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 Canadian
Medical Association Journal
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Children and Youth
Children in the Western world are becoming heavier, and Canadian children are no exception. Two New Brunswick researchers used data from three national databases to compare the body mass index (BMI) of children aged seven to 13 in 1981, 1988 and 1996. Since 1981 the BMI has increased by nearly 0.1 kg/m2 per year for both sexes. In 1981, 15% of children were overweight and 5% were obese. In 1996, 28.8% of boys and 23.6% of girls were overweight and 13.5% of boys and 11.8% of girls were obese. CMAJ 2000;163(11):1429-33.
A related commentary discusses causes, including the sacrifice of school physical education programs to budgetary restraint. CMAJ 2000;163(11):1461-2.
The poor dietary habits learned in childhood come home to roost later in life. Toronto researchers report that about $2.1-billion, or 2.5% of Canada’s direct health care costs, were attributable to physical inactivity in 1999. To put this in context, the authors point out that cigarette smoking accounted for 3.8% of total health care costs in 1992. The calculation is based on a summary of relative-risk estimates for coronary artery disease, stroke, colon cancer, breast cancer, type 2 diabetes mellitus and osteoporosis. The authors suggest that reducing the prevalence of inactivity by just 10% could reduce health care costs by $150 million a year. CMAJ 2000;163(11):1435-40.
A related editorial suggests that while telling people about the economic savings for the health care system is not likely to motivate individual change, that is no reason to give up. "Even if we can’t precisely quantify the economic gains of increasing physical activity, we should continue to provide the best rationale and incentives to encourage participation in the best fitness programs we can," he writes. CMAJ 2000;163(11):1467. BC government must pay for autism therapy The British Columbia Supreme Court says the province violated the Canadian Charter of Rights and Freedoms and discriminated against children with autism by refusing to pay for a controversial form of behaviour-modification therapy. The ruling came after families with autistic children filed a lawsuit. The province has filed an appeal. About 150 BC families were paying up to $60,000 a year for the intensive 40-hour-per-week therapy developed by Dr. Ivar Lovaas of the University of California. CMAJ 2000;163(9):1181. Canada’s social safety net missing the hungry
A related commentary questions how Canadians, with a mean income higher than most other countries, can allow children to go hungry. "As physicians, we must be more suspicious of hunger, and malnutrition in our patients," writes the author. "As a medical community, we must make our country aware of this tragedy and give specific advice for its remedy." CMAJ 2000;163(8):985-7. Child poverty The number of children living in poverty is growing despite an all-party federal promise to eliminate the problem by 2000, the Canadian Institute of Child Health says. And it says, the ramifications are enormous: 35% of children in low-income families live in substandard housing, and these children are twice as likely to need remedial education programs and are at a greater risk of psychosocial problems, injury and death by fire or homicide. CMAJ 2000;163(8):1042. Preventing child maltreatment Since the Canadian Task Force on Preventive Health Care last reported on the prevention of child maltreatment, in 1993, there have been efforts to evaluate strategies intended to reduce physical abuse, sexual abuse, neglect and emotional abuse in childhood. These strategies have included screening techniques such as identification of risk indicators, preventive programs such as home visitation by nurses, comprehensive health care programs, parent education and support programs, and combined services and programs aimed specifically at preventing sexual abuse. In this update the task force reports that there is good evidence to continue home-visitation programs to first-time mothers who are either younger than 19, single or poor. The authors recommend the home visits by nurses begin prenatally and extend until the child’s second birthday. CMAJ 2000;163(11):1451-8. Should adolescents be allowed to make health care decisions? The case of Tyler Dueck, a Saskatoon adolescent who refused potentially lifesaving medical therapy, has made physicians question whether adolescents have the right to make decisions about their health care. Two researchers reviewed the arguments for and against, including the idea of "proportionality," which states that the more serious the health outcome, the higher the level of competency required. The authors identify a clear ethical and legal foundation for permitting competent adolescents to decide whether they will accept life-sustaining medical treatment. "Given that most adolescents have the capacity necessary to make competent health care decisions, the ethical physician should respect this and allow the competent adolescent the right to exercise autonomy," the authors conclude. CMAJ 2000;162(11):1585-8. The risks of raves
A related commentary, applauds the above author’s attempt to shed some light on the rave issue. "Given society’s experience with prohibition, strict bans may prolong the popularity of the rave scene and make rave-related problems more difficult to control than if a modest degree of regulation and education were implemented," states the commentary. CMAJ 2000;162(13):1829-30. Update on stuttering Stuttering is a disturbance in the normal fluency and time patterning of speech that is inappropriate for a person’s age. The most common type of stuttering, developmental, has a gradual onset in childhood and resolves by puberty in 50% to 80% of cases. The authors provide a comprehensive review for clinicians about the diagnosis and management of patients with speech dysfluency. CMAJ 2000;162(13):1849-55. Urinary tract infections in children Urinary tract infections occur in one to eight% of children up to 11 years old, of whom 30 to 40% suffer recurrence. Febrile urinary tract infections are associated with a risk of renal scarring and subsequent development of hypertension. Antibiotic prophylaxis has been used to suppress the growth of contaminating bacteria in the bladder, but there are side effects and concerns about selection for resistant species. In a systematic review of the literature, researchers find that the supportive evidence for antibiotic use is limited for children with normal urinary tracts or neurogenic bladder, and lacking for children with reflux. The authors emphasize the need for well-defined randomized clinical trials. CMAJ 2000;163(5):523-9.
Copyright 2000 Canadian Medical Association or its licensors |
Are we breeding a culture of obesity?
The 1994 national Longitudinal Survey of Children and Youth included questions about whether children had experienced hunger. After reviewing the data, researchers report that of the more than 13,000 households surveyed, 1.2% reported going hungry because of lack of money for food. When extrapolated to the overall Canadian population, this figure represents 57,000 Canadian families fighting hunger. The study found that parents routinely sacrificed their own health in order to provide for their child, which resulted in the overall health of the parent or primary caregiver being poorer. Parents reported coping with a lack of money for food by fasting, reducing food quantity and variety, or seeking help from relatives, food banks or friends. Few applied to social programs. 
Raves, the all-night dance parties attended by large numbers of youths, are notorious for their clandestine venues, hypnotic music and the liberal use of drugs such as ecstasy (3, 4-methylenedioxymethamphetamine), "GHB" (gamma-hydroxyburate), and ketamine. While adolescence and young adulthood have traditionally been times of rebellion and risk-taking, the recent deaths of several young people at raves focused the spotlight on these all-night gatherings. A physician author offered an extensive review of rave culture, the drugs used and the health risks inherent in these gatherings, which can involve thousands of people. She commented that, while there is little medical literature on raves, physicians need to know more about these events so that they can respond when faced with a rave-related emergency. She suggests that prohibiting raves will not work — attempts to do that in Britain failed because the ravers simply moved to legitimate nightclubs. She recommends several harm-reduction strategies, such as ensuring that buildings meet safety and health standards, providing adequate security to accommodate large numbers of people and more education about health effects.