Lymphocytic myocarditis and left ventricular noncompaction are important causes of childhood cardiomyopathy in Australia. The timing and severity of presentation in children with cardiomyopathy are related to the type of cardiomyopathy, as well as to genetic and ethnic factors.

A clear dose-response relationship exists between the number of chronic physical problems and depressive symptoms. The relationship between multimorbidity and depression appears to be mediated via self-perceived health related quality of life. Primary care practitioners will identify more cases of depression if they focus on those with more than one chronic health problem, no matter what the problems may be, being especially aware in the group who rate their health as poor/fair.

OBJECTIVE -To determine the long-term effect of low glycemic index dietary advice on metabolic control and quality of life in children with type 1 diabetes.RESEARCH DESIGN AND METHODS -Children with type 1 diabetes (n ϭ 104) were recruited to a prospective, stratified, randomized, parallel study to examine the effects of a measured carbohydrate exchange (CHOx) diet versus a more flexible low-glycemic index (GI) dietary regimen on HbA 1c levels, incidence of hypo-and hyperglycemia, insulin dose, dietary intake, and measures of quality of life over 12 months.RESULTS -At 12 months, children in the low-GI group had significantly better HbA 1c levels than those in the CHOx group (8.05 Ϯ 0.95 vs. 8.61 Ϯ 1.37%, P ϭ 0.05). Rates of excessive hyperglycemia (Ͼ15 episodes per month) were significantly lower in the low-GI group (35 vs. 66%, P ϭ 0.006). There were no differences in insulin dose, hypoglycemic episodes, or dietary composition. The low-GI dietary regimen was associated with better quality of life for both children and parents.CONCLUSIONS -Flexible dietary instruction based on the food pyramid with an emphasis of low-GI foods improves HbA 1c levels without increasing the risk of hypoglycemia and enhances the quality of life in children with diabetes. Diabetes Care 24:1137-1143, 2001T ype 1 diabetes is one of the most challenging medical disorders because of the demands it imposes on day-to-day life. Good glycemic control, as judged by HbA 1c levels, is clearly related to reduced risk of microvascular complications (1). Although diet plays a major role in the overall management of type 1 diabetes, it is often classed as the most difficult aspect of treatment (2,3). Furthermore, there are surprisingly few longterm studies to support current dietary recommendations. Weighed carbohydrate "exchanges," introduced in the 1950s, have been used to ensure an even distribution of complex carbohydrates throughout the day. Carbohydrate counting and higher carbohydrate intake are now recommended, although in practice, emphasis is still placed on limiting carbohydrates to a specified level and avoiding refined sugars (4,5).Different carbohydrate foods affect blood glucose levels to varying degrees, as measured by their glycemic index (GI) (6,7). Foods such as legumes and dairy products have a low GI, whereas ordinary breads, potatoes, and rice have a high GI (8). Carbohydrate counting and "exchange" diets imply that equal carbohydrate portions have the same effect on glycemia. Not only is the theoretical basis of the exchange system questionable, it is difficult to understand and implement without knowing the carbohydrate content of food (9). Several studies have shown that exchange diets do not improve glycemic control (9,10) and that many children with diabetes and their parents cannot understand or follow them (11-13). It has also been suggested that quantifying carbohydrate intake may be associated with some physiological and psychological problems, including disordered eating behavior (14). This information and the emergi...

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Syndromal, genetic, and metabolic causes predominate in children with hypertrophic cardiomyopathy. Ventricular outflow tract obstruction is common. The clinical status of long-term survivors is good. This population-based study identifies children with hypertrophic cardiomyopathy who are at risk of adverse events.

on behalf of the National Australian Childhood Cardiomyopathy Study Background-Despite considerable mortality, population-based prognostic factors for childhood dilated cardiomyopathy are lacking. Methods and Results-A population-based cohort study was undertaken of all children in Australia who presented with cardiomyopathy at age 0 to 10 years between January 1, 1987, and December 31, 1996. A single cardiologist analyzed all cardiac investigations, and a single pathologist analyzed histopathological material. There were 184 subjects with dilated cardiomyopathy. Positive viral identification or lymphocytic myocarditis was found in 30 (68.2%) of 44 cases with available early histology and 8 of 9 cases presenting with sudden death. Freedom from death or transplantation was 72% (95% CI, 65% to 78%) 1 year after presentation and 63% (95% CI, 55% to 70%) at 5 years. By proportional hazards regression analysis, risk factors for death or transplantation comprised age Ͼ5 years at presentation (hazard ratio 5.6, 95% CI, 2.6 to 12.0), familial dilated cardiomyopathy (hazard ratio, 2.9; 95% CI, 1.5 to 5.6), lower initial fractional shortening z score (hazard ratio per z-score unit, 0.75; 95% CI, 0.65 to 0.87), and failure to increase fractional shortening z score during follow-up (hazard ratio per unit increase, 0.68; 95% CI, 0.58 to 0.79). At follow-up, 78 (44.6%) of 175 cases diagnosed during life have no symptoms and are not taking any cardiac medication. Conclusions-Early mortality is high in childhood dilated cardiomyopathy, but the clinical status of long-term survivors is good. This population-based study identifies children at risk of adverse events.

This study examines the reliability of the Melbourne Assessment of Unilateral Upper Limb Function: a quantitative test of quality of movement in children with neurological impairment. The assessment was administered to 20 children aged from 5 to 16 years (mean age 9 years 10 months, SD 2 years 10 months) who had various types and degrees of cerebral palsy (CP). The performances of the 20 children during assessment were videotaped for subsequent scoring by 15 occupational therapists. Scores were analyzed for internal consistency of test items, inter- and intrarater reliability of scorings of the same videotapes, and test-retest reliability using repeat videotaping. Results revealed very high internal consistency of test items (alpha=0.96), moderate to high agreement both within and between raters for all test items (intraclass correlations of at least 0.7) apart from item 16 (hand to mouth and down), and high interrater reliability (0.95) and intrarater reliability (0.97) for total test scores. Test-retest results revealed moderate to high intrarater reliability for item totals (mean of 0.83 and 0.79) for each rater and high reliability for test totals (0.98 and 0.97). These findings indicate that the Melbourne Assessment of Unilateral Upper Limb Function is a reliable tool for measuring the quality of unilateral upper-limb movement in children with CP.

This study examines the reliability of the Melbourne Assessment of Unilateral Upper Limb Function: a quantitative test of quality of movement in children with neurological impairment. The assessment was administered to 20 children aged from 5 to 16 years (mean age 9 years 10 months, SD 2 years 10 months) who had various types and degrees of cerebral palsy (CP). The performances of the 20 children during assessment were videotaped for subsequent scoring by 15 occupational therapists. Scores were analyzed for internal consistency of test items, inter-and intrarater reliability of scorings of the same videotapes, and test-retest reliability using repeat videotaping. Results revealed very high internal consistency of test items (α=0.96), moderate to high agreement both within and between raters for all test items (intraclass correlations of at least 0.7) apart from item 16 (hand to mouth and down), and high interrater reliability (0.95) and intrarater reliability (0.97) for total test scores. Test-retest results revealed moderate to high intrarater reliability for item totals (mean of 0.83 and 0.79) for each rater and high reliability for test totals (0.98 and 0.97). These findings indicate that the Melbourne Assessment of Unilateral Upper Limb Function is a reliable tool for measuring the quality of unilateral upper-limb movement in children with CP.