Christine L. Williams

Screening for risk factors for chronic disease in children from fifteen countries

Abstract An international collaborative health screening project was undertaken to stimulate interest in child health education, to study feasibility of health screening in young children from diverse cultures, and to compare the distribution of chronic disease risk factors among 15 countries. Data for the 13-year-old participants showed that risk factors defined by cholesterol greater than 180 mg/dl, systolic blood pressure greater than 130 mm Hg, and daily or occasional smoking were present, to varying degrees, in children from each country. We found no relationship between obesity and cholesterol or blood pressure for these children. The acceptability of the screening, the childrens enjoyment in participation, and the prevalence of risk factors at this young age lead to the conclusion that school-based health education programs should be initiated during childhood.

Primary prevention of chronic disease beginning in childhood: The “Know your body” program: Design of study☆

Abstract A controlled study is described for chronic disease risk factor identification and intervention among 3000 (of 4600 eligible) school children, 11 to 14

Lyme disease and pregnancy outcome: A prospective s of two thousand prenatal patients

OBJECTIVE The purpose of the study was to determine if prenatal exposure to Lyme disease was associated with an increased risk of adverse pregnancy outcome. STUDY DESIGN Approximately 2000 Westchester County, New York, women completed questionnaires and had sera tested for antibody to Borrelia burgdorferi at their first prenatal visit and at delivery. Fetal death, birth weight, length of gestation at delivery, and congenital malformations were examined in relation to maternal Lyme disease exposure before and during pregnancy. RESULTS Maternal Lyme disease or an increased risk of exposure to Lyme disease was not associated with fetal death, decreased birth weight, or length of gestation at delivery. Tick bites or Lyme disease around the time of conception was not associated with congenital malformations. Tick bites within 3 years preceding conception were significantly associated with congenital malformations, but this could have reflected reporting differences between exposed and unexposed women. CONCLUSIONS Maternal exposure to Lyme disease before conception or during pregnancy is not associated with fetal death, prematurity, or congenital malformations taken as a whole. We have not ruled out the possibility that exposure to Lyme disease as defined by maternal history increases the risk of specific malformations or has an effect if it is not treated. We have insufficient numbers of women who were seropositive at their first prenatal visit to determine if this subgroup of exposed women are at a moderately increased risk of having a child with a congenital abnormality. The low frequency of seroconversion at delivery in this endemic area suggests that preventive measures are being taken by obstetricians and patients.

The “know your body” program: A developmental approach to health education and disease prevention☆

Abstract The goal of health education is to motivate society to adopt health behaviors that will reduce premature morbidity and mortality from known preventable causes, including major chronic disease (heart disease, cancer, and stroke) and accidents. This motivation can be effective only within the framework of an action-oriented school health education program with a high degree of personal involvement. This paper describes the foundations of a new school health education system combining health screening, a “Health Passport,” a behavior-oriented health curriculum, and special interventions for high-risk students. We suggest that effective health education programs such as Know Your Body (KYB) become as important in our schools as reading, writing, and arithmetic, and that these be taught each year on a developmentally progressive scale, much in the same fashion as the three Rs.

Prevalence of selected cardiovascular and cancer risk factors in a pediatric population: The “Know Your Body” project, New York

Abstract The “Know Your Body” health education program attempts to reduce childrens risk for future disease through a multidimensional approach that combines health screening, a Health Passport that provides feedback to students on their results, teacher training, and curriculum materials on behavior-oriented learning activities, and special activities for high-risk students. As part of an international collaborative project with 14 other nations, more than 3,600 New York City area children age 12 to 15 years underwent health screening evaluations consisting of height, weight, triceps skinfold thickness, blood pressure, plasma total cholesterol and HDL cholesterol, pulse rate recovery index after exercise, and cigarette smoking history. This report provides mean, standard deviations, 90th and 95th percentiles for these measurements by age and sex of the child. These values could be useful in evaluating risk factor levels in childhood.

Lyme disease in childhood: clinical and epidemiologic features of ninety cases.

In 1982 and 1983 practicing pediatricians in a Lyme disease-endemic county, reported 90 cases of Lyme disease among children 19 years of age and younger (median age, 9 years). Three-fourths of the children had initial symptom onset in the summer months, with peak incidence in July. Infection occurred twice as often in boys than in girls, and tick bites were recalled by less than half (49%) of the children or parents. Erythema chronicum migrans was present in two-thirds (67%) of the cases with median onset 7 days after a definite tick bite. Arthritis or arthralgia occurred in 59% and neurologic symptoms, especially seventh nerve palsy, occurred in 14%. Asymmetric involvement of a few large joints, especially the knee, was most commonly reported for those with joint involvement. Antibiotics were prescribed for 79% of the children, three-fourths of whom were treated with oral penicillin. Initial diagnosis of Lyme disease is usually made on clinical grounds alone because serologic tests are often negative. Serologic tests for antibody to Borre-lia burgdorferi were more often positive in cases with neurological or joint involvement, in addition to erythema chronicums migrans (80%), than in cases presenting with erythema chronicums migrans only.

Soluble fiber enhances the hypocholesterolemic effect of the step I diet in childhood

BACKGROUND Psyllium, a water-soluble fiber, has been shown to have a cholesterol-lowering effect in studies of adults. A small number of studies in children have produced variable results. METHODS A 12-week, randomized, single-blind, placebo-controlled, parallel clinical trial was conducted to test the effectiveness of psyllium in lowering total (TC) and low-density lipoprotein cholesterol (LDL-C) in 50 healthy 2 to 11 year old children. Children with two baseline LDL-C levels > or = 110 mg/dL were invited to participate in the trial, and were randomly assigned to follow a usual Step I (Control) diet of low dietary fat, saturated fat and cholesterol, or a Step I diet enriched with psyllium. Children consumed two 1-oz boxes of cereal per day, with each box of psyllium-enriched cereal containing 3.2 g of soluble fiber, and each box of placebo cereal containing less than 0.5 g of soluble fiber. RESULTS Greater reduction of total and LDL-cholesterol, and increase in HDL-cholesterol were noted after 12 weeks of the psyllium-enriched Step I diet compared to the Step I control diet. Total cholesterol decreased 21 mg/dL for the high fiber group compared with 11.5 mg/dL for the control group. LDL-C decreased 23 mg/dL for the high fiber group compared with 8.5 mg/dL for the control group. HDL-C increased 4 mg/dL for the high fiber group compared with 1 mg/dL for the controls. TC/HDL and LDL/HDL ratios decreased significantly more so for the high fiber group as well. CONCLUSIONS In this 12-week study, soluble fiber (psyllium) provided added benefit to the Step I diet in the treatment of hypercholesterolemia.

Lyme disease: epidemiologic characteristics of an outbreak in Westchester County, NY.

Epidemiological and clinical characteristics of 210 cases of Lyme disease in Westchester County, New York, reported during 1982 and 1983 are described. Most cases occurred during summer months in individuals under age 40 (male: female ratio 1:2 to 1). Symptoms included skin rash (75 per cent), joint pain or swelling (50 per cent), Bells palsy (11 per cent), and aseptic meningitis (3 per cent). With greater public and medical awareness of this tick-borne disease, Lyme disease is being recognized with increasing frequency characteristic of an emerging epidemic in Westchester County.

Reducing Fat in Preschool Meals: Description of the Foodservice Intervention Component of Healthy Start

Abstract Healthy Start is a 3–year demonstration and education research project to evaluate the effectiveness of a coronary heart disease risk reduction program in Head Start centers in New York State. The primary goal of the program is to demonstrate that it is possible and safe to reduce young childrens intake of fat to desirable levels. The development and initial implementation of the nutrition intervention component of the program are described in this report. Nutrition intervention includes nutrition education for the childrens care givers and modifications in the foodservice operation in each of the studys six intervention sites. Recommendations are provided to guide educators in future research and practice.

Primary prevention of cancer beginning in childhood

Abstract There is evidence suggesting that a large proportion of adult morbidity and mortality from major chronic disease, particularly cancer and atherosclerosis, might be prevented through educational strategies designed to motivate adoption of a healthier lifestyle beginning in childhood. The “Know Your Body” project is a behaviorally oriented prototype chronic disease prevention education program, based on developmental capabilities and focused on facilitating appropriate personal health decisions at each age.