The area of screening and treatment for dyslipldemla in children and adolescents has been controversial. One reason for this is that dyslipidemia is heterogeneous with multiple underlying causes, ...including genetic and lifestyle causes. One area that is less controversial is that of familial hypercholesterolemia (FH). Familial hypercholesterolemia is due to a genetic abnormality impacting the structure, function, or metabolism of the low-density lipoprotein (LOL) receptor, resulting in elevated plasma LDL cholesterol (LOL-C). There is a variety of gene variants that can underlie FH, including those involving the LDL receptor, apolipoprotein B, or proprotein subtilisin/kexin type 9 (PLSK9), which result in marked elevation of plasma LOL-C from birth and, without intervention, throughout life.
Researchers are only gradually becoming aware of the gravity of the risk that overweight and obesity pose for children's health. In this article Stephen Daniels documents the heavy toll that the ...obesity epidemic is taking on the health of the nation's children. He discusses both the immediate risks associated with childhood obesity and the longer-term risk that obese children and adolescents will become obese adults and suffer other health problems as a result. Daniels notes that many obesity-related health conditions once thought applicable only to adults are now being seen in children and with increasing frequency. Examples include high blood pressure, early symptoms of hardening of the arteries, type 2 diabetes, nonalcoholic fatty liver disease, polycystic ovary disorder, and disordered breathing during sleep. He systematically surveys the body's systems, showing how obesity in adulthood can damage each and how childhood obesity exacerbates the damage. He explains that obesity can harm the cardiovascular system and that being overweight during childhood can accelerate the development of heart disease. The processes that lead to a heart attack or stroke start in childhood and often take decades to progress to the point of overt disease. Obesity in childhood, adolescence, and young adulthood may accelerate these processes. Daniels shows how much the same generalization applies to other obesity-related disorders-metabolic, digestive, respiratory, skeletal, and psychosocial-that are appearing in children either for the first time or with greater severity or prevalence. Daniels notes that the possibility has even been raised that the increasing prevalence and severity of childhood obesity may reverse the modern era s steady increase in life expectancy, with today's youth on average living less healthy and ultimately shorter lives than their parents-the first such reversal in lifespan in modern history. Such a possibility, he concludes, makes obesity in children an issue of utmost public health concern.
Historically, the focus on the development of atherosclerotic cardiovascular disease has been on individual risk factors. These factors, which are associated with increased risk of myocardial ...infarction and stroke, were identified in the Framingham Study and other longitudinal observational studies of adults. The traditional risk factors are hypertension, dyslipidemia, obesity, diabetes, and cigarette smoking. Subsequent research has demonstrated that interventions that result in improvement in risk factors do reduce the risk of morbidity and mortality from cardiovascular disease. Research has shown that these risk factors are present in children and adolescents and are associated with increased prevalence and severity of atherosclerotic lesions in individuals who had autopsies after death due to various causes and trauma.
The incorporation of the United Nations Convention on the Rights of the Child (UNCRC) into Scots law offers an unprecedented opportunity to improve the realisation of the right to education for all ...children and young people living in Scotland. One feature of such a commitment ought to be clear and comprehensive policies on Human Rights Education (HRE) within Scottish educational policy. This article explores what incorporation of the UNCRC means in the Scottish context and reflects on the current status of HRE in Scottish education. It also asks what role HRE might play alongside incorporation and as part of wider proposed reforms in Scottish education following the Muir Report. I argue that such an examination provides significant opportunities to ask and seek to answer key questions about how HRE may be developed in Scottish education, both conceptually and in classroom practice.
The Use of BMI in the Clinical Setting Daniels, Stephen R
Pediatrics (Evanston),
09/2009, Letnik:
124, Številka:
Supplement
Journal Article, Conference Proceeding
Recenzirano
Odprti dostop
BMI has been recommended for evaluating overweight and obesity in children and adolescents in the clinical setting. Definitions of overweight and obesity are based on percentile cutoff points. There ...are both strengths and limitations of BMI for this use. The strengths include the fact that BMI is cheap and relatively easy to use. The weaknesses include the fact that BMI percentiles are not widely used, and categorization of BMI percentiles may not adequately define risk of comorbid conditions. In addition, percentiles are not optimal for stratifying children and adolescents with very high BMI. Alternatives to the use of BMI and BMI percentiles include waist circumference to evaluate regional fat deposition and replacement of percentiles with z scores. Despite limitations, BMI and BMI percentiles have great utility in the clinical setting and the potential to be even more useful as BMI is used more frequently and more appropriately by primary care providers. Additional research on alternatives or adjuncts to BMI is needed.
PURPOSE—Much has transpired since the last scientific statement on pediatric stroke was published 10 years ago. Although stroke has long been recognized as an adult health problem causing substantial ...morbidity and mortality, it is also an important cause of acquired brain injury in young patients, occurring most commonly in the neonate and throughout childhood. This scientific statement represents a synthesis of data and a consensus of the leading experts in childhood cardiovascular disease and stroke.
METHODS—Members of the writing group were appointed by the American Heart Association Stroke Council’s Scientific Statement Oversight Committee and the American Heart Association’s Manuscript Oversight Committee and were chosen to reflect the expertise of the subject matter. The writers used systematic literature reviews, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize existing evidence and to indicate gaps in current knowledge. This scientific statement is based on expert consensus considerations for clinical practice.
RESULTS—Annualized pediatric stroke incidence rates, including both neonatal and later childhood stroke and both ischemic and hemorrhagic stroke, range from 3 to 25 per 100 000 children in developed countries. Newborns have the highest risk ratio1 in 4000 live births. Stroke is a clinical syndrome. Delays in diagnosis are common in both perinatal and childhood stroke but for different reasons. To develop new strategies for prevention and treatment, disease processes and risk factors that lead to pediatric stroke are discussed here to aid the clinician in rapid diagnosis and treatment. The many important differences that affect the pathophysiology and treatment of childhood stroke are discussed in each section.
CONCLUSIONS—Here we provide updates on perinatal and childhood stroke with a focus on the subtypes, including arterial ischemic, venous thrombotic, and hemorrhagic stroke, and updates in regard to areas of childhood stroke that have not received close attention such as sickle cell disease. Each section is highlighted with considerations for clinical practice, attendant controversies, and knowledge gaps. This statement provides the practicing provider with much-needed updated information in this field.
This clinical report replaces the 1998 policy statement from the American Academy of Pediatrics on cholesterol in childhood, which has been retired. This report has taken on new urgency given the ...current epidemic of childhood obesity with the subsequent increasing risk of type 2 diabetes mellitus, hypertension, and cardiovascular disease in older children and adults. The approach to screening children and adolescents with a fasting lipid profile remains a targeted approach. Overweight children belong to a special risk category of children and are in need of cholesterol screening regardless of family history or other risk factors. This report reemphasizes the need for prevention of cardiovascular disease by following Dietary Guidelines for Americans and increasing physical activity and also includes a review of the pharmacologic agents and indications for treating dyslipidemia in children.
These pediatric hypertension guidelines are an update to the 2004 "Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents." Significant changes ...in these guidelines include (1) the replacement of the term "prehypertension" with the term "elevated blood pressure," (2) new normative pediatric blood pressure (BP) tables based on normal-weight children, (3) a simplified screening table for identifying BPs needing further evaluation, (4) a simplified BP classification in adolescents ≥13 years of age that aligns with the forthcoming American Heart Association and American College of Cardiology adult BP guidelines, (5) a more limited recommendation to perform screening BP measurements only at preventive care visits, (6) streamlined recommendations on the initial evaluation and management of abnormal BPs, (7) an expanded role for ambulatory BP monitoring in the diagnosis and management of pediatric hypertension, and (8) revised recommendations on when to perform echocardiography in the evaluation of newly diagnosed hypertensive pediatric patients (generally only before medication initiation), along with a revised definition of left ventricular hypertrophy. These guidelines include 30 Key Action Statements and 27 additional recommendations derived from a comprehensive review of almost 15 000 published articles between January 2004 and July 2016. Each Key Action Statement includes level of evidence, benefit-harm relationship, and strength of recommendation. This clinical practice guideline, endorsed by the American Heart Association, is intended to foster a patient- and family-centered approach to care, reduce unnecessary and costly medical interventions, improve patient diagnoses and outcomes, support implementation, and provide direction for future research.
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