturnal symptoms of gastro-oesophageal reflux disease (GERD-FNS) on health-related quality of life (HRQOL) and work productivity are not well documented.

AIM

To assess symptom severity, production loss, and HRQOL among employed adults with and without GERD-FNS.

METHODS

Using several validated outcome measures in a web survey design, GERD was pre-specified as GERD Symptom and Medication Questionnaire score >9, and > or =1 episode of heartburn or acid regurgitation during the preceding week. GERD-FNS patients were those reporting > or =2 symptom-nights during the previous week; their outcomes were compared with those of patients having minimal or no nocturnal symptoms (GERD-NNS) and vs. non-GERD controls.

RESULTS

Data were collected from 1002 GERD patients (476 GERD-FNS, 526 GERD-NNS) and 513 controls. Severe symptoms were more common, sleep abnormalities were more frequent (P < 0.0001) and SF-36 scores lower (P < 0.05, all scores) among GERD-FNS patients vs. GERD-NNS patients. GERD-related work loss was greater among those with GERD-FNS vs. GERD-NNS (P < 0.0001). Work loss and functional limitations were more pronounced when comparing GERD-FNS cases vs. non-GERD controls.

CONCLUSION

Employed adults with frequent nocturnal GERD report more severe symptoms, and are associated with impaired sleep, HRQOL and work productivity compared with controls and patients with minimal or no nocturnal symptoms.