Effects of transfusion in anemia of prematurity

The authors aimed to test the hypothesis that blood transfusions depress hematopoiesis in healthy infants with anemia of prematurity (AOP). They also set out to find markers that predict recovery from AOP. Thirty-nine premature babies underwent weekly and post-transfusion measurements of hemoglobin concentrations, reticulocyte counts (RCC), and erythropoietin levels (EPO). RCC and EPO dropped significantly 7 days after a blood transfusion but had normalized after 14 days. Elevated RCC or EPO levels were not predictive of an increase in hemoglobin. Postnatal HbFg/dL was higher in babies who had received transfusions. The authors conclude that blood transfusions depress erythropoiesis in infants with AOP and stimulate HbF synthesis but this effect is not sustained. Reticulocyte counts and erythropoietin levels are unhelpful in predicting recovery from AOP.

Recommendations for postmarketing surveillance studies in haemophilia and other bleeding disorders

Prospective surveillance studies to monitor drug safety in the postapproval period are rarely employed systematically, although they are of greatest value for caregivers, drug users and regulatory authorities. Safety issues have affected not only conventional pharmaceuticals, but also especially coagulation factors in haemophilia treatment. The reputation of postmarketing surveillance (PMS) studies has been questionable, mainly due to their misuse to solicit prescriptions. Other weaknesses include inappropriate design, lack of standardized observation, limited follow-up periods, absence of rigour in identifying potential adverse drug effects, and infrequent publication. Although well-designed clinical trials represent the gold standard for generating sound clinical evidence, a number of aspects would make PMS studies valuable, if properly conducted. One of their main advantages is broader inclusion, and absence of an 'experimental' design. Lack of proper guidelines, and standardization may constitute a reason for the generally low quality of PMS studies. This paper proposes guidelines for haemophilia-specific PMS studies, in order to improve the acceptance of a basically valuable tool. In the absence of consistent regulatory guidance it will be especially important that the design and supervision of PMS studies involves physicians from the beginning. This will not only make such studies more scientifically relevant, but also help to implement them into daily clinical practice. Specifically in haemophilia, PMS studies may provide valuable data on clinical outcomes, or Quality of Life, which is of great importance when considering adequate standards of care in haemophilia patients.

The use of recombinant factor VIIa for bleeding in paediatric practice

Summary. Recombinant factor VIIa is licensed for use in patients with haemophilia and inhibitors. More recently it has been used as an unlicensed product in adults for the treatment of life threatening bleeding. However, its use in paediatric practice has been limited. We describe a series of patients from one paediatric centre, where recombinant factor VIIa has been used when conventional treatment has failed to achieve haemostasis.

Social outcomes in adulthood of children with intellectual impairment: evidence from a birth cohort

BACKGROUND

Social Policy for people with intellectual disabilities (ID) continues to evolve, but little is known about the lives to which such policies are applied. We aimed to use a prospective follow-up of a British birth cohort to identify children with mild and more severe intellectual impairment, and compare a range of social outcomes in adulthood with people in the rest of the cohort.

METHOD

We used data from the MRC National Survey for Health and Development. Intellectual impairment was identified by intelligence tests and educational history. Adult outcome measures included employment and social class, education, marriage and children, home ownership, social networks and community use.

RESULTS

We identified 111 people with mild intellectual impairment (2.7%) and 23 with severe intellectual impairment (0.6%) at age 15/16. By the age of 43, there were 52 people remaining in the mild impairment group and 14 in the severe impairment group. In adulthood those with intellectual impairment enjoyed contact with friends and family, and joined in informal social activities. Although the mild intellectual impairment group were less likely to attain the following social outcomes than people with normal intellectual functioning, 67% had jobs, 73% were married, 62% had children and 54% owned their own homes. 12% participated in adult education. People with more severe intellectual impairment were less likely to attain these outcomes.

CONCLUSIONS

These outcomes highlight issues in current social policy and suggest efforts should be directed particularly towards promoting educational opportunities and developing social inclusion for people with ID.

Long term effects of early adversity on cognitive function

AIMS

To investigate long term effects of early adverse circumstances on cognitive function.

METHODS

Associations between early material home circumstances, parental divorce, maternal management and understanding, and cognitive function in childhood, adolescence, and adulthood were analysed using multiple linear regression, controlling for sex, parental SES, and birth order in 1339 males and females from the MRC National Survey of Health and Development.

RESULTS

Early adverse circumstances were strongly associated with lower cognitive ability in childhood and adolescence, and were detectable on measures of verbal ability, memory, and speed and concentration in midlife. However, these long term effects were mostly explained by the effects of adversity on childhood or adolescent cognitive ability or by differences in educational attainment and adult social class. An exception was the effect of poor material home conditions on visual search speed at 53 years, which was maintained after controlling for adolescent ability, as well as further control for educational attainment, adult social class, physical growth, cigarette smoking, and affective state. There was no evidence of more rapid decline in memory and psychomotor function across middle age in those exposed to early adversity.

CONCLUSIONS

The effect of early adversity on cognitive function tracks across the life course at least as far as middle age, although there was little evidence from this study of effect amplification over this interval. Nevertheless, in view of the persistence of child poverty in the industrialised world, these findings give cause for concern.

Optimal single intraocular lens power for the Nepali population

AIM

To evaluate optimal standard intraocular lens power for Nepalese eye camp cataract patients.

METHOD

A retrospective case series of 5109 preoperative cataract patients.

RESULTS

Average axial length of 23.08 (SD 1.26). Average dioptre intraocular lens power 21.37 (3.04).

CONCLUSION

An increase in the intraocular lens power used at Nepalese eye camps from +21.0 to 22.5 dioptres would improve overall visual outcome.

Identification of Native American founder mtDNAs through the analysis of complete mtDNA sequences: some caveats

In this study, a detailed analysis of both previously published and new data was performed to determine whether complete, or almost complete, mtDNA sequences can resolve the long-debated issue of which Asian mtDNAs were founder sequences for the Native American mtDNA pool. Unfortunately, we now know that coding region data and their analysis are not without problems. To obtain and report reasonably correct sequences does not seem to be a trivial task, and to discriminate between Asian and Native American mtDNA ancestries may be more complex than previously believed. It is essential to take into account the effects of mutational hot spots in both the control and coding regions, so that the number of apparent Native American mtDNA founder sequences is not erroneously inflated. As we report here, a careful analysis of all available data indicates that there is very little evidence that more than five founder mtDNA sequences entered Beringia before the Last Glacial Maximum and left their traces in the current Native American mtDNA pool.

Diagnosing childhood cancer in primary care--a realistic expectation?

The burden of childhood cancer for Primary Care Trusts (PCTs) is unknown. PCTs in Yorkshire are representative of England and Wales and show little heterogeneity in the incidence rates of childhood cancer. Each PCT will expect three to five newly diagnosed children per year. A single GP is likely to see an incident case once every 20 years.

Leisure activities and cognitive function in middle age: evidence from the Whitehall II study

OBJECTIVES

To test the hypothesis of a positive association, independent of social position, between participation in leisure activities and cognitive function in middle age. The nature of this relation is explored by first classifying leisure activities as entailing high or low cognitive effort, and then classifying them as entailing individual or social activities.

SETTING

London based office staff (Whitehall II study) in 20 civil service departments at baseline.

METHODS

Data are from the fifth wave of data collection (phase 5) of a prospective cohort study, collected through clinical examination and a self administered questionnaire. Firstly, hierarchical multiple regression was used to examine age and socioeconomic status (SES) adjusted effect of each leisure activity on cognition. Then structural equation models were used to examine the effects of two categories of leisure activities-activities entailing high or low cognitive effort and social or individual activities. All analyses are cross sectional.

RESULTS

There was an age and SES adjusted association between participation in leisure activities and cognitive function. More specifically, leisure activity entailing high cognitive effort or social interaction was associated with better cognitive ability.

CONCLUSIONS

Participation in cognitively complex or social leisure activities has an independent association with adult cognition, suggesting that seeking mental stimulation may have a beneficial effect on cognition in middle age.

The life course prospective design: an example of benefits and problems associated with study longevity

Although the life course prospective study design has many benefits, and information from such studies is in increasing demand for scientific and policy purposes, it has potential inherent design problems associated with its longevity. These are in particular the fixed sample structure and the data collected in early life, which are each determined by the scientific principles of another time and the risk over time of increased sample loss and distortion through loss. The example of a national birth cohort in Britain, studied from birth so far to age 53 years is used to address these questions. Although the response rate is high, avoidable loss, which was low in childhood, increased in adulthood, and was highest in those in adverse socio-economic circumstances and those with low scores on childhood cognitive measures. Recent permanent refusal rate rises may be the result of better tracing and/or a response to increased requests for biological measurement. Nevertheless, the responding sample continues in most respects to be representative of the national population of a similar age. Consistency of response over the study's 20 data collections has been high. The size of the sample responding in adulthood is adequate for the study of the major costly diseases, and for the study of functional ageing and its precursors. This study's continuation has depended not only on scientific value but also policy relevance. Although the problems inherent in the prospective design are unavoidable they are not, in the study described, a barrier to scientific and policy value. That seems also likely in Britain's two later born national birth cohort studies that have continued into adulthood.

Symptoms and concerns amongst cancer outpatients: identifying the need for specialist palliative care

This study aimed to define and prioritize the need for specialist palliative care (SPC) in cancer outpatient clinics. A validated assessment tool, the Symptoms and Concerns Checklist, was used to determine the prevalence and severity of symptoms and concerns. The checklist was completed by 480 outpatients with a cancer diagnosis. Sixty patients from each of eight primary tumour groups (lung, breast, gastrointestinal, gynaecological, urological, head and neck, brain and lymphoma) were recruited. The majority of patients (over 90%) rated 27 of the 29 checklist items, reporting a mean of 10 items as current problems. The influences of disease site and status, demographic factors and treatment on the number and type of symptoms and concerns reported were investigated. The highest number of symptoms and concerns and most severe problems were reported by patients with lung cancer, followed by those with brain tumours; the lowest by those with lymphoma and urological tumours. A high proportion of patients (83%) reported one or more items likely to benefit from SPC intervention. The results of this study suggest an extensive need for better symptom control in all cancer outpatients and in centres where SPC resources are limited, priority could be given to patients attending lung and brain tumour clinics.

Ovarian function in the Nile hippopotamus and the effects of Depo-Provera administration

The preliminary results of an investigation into the reproductive endocrinology of the hippopotamus (Hippopotamus amphibius) and the effects of the progestin Depo-Provera on ovarian function are presented. Faecal progestagen analysis indicated that hippos have an oestrous cycle of 29.2 +/- 0.9 days and faecal progestagen concentrations of 323.6 +/- 31.4 ng g(-1) during the luteal phase. Concentrations were higher (765.9 +/- 162.4 ng g(-1); P < 0.05) during pregnancy than during the luteal phase and remained high until parturition. A lactational anoestrus was usually, but not always, observed during nursing. The onset of puberty was observed in three animals and started at 2.5-3.5 years of age. After Depo-Provera treatment, increases in faecal progestagens indicative of ovulation were observed and were not significantly different from luteal concentrations observed before treatment (236.3 +/- 24.4 versus 340.1 +/- 47.9 ng g(-1), respectively); however, the duration of the luteal phase was shorter (P < 0.05) than before treatment (11.3 +/- 1.0 versus 18.9 +/- 1.0 days, respectively). Females returned to normal cyclicity at day 100.7 +/- 15.3 (range 70-116 days) after administration and one female conceived on day 100 after administration.