September 1956: on the radar

Deep blue skies and the merest hint of a breeze meant perfect flying weather. He mused he’d be back in time for a steak with the crew at the base and a call to his wife, all those thousands of miles away in Kansas, now just weeks from the delivery date of their first baby. The F82 twin mustang gleamed, basking in its post-chamois care and the standard checks (flaps, pitot, magnetos, check, check, check.) as clean as a whistle. The flight itself a cakewalk, the radio signal to control 5/5 from take-off and, despite a patch of slate-grey cumulonimbus, found himself humming the latest Elvis EP on the return. Then, suddenly, worried voices on the (now quite crackly) RT: ‘You’re off the radar, check the transponder—do it now!’

Park life

Access to ‘green space’ (parks, gardens, tree-lined streets) has become a hot topic in paediatrics and adolescent medicine, the associations with cardiovascular and mental health at the forefront of the dialogue. The perinatal biology, though is still gestating even though this is the area where fetal wellbeing is best reflected. Having worked with David Barker (who launched the fetal origins hypothesis) and his group in India for several years, this has a special resonance for me.

Dimitris Tsomokos and colleagues test the hypothesis further using the rich Millenium Cohort Study data set assessing a range of quantifiable perinatal outcomes by known and potential exposures and confounders. To explore new territory, they test the moderating effect of degree of green space (in terms of deciles) with each of the candidate exposures. The assiduous approach and large association with gestational length (3 days, an aeon in perinatal terms) are hard to shy away from.

So, on whose shoulders should the responsibility for this land. As paediatricians, we have a duty to make noise about the issue at the level politicians can’t ignore. See page 1017

Gut feeling

It’s one of the first things we’re taught as medical students: listen to the parents: Why are they here today? What’s nagging at their subconscious? And we process and file but, do we always then reopen the subliminal document in the face of non-specific concern: of course, we want to think we do. Aurelie Chausset and colleagues from multiple centres in France couch this aphorism in the context of juvenile idiopathic arthritis, a heterogeneous family of chronic inflammatory phenotypes and the qualitative experiences of children and parents during the work up. The recurring theme? Clues: clue in the history, clues in the latent frustration and clues in the level of symptomatology ascribed functional or physiological: ‘growing pains can be really sore’. That fourth-year college dictum really was important, after all… See page 1003

Tightening the net

Archives has published widely in the recent past on immigrant health with an emphasis of the most vulnerable group, refugees whose baggage so often includes post traumatic stress, enroute death of family, exploitation which doesn’t always stop (and sometimes only starts) past customs and previously unrecognised latent infection.

We already know that the majority fulfil criteria for mental health support which is why the information in the piece by Hodan Mohamud and colleagues at the University of Toronto, Ontario, Canada (a region with vast experience in the area) assessing the risk groups in terms of non-use the well-established virtual psychiatry services. Though data was collected during the pandemic so is likely a decent proxy for overall uptake, and the vulnerability of the non-fluent refugees suggesting a discontinuity somewhere along the post arrival immigration journey. See page 997

The next hour, he would recount some years later, was a blur, hands glued to the stick, epinephrine, sweat, insubstantial fleeting moments of connection to control, the unfavourable fuel level but, then the reappearance of a familiar hill—the summit reminiscent of a horse’s back—this meant he was close, just 7 knots from base on 070 for the left hand overhead rejoin, he was back.