417Child health certificates: cardiovascular examination by the paediatricianguidelines
I. Germanakis, π. Papagiannis, G. Varlamis
426The effect of childhood epilepsy on cognitive function and behaviour
A. Prassouli, A. Attilakos, I. Antoniadou
434Internet addiction in adolescence
∞. Papadopoulou, P. Georgiopoulou-Micha
ORIGINAL ARTICLES
441Study on the use and misuse of internet among Greek adolescents
∞. Tsitsika, ∂. Kritseli, ∂. Konstantoulaki, G. Kormas, ∞. Filippopoulou, D. Tounissidou, ∞. Freskou, T. Spiliopoulou, ∞. Louizou, A. Constantopoulos, D. Kafetzis
449Computer and internet use by school age children in Athens
A. Papadopoulou, G. Michas, F. Michas, A. Zervoudakis, K. Tsoumakas, P. Georgiopoulou-Miha
458The A TEST; assessment of school readiness
S. Mantoudis, L. Thomaidis
469Model health promotion program in an urban community by a primary health care setting
A. Xekalaki, D. Menegas, K. Zolota, Z. Iliodromiti, A. Prasouli, E. Tzini, P. Mavrika, K. Dimopoulou, A. Margari, I. Antoniadou-Koumatou
475Application of the legislation on allergen labelling for selected food products in the Greek market
∞. Vassilopoulou, ∂. Stroumpi, ¡.G. Papadopoulos, V. Karathanos
PRACTICAL ISSUE
482Non-nutritive sucking habits: their influence on children’s health
G. Tsolas
CASE REPORT
486Mastocytosis in children: a report of two cases
V. Aggelakou, M. Koutli, N. Papadopoulos, E. Manoussakis, P. Xepapadaki, I. Charoniti
On behalf of the Editorial Board of “Paediatriki”, I wish you Merry Christmas and a happy and creative new year.
On this occasion, we would like to thank you for your continuous participation to the journal and we look forward for your advice and feedback. We would especially like to thank the authors, the reviewers and each one of you who has contributed to the success of the journal.
I am sure that with your contributions the New Year will also prove to be creative for “Paediatriki”.
Child health certificates: cardiovascular examination by the paediatrician - guidelines
I. Germanakis1, π. Papagiannis2, G. Varlamis3
Abstract: Preparticipation cardiovascular evaluation is obligatory for all children in Greece before participation in school athletic activities, while additional evaluation is requested by individual sports clubs. The current policy regarding preparticipation screening in Greece was reviewed. According to recent practice guidelines, the current screening practices could be improved by the addition of further details of the personal and family history, parental confirmation of the accuracy of the history provided, the use of a standardized physical evaluation and possibly the performance of an electrocardiogram before participation in competitive sports. However, as none of the current preparticipation screening systems can guarantee a ‘zero risk’ state during high intensity competitive sports, effective screening continues to be based on a detailed personal and family history and physical evaluation performed by a well trained general paediatrician.
1 Medical School, University of Crete, Crete, Greece
2 Pediatric Cardiologic Clinic, “Mitera” General, Maternity & Children’s Hospital
3 Medical School, Aristotelio University of Thessaloniki, Thessaloniki, Greece
Correspondence: Ioannis Germanakis germjohn@med.uoc.gr Paediatric Cardiology Unit, Department of Paediatrics, University Hospital of Heraklion, Crete, Greece
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Department of Social and Developmental Paediatrics, Institute of Child Health, “Aghia Sophia” Children’s Hospital
Thivon & Levadias St., 115 27, Athens
A.
Prassouli,
A. Attilakos, I. Antoniadou
Abstract: Epilepsy is one of the most common neurological disorders in childhood. Children with epilepsy are at increased risk of cognitive dysfunction and behavioural problems, compared with normal children or children with other chronic diseases not involving the central nervous system. Cognitive dysfunction and behavioural problems may precede, coincide with or follow the diagnosis of childhood epilepsy. Numerous investigators have attempted to identify specific factors contributing to or predictive of cognitive and behavioural impairment in epileptic children, with conflicting results. The investigation of the precise relationship between epilepsy and cognitive/behavioural dysfunction is confounded by several variables, including the type of seizures, the pathophysiology of the epilepsy, the underlying brain damage, the occurrence of subclinical epileptiform discharges, the effect of antiepileptic drug treatment and family-related parameters. Epilepsy type, age at onset, seizure frequency, and subclinical epileptiform disharges have been associated with the occurrence of cognitive impairment, while additional neurological deficits, drug-resistant epilepsy, and family-related factors have been associated with the occurrence of behavioural disturbance in epileptic children. In any case, the neurological monitoring of children with epilepsy should include evaluation of cognitive and behavioural functions, and provision of appropriate intervention when needed.
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Department of Pediatrics, “KAT” General Hospital, Athens, Greece
Abstract: Internet addiction has been diagnosed increasingly in the last decade and it is a recognized phenomenon in adolescence in developed countries. It is characterized by compulsive use and addictive behaviour, to a degree which interrupts personal, social, academic, economic and occupational activities and is associated with withdrawal symptoms, such as anxiety, trembling, tremors, aggressiveness and fantasies, which are relieved by re-use of the internet. Internet addiction is the combined result of many social factors and personal characteristics and is often associated with depression. Its prevalence in adolescence ranges from 1% to 9%. A few internet addiction recovery centres have been organized, with their main task that of changing the subjects’ everyday life, encouraging them to create other activities and trying to influence the family environment in a positive way. The internet offers an on-line updated library in the home, an open window to the world knowledge, and a means for children to improve their talents. However, for children and adolescents its use must be logical, with specific purposes and for certain time periods, supervised by adults; all persons responsible for children’s biopsychosocial development (parents, teachers, paediatricians, mental health professionals) should be aware of the problem of internet addiction and be able to identify prodromal symptoms and recognize children and adolescents who are at risk.
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34. Grüsser SM, Thalemann R, Griffiths MD. Excessive computer game playing: evidence for addiction and aggression? Cyberpsychol Behav 2007;10:290-292.
36. Subrahmanyam K, Kraut RE, Greenfield PM, Gross EF. The impact of home computer use on children's activities and development. Future Child 2000;10:123-144.
37. Beard KW. Internet addiction: a review of current assessment techniques and potential assessment questions. Cyberpsychol Behav 2005;8:7-14.
38. Meenan AL. Internet Gaming: A Hidden Addiction. Am Fam Physician 2007;76:1116-1117.
39. Wu CS, Cheng FF. Internet café addiction of Taiwanese adolescents. Cyberpsychol Behav 2007;10:220-225.
40. Subrahmanyam K, Lin G. Adolescents on the net: Internet use and well-being. Adolescence 2007;42:659-677.
41. Olson CK, Kutner LA, Warner DE, Almerigi JB, Baer L, Nicholi AM 2nd, et al. Factors correlated with violent video game use by adolescent boys and girls. Adolesc Health 2007;41:77-83.
42. Ng BD, Wiemer-Hastings P. Addiction to the internet and online gaming. Cyberpsychol Behav 2005;8:110-113.
43. Van den Bulck J. Television viewing, computer game playing, and Internet use and self-reported time to bed and time out of bed in secondary-school children. Sleep 2004;27:101-104.
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47. Young KS. Cognitive behavior therapy with Internet addicts: treatment outcomes and implications. Cyberpsychol Behav 2007;10:671-679.
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49. Chien C, Linda C, Belland JC. A Review of the Research on Internet Addiction. Educational Psychology Review 2005; 17:363-388.
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Study on the use and misuse of internet among Greek adolescents
∞. Tsitsika1, ∂. Critselis2, ∂. Konstantoulaki1, G. Kormas1, ∞. Filippopoulou1, D. Tounissidou1, ∞. Freskou1, T. Spiliopoulou1, ∞. Louizou1, A. Constantopoulos1, D. Kafetzis2
Abstract
Background: The internet is an integral tool for information, social communication, and entertainment among adolescents. However, the risk of adopting pathological internet use behaviour is inherent. The aim of this study was: (1) to evaluate the prevalence and (2) to assess the characteristics and predictors of internet use, and (3) to measure the prevalence of pathological internet use among Greek adolescents.
Methods: A cross-sectional study design was applied. The source population (N=897) consisted of a random sample, stratified according to locality and population density, of adolescents residing in Athens, Greece. Self-completed questionnaires, pertaining to internet access characteristics, and the Young Internet Addiction Score (YIAS) were utilized in order to assess the predictors of internet use and the prevalence of pathological internet use.
Results: Multivariate logistic regression analysis indicated that the most significant predictors of all categories of internet use included accessing the internet via one’s own home portal and internet access for on-line games and social interaction (i.e. e-mail and chat room use). Internet access via the school environment was a significant protective factor against the development of misuse. Access via internet cafés was a significant predictor for high (11-20 hours/week) internet users. According to the YIAS, 1% of the study population reported Addictive Internet Use and 12.8% recorded problems of use that could potentially lead to future pathology (Borderline Internet Use).
Conclusions: Internet misuse is apparent among Greek adolescents and calls for intervention and preventive public health programmes.
Key words: Adolescence, internet use, internet misuse, internet addiction.
AÏÏËÏÔÁÚ·Ê›·:
1 Adolescent Health Unit (AHU), 2nd Department of Paediatrics, Medical School, University of Athens, “P. & A. Kyriakou” Children’s Hospital, Athens, Greece 2 2nd Department of Paediatrics, Medical School, University of Athens, “P. & A. Kyriakou” Children’s Hospital, Athens, Greece
Correspondence: Artemis Tsitsika info@youth-health.gr Adolescent Health Unit (AHU), 2nd Department of Paediatrics, Medical School, University of Athens, “P. & A. Kyriakou” Children’s Hospital, Athens, Greece
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0-1 ÒÚ·/ ‚‰ÔÌ¿‰· 1-3 ÒÚ˜/‚‰ÔÌ¿‰· 4-10 ÒÚ˜/‚‰ÔÌ¿‰· 11-20 ÒÚ˜/‚‰ÔÌ¿‰· >20 ÒÚ˜/‚‰ÔÌ¿‰· (N=277) (N=318) (N=191) (N=55) (N=56) N (%) N (%) OR 95% CI N (%) OR 95% CI N (%) OR 95% CI N (%) OR 95% CI
(N=897) 1-3 ÒÚ˜/‚‰ÔÌ¿‰· (N=524) 4-10 ÒÚ˜/‚‰ÔÌ¿‰· (N=381) 11-20 ÒÚ˜/‚‰ÔÌ¿‰· (N=262) >20 ÒÚ˜/‚‰ÔÌ¿‰· (N=264) Maximum Wald CI Maximum Wald CI Maximum Wald CI Maximum Wald CI Likelihood for Likelihood for Likelihood for Likelihood for Estimates Adj OR Estimates Adj OR Estimates Adj OR Estimates Adj
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differences and related factors affecting online gaming addiction among Taiwanese adolescents. J Nerv Ment Dis 2005; 193:273-277.
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31. Nalwa K, Anand AP. Internet addiction in students: a cause of concern. Cyberpsychol Behav 2003;6:653-656.
32. Whang LS, Lee S, Chang G. Internet over-users’ psychological profiles: a behaviour sampling analysis on internet addiction. Cyberpsychol Behav 2003;6:143-150.
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Computer and internet use by school age children in Athens
A. Papadopoulou, G. Michas, F. Michas, A. Zervoudakis, K. Tsoumakas, P. Georgiopoulou-Miha
Abstract
Background: Children are attracted to computer and internet early in life, which may make them vulnerable to adopting high risk behaviour. The aim of this study was to investigate the prevalence of internet use in school age children and to determine risk factors.
Methods: The population sample comprised 213 children (46% boys, mean age 12.3 years) from primary and secondary public schools in Athens, who answered an anonymous questionnaire.
Results: Among children in the study, 90.1% used a computer and 69.9% had access to internet, with a mean age of initiation 8.5 years. Children were instructed mainly by parents and siblings (44.6%), only 14.5% by school teachers, while 22% attended private tutorial centres. In their families, 70% of fathers and 55.3% of mothers used a computer, with significant relationship to their occupation [OR (95% CI): 3.11 (1.55-6.26) and 2.37 (1.31-4.28), respectively]. The computer was located in the child’s bedroom in 46.4% of the cases, and daily use was reported to be 52.6% for computer and 26.2% for internet. The main reasons given for the use were recreation (70%) and education (29%). Only 51.6% of parents regularly supervised their children’s use of internet. Among the study children, 32.3% reported visiting an internet café (mean age 13 years) and 37.8% pornographic sites (mean age 12.5 years). Health problems due to overuse were reported by 43 children (22.3%).
Conclusions: The majority of school age children in Athens use computer and internet, mainly for recreation. The family is reported to be the main educator; however, parental supervision is inadequate and many children have opportunities to visit “garbage sites”.
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15. Dannon PN, Iancu I. Internet addiction. Harefuah 2007; 146:549-553.
16. Nichols LA, Nicki R. Development of a psychometrically sound internet addiction scale: a preliminary step. Psychol Addict Behav 2004;18:381-384.
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24. Grüsser SM, Thalemann R, Albrecht U, Thalemann CN. Excessive computer usage in adolescents-results of a psychometric evaluation. Wien Klin Wochenschr 2005;117: 188-195.
25. Jang KS, Hwang SY, Choi JY. Internet addiction and psychiatric symptoms among Korean adolescents. J Sch Health 2008;78:165-171.
26. Cao F, Su L. Internet addiction among Chinese adolescents: prevalence and psychological features. Child Care Health Dev 2007;33:275-281.
27. Johansson A, Götestam KG. Internet addiction: characteristics of a questionnaire and prevalence in Norwegian youth (12-18 years). Scand J Psychol 2004;45: 223-229.
Department of Developmental Paediatrics, “P. & A. Kyriakou” Children’s Hospital, Athens, Greece
Correspondence: Loretta Thomaidis developmental-health@ yahoo.gr Department of Developmental Paediatrics, “P. & A. Kyriakou” Children’s Hospital, Athens, Greece
Ì ÙËÓ Îϛ̷η TVƒS (r=0,895, p=0,000) Ô˘ ÌÂÙÚ¿
TVªS (r=0,599, p=0,000) Ô˘ ÌÂÙÚ¿ ·ÔÎÏÂÈ-
The A TEST; assessment of school readiness
S. Mantoudis, L. Thomaidis
Abstract
Objectives: The development of a reliable, flexible, short instrument for the detection of early learning disabilities.
Methods: Two representative samples of children were studied: a sample aged 4-7 years for a pilot study (N=322), and a sample with an average age of 5 years and 8 months, that of the final study (¡=2002). In order to decide on the final scales to be included in the test, many developmental assessment instruments were used, such as: hand-eye coordination, visual perception, linguistic development tasks, intelligence scales and learning ability tests. The sectors that showed a deviation of equal to or more than two standard deviations were selected. The final composition of the 7 scales which comprise the test was based on the statistical analysis.
Results: The assessment standards of children’s abilities were determined according to the first administration of the A TEST (Excellent, Normal, Borderline and Low performance). The A TEST was found to be positively correlated with the TVPS scale (r=0.895, p=0.000), which is used exclusively for the assessment of Visual Perception, and with the TVMS scale (r=0.599, p=0.000), which is used exclusively for the assessment of hand-eye coordination.
Conclusions: The reliability and validity of the ∞ TEST were found to be 99.8% and 97%, respectively; the A TEST thus detects effectively both those children who have all the essential skills to start primary school and those who do not.
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Model health promotion program in an urban community by a primary health care setting
A. Xekalaki1, D. Menegas1, K. Zolota1, Z. Iliodromiti1, A. Prasouli1, E. Tzini1, P. Mavrika1, K. Dimopoulou1, A. Margari2, I. Antoniadou-Koumatou1
Abstract Background: The role of primary health care has been identified as very important for improving the health of the population. Community participation is a prerequisite in contemporary health promotion models.
The Child Health Centre of Kessariani, an urban primary health care centre scientifically supervised by the Institute of Child Health, designed and implemented a health education-promotion programme in the community, on the issue of “Health and the Environment”. The aims of the programme were: a) to enable the children to understand how the pollution of the environment affects health, and that health is protected when environment is protected, and b) to create a model programme which can be implemented by various settings.
Methods: The target population comprised the pupils of the kindergartens and the elementary and secondary schools of the area. The action plan included: 1) community participation, 2) education of professionals and educators, 3) health education sessions in schools, 4) community health education, and 5) evaluation of the programme using questionnaires completed by pupils and teachers.
Results: Data from the analysis of the questionnaires showed a statistically significant difference (p<0.01) in the level of relevant knowledge after the interventions, which was demonstrated to be excellent. The content of the electronic presentations was evaluated as from exceptional to very appropriate for each age
1 Institute of Child Health, Health Care Centre of Kessariani, Athens, Greece
2 Ecological Workshop of Municipality of Kessariani, Athens, Greece
Correspondence: Ioanna AntoniadouKoumatou inchildh@otenet.gr Institute of Child Health “Aghia Sophia” Children’s Hospital Thivon and Levadias St. 11527, Athens, Greece
group by 89.6% of the elementary school teachers and 84.2% of the secondary school teachers. The mode of presentation was evaluated by the teachers as very accurate, vivid and flexible.
Conclusions: Promoting community participation in health education-promotion by a primary health care team is an innovative approach in Greece, since it requires a health care system based on primary care. It is suitable for standard work practice in the primary care setting.
Key words: Health education, environment, community.
Application of the legislation on allergen labelling for selected food products in the Greek market
∞. Vassilopoulou1, ∂. Stroumpi2, ¡.G. Papadopoulos1, V. Karathanos2
Abstract
Introduction: Food labelling legislation has been established by the European Union (EU) for the protection of the health of consumers, in particular those who have food allergies, and to guarantee their right to be reliably informed about the food they consume. The aim of this study was to evaluate the labelling of food products available in the Greek market for certain allergens and their derivatives in 198 selected foods (biscuits, dark chocolate, milk, and packaged bread), with respect to the application of the EU legislation and the precautionary measures taken to avoid cross-contamination during production and sale.
Methods: The EU legislation on food labelling was reviewed in detail. Its application on selected food products was assessed by a detailed record of the terms used on packages to describe common allergens (milk, egg, wheat, peanuts, tree-nuts, soya). A standard questionnaire was used to evaluate the precautionary measures taken by the manufacturers to avoid cross contamination.
Results: Food allergens and their derivatives were recorded in a variety of ways on food packaging labels (7 for wheat, 29 for milk, 6 for egg, 8 for tree-nuts, 2 for peanuts and 5 for soya). The frequent use of complex terms to describe food allergens and the extensive use of precautionary labelling (65.66%) makes it impossible for the consumer to recognise a specific allergen. Companies report inability to avoid crosscontamination during production.
Conclusion: The use of complicated, non-specific terminology and precautionary labelling in the majority of products sold in the Greek market make it difficult to characterise a product as “allergen free”. It is
1 Allergology Research Center & Department of Allergology, 2nd University Department, “P. & A. Kyriakou” Children’s Hospital, Athens, Greece
2 Department of Nutrition, Harokopio University, Athens, Greece
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Non-nutritive sucking habits: their influence on children’s health
2nd Department of Paediatrics, University of Athens, “P. & A. Kyriakou” Children’s Hospital, Athens, Greece
Correspondence: Georgios Tsolas geotsol@otenet.gr
2nd Department of Paediatrics, University of Athens, “P. & A. Kyriakou” Children’s Hospital, Athens, Greece
G. Tsolas
Abstract: Certain oral habits in infants have been linked to medical conditions or adverse outcomes, especially related to orofacial structures. Most children suck their thumbs, fingers, or a pacifier at some time in their early life. These habits are very common and have a soothing and calming effect. There is also evidence that pacifiers may help reduce the risk of sudden infant death syndrome (SIDS). The only time sucking habits might be a concern is if they continue beyond the age of 6 to 8 years or affect the shape of the child’s mouth or teeth pattern. The good news is that most children stop their sucking habits before they get very far in school. This means that parents may be assured that their child will eventually stop the habit on his/her own, and they should know that putting too much pressure on their child to stop the habit may cause more harm than good.
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Abstract: Mastocytosis is an uncommon disease in infants and children. It is characterized by aggregates of large numbers of mast cells in several body tissues. The clinical manifestations depend on the dispersion of mast cells in specific organs and the secretion of mast cell mediators. Skin is the tissue usually affected in children and dermal manifestations may be the only presenting feature of the disease. Adults usually present with systemic mastocytosis and are more often affected by the more severe forms of the disease. Two cases of cutaneous mastocytosis in childhood of different types are presented. A 7 month-old male infant had first presented at the age of three months, with brownish maculopapular cutaneous lesions. There were no other clinical signs, apart from jitteriness and pruritus. The Darier sign was positive. Biopsy of the lesion revealed large perivascular aggregates of mast cells, which were compatible with maculopapular cutaneous mastocytosis. A 13 year-old boy presented with episodes of respiratory distress, expiratory wheezing, epigastric pain, flushing, facial angioedema, pruritus and lowered blood pressure. No apparent cutaneous lesions were reported and the Darier sign was negative. Skin biopsy revealed perivascular mast cell aggregates, while examination for systemic mastocytosis was negative. The diagnosis was made of diffuse cutaneous mastocytosis.
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