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1.  The influence of maternal socioeconomic and emotional factors on infant weight gain and weight faltering (failure to thrive): data from a prospective birth cohort 
Archives of Disease in Childhood  2006;91(4):312-317.
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.
doi:10.1136/adc.2005.077750
PMCID: PMC2065961  PMID: 16397011
failure to thrive; postnatal depression; eating disorders; socioeconomic deprivation
2.  Failure to thrive: the prevalence and concurrence of anthropometric criteria in a general infant population 
Archives of Disease in Childhood  2006;92(2):109-114.
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.
doi:10.1136/adc.2005.080333
PMCID: PMC2083342  PMID: 16531456
3.  Unilateral visual impairment and neurodevelopmental performance in preschool children 
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.
doi:10.1136/bjo.2006.090910
PMCID: PMC1857168  PMID: 16540485
visual acuity; stereoacuity; child, preschool; psychomotor performance
4.  Relationships between paediatricians and infant formula milk companies 
Archives of Disease in Childhood  2006;91(5):383-385.
Paediatricians should recognise the influence of infant formula milk companies and avoid intentionally or inadvertently promoting them
doi:10.1136/adc.2005.072892
PMCID: PMC2082719  PMID: 16632663
breast feeding; conflict of interest; infant formula; nutrition
6.  Comparison of the use of Tanner and Whitehouse, NCHS, and Cambridge standards in infancy. 
Archives of Disease in Childhood  1993;69(4):420-422.
The British (Tanner and Whitehouse) and American (National Center for Health Statistics, NCHS) growth standards are widely used internationally, although the data are now over 30 years old. Routine weight data was retrieved from the child health records of a complete annual cohort of 3418 children aged 18-30 months to test the validity of these standards for modern infants. Compared with the Tanner and Whitehouse standards, Newcastle children rose initially and then fell a mean of 0.7 SDs between 6 weeks and 18 months, resulting in a threefold difference in the proportion of children below the 3rd centile at different ages. NCHS standards showed a similar pattern. When compared with modern standards from the Cambridge growth study, there was a much closer match, although Newcastle children showed a slight gain by the age of 1 year. Existing standards for weight introduce inaccuracy into the estimation of centile position in the early months of life. As both standards show similar problems this probably represents a real secular change due to changes in infant nutrition. These findings support the need to develop new national growth reference standards.
PMCID: PMC1029547  PMID: 8259870
7.  Low level microsatellite instability may be associated with reduced cancer specific survival in sporadic stage C colorectal carcinoma 
Gut  2005;54(1):103-108.
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 ⩾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.
doi:10.1136/gut.2003.034579
PMCID: PMC1774365  PMID: 15591513
microsatellite instability; colorectal cancer; prognosis
9.  Randomised controlled trial of treatment of unilateral visual impairment detected at preschool vision screening 
BMJ : British Medical Journal  2003;327(7426):1251.
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.
PMCID: PMC286242  PMID: 14644966
11.  Iron deficiency in adolescents. 
BMJ : British Medical Journal  1989;298(6679):1035-1036.
PMCID: PMC1836338  PMID: 2499384
13.  Induction of Mutations in DNA-repair Deficient Bacteria by a Liver Microsomal Metabolite of Aflatoxin B1 
British Journal of Cancer  1973;28(6):544-551.
Certain strains of Salmonella typhimurium and Escherichia coli, particularly those which are very sensitive to u.v. light, are killed when incubated with rat liver mixed function oxidases and aflatoxin B1. UvrA or recA strains of E. coli are more susceptible than the wild-type strain, while the double mutant uvrA recA is the most sensitive strain yet tested. The aflatoxin B1 metabolite is also able to induce reverse mutations in 2 histidine auxotrophic strains of S. typhimurium, one strain of which is reverted specifically by frame shift mutagens and the other by agents inducing base pair substitutions.
Pretreatment of rats with either 3-methylcholanthrene or benzo(a)pyrene, both inducers of liver microsomal mixed function oxidases, did not alter the amount of lethal aflatoxin B1 metabolite formed, whereas an increase was observed after phenobarbitone pretreatment. Addition of the nucleophiles methionine, cysteine, glutathione, sodium thiosulphate or sodium sulphide, or the epoxide hydrase inhibitor, cyclohexene oxide to the toxicity assay medium did not alter bacterial killing by the aflatoxin B1 metabolite. 2,3-Dimercaptopropanol had some protective action.
Toxic metabolites were also formed when 5-methoxysterigmatocystin, O-methylsterigmatocystin, parasiticol or versicolorin A, but not vericolorin B, were incubated with mixed function oxidases. The relationship between the metabolite of aflatoxin B1 lethal to bacteria and that which initiates liver cancer is discussed.
PMCID: PMC2008936  PMID: 4593223
14.  Medical treatment of patients with severe exertional and rest angina: double blind comparison of beta blocker, calcium antagonist, and nitrate. 
British Heart Journal  1987;57(6):505-511.
The role of medical treatment of patients who had resting nocturnal angina as well as exertional angina was investigate. The effects of atenolol 100 mg a day, nifedipine 20 mg three times a day, and isosorbide mononitrate 40 mg twice a day were investigated in a double blind, triple dummy randomised study. Nine patients with coronary artery disease, early positive exercise tests, and transient daytime and nocturnal ambulatory ST segment changes were initially assessed off all antianginal medication. They were then treated with each drug for three five day periods. Angina diaries were reviewed and maximal treadmill exercise tests and 48 hour ambulatory ST segment monitoring were performed at the end of each treatment period. Resting and exercise heart rate and blood pressure were significantly lower on atenolol than on either isosorbide mononitrate or nifedipine. The duration of exercise to 1 mm ST segment depression was significantly greater on atenolol than on isosorbide mononitrate. Only one patient had an improvement in exercise tolerance on nifedipine that was greater than the improvement on atenolol; this patient had single vessel disease. The total number and duration of episodes of ST segment change during ambulatory monitoring were significantly lower with atenolol than on either isosorbide mononitrate or nifedipine. Nocturnal ST segment changes were abolished in six patients on atenolol, in six patients on nifedipine, and in five patients on isosorbide mononitrate. When nocturnal ST segment changes occurred, their frequency was reduced with all three drugs. Pain was abolished in four patients on atenolol and pain relief was significantly better on atenolol than on isosorbide mononitrate. There was no significant difference in pain relief between isosorbide mononitrate and nifedipine. Thus beta receptor blockade with atenolol was the most effective means of reducing myocardial ischaemia both during exercise and at rest at night without causing deterioration in any patient. Nocturnal myocardial ischaemia in patients with severe coronary artery disease can be effectively treated with beta receptor antagonists and vasodilators.
PMCID: PMC1277219  PMID: 3304367
15.  Accessory mitral valve tissue causing left ventricular outflow tract obstruction. 
British Heart Journal  1986;55(4):376-380.
Although left ventricular outflow tract obstruction is commonly associated with congenitally corrected transposition of the great vessels, this obstruction is seldom caused by accessory mitral valve tissue. Three cases in which accessory mitral valve tissue caused left ventricular outflow tract obstruction in children are described. Two had congenitally corrected transposition and one had normally connected great vessels. The accessory leaflet tissue, which was identified by echocardiography and angiography, was attached by chordae tendineae to normally sited papillary muscles and herniated into the left ventricular outflow tract during systole. Operation was successful in these patients. The accessory valve tissue was excised via an arteriotomy in the great vessel that arose from the left ventricle. The obstructive tissue was excised close to its peripheral attachments in the outflow tract and its chordae tendineae were divided. Resection was performed without injury to the abnormally placed conduction system or to the normal valve structures.
Images
PMCID: PMC1236741  PMID: 3964505
16.  Sex differences in weight in infancy and the British 1990 national growth standards. 
BMJ : British Medical Journal  1996;313(7056):513-514.
OBJECTIVES: To determine if there is a sex difference in infancy in the new British national standards for weight (based on data from 1990). DESIGN: Weight data in a birth cohort were compared with the 1990 standards and Tanner and Whitehouse (1966) standards up to age 12 months. SETTING: Newcastle upon Tyne. SUBJECTS: 3418 term infants. RESULTS: Our cohort showed a mean difference in standard deviation scores of 0.42 between boys and girls (P < 0.0001) when compared with the 1990 standards. Two and a half times as many girls as boys had weights below the 3rd centile during the first year, with an equivalent excess of boys above the 97th centile (P < 0.0001). Similar results were found with Tanner and Whitehouse standards. CONCLUSIONS: These differences could result in substantial sex bias in the identification of poor growth in early childhood. The standards need modification.
PMCID: PMC2351949  PMID: 8789973
17.  How important is a history of chest pain in determining the degree of ischaemia in patients with angina pectoris? 
British Heart Journal  1985;54(1):22-26.
Since therapeutic decisions in patients with angina pectoris are usually based on the reported frequency of exertional and rest pain the relations between the historical frequency of chest pain and objective evidence of myocardial ischaemia during normal daily activity were investigated in 100 patients by 48 hour ambulatory ST segment monitoring. Of these 100 consecutive patients with chest pain, 91 had typical pain and nine some atypical features. Twenty six patients had normal coronary arteries and 52 of the 74 with significant coronary disease had ambulatory ST segment changes. There was no relation between the frequency of reported exertional or rest pain and (a) the severity of coronary artery disease or (b) the frequency of daytime or nocturnal ST segment changes. Twelve patients had nocturnal ST segment changes but only four complained of nocturnal angina. Most patients had both painful and painless episodes of ST segment changes, but a substantial number had either painless or painful episodes only. These differences were not related to the severity of coronary artery disease. Chest pain after the onset of ST segment change was perceived with wide interpatient and intrapatient variability. Thus the frequency of pain is a poor indicator of the frequency of significant cardiac ischaemia. Individual differences in the perception of pain may be more important.
PMCID: PMC481842  PMID: 4015912

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