Omineca Herald, May, 10, 1933

Context. In central hypothyroidism (CeH) free thyroxine (FT4) concentrations are low while TSH concentrations may be low, normal or even slightly elevated due to reduced bioactivity. Congenital CeH (CCeH) may be isolated or part of multiple pituitary hormone deficiency (MPHD). Objective. To test our hypotheses that (1) TSH concentrations have a more U-shaped distribution in children with CCeH compared to children with a normally functioning hypothalamic-pituitary-thyroid-axis, and (2) TSH concentrations in children with CCeH with MPHD are higher compared to children with isolated CCeH. We also studied whether FT4 levels are helpful in distinguishing CCeH from mild primary CH (CH-T). Methods. Dutch neonatal screening TSH and first diagnostic TSH and FT4 were analyzed of all children diagnosed with permanent CCeH between 1995 and 2012. Controls were children with TBG deficiency. FT4 concentrations in CCeH were compared to those in CH-T with TSH-values in the same range as those of CCeH. Results. We studied 120 children with CCeH (isolated CCeH, N=50; MPHD, N=70) and 350 controls. Screening TSH concentrations were not significantly different (p =0.055) but diagnostic TSH values were significantly different between the CCeH group and the control group (p=0.037). TSH was significantly higher in MPHD compared to isolated CCeH (p=0.004). FT4 concentrations were significantly lower in CCeH compared to mild CH-T (p<0.0005). Conclusion. TSH values in CCeH have a more U-shaped distribution compared to controls with the TSH concentrations in CCeH with MPHD. FT4 levels were significantly lower in CCeH compared to CH-T. Chemicals/CAS: thyrotropin, 9002-71-5; thyroxine, 7488-70-

Predictive validity of developmental milestones for detecting limited intellectual functioning

Developmental milestones are commonly used in child health care, although from many milestones the predictive validity has not been adequately assessed. We aimed to determine the predictive validity of 75 developmental milestones for detecting limited intellectual functioning that can be obtained before the age of 4 years. We performed a case-control study with 148 children aged 5–10 years with limited intellectual functioning (IQ 50–69), who were in special education (cases) and a random sample of 300 children aged 5–10 years who were in regular elementary education (controls). Developmental milestones scores were retrieved from Child Healthcare files. We calculated sensitivity, specificity, positive likelihood ratios (LR+) and diagnostic odds ratios (DOR) for limited intellectual functioning. The LR+ determines whether a test result changes the probability that a condition exists. Given the prevalence of intellectual disability (1–3%), we considered that an LR+ > 10 would be clinically useful, as it increases the a priori probability of limited intellectual functioning from 2% to a posteriori probability of at least 17%. Out of 75 assessed milestones, 50 were included in the analysis. We found nine milestones to have a significant adjusted (for socio-economic status and prematurity) DOR > 1 and a significant LR+ > 10 (assessment age in months between brackets): ‘says "dada-baba‴ (9), ‘balances head well while sitting’ (9), ‘sits on buttocks while legs stretched’ (9), ‘babbles while playing’ (12), ‘sits in stable position without support’ (12), ‘walks well alone’ (24), ‘says "sentences" of 3 or more words’ (36), ‘places 3 forms in form-box’ (36) and ‘copies circle’ (48). Sensitivities of these 9 milestones varied from 8–54%, specificities of these 9 milestones varied from 95–100%. Combining these milestones at 9, 12, and 36 months respectively resulted in sensitivities of 27–60% and specificities of 94–99%. These nine developmental milestones have substantial predictive validity for limited intellectual functioning.Multivariate analysis of psychological dat

Challenges and opportunities in mapping land use intensity globally

Future increases in land-based production will need to focus more on sustainably intensifying existing production systems. Unfortunately, our understanding of the global patterns of land use intensity is weak, partly because land use intensity is a complex, multidimensional term, and partly because we lack appropriate datasets to assess land use intensity across broad geographic extents. Here, we review the state of the art regarding approaches for mapping land use intensity and provide a comprehensive overview of available global-scale datasets on land use intensity. We also outline major challenges and opportunities for mappinglanduseintensityfor cropland, grazing, and forestry systems, and identify key issues for future research.Peer Reviewe

Costs and effects of conventional vision screening and photoscreening in the Dutch preventive child health care system

Background: Little is known about costs and effects of vision screening strategies to detect amblyopia. Aim of this study was to compare costs and effects of conventional (optotype) vision screening, photoscreening or a combination in children aged 3-6 years. Methods: Population-based, cross-sectional study in preventive child health care in The Hague. Children aged 3 years (3y), 3 years and 9 months (3y9m) or 5-6 years (5/6y) received the conventional chart vision screening and a test with a photoscreener (Plusoptix 512C). Costs were based on test duration and additional costs for devices and diagnostic work-up. Results: Two thousand, one hundred and forty-four children were included. The estimated costs per child screened were (sic)17.44, (sic)20.37 and (sic)6.90 for conventional vision screening at 3y, 3y9m and 5/6y, respectively. For photoscreening, these estimates were (sic)6.61, (sic)7.52 and (sic)9.40 and for photoscreening followed by vision screening if the result was unclear (combination) (sic)9.32 (3y) and (sic)9.33 (3y9m). The number of children detected with amblyopia by age were 9, 14 and 5 (conventional screening), 6, 13 and 3 (photoscreening) and 10 (3y) and 15 (3y9m) (combination), respectively. The estimated costs per child diagnosed with amblyopia were (sic)1500, (sic)1050 and (sic)860 for conventional vision screening, (sic)860, (sic)420 and (sic)1940 for photoscreensic)ing and (sic)730 (3y) and (sic)450 (3y9m) for the combination. Conclusions: Combining photoscreening with vision screening seems promising to detect amblyopia in children aged 3y/3y9m, whereas conventional screening seems preferable at 5/6y. As the number of study children with amblyopia is small, further research on the effects of these screening alternatives in detecting children with amblyopia is recommended.Research into fetal development and medicin

Alcohol, pregnancy and child development

COP/JEUG