Jennifer R. Hayford

Psychopathology and health care use among preschool children: A retrospective analysis

OBJECTIVE To examine the relationship between psychopathology and health care utilization beginning in the preschool (ages 2 to 5) years. METHOD Five hundred ten preschool children were enrolled through 68 primary care physicians. The test battery used for diagnoses included the Child Behavior Checklist, a developmental evaluation, the Rochester Adaptive Behavior Inventory, and a videotaped play session. Consensus DSM-III-R diagnoses were assigned using best-estimate procedures. Frequency of primary care visits was established through 1-year retrospective record review; mothers estimated total visits and emergency department (ED) use. RESULTS Logistic regression models showed that a DSM-III-R diagnosis was related to increased ED use but not primary care or total visits. Greater functional impairment was associated with fewer primary care visits and more ED visits. Total, internalizing, and externalizing behavior problem scores were associated with increased primary care and total visits; ED visits were associated with increased total and internalizing problems. Childs health status consistently correlated with utilization. CONCLUSION There is a consistent relationship between health care use and child psychopathology beginning in the preschool years.

Interrater reliability of the DSM-III-R with preschool children

Little attention has been paid to evaluating the use of DSM-III-R with preschool children. Children (N = 510) ages 2 to 5 years who were screened at the time of a pediatric visit were selected to participate in an evaluation which included questionnaires, a semistructured interview, developmental testing, and a play observation. Following the evaluation, two clinical child psychologists independently assigned DSM-III-R diagnoses. For each diagnostic category, kappa and Ycoefficients were calculated; Ycoefficients are less sensitive to base rates of disorders. For overall agreement, the weighted mean kappa (.61), and mean Y(.66) were moderately high. Overall agreement that the child had at least one of the disruptive disorders was substantial (kappa =.64; Y =.65);agreement that there was at least one of the emotional disorders was moderate for kappa (.54), but substantial for Y(.70). Kappa coefficients were higher for major categories of disorder than for specific disorders; however, Ycoefficients did not show a decline for specific disorders. Interrater reliability of DSM-III-R appears to be similar for preschoolers and older children.

Increase in serum concentration of keratan sulfate after treatment of growth hormone deficiency with growth hormone

Keratan sulfate is a glycosaminoglycan; in man, most KS is present in cartilage proteoglycans, 1 but small amounts have been identified in blood.l, 2 Recent evidence indicates that this KS is almost exclusively derived from catabolism of cartilage proteoglycans.l-3 As a result, it has been postulated that the concentration of KS in the blood is directly proportional to the rate of degradation of cartilage proteoglycans.I, 2 Linear growth results from bone formation on a cartilage scaffold (endochondral ossification) and depends on adequate function of the hypothalamic-pituitary-somatomedin-insulin-like growth factor I axis and the genetic ability of cartilage to respond to these secretions. 4, 5 In the growing child, serum levels of KS are elevated, which is not unexpected because growing cartilages are constantly undergoing degradation and replacement by new bone formation. We previously reported that serum levels of keratan sulfate rise from low levels in infancy and reach a plateau by the age of 4 to 5 years. Serum concentrations of KS appear to remain high until age 12 years, when they rapidly decline toward the levels found in normal adult sera. Serum levels of KS in a growing child correlate with the individual childs age-adjusted percentile height. 6 In our investigation, we measured the serum concentrations of KS in two groups of children with short stature: one group with Constitutional delay of maturity and the other with growth hormone deficiency. In the latter group, we compared KS levels before and after treatment with growth

Juvenile Dermatomyositis at Onset: Demographics, Clinical Characteristics, and Access to Care. ♦ 1844

Juvenile Dermatomyositis at Onset: Demographics, Clinical Characteristics, and Access to Care. ♦ 1844

COMPARISONS OF SERUM LEVELS OF KFRATAN SULFATE (KS) WITH HEIGHT IN AN OUTPATIENT PEDIATRIC POPULATION (GFNPFDS), CONSTITUTIONAL. GROWTH DELAY (CD), AND IN JUVENILE RHEUMATOID ARTHRITIS (JRA)

We had previously reported that serum levels of KS increased from birth, reached a plateau between 6-11 years of age and then rapidly declined to levels which were maintained throughout normal adulthood. The purpose of this study was to determine if serum levels of KS were correlated with the percentile height in children in the 6-11 year old age range, using an ELISA with a monoclonal antibody 1/20/5-D-4 to KS. Sera were obtained from 33 GENPEDS whose records had been screened and who had no evidence of autoimmune disease. Levels of KS (ng/ml ± SD) were higher in taller children (≥75th percentile) than shorter children (≤25th percentile): 632±122 vs. 480±126, (p<.007). Fourteen children with CD (<5th percentile) had KS values of 414±118 which were not significantly different from the shorter group of GENPEDS, p=O.11. In contrast, the CD group had KS values significantly different from the ≥75th percentile GENPEDS, p=0.001. KS values in 10 JRA children, ages 6-11, of varying percentile height prior to any steroid treatment were low, i.e. 451±98. Another group of JRA children, on steroids, had an even lower KS value; 399±83. These studies suggest that KS values are correlated not only with the height of the child but may also reflect alterations in cartilage proteoglycan metabolism in JRA which is accentuated by prednisone.