Effect of asthma and its treatment on growth: four year follow up of cohort of children from general practices in Tayside, Scotland

OBJECTIVE

To investigate whether asthma or its treatment impairs children's growth, after allowing for socioeconomic group.

DESIGN

4 year follow up of a cohort of children aged 1-15.

SETTING

12 general practices in the Tayside region of Scotland.

SUBJECTS

3347 children with asthma or features suggestive of asthma registered with the general practices.

MAIN OUTCOME MEASURES

Height and weight standard deviation scores.

RESULTS

Children who lived in areas of social deprivation (assessed by postcode) had lower height and weight than their contemporaries (mean standard deviation score -0.26 (SD 1.02) and -0.18 (1.15) respectively, P < 0.001 for both). Children who were receiving > or = 400 micrograms daily of inhaled steroids and who were attending both hospital and general practice for asthma care had lower height and weight than average, independent of the effect of deprivation (mean standard deviation score -0.62 (1.01), P = 0.002, for height and -0.58 (0.94), P = 0.005, for weight). Children receiving high doses of inhaled corticosteroids also showed lower growth rates (mean change in standard deviation score -0.19 (0.51), P = 0.003). However, no other children with asthma showed growth impairment.

CONCLUSION

Most children with asthma were of normal height and weight and had normal growth rates. However, children receiving high doses of inhaled steroids and requiring both general practice and hospital services had a significant reduction in their stature. This effect was independent from but smaller than the effect of socioeconomic group on stature.

Evaluating the use of TalksBac, a predictive communication device for nonfluent adults with aphasia

This paper describes the design and evaluation of a computer-based communication system called 'TalksBac' with four nonfluent adults with aphasia. Despite the increased availability of computer-based augmentative and alternative communication (AAC) devices, their use with adults with aphasia is limited as few devices have been designed for this population. The TalksBac system was designed specifically for nonfluent adults with aphasia and was used by four nonfluent aphasic individuals for a period of 9 months. The TalksBac system is word-based and exploits the ability of some nonfluent individuals with aphasia to recognize familiar words and short sentences. The system consists of two programs. Personal sentences and stories are entered into the TalksBac database by use of a 'carer program'. The 'user program' assists the nonfluent aphasic user to retrieve these prestored conversational items by offering probable items based on previous use of the system. The database has a hierarchical structure, but the links to individual items adapt automatically to reflect usage by individual users over time. Four nonfluent adults with aphasia were selected to participate in the study. Each subject was assessed by use of a battery of tests to provide pre-intervention data about their comprehension, expression and communication skills. Subjects and their carers were trained to use the TalksBac system and were involved in developing personalized databases. They were supported in use of the personalized systems for an intervention period of 9 months. At the end of this period, subjects' communication skills wre reassessed by use of a battery of tests. Clients' conversational abilities with and without the TalksBac system were also compared to see if use of TalksBac did augment their conversation and allow the aphasic partner to participate more fully within conversations. This was done by analysing videotaped conversations between subjects and non-aphasic partners. Results from the formal assessments indicated that there was little change in the underlying comprehension and expressive abilities of the subjects. An analysis of videotaped conversations showed that 1 subject was unable to carry out conversations using TalksBac independently, so the data for this subject was not included in the results of the analysis of conversations. Results from the video analysis for the remaining three subjects indicated that when using the TalksBac system, the conversational abilities of two subjects improved. The conversational abilities of the other subject were not enhanced by using the system as he had developed his own nonverbal strategies which he found to be more effective. This study has shown that TalksBac has the potential to augment the communication abilities of nonfluent adults with aphasia, who have not been able to develop their own compensatory strategies. Work continues to improve the efficiency of the software and to develop techniques to facilitate the carers' ability to generate conversational information for the system.

Body mass index centile charts to assess fatness of British children

Body mass index (BMI) relates weight to height and reflects the shape of a child, but because of age dependency it has not been used conventionally for the estimation of fatness in children. From measurements of Tayside children (n = 34,533) centile charts were constructed for BMI (wt/ht2) from the raw data of height and weight, using Cole's LMS method for normalised growth standards. These data were compared with the only available European BMI charts published from data of French children obtained over a period of 24 years from 1956-79. British children appear to be 'fatter'. Within a subgroup (n = 445) the BMI values were correlated with estimations of body fat, for boys and girls, from skinfold thickness (r = 0.8 and 0.81) and bioelectrical impedance (r = 0.65 and 0.7). The limits of acceptable BMI have yet to be defined.

Segmenting radiographs of the hand and wrist

The work presented in this paper concerns the development of computer-based techniques for the segmentation of hand-wrist radiographs and in particular those obtained for the TW2 method for the assessment of skeletal maturity (bone age). The segmentation method is based on the concept of regions and it consists of region growing and region merging stages. A bone extraction stage follows, which labels regions as either bone or background using heuristic rules based on the grey level properties of the scene. Finally, a technique is proposed for the segmentation of bone outlines which helps in identifying conjugated bones.