Influence of socioeconomic conditions on growth in infancy: the 1921 Aberdeen birth cohort.
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OBJECTIVES: To identify environmental influences on infant growth using data from a birth cohort established in 1921. DESIGN: A longitudinal cohort study. SETTING: Aberdeen 1921-22. SUBJECTS: Five hundred and sixteen individuals (263 boys and 253 girls) born in Aberdeen during 1921. Health visitor assessments ranged from two to 40 (47% received at least 10 visits). No records were available for infants who died. Individuals were grouped as those who did not breast feed, those who breast fed initially but not at 6 months, and those who were continuing to breast feed at 6 months. MAIN OUTCOME MEASURE: Rate of weight gain over the 1st year of life. A random effects model was used to identify environmental factors and conditions contributing to rate of weight gain in the 1st year of life. RESULTS: Breast feeding rates were about 80% and 50% at 10 days and 6 months, respectively. Breast fed infants were significantly heavier than bottle fed infants at 28 days but this difference disappeared by 12 months. Significant negative effects on rate of weight gain, independent of initial body weight, were found for overcrowding in family homes and maternal parity, whereas social class had no effect. CONCLUSION: Studies based on historical cohorts that have controlled socioeconomic variables only in terms of social class (derived from parental occupation) may have been subject to residual confounding. Growth in the 1st year of life is likely to reflect a number of environmental influences, some of which may continue to have effects throughout early life and beyond. (+info)
Cortisol effects on body mass, blood pressure, and cholesterol in the general population.
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The effects of excess cortisol secretion on blood pressure and fat deposition are well documented, but the importance of this glucocorticoid in controlling these processes in normal individuals is less clear. We studied the relationship between cortisol excretion rate (tetrahydrocortisol [THF]+allo-THF+tetrahydrocortisone [THE]) and a range of important cardiovascular risk factors in 439 normal subjects (238 male) sampled from the North of Glasgow (Scotland) population. There were marked gender differences: female subjects were lighter and had lower blood pressures and cortisol levels, whereas HDL cholesterol was higher. The pattern of cortisol metabolism was also different; the index of 11beta-hydroxysteroid dehydrogenase activity (THF+allo-THF/THE) was lower and that of 5alpha-reductase (allo-THF/THF) was higher. There was a strong correlation of blood pressure (positive), cholesterol (positive), and HDL cholesterol (negative in women, positive in men) with age. Cortisol excretion rate did not correlate with blood pressure but correlated strongly with parameters of body habitus (body mass index and waist and hip measurements [positive]) and HDL cholesterol (negative). With multiple regression analysis, there remained a significant association of cortisol excretion rate with HDL cholesterol in men and women and with body mass index in men. These results suggest that glucocorticoids regulate key components of cardiovascular risk. (+info)
Alcohol consumption and mortality from all causes, coronary heart disease, and stroke: results from a prospective cohort study of scottish men with 21 years of follow up.
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OBJECTIVES: To relate alcohol consumption to mortality. DESIGN: Prospective cohort study. SETTING: 27 workplaces in the west of Scotland. PARTICIPANTS: 5766 men aged 35-64 when screened in 1970-3 who answered questions on their usual weekly alcohol consumption. MAIN OUTCOME MEASURES: Mortality from all causes, coronary heart disease, stroke, and alcohol related causes over 21 years of follow up related to units of alcohol consumed per week. RESULTS: Risk for all cause mortality was similar for non-drinkers and men drinking up to 14 units a week. Mortality risk then showed a graded association with alcohol consumption (relative rate compared with non-drinkers 1. 34 (95% confidence interval 1.14 to 1.58) for 15-21 units a week, 1. 49 (1.27 to 1.75) for 22-34 units, 1.74 (1.47 to 2.06) for 35 or more units). Adjustment for risk factors attenuated the increased relative risks, but they remained significantly above 1 for men drinking 22 or more units a week. There was no strong relation between alcohol consumption and mortality from coronary heart disease after adjustment. A strong positive relation was seen between alcohol consumption and risk of mortality from stroke, with men drinking 35 or more units having double the risk of non-drinkers, even after adjustment. CONCLUSIONS: The overall association between alcohol consumption and mortality is unfavourable for men drinking over 22 units a week, and there is no clear evidence of any protective effect for men drinking less than this. (+info)
Randomised controlled trial of effect of Baby Check on use of health services in first 6 months of life.
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OBJECTIVE: To evaluate the effect of Baby Check, an illness scoring system for babies of 6 months or less, on parents' use of health services for their baby. DESIGN: Randomised controlled trial. SETTING: 13 general practices in Glasgow. SUBJECTS: 997 newly delivered mothers, randomised to receive either Baby Check and Play It Safe, an accident prevention leaflet (n=497), or Play It Safe alone (control group, n=500). MAIN OUTCOME MEASURES: Data on consultations and referrals extracted from general practice notes after 6 months. RESULTS: At the time of recruitment, maternal characteristics were similar for both groups (mean maternal age 29 years; deprivation categories 6 and 1 in both groups; 424 (45%) mothers were primiparous). At 6 months, general practice notes were available for 467 (94%) of the Baby Check group and 468 (94%) of the control group. The number of general practitioner consultations did not differ between the groups: median number of consultations was 2 (interquartile range 1 to 4) in the Baby Check group, and 2 (1 to 3) in the control group. Use of out of hours services did not differ significantly between the two groups (86 v 85; P=0.93). CONCLUSION: Distributing Baby Check to an unselected group of mothers does not affect use of health services for infants up to 6 months of age. (+info)
Eye injuries in children: the current picture.
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AIMS: To investigate the current causes and outcomes of paediatric ocular trauma. METHODS: A prospective observational study of all children admitted to hospital with ocular trauma in Scotland over a 1 year period. RESULTS: The commonest mechanism of injury was blunt trauma, accounting for 65% of the total. 60% of the patients were admitted with a hyphaema. Injuries necessitating admission occurred most frequently at home (51%). Sporting activities were the commonest cause of injury in the 5-14 age group. There were no injuries caused by road traffic accidents or fireworks. Patients were admitted to hospital for a mean of 4.2 days (range 1-25 days). One (1%) child had an acuity in the "visually impaired" range (6/18-6/60) and one (1%) was "blind" (6/60) in the affected eye. No child was bilaterally blinded by injury and none required blind or partial sight registration. CONCLUSION: This study has shown that the incidence of eye injuries affecting children has fallen. The outcome of ocular trauma has improved significantly, and for the first time paediatric injuries appear to have a better prognosis than injuries affecting adults. (+info)
Expressed emotion and relapse in young schizophrenia outpatients.
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High familial expressed emotion (EE) reliably predicts 9-month relapse rates in schizophrenia patients. Difficulties interpreting the EE-relapse finding arise, however, because EE is usually assessed during a hospital admission, yet relapse following discharge is predicted. Researchers in Scotland assessed EE in relatives while the patients were out of hospital; using conservative relapse criteria, they failed to find higher subsequent 6- and 12-month relapse rates among patients living in high-EE homes (McCreadie and Phillips 1988). Our goal was to determine the ability of EE to predict relapse in a sample of 69 schizophrenia outpatients using both conservative criteria (for 6-and 12-month rates) and standard relapse criteria (for 9- and 18-month rates). According to the conservative criteria, EE failed to predict 6- and 12-month relapse. According to the standard criteria, 9-month relapse rates were significantly greater among patients in high-EE households. In parental homes, relapse at both 9 months and 18 months was best predicted by fathers' critical comments and mothers' emotional overinvolvement. Relapse was not associated with medication compliance and the amount of contact with high-EE relatives. (+info)
The molecular basis of malonyl-CoA decarboxylase deficiency.
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We characterized a 2.1-kb human cDNA with a 1362-bp (454-amino acid) open reading frame showing 70.3% amino acid identity to goose malonyl-CoA decarboxylase (MCD). We have identified two different homozygous mutations in human MCD (hMCD) by using RT-PCR analysis of fibroblast RNA from two previously reported consanguineous Scottish patients with MCD deficiency. The first mutation is a 442C-->G transversion resulting in a premature stop codon (S148X) in the N-terminal half of the protein. The second is a 13-bp insertion in the mature RNA, causing a frameshift with predicted protein truncation. This insertion is the result of an intronic mutation generating a novel splice acceptor sequence (IVS4-14A-->G). Both mutations were found to segregate appropriately within the families and were not found in 100 normal unrelated individuals. These mutations would be predicted to cause MCD deficiency, thus confirming this transcript as the hMCD ortholog. The peptide sequence of hMCD revealed a C-terminal peroxisomal targeting sequence (-SKL). This targeting signal appears to be functional in vivo, since the distribution of MCD enzymatic activity in rat liver homogenates-as measured by means of subcellular fractionation-strongly suggests that MCD is localized to peroxisomes in addition to the mitochondrial localization reported elsewhere. These data strongly support this cDNA as encoding human MCD, an important regulator of fatty acid metabolism. (+info)
Early referral, diagnosis, and treatment of rheumatoid arthritis: evidence for changing medical practice.
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OBJECTIVES: To study the delay in starting disease modifying anti-rheumatic drugs (DMARDs) in patients with rheumatoid arthritis (RA), and any changes in medical practice between 1980 and 1997. METHODS: 198 consecutive RA patients attending the rheumatology clinics at a teaching hospital, for routine review, had their case sheet reviewed. The dates of symptom onset, general practitioner (GP) referral, first clinic appointment and first use of DMARD were recorded. Data were collected on the erythrocyte sedimentation rate, C reactive protein, rheumatoid factor, and the presence/absence of erosions at the first clinic assessment. Patients were split into four groups according to the date of their first clinic assessment-before 1986, 1987-9, 1990-3, and 1994-7. RESULTS: There was a sharp drop in the delay between symptom onset and GP referral (before 1986, 21 months; 1987-89, 23 months; 1990-3, 7 months; 1994-7, 4 months, p<0.03), and in the delay between first assessment at the rheumatology clinic and the start of DMARD treatment (before 1986, 32 months; 1987-89, 21 months; 1990-1993, 8 months; 1994-7, 1 month, p<0.001). The number of patients given DMARD treatment within six months of symptom onset increased from 5% (before 1994) to 44% (1994-7). Seventy three per cent of patients waiting more than a year from symptom onset to first clinic appointment already had erosive change, compared with 34% of patients seen within a year. CONCLUSIONS: Patients are being referred earlier in their disease, and DMARDs are prescribed sooner in the disease course. There has been a substantial increase in the proportion of patients treated with a DMARD within six months of symptom onset. (+info)