UN report on the world's children: Things are better?and worse, Have we located a gene for language? Can parents tell how good their child's care is? Eye on Washington
This year, annual publication of the United Nations Children's Fund (UNICEF) report, The State of the World's Children, had been timed to coincide with a United Nations Special Session on Children, devoted to assessing progress since the UN's World Summit for Children held 11 years ago and setting new goals. The session, scheduled to start at UN headquarters in New York City on September 19, was one more casualty of the September 11th terrorist attack. UNICEF hopes to reconstitute the meeting in June 2002.
The report itself is well worth reading. It records impressive goals met: a reduction of 14% in mortality among infants and among children under 5 years of age; a 17% cut in the worldwide rate of malnutrition in children; greater access to safe drinking water and sanitary disposal of human feces; an increase in primary school enrollment and a slight improvement in the numbers of girls who have opportunities for primary schooling.
These improvements in the status of children are unevenly distributed; in some areas, such as sub-Saharan Africa, the condition of children has not improved at all or has become worse. Consider that:
Warfare disrupts the lives of children in many parts of the globe.
The epidemic of HIV infection and AIDS in places such as Haiti and southern and eastern regions of Africa continues to deprive thousands of children of the parents and teachers who might have nurtured their development.
Debt-ridden developing countries are unable to provide basic health and educational services for their children.
Strangely enough, one of the bright spots of reporting in The State of the World's Children involves the education of girls in Afghanistanin the northeastern province of Badakhshan, an area under the control of the so-called Northern Alliance, where Taliban policies that have closed girls' schools in the rest of the country can be ignored. In Badakhshan, international agencies have brought in school supplies, trained teachers, and provided monthly food rations for teachers and students who attend school regularly. Since 1993, the number of children enrolled in the province's schools has gone from 45,000 to 64,000, the percentage of female students has jumped from 19% to 33%, and the percentage of female teachers from 15% to 29%.
Other chapters of the report include specific instances of progress like this one, statistical measures of children's well-being in various parts of the world, accounts of successful global partnerships with industry and government on behalf of children, and calls for leadership in making the world a better place for children.
The State of the World's Children is available for $12.95 from UNICEF. For purchasing information, visit www.unicef.org .
Pediatricians know that some children have problems with language. These children may not be able to articulate certain sounds, or have difficulty finding the right word to express their ideas or generating grammatical sentences. The origin of such language difficulties has been a matter of dispute, but genetic explanations have not usually been invoked.
But what if a researcher found a family in which many members had such language problems, so that a familial explanation seemed logical? That is what happened in London in 1990, where a family, spanning three generations, first came to medical attention. Almost half (14 of 29) of family members had similar difficulty with articulation and verb tenses, other language problems, andin some but not all those affecteddefects in global intelligence. Linguists and geneticists have been at work analyzing the genetic map of this family ever since.
In a study published in Nature in October, Dr. Anthony P. Monaco of the University of Oxford announced the discovery of a mutation of a specific gene on chromosome 7 in affected members of this family that appears to unravel the mystery. All those plagued by language problems have this same genetic variation, as does an unrelated patient with the same pattern of impaired language.
Some students of language observe that this discovery buttresses the thesis of linguist Noam Chomsky, who hypothesized that the capacity for language is hard-wired into a particular area of the brain. Tracking the emergence of this mutation may provide clues to how long ago the capacity for language evolved in human beings. The implications of the finding for the diagnosis and treatment of language disorders in children have yet to be explored.
When it comes to evaluating the quality of pediatric health care, who should be the judge? Managed care administrators? Other physicians? The Agency for Healthcare Research and Quality? Michael Seid, PhD, and his colleagues at the Center for Child Health Outcomes in San Diego, believe that the answer is simple: Ask parents.
Dr. Seid's group has developed a measure of the quality of pediatric primary care that is brief, practical, reliable, and valid. His measure has been tested with 3,371 parents of children who are in kindergarten through 6th grade in a large, urban school district. Parents were asked to respond to 23 questions designed to measure continuity, access, physician's knowledge of the patient and family, comprehensiveness, and coordinationcharacteristics singled out by the Institute of Medicine as defining high-quality primary care. The instrument includes questions like these:
The instrument was administered in English, Vietnamese, Spanish, and Tagalog. Analysis of the responses indicated that parents were able to respond to the questions, that the instrument was internally consistent, and that the scores (on a 5-point scale) jibed with their children's health-related quality of life as measured by the PedsQL, an independently validated measure.
arents whose children had health insurance, those who completed the form in English, and those who had a regular doctor rated the quality of care their children received more highly than did parents who lacked these characteristics. For details of the study, see Pediatrics 2001;108(2):264.
The gentle air of Indian summer envelops a capital city now almost entirely preoccupied by war, the darkening shadow of bioterrorism, and rumors of more war. Responses to the catastrophe of September 11 continue to displace almost every other item on the Congressional agenda.
According to Senate Majority Leader Tom Daschle, earlier hopes for passing significant legislation on such issues as patients' rights, aid to education, mental health parity in insurance coverage, and prescription drug benefits under Medicare are no longer reasonable. At the same time, extensive tax cuts embedded in the administration's economic stimulus proposals will probably have smooth sailing, despite accusation from leading Democrats that the $100 billion package rewards the wealthy while low-income families continue to be shortchanged.
At the end of a press conference entirely dominated by the terrorism issue, President Bush expounded on the sufferings of the children of Afghanistan in a time of war and offered the children of America a unique opportunity for character development: "Earn or give a dollar to provide food and medical help for the children of Afghanistan." Children (and parents) moved by the presidential plea can send their dollar to America's Fund for the Children of Afghanistan, The White House, 1600 Pennsylvania Avenue, Washington, DC.
Few federal agencies were untouched by these preoccupations. Every news item on the Web site of the Department of Health and Human Services (DHHS) concerned the federal response to the disaster:
$35 million in grants to public and not-for-profit entities that have incurred health-carerelated expenses or lost revenues as a result of their immediate response to the public health emergency caused by the attacks
$10 million for the National Child Traumatic Stress Initiative to improve treatment and services for children and adolescents exposed to traumatic events
a program to accelerate production of 40 million doses of a new smallpox vaccine by the middle of next year
and federal assistance to help states beef up the public health infrastructure.
Initiatives of this kind may have significant fallout that will benefit public health generally.
The few federal actions involving children that did not fall under the antiterrorist penumbra last month included:
Healthfinder.gov/espanol, a new site on the World Wide Web launched by DHHS to provide Spanish-speaking consumers with access to reliable health information and allow English-speaking family members and health professionals to search in English for information to share with Spanish-speaking families.
Food and Drug Administration (FDA) approval of Augmentin ES-600 for children at risk of repeat episodes of middle-ear infection caused by penicillin-resistant strains of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. The medication, formulated as a powder for oral suspension, is now available in drug stores nationwide.
December 35, Mobilizing for a Safe USA: A leadership conference to reduce violence and injury in America, Atlanta, Ga. For information, go to the CDC Web site, www.cdc.gov/safeusa .
December 68, Second International Conference on Immunosuppression, San Diego, Calif. For information, e-mail Kzavetz@pweg.com.
December 79, Practical Pediatrics CME, San Antonio, Texas. To register, call the American Academy of Pediatrics at 800-433-9016.
December 912, Institute for Healthcare Improvement, Orlando, Fla. For information, go to www.ihi.org .
February 13, 40th Clinical Conference in Pediatric Anesthesiology, Anaheim, Calif. For information, e-mail firstname.lastname@example.org.
February 2223, Society for Pediatric Pathology, Chicago, Ill. For information, call 703-556-9222.
Judith Asch-Goodkin. Updates. Contemporary Pediatrics 2001;11:11.