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Bridging Radiotherapy Prior to Chimeric Antigen Receptor T-Cell Therapy for B-Cell Lymphomas: An ILROG Multi-Institutional Study. Int J Radiat Oncol Biol Phys 2023; 117:S50-S51. [PMID: 37784516 DOI: 10.1016/j.ijrobp.2023.06.333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To report an ILROG multi-institutional analysis of bridging radiotherapy (BRT) prior to CD19-targeting chimeric antigen receptor T-cell (CAR T) therapy for relapsed/refractory aggressive B-cell lymphomas (BCL). MATERIALS/METHODS Weretrospectively reviewed 115 patients (pts) with diffuse large BCL (n = 101, 88%), primary mediastinal BCL (n = 11, 10%), mantle cell lymphoma (n = 2, 2%), and T-cell/histiocyte rich large BCL (n = 1, 1%) who received BRT prior to commercial CAR T from 2018-2020 across 6 institutions. BRT toxicities were graded per CTCAE v5.0, cytokine release syndrome (CRS) per ASTCT, and immune effector cell-associated neurotoxicity syndrome (ICANS) per either ASTCT or CTCAE v5.0. Progression-free survival (PFS) and overall survival (OS), measured from CAR T infusion, were estimated using the Kaplan-Meier method. PFS was modeled using Cox regression with stepwise variable selection. RESULTS BRTwas given prior to axicabtagene ciloleucel (axi-cel; n = 82, 71%), tisagenlecleucel (tisa-cel; n = 31, 27%), or brexucabtagene autoleucel (n = 2, 2%). Median age was 62 years with median of two prior lines of therapy. Most pts had advanced stage III/IV disease at leukapheresis (n = 87, 76%), elevated pre-leukapheresis LDH (n = 73, 63%), and bulky disease (n = 55, 50%) (1 lesion ≥7.5 cm). 78 pts (68%) had extranodal disease, 12 (10%) had central nervous system (CNS) involvement, and 36 (31%) had bone involvement. Systemic bridging therapy was given to 42 pts (37%). Median intervals from leukapheresis to BRT start and from BRT completion to CAR T infusion were 5 days (IQR -6, 11) and 12 days (IQR 9, 23), respectively. BRT was delivered to 163 total sites; most commonly the abdomen/pelvis (n = 58, 50%), head/neck (n = 34, 30%), thorax (n = 20, 17%), extremity/soft tissue (n = 20, 17%), and CNS (n = 13, 11%). Median biologically effective dose was 31.3 Gy (IQR 24, 39). Most common regimen was 30 Gy in 10 fractions (n = 27, 17%). 40 pts (35%) received comprehensive BRT (to all active lesions). There were no grade ≥3 BRT toxicities. Grade ≥3 CRS occurred in 9 pts (8%), including 8/82 (10%) after axi-cel and 1/31 (3%) after tisa-cel. Grade ≥3 ICANS occurred in 23 pts (20%), including 22/82 (27%) after axi-cel and 1/31 (3%) after tisa-cel. Median follow up was 26.9 months. 1- and 2-year OS rates were 60% and 49%. 1- and 2-year PFS rates were 41% and 35%. Comprehensive BRT associated with superior PFS (HR 0.34, 95% CI 0.19-0.62, p<0.001) in a multivariable model with age ≥60, ECOG ≥2, advanced stage, CNS disease, pre-leukapheresis LDH, and axi-cel. CONCLUSION In this multi-institutional study, pts receiving BRT prior to CAR T therapy for BCL frequently had bulky disease yet experienced favorable PFS and OS. There were no serious toxicities attributable to BRT, and the rates of CRS and ICANS are comparable to those after CAR T alone. Comprehensive BRT associated with superior PFS.
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Cost-effectiveness of radioguided occult lesion localization using 125I seeds versus hookwire localization before breast-conserving surgery for non-palpable breast cancer. Br J Surg 2021; 108:843-850. [PMID: 33638646 DOI: 10.1093/bjs/znaa160] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/03/2020] [Accepted: 12/07/2020] [Indexed: 11/13/2022]
Abstract
BACKGROUND The aim was to determine the cost-effectiveness of radioguided occult lesion localization using 125I-labelled seeds (125I seeds) versus hookwire localization in terms of incremental cost per reoperation avoided for women with non-palpable breast cancer undergoing breast-conserving surgery. METHODS This study was based on a multicentre RCT with eight study sites comprising seven public hospitals and one private hospital. An Australian public health system perspective was taken. The primary effectiveness outcome for this study was reoperations avoided. Cost-effectiveness was expressed as an incremental cost-effectiveness ratio (ICER). One-way and probabilistic sensitivity analyses were used to explore uncertainty. The willingness to pay (additional cost of localization using 125I seeds justified by reoperation cost avoided) was set at the weighted, top-down cost of reoperation. Costs were in 2019 Australian dollars ($1 was equivalent to €0.62). RESULTS The reoperation rate was 13.9 (95 per cent confidence interval 10.7 to 18.0) per cent for the 125I seed group and 18.9 (14.8 to 23.8) per cent for the hookwire localization group. The ICER for 125I seed versus hookwire localization was $4474 per reoperation averted. The results were most sensitive to uncertainty around the probability of reoperation. Accounting for transition probability and cost uncertainty for 125I seed localization, there was a 77 per cent probability that using 125I seeds would be cost-effective, with a willingness to pay of $7693 per reoperation averted. CONCLUSION Radioguided occult lesion localization using 125I seeds is likely to be cost-effective, because the marginal (additional) cost compared with hookwire localization is less than the cost of reoperations avoided.
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Retraction: The Achilles' heel hypothesis: misinformed keystone individuals impair collective learning and reduce group success. Proc Biol Sci 2020; 287:20200255. [PMID: 33043869 PMCID: PMC7423664 DOI: 10.1098/rspb.2020.0255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
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Pathways into and out of overweight and obesity from infancy to mid-childhood. Pediatr Obes 2018; 13:621-627. [PMID: 29998577 PMCID: PMC6220864 DOI: 10.1111/ijpo.12427] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/13/2018] [Accepted: 04/24/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To investigate whether high weight in infancy predicts obesity in childhood. METHOD Data from two UK cohorts (Newcastle Growth and Development N = 795, Gateshead Millennium N = 393) and one Finnish (Tampere N = 1262) were combined. Z scores of weight at 3 and 12 months and body mass index (BMI) at 5 and 8 years were categorized as raised/overweight (1 to <2 SD) or high/obese (≥2 SD). RESULTS The majority of infants with raised or high weight at birth tended to revert to normal by 3 months and to track in the same category from 3 to 12 months. Although infants with high weight were five times more likely to have BMI ≥ 2 SD at 8 years (p < 0.001), only 22% went on to have BMI ≥ 2 SD, while 64% of infants with raised weight had normal BMI at 8 years. Of children with BMI ≥ 2 SD aged 8 years, only 22% had raised weight in infancy and half had BMI ≥ 2 SD for the first time at that age. CONCLUSIONS Infants with raised weight in infancy tend to remain so, but most children who go on to have BMI ≥ 2 SD were not unusually heavy infants and the majority of infants with high weight reverted to overweight or normal weight in childhood.
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Abstract
Background and Aims Dental decay remains a major public health problem in Scottish children. The aim of this study was to investigate the relationship between diet, bowel habit, social class, and body mass index (BMI) in children with severe tooth decay. Children and Methods A cross sectional study of 165 children aged 3 -11 years attending Glasgow Dental Hospital for extraction of teeth under dental general anaesthesia (DGA), was undertaken. A structured questionnaire was used to obtain information from each child on diet, bowel habit, and social status of their parents. Fibre and sugar scores were calculated from the frequency of consumption of a range of relevant foods. Results The children (mean age 5.7 (SD1.8) years) had between 1 and 20 decayed, missing or filled primary teeth (dmft) with a mean dmft of 7.9 (SD 3.5). 37% ate a chocolate bar daily, and 29% regularly drank a sugary drink after brushing their teeth. An excess of children were from the most deprived parts of the city and they had the worst decay. Children with the worst decay were also significantly thinner. No relationship was found between tooth decay and bowel habit. Conclusions In this selected group of children with poor dental health, those from deprived families were over-represented and had significantly more decay. Severe dental decay was also associated with underweight.
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'Now I understand': consulting parents on chart design and parental information for the UK-WHO child growth charts. Child Care Health Dev 2012; 38:435-40. [PMID: 21668464 DOI: 10.1111/j.1365-2214.2011.01256.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Regular assessment of growth is an important part of child health surveillance in the UK and most parents are very interested in their child's growth. UK parents are given a personal child health record (PCHR), including growth charts, which are plotted during baby clinic visits. Parents were consulted as part of the process of designing new UK charts to incorporate the World Health Organization growth standard. This paper describes the main themes that emerged and how they influenced the final design. METHOD Three sets of consultations with 47 parents were conducted to collect preliminary information, and to evaluate proposed chart designs, instructions and written information for parents. RESULTS At every consultation, the impact of the depiction of the 50th centile line in bold was mentioned spontaneously by parents. They also found aspects of the charts unclear, including the implications of a recorded weight on any particular centile, the difficulty of understanding existing text about charts in the PCHR, their preference for using pounds and ounces rather than metric weights and confusion about how frequently babies should be weighed. This led to the production of parental information including explanation of these issues which were then tested in two further sets of focus groups. CONCLUSION Involving parents in the process of designing growth charts and information influenced the finished design and the text in the PCHR. Ensuring information meets parents' needs is important to ensure successful growth monitoring.
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Abstract
OBJECTIVE To quantify how overweight children have to be for their mothers to classify them as overweight and to express concern about future overweight, and to investigate the adiposity cues in children that mothers respond to. DESIGN Cross-sectional. SUBJECTS A total of 531 children from the Gateshead Millennium Study cohort at 6-8 years and their mothers. MEASUREMENTS In the mother: responses to two questions concerning the child's adiposity; height; weight; educational qualifications; and economic status. In the child: height; weight; waist circumference; skinfold thicknesses; bioelectrical impedance; and bone frame measurements. RESULTS The body mass index (BMI) at which half the mothers classify their child as overweight was 21.3 (in the obese range for children of this age). The BMI at which half the mothers were concerned about their child becoming overweight in the future was 17.1 (below the overweight range). Waist circumference and skinfolds contributed most to mothers' responses. Although BMI and fat scores were important predictors individually, they did not contribute independently once waist circumference and skinfolds (their most visible manifestations) were included in the regression equations. Mothers were less likely to classify girls as overweight. Mothers with higher BMIs were less likely to classify their child as overweight, but were more likely to be concerned about future overweight. CONCLUSION Health promotion efforts directed at parents of young primary school children might better capitalise on their concern about future overweight in their child than on current weight status, and focus on mothers' response to more visible characteristics than the BMI.
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Screening for activating EGFR mutations in surgically resected nonsmall cell lung cancer. Eur Respir J 2011; 38:903-10. [PMID: 21349912 DOI: 10.1183/09031936.00190110] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The clinical applicability of screening surgically resected nonsmall cell lung cancer (NSCLC) tumour tissue and serum for activating epidermal growth factor receptor (EGFR) mutation is unknown. Furthermore, the comparative accuracy of inexpensive EGFR mutation tests, mutant-enriched (ME)-PCR and high-resolution melt (HRM) has not been determined. Lung tumour DNA from 522 surgically resected stage I-IV NSCLC and matched serum DNA from a subset of 64 subjects was analysed for EGFR mutations in exons 19 and 21 using ME-PCR and HRM. Additionally, 97 subjects had previous EGFR DNA sequencing data available for comparison. ME-PCR and HRM detected EGFR mutations in 5% (27 out of 522) of tumour samples. Compared to DNA sequencing, ME-PCR had a sensitivity of 100% and specificity of 99%, while HRM had 100% sensitivity and specificity. Six subjects with EGFR mutation tumours had matched serum, where ME-PCR detected mutations in three samples and HRM in two samples. In the cohort of never-smoker subjects, those with EGFR mutated tumours had worse survival compared with wild-type tumours (30 versus 49 months; p=0.017). ME-PCR and HRM have similar accuracy in detecting EGFR mutations but the prognostic implications of the mutations in resected NSCLC warrants further study.
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Abstract
OBJECTIVES To explore how fat, lean and body mass index (BMI) track in childhood and how this relates to parental obesity. DESIGN AND SETTING Prospective population-based cohort study: Avon Longitudinal Study of Parents and Children, UK. METHOD Height, weight and leg-to-leg bioelectrical impedance (BIA) were collected at ages 7 and 11 years, as well as pre-pregnancy parental heights and weights. For BMI International Obesity Task Force thresholds of obesity and overweight were used. Impedance data were expressed as separate lean and fat z scores, internally standardised for gender, height and age and a child was defined as over-fat if fat z score was >85th and very over-fat if >95th internal centile. RESULTS Data were available for 7723 and 7252 children at ages 7 and 11 years, respectively (6066 at both time points). Of those obese at age 7, 75% were still obese at age 11, while of those who had been overweight 16% had become obese and 20% now had normal BMI. Both fat and lean z scores showed moderate levels of tracking (correlation coefficients 0.70 and 0.73, respectively). Children with one or two obese parents had higher fat z scores at age 7 and showed greater increases in fat thereafter. They were more likely to be very over-fat at age 7 and, of these, 69% remained so at age 11 compared to only 45% with non-obese parents (p <0.001). CONCLUSIONS Children of obese parents already have high fat levels at age 7 and are more likely to remain very over-fat.
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Genetic association study of CYP1A1 polymorphisms identifies risk haplotypes in nonsmall cell lung cancer. Eur Respir J 2009; 35:152-9. [DOI: 10.1183/09031936.00120808] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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The detection of early weight faltering at the 6-8-week check and its association with family factors, feeding and behavioural development. Arch Dis Child 2009; 94:549-52. [PMID: 19052031 DOI: 10.1136/adc.2008.139063] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To identify infants with early weight faltering at the 6-8-week check and examine their family circumstances, feeding and behavioural development. METHODS Over a 2-year period, the weight gain of all infants born in an area of North East England was screened. z Scores for weights at birth and at 6-8 weeks were used to calculate a "thrive index" (z score for weight gain). In a nested case-control study within the larger cohort, infants below the fifth centile on the thrive index were identified. 74 cases and 86 controls were followed up. Their development was assessed at 4 and 9 months using the Bayley Scales and their mothers interviewed. RESULTS Of 1996 infants, weights at birth and at 6-8 weeks were available for 1880 (94%), and 6.1% of term-born infants were identified as weight faltering over the first 6-8 weeks. These infants had more feeding problems and showed some developmental delay as assessed using the Bayley Scales (at 4 months, mean difference and 95% CI -3.5, -0.6 to -6.4 for the Mental Developmental Index (MDI) and -3.6, -0.2 to - 6.9 for the Psychomotor Developmental Index (PDI); at 9 months -2.3, 1.3 to -5.8 for MDI and -2.2, 2.5 to -7.0 for PDI). Their families were not significantly different from those of controls on any economic or educational measure. CONCLUSION Infants whose early weight gain is slow show more feeding problems than controls, and some developmental delay. They can be identified using a thrive index at the 6-8-week check.
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Abstract
AIM The aim of the study was to investigate the frequency and detail of family history recorded for patients diagnosed with potentially high-risk colorectal cancer, and to determine the proportion of these patients referred to a high-risk assessment clinic. METHOD Medical records of patients diagnosed with colorectal cancer under the age of 50 admitted to a major Sydney teaching hospital were reviewed. The proportion of records containing information about family history was calculated. Associations between recording of family history and demographic and clinical characteristics of patients were investigated. Logistic regression modelling was performed to identify significant, independent predictors of study outcomes. RESULTS Of 113 patients with colorectal cancer diagnosed under the age of 50 years, 61 (54%, 95% CI: 44-63%) had an entry in their hospital medical record about family history. Family history was significantly less likely to be recorded for females, for those admitted via the Emergency Department, and for those with shorter lengths of stay. A significant family history was found in 51% of the 61 patients who had a family history recorded. Records of patients attending specialist colorectal surgeons were significantly more likely to contain information about family history than those who attended other specialists (P = 0.04). Only 14 patients (12%, 95% CI: 7-20%) were formally referred for further genetic assessment. CONCLUSION These results suggest that family history is still being neglected in routine clinical practice, and high-risk assessment services are underutilized, implying the need for further dissemination of guidelines with regard to the recognition and management of hereditary colorectal cancer.
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Childhood growth and dental caries. COMMUNITY DENTAL HEALTH 2009; 26:38-42. [PMID: 19385439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVES The aim of the study was to examine whether the removal of carious teeth affected children's growth relative to that of a standard population. DESIGN Longitudinal prospective observational study. SETTING Manchester Dental Hospital (MDH), U.K. PARTICIPANTS Five- and six-year-old children who attended for extraction of carious teeth under general anaesthesia. MAIN OUTCOME MEASURE Change in height, weight and BMI standard deviation scores during the six months after extraction of carious teeth. METHODS AND MATERIALS The children's dental caries levels, weight and height were measured prior to extraction using standard criteria and a single trained examiner and they were then re-measured six months later. The body mass index of the children was calculated and all measurements were converted to standard deviation scores (SDS) using the U.K. 1990 growth reference. Changes in growth SDS during the six months subsequent to the extractions were then calculated. RESULTS Two hundred and eighteen children, mean (range) age 5.9 (5-6) were examined initially, of whom 131 were successfully followed up a mean 7.1 (0.13) months later. The participants had a mean dmft of 7.18 (SD 3.27) at baseline and were not shorter than expected (8.3% <10th percentile), or more underweight (6.9% <10th percentile for weight). At follow up children showed a statistically significant gain in BMI SDS (mean (SD) 0.26 (37) p < 0.001) and a small gain in height SDS (0.05 (0.38) p = 0.05). CONCLUSION This study suggests that the extraction of carious teeth in five and six year old children promotes weight gain and possibly growth.
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Abstract
BACKGROUND UK child health promotion guidelines expect health visitors to assess family needs before new babies are aged 4 months and offer targeted care on that basis thereafter. Data from an intensive family support programme were used to assess how accurately family needs can be predicted at this stage. DESIGN A population based cohort of 1202 families with new babies receiving an intensive health visiting programme. Analysis of routinely recorded data. SETTING Starting Well project, Glasgow, UK. PREDICTORS Health visitor rating of family needs. MAIN OUTCOME MEASURES Families receiving high visiting rates or referred to social work services. RESULTS Of 302 families rated high need, only 143 (47%) were identified by age 4 months. Visiting rates in the first year for those initially rated high need were nearly double those for the remainder, but around two thirds of those with high contact rates/referred to social work were not initially rated high need. Six family characteristics (no income, baby born preterm, multiple pregnancy, South Asian, prior social work/criminal justice involvement, either parent in care as a child) were identified as the commonest/strongest predictors of contact rates; 1003 (83%) families had one such characteristics and/or lived in a highly deprived area, including 228 (93%) of those with high contact rates and 157 (96%) of those referred to social work. CONCLUSIONS Most families at risk will not be identified on an individual basis in the early weeks. Most families in deprived areas need continued input if the most vulnerable families are to be reliably identified.
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Erratum: Development of bioelectrical impedance-derived indices of fat and fat-free mass for assessment of nutritional status in childhood. Eur J Clin Nutr 2008. [DOI: 10.1038/ejcn.2008.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Association between systemic calcified atherosclerosis and bone density. Calcif Tissue Int 2007; 80:301-6. [PMID: 17505774 DOI: 10.1007/s00223-007-9004-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2006] [Accepted: 01/23/2007] [Indexed: 10/23/2022]
Abstract
Both atherosclerosis and osteoporosis are responsible for significant morbidity and mortality, are independent predictors of cardiovascular disease (CVD) events, and may share common regulatory mechanisms as well as histopathology. Multiple reports of weak or null relationships between traditional CVD risk factors and calcified atherosclerosis have heightened interest in novel predictors of arterial calcium. One such hypothesis is for an inverse relationship between bone mineral density (BMD) and calcified coronary atherosclerosis. Although contrary findings have been reported, the majority of cross-sectional and all prospective studies have demonstrated a significant inverse association between arterial calcium deposits and BMD. The few studies that include men are equivocal, and, to date, no study has investigated the relationship between BMD and systemic arterial calcium. The aim of this study was to test the hypothesis that lumbar BMD is significantly associated with the presence of arterial atherosclerotic calcium in the carotid, coronary, and iliac vascular beds as well as the aorta.
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Development of bioelectrical impedance-derived indices of fat and fat-free mass for assessment of nutritional status in childhood. Eur J Clin Nutr 2007; 62:210-7. [PMID: 17356557 DOI: 10.1038/sj.ejcn.1602714] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES (1) To develop a method of manipulating bioelectrical impedance (BIA) that gives indices of lean and fat adjusted for body size, using a large normative cohort of children. (2) To assess the discriminant validity of the method in a group of children likely to have abnormal body composition. DESIGN Two prospective cohort studies. SETTING Normative data: Avon Longitudinal Study of Parents and Children (ALSPAC), population based cohort; proof of concept study: tertiary feeding clinic and special needs schools. SUBJECTS Normative data: 7576 children measured aged between 7.25 and 8.25 (mean 7.5) (s.d.=0.2) years; proof of concept study: 29 children with either major neurodisability or receiving artificial feeding, or both, mean age 7.6 (s.d.=2) years. MEASURES Leg-to-leg (Z (T)) and arm-to-leg (Z (B)) BIA, weight and height. Total body water (TBW) was estimated from the resistance index (RI=height(2)/Z), and fat-free mass was linearly related to TBW. Fat mass was obtained by subtracting fat-free mass from total weight. Fat-free mass was log-transformed and the reciprocal transform was taken for fat mass to satisfy parametric model assumptions. Lean and fat mass were then adjusted for height and age using multiple linear regression models. The resulting standardized residuals gave the lean index and fat index, respectively. RESULTS In the normative cohort, the lean index was higher and fat index lower in boys. The lean index rose steeply to the middle of the normal range of body mass index (BMI) and then slowly for higher BMI values, whereas the fat index rose linearly through and above the normal range. In the proof of concept study, the children as a group had low lean indices (mean (s.d.) -1.5 (1.7)) with average fat indices (+0.21 (2.0)) despite relatively low BMI standard deviation scores (-0.60 (2.3)), but for any given BMI, individual children had extremely wide ranges of fat indices. The lean index proved more stable and repeatable than BMI. CONCLUSIONS This clinical method of handling BIA reveals important variations in nutritional status that would not be detected using anthropometry alone. BIA used in this way would allow more accurate assessment of energy sufficiency in children with neurodisability and may provide a more valid identification of children at risk of underweight or obesity in field and clinical settings.
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Abstract
BACKGROUND Failure to thrive (FTT) in early childhood is associated with subsequent developmental delay and is recognised to reflect relative undernutrition. Although the concept of FTT is widely used, no consensus exists regarding a specific definition, and it is unclear to what extent different anthropometric definitions concur. OBJECTIVE To compare the prevalence and concurrence of different anthropometric criteria for FTT and test the sensitivity and positive predictive values of these in detecting children with "significant undernutrition", defined as the combination of slow conditional weight gain and low body mass index (BMI). METHODS Seven criteria of FTT, including low weight for age, low BMI, low conditional weight gain and Waterlow's criterion for wasting, were applied to a birth cohort of 6090 Danish infants. The criteria were compared in two age groups: 2-6 and 6-11 months of life. RESULTS 27% of infants met one or more criteria in at least one of the two age groups. The concurrence among the criteria was generally poor, with most children identified by only one criterion. Positive predictive values of different criteria ranged from 1% to 58%. Most single criteria identified either less than half the cases of significant undernutrition (found in 3%) or included far too many, thus having a low positive predictive value. Children with low weight for height tended to be relatively tall. CONCLUSIONS No single measurement on its own seems to be adequate for identifying nutritional growth delay. Further longitudinal population studies are needed to investigate the discriminating power of different criteria in detecting significant undernutrition and subsequent outcomes.
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Abstract
Paediatricians should recognise the influence of infant formula milk companies and avoid intentionally or inadvertently promoting them
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Abstract
BACKGROUND Previous studies suggest that failure to thrive in infancy may be associated with adverse sequelae in childhood. Although cognitive abilities have been extensively investigated, little systematic research is available on other aspects of development. METHODS Eighty-nine children who failed to thrive as infants and 91 controls were followed up when twelve years old and examined using anthropometric measurement, self-ratings of appetite and body image, the Dutch Eating Behaviour Questionnaire, the Self-perception Profile for Children, The Revised Children's Manifest Anxiety Scale, the parent and child form of the Mood and Feelings Questionnaire and the parent and teacher's form of the Child Behavior Checklist. RESULTS The children who failed to thrive were significantly shorter and lighter at twelve and had significantly lower BMIs, but they did not go into puberty any later. They were more likely to rate their appetite as lower than their best friend's, were generally more satisfied with their body shape, and had significantly lower restraint score on the Dutch Eating Behaviour Questionnaire. They were not significantly different from controls on any of the measures reflecting anxiety, depression or low self-esteem. CONCLUSIONS Failure to thrive in infancy is not associated with adverse emotional development in childhood.
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The influence of maternal socioeconomic and emotional factors on infant weight gain and weight faltering (failure to thrive): data from a prospective birth cohort. Arch Dis Child 2006; 91:312-7. [PMID: 16397011 PMCID: PMC2065961 DOI: 10.1136/adc.2005.077750] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To study the influence of maternal socioeconomic and emotional factors on infant weight gain and weight faltering (failure to thrive) in the first year of life. METHODS The Gateshead Millennium Baby Study is a population birth cohort in northeast England studied prospectively from birth, via parental questionnaires and a health check aged 13 months. Data were collected on maternal education, deprivation, eating attitudes, and depression, using the Edinburgh Post Natal Depression Scale (EPDS) at 3 months. Weight gain was assessed using change in weight SD score, conditional on birth weight (Thrive Index); weight faltering was defined as conditional weight gain below the 5th centile. RESULTS Of 923 eligible infants born at term, 774 (84%) had both weight and questionnaire data. Replicating a previous finding, both the highest and the lowest levels of deprivation were associated with weight faltering; this was independent of the type of milk feeding. No relation was found with maternal educational status. Maternal eating restraint was unrelated to weight gain. Infants of mothers with high depression symptom scores (EPDS >12) had significantly slower weight gain and increased rates of weight faltering up to 4 months (relative risk 2.5), especially if they came from deprived families, but by 12 months they were no different from the remainder of the cohort. CONCLUSIONS In this setting, social and maternal characteristics had little influence on infants' weight gain, apart from a strong, but transient effect of postnatal depression.
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Abstract
BACKGROUND Unilateral visual impairment (UVI) as a result of amblyopia or refractive error is common in childhood, but its functional significance remains largely unexplored. AIM To investigate the influence of visual acuity and stereoacuity on the performance of preschool children on tasks requiring visuomotor skills and visuospatial ability. METHODS Children with normal (6/6) visual acuity (VA) in both eyes and children with UVI ranging from 6/9 to 6/60, with no strabismus and normal vision in the fellow eye, were assessed on a neurodevelopmental test battery of visually guided tasks. RESULTS 50 children (mean age (SD): 52.4 (5.7) months; median (range) VA: 6/9 (6/6 to 6/60); median (range) stereoacuity: 70 seconds arc (40-absent)) completed the test battery. UVI and stereoacuity correlated moderately (Pearson's r = 0.537, p < 0.001) but seven of 28 children with impaired VA had normal stereoacuity (< 70 seconds arc) while five of 22 with normal VA had abnormal stereoacuity. Stereoacuity correlated with performance on a task requiring fine hand-eye coordination and a task measuring visuomotor integration. UVI did not correlate with performance on any test battery items. CONCLUSIONS UVI itself does not appear to relate to visuomotor actions, except when associated with reduced stereoacuity. Stereoacuity appears to have an influential role in fine visuomotor actions and spatial representation in preschool children.
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How widely are personal child health records used and are they effective health education tools? A comparison of two records. Child Care Health Dev 2006; 32:55-61. [PMID: 16398791 DOI: 10.1111/j.1365-2214.2006.00575.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Abstract Background Although the Personal Child Health Records (PCHR) has been in use for 15 years, its efficacy as a health education tool has not been evaluated. The phased introduction of a new, professionally designed record within a large cohort study provided the opportunity to compare parental rating and use of the different records and recall of health topics covered. Subjects and methods All babies born over a 15-month period were eligible. Half (679) were born during study recruiting periods and received an expanded version of the new record; 30% (411) were born in non-recruiting periods and received the old record and 20% (279) were born after the new record had been fully introduced. Parents completed a one-page postal questionnaire when their child was aged 6-17 months. Results Parents rated both record types highly and the majority used them regularly to take to baby clinics and for information. Health visitors wrote frequently in the record, compared with only half of parents and less than a quarter of family doctors. Old format records were significantly more likely to be taken to and written in by the family doctor. Parents used new format records less as a source of information, but were no more likely to use other recommended information sources. Parents with new format records showed better recall of information found only, or more prominently in the new records, but the actual differences were small. Conclusions The PCHR remains popular with parents, but is still underused except by health visitors. Recall of health information in the record is fairly poor, but families make little use of other, better information sources. Professional redesign did not improve the efficacy of the record.
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Low level microsatellite instability may be associated with reduced cancer specific survival in sporadic stage C colorectal carcinoma. Gut 2005; 54:103-8. [PMID: 15591513 PMCID: PMC1774365 DOI: 10.1136/gut.2003.034579] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Colorectal cancers (CRCs) may be categorised according to the degree of microsatellite instability (MSI) exhibited, as MSI-high (MSI-H), MSI-low (MSI-L), or microsatellite stable (MSS). MSI-H status confers a survival advantage to patients with sporadic CRC. AIMS To determine if low levels of MSI are related to the clinicopathological features and prognosis of sporadic stage C CRC. PATIENTS A total of 255 patients who underwent resection for sporadic stage C CRC were studied. No patient received chemotherapy. Minimum follow up was five years. METHODS DNA extracted from archival malignant and non-malignant tissue was amplified by polymerase chain reaction using a panel of 11 microsatellites. MSI-H was defined as instability at > or =40% of markers, MSS as no instability, and MSI-L as instability at >0% but <40% of markers. Patients with MSI-H CRC were excluded from analysis as they have previously been shown to have better survival. RESULTS Thirty three MSI-L and 176 MSS CRCs were identified. There was no difference in biological characteristics or overall survival of MSI-L compared with MSS CRC but MSI-L was associated with poorer cancer specific survival (hazard ratio 2.0 (95% confidence interval 1.1-3.6)). CONCLUSIONS Sporadic MSI-L and MSS CRCs have comparable clinicopathological features. Further studies are required to assess the impact of MSI-L on prognosis.
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Abstract
BACKGROUND Iron deficiency is common in early childhood and has been associated with developmental delay. It is not known how reliably markers of iron deficiency identify true iron deficiency, defined as a therapeutic response to oral iron. METHODS The subjects were members of the Millennium Baby Study cohort. At age 13 months a venous blood sample was taken for mean cell volume (MCV), haemoglobin, mean cell haemoglobin (MCH), ferritin, and zinc protoporphyrin (ZPP). Children with abnormal values were offered treatment with oral iron and dietary modification, and re-sampled after 3 months. RESULTS Samples were obtained for 462 children. All markers were moderately correlated with each other except ferritin. Treatment was offered to 147 (32%) children with at least one abnormal value, of whom 126 (86%) were re-sampled. Children with a haemoglobin or an MCH below the screening cut off, or with abnormal values for two or more of the remaining three measures, showed a large therapeutic response to iron, but isolated abnormalities of MCV, ZPP, or ferritin were not consistently associated with a response. Of the screened population 13% could be defined as iron deficient (abnormal haemoglobin or MCH, or abnormal levels of two or more of the remaining three markers), but this was not strongly associated with any dietary, demographic, or anthropometric characteristic. CONCLUSIONS Low total or mean cell haemoglobin in isolation is a specific marker of iron deficiency, but other markers are only predictive when found in combination with other abnormal values.
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Abstract
The purpose of the study was to determine whether chronic immunostimulation could explain growth faltering in disadvantaged children in the UK, as it does in developing countries such as The Gambia. In all, 216 infants, age 10-21 months, were recruited when blood samples were taken for the routine or clinical purposes of a longitudinal study tracking a larger cohort of children. Aliquots of blood were collected on Guthrie cards to determine blood concentrations of albumin (Alb), alpha(1)-antichymotrypsin (ACT), and immunoglobulin G (IgG). Haemoglobin concentrations were determined by routine hospital laboratory analysis. Heights and weights were measured and converted to z-scores; birth weights were used with recruitment weight to calculate a 'thrive index' for each child. Age-corrected plasma IgG concentration was negatively associated with both height- and weight-for-age z-scores (P = 0.042 and 0.038, respectively) but not with the thrive index or body mass index z-scores. Blood haemoglobin levels were positively related to height- and weight-for age z-scores, as well as to the thrive index (P = 0.026, 0.014, and 0.007, respectively). Although significant, these relationships could only account for a small part the observed growth variation. Although the relationships were weak, the results suggest that some of the observed variation in growth of these UK infants may be explained on the basis of persistent immunostimulation or poor iron status. In terms of markers of immunostimulation (Alb, ACT, ACT:Alb ratio, IgG), both absolute levels and relationships with height-for-age are substantially different than those previously observed in cohort studies of infants in The Gambia.
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Abstract
BACKGROUND The recommended age of introduction of solids food to the diet of infants (weaning) has recently been increased in the UK to 6 months, but most babies are still weaned before the age of 4 months. AIMS To examine what predicts the age of weaning and how this relates to weight gain and morbidity using data from a population based cohort. METHODS Parents of 923 term infants born in a defined geographical area and recruited shortly after birth were studied prospectively using postal questionnaires, weaning diaries, and routinely collected weights, of whom 707 (77%) returned data on weaning. RESULTS The median age of first weaning solids was 3.5 months, with 21% commencing before 3 months and only 6% after 4 months of age. Infants progressed quickly to regular solids with few reported difficulties, even when weaned early. Most parents did not perceive professional advice or written materials to be a major influence. The strongest independent predictors of earlier age at weaning were rapid weight gain to age 6 weeks, lower socioeconomic status, the parents' perception that their baby was hungry, and feeding mode. Weight gain after 6 weeks was unrelated to age of weaning. Babies weaned before 3 months, compared to after 4 months, had an increased risk of diarrhoea. CONCLUSIONS Social factors had some influence on when weaning solids were introduced, but the great majority of all infants were established on solids before the previously recommended age of 4 months, without difficulty. Earlier weaning was associated with an increased rate of minor morbidity.
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The emotional impact of amblyopia treatment in preschool children. Ophthalmology 2004; 111:1550-6. [PMID: 15288987 DOI: 10.1016/j.ophtha.2003.12.059] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2003] [Accepted: 12/23/2003] [Indexed: 10/26/2022] Open
Abstract
PURPOSE To investigate the emotional status of children undergoing active treatment for amblyopia. DESIGN Postal survey, in the context of a prospective, multicenter, randomized controlled trial. PARTICIPANTS Parents of 177 children with a unilateral visual impairment referred from preschool vision screening. The children had been recruited to a randomized controlled trial of treatment for unilateral visual impairment and randomly assigned to receive either glasses with or without patches, glasses alone, or treatment deferred for 1 year. METHODS A self-completion questionnaire, including a psychometric behavioral scale, was sent to the parents of all children recruited to the trial at age 4 years, to 66 whose deferred treatment began at age 5 years, and finally to 151 remaining in the trial at the end of follow-up. MAIN OUTCOME MEASURES Mean scores per treatment group on the Revised Rutter Parent Scale for Preschool Children. Comparison of parent responses to questions assessing the child's general well-being and difficulties associated with treatment. RESULTS Completed questionnaires were returned for 144 of 177 (81%) children at a mean age (standard deviation) of 48 months (5.0), for 45 of 66 (68%) at a mean age of 61 months (5.8), and for 78 of 151 (52%) at a mean age of 67 months (5.0). Most parents reported having difficulty with patching their child regardless of age (77% at age 4 years and 73% at age 5 years), with fewer reporting difficulties with glasses alone (42% and 53%, respectively). Children were significantly more upset by patching than by glasses only (chi-square test, P = 0.03 for age 4 years and P = 0.01 for age 5 years), as were the parents of 4-year-olds (chi-square test, P = 0.01). Most parents thought their children were happy, cooperative, and good tempered, and behavioral scores did not differ between treatment groups. CONCLUSIONS Treatment for unilateral visual impairment is not easy to implement and is commonly associated with some degree of distress. Despite this, no impact on the child's global well-being or behavior was seen either during or after the treatment period.
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Abstract
BACKGROUND Although it is a well known phenomenon, limited normative data on neonatal weight loss and subsequent gain are available, making it hard to assess individual children with prolonged weight loss. OBJECTIVE To establish, using data from a large prospective population based cohort study, norms and limits for postnatal weight loss and its impact on current growth reference charts. METHOD A cohort of 961 term infants were recruited at birth and followed using parental questionnaires and community nursing returns. Routine weights were collected for half the cohort at 5 days and for all at 12 days and 6 weeks. RESULTS Less weight loss was seen than the 3-6% suggested by previous studies, but one in five infants had not regained their birth weight by 12 days. Those lightest at birth showed least weight loss. Twenty six (3%) children had more than 10% weight loss, but none showed evidence of major organic disease. Actual weights in the first fortnight are half to one centile space lower than growth charts suggest, while birthweight centiles for children born at 37 weeks were two centile spaces lower. CONCLUSIONS Neonatal weight loss is brief, with few children remaining more than 10% below birth weight after 5 days. Growth charts are misleading in the first 2 weeks, because they make no allowance for neonatal weight loss.
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Do early infant feeding patterns relate to breast-feeding continuation and weight gain? Data from a longitudinal cohort study. Eur J Clin Nutr 2004; 58:1290-6. [PMID: 15054405 DOI: 10.1038/sj.ejcn.1601964] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To describe the first-week feeding patterns for breast- vs bottle-fed babies, and their association with sustained breast-feeding and infant weight gain at 6 weeks. DESIGN A longitudinal cohort study. SETTING Feeding diaries were completed by mothers in an urban UK community shortly after birth; follow-up weight and feeding data were collected at routine health checks. SUBJECTS Mothers of 923 full-term infants born during the recruiting period agreed to join the study. In all, 502 usable diaries were returned from 54% of the cohort. RESULTS Breast-fed infants were fed more frequently (2.71 h between feeds) than bottle-fed infants (3.25 h between feeds) and mixed-fed infants (3.14 h between feeds) (P<0.001) in the first week of life, while duration of feeds was similar. Only exclusive breast-feeding in the first week (P<0.001) and maternal education (P=0.004) were related to continued breast-feeding at 6 weeks. Greater first-week feeding frequency (as measured by feed-to-feed interval, h) was associated with higher weight gain at 6 weeks for breast-feeders, but no analysed factors were associated with higher weight gain for bottle-feeders. CONCLUSIONS This large-scale study of first-week feeding patterns sheds light on the important and complicated issues of breast-feeding continuation and infant weight gain, with implications for the feeding advice given to mothers. Supplementary bottle feeds were clearly associated with discontinued breast-feeding at 6 weeks. Over that period, higher weight gain was associated with more frequent feeding for breast-fed infants only. SPONSORSHIP Henry Smith Charity, SPARKS, Child Growth Foundation.
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Randomised controlled trial of treatment of unilateral visual impairment detected at preschool vision screening. BMJ 2003; 327:1251. [PMID: 14644966 PMCID: PMC286242 DOI: 10.1136/bmj.327.7426.1251] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/24/2003] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To test the efficacy of treatment for unilateral visual loss detected by preschool vision screening and the extent to which effectiveness varies with initial severity. DESIGN Randomised controlled trial of full treatment with glasses and patching, if required, compared with glasses only or no treatment. Masked assessment of best corrected acuity after one year of follow up. SETTING Eight UK eye departments. PARTICIPANTS 177 children aged 3-5 years with mild to moderate unilateral impairment of acuity (6/9 to 6/36) detected by screening. RESULTS Children in the full and glasses treatment groups had incrementally better visual acuity at follow up than children who received no treatment, but the mean treatment effect between full and no treatment was equivalent to only one line on a Snellen chart (0.11 log units; 95% confidence interval 0.050 to 0.171; P < 0.0001). The effects of treatment depended on initial acuity: full treatment showed a substantial effect in the moderate acuity group (6/36 to 6/18 at recruitment) and no significant effect in the mild acuity group (6/9 to 6/12 at recruitment) (P = 0.006 for linear regression interaction term). For 64 children with moderate acuity loss the treatment effect was 0.20 log units, equivalent to one to two lines on a Snellen chart. When all children had received treatment, six months after the end of the trial, there was no significant difference in acuity between the groups. CONCLUSIONS Treatment is worth while in children with the poorest acuity, but in children with mild (6/9 to 6/12) unilateral acuity loss there was little benefit. Delay in treatment until the age of 5 did not seem to influence effectiveness.
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The Electrochemistry of Inorganic Difluoramino Compounds. II. Solution Chemistry and Electrochemical Reduction of Difluoramine. J Am Chem Soc 2002. [DOI: 10.1021/ja00956a018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chelate Chemistry. I. Tropolone and Aminotroponimine Derivatives of the Main-Group Elements. J Am Chem Soc 2002. [DOI: 10.1021/ja01077a017] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
This article reports a non-randomized intervention study conducted in two market towns to find out whether participant-centred health education discussions improve parents' knowledge and actions concerning infant feeding. Following an initial quiz, parents of 8-week-old infants attended a discussion on weaning (intervention) or home safety (control). They were then asked to complete a questionnaire about their knowledge and actions concerning weaning when their infants were 7-9 months old. A total of 61 parents took part in the intervention and 49 in the control. In the post-intervention questionnaire, the intervention group reported using more home-cooked foods and less commercially-prepared foods and knew the optimum time to register their infants with the dentist. These results suggest that participant-centred discussions are an effective way of disseminating public health messages concerning infant feeding.
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Abstract
Since the introduction of new growth charts in the mid 1990s, there has been confusion about which charts should be used, with many districts using more than one version. Because of this uncertainty, an expert working party, the Growth Reference Review Group, was convened by the Royal College of Paediatrics and Child Health to provide guidance on the validity and comparability of the different charts currently in use. This paper describes the technical background to the construction and evaluation of growth charts and outlines the group's findings on the validity of each growth reference in relation to contemporary British children. The group concluded that for most clinical purposes the UK90 reference is superior and for many measures is the only usable reference that can be recommended, while the original Tanner-Whitehouse and the Gairdner-Pearson charts are no longer reliable for use at any age. After the age of 2 the revised Buckler-Tanner references are still suitable for assessing height. There are presently no reliable head circumference reference charts for use beyond infancy. The group propose that apart from refinements of chart design and layout, the new UK90 reference should now be "frozen", with any future revisions only undertaken after careful planning and widespread consultation.
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Implications of childhood obesity for adult health: findings from thousand families cohort study. BMJ (CLINICAL RESEARCH ED.) 2001; 323:1280-4. [PMID: 11731390 PMCID: PMC60301 DOI: 10.1136/bmj.323.7324.1280] [Citation(s) in RCA: 249] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine whether being overweight in childhood increases adult obesity and risk of disease. DESIGN Prospective cohort study. SETTING City of Newcastle upon Tyne. PARTICIPANTS 932 members of thousand families 1947 birth cohort, of whom 412 attended for clinical examination age 50. MAIN OUTCOME MEASURES Blood pressure; carotid artery intima-media thickness; fibrinogen concentration; total, low density lipoprotein, and high density lipoprotein cholesterol concentrations; triglyceride concentration; fasting insulin and 2 hour glucose concentrations; body mass index; and percentage body fat. RESULTS Body mass index at age 9 years was significantly correlated with body mass index age 50 (r=0.24, P<0.001) but not with percentage body fat age 50 (r=0.10, P=0.07). After adult body mass index had been adjusted for, body mass index at age 9 showed a significant inverse association with measures of lipid and glucose metabolism in both sexes and with blood pressure in women. However, after adjustment for adult percentage fat instead of body mass index, only the inverse associations with triglycerides (regression coefficient= -0.21, P<0.01) and total cholesterol (-0.17, P<0.05) in women remained significant. CONCLUSIONS Little tracking from childhood overweight to adulthood obesity was found when using a measure of fatness that was independent of build. Only children who were obese at 13 showed an increased risk of obesity as adults. No excess adult health risk from childhood or teenage overweight was found. Being thin in childhood offered no protection against adult fatness, and the thinnest children tended to have the highest adult risk at every level of adult obesity.
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Society for Social Medicine and the International Epidemiological Association European Group. Abstracts of oral presentations. Br J Soc Med 2001. [DOI: 10.1136/jech.55.suppl_1.a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
BACKGROUND AND AIMS Little is known about injuries resulting from accidents in premobile infants. We aimed to describe the pattern of minor accidents in infants and their resulting injuries. METHODS The ALSPAC study collected data in successive postal questionnaires. At 6 months of age, parents were asked to describe any accident since birth. The type of fall, distance fallen, resulting injury, and help sought were independently coded. Burns were similarly coded. RESULTS A total of 11 466 responses were available. In 2554 children, 3357 falls were reported; 53% fell from beds or settees and 12% fell from arms or while being carried. Only 14% reported visible injury, of which 56% were bruises; 97% of injuries specified involved the head. Only 21 falls (<1%) resulted in concussion or fracture. A burn or scald occurred in 172 cases (1.5%). The main causes of scalds were hot drinks and water, with contact burns caused by radiators, cookers, and hot food. CONCLUSIONS Falls in young infants are common while burns are rare. Injuries from falls are infrequent, predominantly trivial, and almost entirely confined to the head. Falls from beds and settees did not result in skull fractures. Serious injury was the result of complex accidents.
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Abstract
Diabetes mellitus is a chronic disease that leads to complications including heart disease, stroke, kidney failure, blindness and nerve damage. Type 2 diabetes, characterized by target-tissue resistance to insulin, is epidemic in industrialized societies and is strongly associated with obesity; however, the mechanism by which increased adiposity causes insulin resistance is unclear. Here we show that adipocytes secrete a unique signalling molecule, which we have named resistin (for resistance to insulin). Circulating resistin levels are decreased by the anti-diabetic drug rosiglitazone, and increased in diet-induced and genetic forms of obesity. Administration of anti-resistin antibody improves blood sugar and insulin action in mice with diet-induced obesity. Moreover, treatment of normal mice with recombinant resistin impairs glucose tolerance and insulin action. Insulin-stimulated glucose uptake by adipocytes is enhanced by neutralization of resistin and is reduced by resistin treatment. Resistin is thus a hormone that potentially links obesity to diabetes.
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MESH Headings
- 3T3 Cells
- Adipocytes/metabolism
- Amino Acid Sequence
- Animals
- Base Sequence
- Chromosomes, Human, Pair 19
- Cloning, Molecular
- DNA
- Diabetes Mellitus/blood
- Diabetes Mellitus/etiology
- Diabetes Mellitus/metabolism
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/metabolism
- Diet
- Female
- Gene Expression Regulation/drug effects
- Glucose Intolerance
- Hormones/genetics
- Hormones/metabolism
- Hormones/physiology
- Hormones, Ectopic/genetics
- Hormones, Ectopic/metabolism
- Hormones, Ectopic/physiology
- Humans
- Hypoglycemic Agents/pharmacology
- Insulin Antagonists
- Insulin Resistance
- Intercellular Signaling Peptides and Proteins
- Male
- Mice
- Mice, Inbred C57BL
- Molecular Sequence Data
- Nerve Growth Factor
- Neutralization Tests
- Obesity
- Proteins
- Resistin
- Rosiglitazone
- Signal Transduction
- Thiazoles/pharmacology
- Thiazolidinediones
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Abstract
We have identified a family of resistin-like molecules (RELMs) in rodents and humans. Resistin is a hormone produced by fat cells. RELMalpha is a secreted protein that has a restricted tissue distribution with highest levels in adipose tissue. Another family member, RELMbeta, is a secreted protein expressed only in the gastrointestinal tract, particularly the colon, in both mouse and human. RELMbeta gene expression is highest in proliferative epithelial cells and is markedly increased in tumors, suggesting a role in intestinal proliferation. Resistin and the RELMs share a cysteine composition and other signature features. Thus, the RELMs together with resistin comprise a class of tissue-specific signaling molecules.
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Data presented do not justify pessimistic conclusions. Arch Dis Child 2001; 84:92. [PMID: 11213785 PMCID: PMC1718616 DOI: 10.1136/adc.84.1.89i] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Prognostic significance of extensive microsatellite instability in sporadic clinicopathological stage C colorectal cancer. Br J Surg 2000; 87:1197-202. [PMID: 10971428 DOI: 10.1046/j.1365-2168.2000.01508.x] [Citation(s) in RCA: 166] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Colorectal cancers exhibiting microsatellite instability (MSI) appear to have unique biological behaviour. This study analyses the association between extensive MSI (MSI-H), clinicopathological features and survival in an unselected group of patients with sporadic Australian Clinico-Pathological Stage (ACPS) C (tumour node metastasis stage III) colorectal cancer. METHODS Some 255 patients who underwent resection for sporadic ACPS C colorectal cancer between 1986 and 1992 were studied. No patient had received chemotherapy. Minimum follow-up for all patients was 5 years. Archival normal and tumour DNA was extracted and amplified by polymerase chain reaction using a radioactive labelling technique. MSI-H was defined as instability in 40 per cent or more of seven markers. RESULTS Twenty-one patients showed MSI-H. No association was found between MSI and age or sex. Tumours exhibiting MSI-H were more commonly right sided (P<0.00001), larger (P = 0.002) and more likely to be high grade (P = 0.049). After adjustment for age, sex and other pathological variables, patients whose cancers exhibited MSI-H had improved survival (P = 0.015). CONCLUSION Recognition of MSI-H in sporadic ACPS C tumours identifies a subset of cancers with improved prognosis. Such stratification should be considered in trials of adjuvant therapy and may be relevant to therapeutic decision making.
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Detection of Interstellar CH3. THE ASTROPHYSICAL JOURNAL 2000; 535:L111-L114. [PMID: 10835311 DOI: 10.1086/312711] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2000] [Accepted: 05/02/2000] [Indexed: 05/23/2023]
Abstract
Observations with the Short Wavelength Spectrometer on board the Infrared Space Observatory have led to the first detection of the methyl radical CH(3) in the interstellar medium. The nu(2) Q-branch at 16.5 µm and the R(0) line at 16.0 µm have been unambiguously detected toward the Galactic center Sagittarius A*. The analysis of the measured bands gives a column density of &parl0;8.0+/-2.4&parr0;x1014 cm(-2) and an excitation temperature of 17+/-2 K. Gaseous CO at a similarly low excitation temperature and C(2)H(2) are detected for the same line of sight. Using constraints on the H(2) column density obtained from C(18)O and visual extinction, the inferred CH(3) abundance is &parl0;1.3+2.2-0.7&parr0;x10-8. The chemically related CH(4) molecule is not detected, but the pure rotational lines of CH are seen with the Long Wavelength Spectrometer. The absolute abundances and the CH(3)/CH(4) and CH(3)/CH ratios are inconsistent with published pure gas-phase models of dense clouds. The data require a mix of diffuse and translucent clouds with different densities and extinctions, and/or the development of translucent models in which gas-grain chemistry, freeze-out, and reactions of H with polycyclic aromatic hydrocarbons and solid aliphatic material are included.
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Abstract
Mid-parental heights are widely used to help assess an individual child's growth. However, the methods in use vary, and most make no allowance for extremes of parental height. This study aimed to examine the actual distribution of parental heights in a survey population and the relation with their children's heights. The heights of 419 representatively sampled children aged 8-9 years were compared with their reported mid-parental heights, all expressed as standard deviation scores (SDS). These confirmed previous predictions that 90% of the children's heights would fall within 1.5 SDS (approximately two centile spaces) of their mid-parental heights. However, where parents were unusually tall or short, their children were relatively less tall or short, respectively, and the mid-parental height was a poor predictor of attained height. A simple calculator for expected height centile is described that automatically adjusts for this regression to the mean. Of 13 children below the second centile for height, eight were within two centile spaces (90% range) of their mid-parental height SDS. However, when allowance was made for regression to the mean, only three of 13 were within the 90% range. Although mid-parental height provides a useful guide to expected height centile for children and parents of average stature, it can be misleading when used to assess short children.
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Cognitive and educational attainments at school age of children who failed to thrive in infancy: a population-based study. J Child Psychol Psychiatry 1999; 40:551-61. [PMID: 10357162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
A 1-year cohort of children born at term in Newcastle-upon-Tyne in 1987/8 was screened for failure to thrive in infancy using a conditional longitudinal standard which identified those whose weight gain was in the lowest 5%. A group of 136 cases and 136 controls (from the same GP practice and living in a neighbourhood with the same deprivation index) was followed up at 7-9 years of age, when 79% of cases and 87% of controls were successfully studied. Cases at 7-9 were significantly shorter (mean 126.0 cm, SD 5.6) than controls (mean 130.7 cm, SD 5.9); adjusted for parental heights a difference of 4.4 cm (95% CI 2.92 to 5.90 cm) remained. They had smaller head circumferences (mean 51.9 cm, SD 1.8) than controls (mean 52.8 cm, SD 1.7), were significantly lighter (medians 23.8 kg, IR 21.5 to 26.9 in cases, and 27.9 kg, IR 25.2 to 31.6 in controls) and had a lower body mass index (median 14.9, IR 14.1 to 16.0 in cases, and 16.3, IR 15.3 to 17.8 in controls). Despite these large growth differences, no statistically significant differences in cognitive outcomes were found. Mean IQ was 87.6 (SD 17.4) in cases and 90.6 (SD 17.1) in controls; after adjustment for organic cause and mother's IQ the mean difference was 1.7 IQ points (95% CI -5.2 to 1.9). There were no statistically significant differences in the reading, spelling, or reading comprehension scores; the mean standardised reading score was 93.5 (SD 16.2) for cases and 94.5 (SD 15.6) for controls. These results show that when carefully defined by velocity-based anthropometric criteria, nonorganic failure to thrive in infancy is followed by persisting stunting and wasting, and a reduced head circumference, but is not associated with cognitive or educational disadvantages at school age.
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