57,441 research outputs found
Cognitive and behavioural outcomes of non-organic failure to thrive
No full textIn a study of failure to thrive in 1987-8, 54 children (21%) from an annual cohort attending two clinics in a deprived area of Newcastle Upon Tyne were identified as having fallen across two or more major weight centiles for a month or more during the first 18 months of life. They were studied with 52 normally growing controls selected from the same clinics. Eighty nine per cent of these children were traced for a follow up study at age 6-7 years old. This follow up study is reported in this thesis. IQ was assessed using the Weschler Preschool and Primary Scale of Intelligence. The Teacher's Report Form (Achenbach, 1991) was used to assess behaviour problems in the groups. Testers were unaware of the clinical status of the children. Height was routinely measured at school entry and the original data were analysed to determine age at the lowest centile point and severity of fall in weight gain. In an independent samples analysis, a small but statistically significant difference in height at school entry age was found, but there was no statistically significant difference between the cases and controls in IQ (mean IQ 83.6 and 87 respectively, P=0.16), or ratings of behaviour problems (TRF median problems reported 23 and 14, Mann U=1.05, P=0.297). Teacher ratings did not reach conventional levels of statistical significance in any subsequent analysis. A within case group analysis of growth data was carried out to determine if there was a larger effect on a subset of cases sharing characteristics of growth failure. The effects of chronicity, age at the lowest centile point and severity of failure to thrive were analysed. A significant association was found between IQ and severity of failure to thrive (P=.03).Analysis of weight gains showed that while the screening criterion used was sensitive, identifying a group of children with a median rate of weight gain below the 10th centile for expected weight gain, 6 had fallen no lower than their expected weight gain and 17 were only mildly growth retarded. However, the measure for severity of fall used in this study is not only a sensitive criterion, but can also distinguish between a normal fall in rate of weight gain towards the population mean and an abnormal fall away from the mean and it was this measure that was significantly associated with IQ
Early screening for failure to thrive in infancy.
No full textThe detection of failure to thrive in infancy is an important goal in routine surveillance of children. Failure to thrive is normally identified by slow weight gain, but is associated with feeding problems, and may lead to developmental delay and enduring intellectual defects. The prevention of these consequences is likely to depend on earlier detection of the condition than is currently achieved using traditional methods. An experimental computer based early screening method for the detection of failure to thrive was implemented in a two-year birth cohort (1,966 infants) in 18 general practices in the Easington area. The methods utilised an ACCESS database incorporating the British 1995 growth reference, which was used to convert the infant’s weight to a z score (conditional on age and sex). A 'thrive index' (a z score for weight gain conditional on age, sex and birth weight) was then calculated for the period from birth to the six to eight to week check and the infants in the slowest growing 5% automatically identified. The projected number of births in the 18 practices over the period 1 April 2001 to 31 March 2003 was 1800, and the actual number identified from health visitors' birth registers was 1966. For the 1966 infants, records of both a birth weight and a six to eight week weight were identified for 1880 infants. One hundred and twenty one infants met the criteria for FTT over this period (thrive index <-1.17) and of these, 102 term singletons were eligible to be recruited to the study. Those who participated had their development and weight gain followed to one year of age. Infants were tested at four months and again at nine months using the Bayley Scales of Infant Development (2nd ed). Mental development index (MDI) scores and psychomotor development index (PDI) scores of case infants and controls were compared and a mean difference was found between cases and controls in MDI scores at four months of 3.52 which was statistically significant. The mean difference in PDI scores at four months was 3.59, which was also statistically significant. At nine months the mean difference in MDI scores was 2.26 and the mean difference in PDI scores at nine months was 2.25, which was not statistically significant in either case. Information about demographic characteristics, health and feeding behaviour was obtained by using a structured questionnaire with the mothers. There were no statistically significant differences between families of case and control infants in indicators of affluence such as home or car ownership, nor were there any statistically significant differences between their mothers in their levels of educational achievement. There were no statistically significant differences between cases and controls in whether infants had ever been breast fed. Case group infants, however, were significantly more likely to be slow feeders than controls, and were more likely to take only small quantities and to be weak suckers. They were also more likely to be described by their mothers as having feeding problems. The screening method described provides a practical procedure for weight screening at the six to eight week check that allows identification of children who fail to thrive in the early weeks of life
Feeding and failure to thrive in early infancy
No full textThe aims of this thesis were fourfold. The first aim was the early identification of cases of non organic failure to thrive in a community based study and of randomly selected controls. Cases and controls were identified at six weeks of age using Thrive Index (Wright et al, 1994). The Thrive Index was used to measure growth velocity from birth to six weeks using two weights (birth weight and six weeks weight).The second aim was to analyse the familial characteristics of case and control families to investigate whether the frequency of failure to thrive over this period was higher in more deprived families, or families with other social characteristics. The characteristics recorded were maternal education, wage earning status, home and car ownership number of previous children and religious affiliation. The results showed that there were no statistically significant differences between the two groups or any of these variables. The third aim was to investigate the early feeding behaviour of the case and control infants. This was done using two separate approaches. The first was a six week feeding questionnaire given to all mothers asking them to provide information about their infant's feeding behaviour. Case infants were more likely to be fed on demand than set times (Chi-square =5.035, df=l, p=0.025). Also, mothers of cases reported their infants’ appetite to be poorer than that of controls (Mann-Whitney U = 1494, z=-2.179, p=0.02). The second approach was to directly observe and measure the infants feeding behaviour when the infants were aged between eight and twelve weeks. This was carried out blind to eliminate experimental bias. The sucking behaviour was analysed using a method described in Woolridge and Drewett (1986). Cases and controls did not differ on any of the recorded sucking behaviour characteristics. The fourth aim was to monitor the growth of cases and controls over one year. Using regression analyses it was found that only sex predicted weight gain to the end of the first year
The UN-SUSTAINABLE Match in HCV Recipients. Evidences from the Italian D-MELD Study on Balancing Donor-Recipient Risk Factors
No full textThe UN-SUSTAINABLE Match in HCV Recipients. Evidences from the Italian D-MELD Study on Balancing Donor-Recipient Risk Factor
Statistical analysis of child growth data
No full textThe study of child growth is complex. There are many clinical questions to answer but not necessarily the statistical methodology to deal with these questions. Human growth begins at conception and continues into adult life. In chapter 1 we discuss the characteristics of the growth process from conception to maturity and the purpose of growth monitoring. In chapter 2 we summarise the mathematical approaches to growth data. In chapter 3 we summarise the approaches that have been used to detect growth faltering. In this chapter we introduce the conditional gain Z-score. The data set analysed within this thesis is from the Newcastle growth and development study. In infancy we have routine weights of 3415 term infants. A sub-sample of these infants were followed-up at 7-9 years as part of a research study. These children belonged to three subgroups: cases were children that were defined as failing to thrive in infancy, controls were matched to cases and a 20% systematic sample. The school entry data of the sub-sample followed at 7-9 years were retrieved from school health records. In chapter 4 we carry out a preliminary analysis of the routine infancy weight Z-scores. The infancy data provided the opportunity to generate the correlation structure of routine weight Z-scores in infancy. In chapter 5 we develop a model for this correlation structure. In chapter 7 we explore patterns in the conditional weight gain Z-scores and also suggest some alternative criteria for identifying growth faltering in infancy. In chapters 6, 8 and 9 we analyse the anthropometric data obtained at follow-up and school entry. In childhood, the conditional gain Z-score is used to contrast height with mid-parental height and height at follow-up with height at school entry. The anthropometric data of the case and control children will be compared
All repair and reconstruction. Techniques from the SANTI study group
No full textBackground: Combining an anterior cruciate ligament (ACL) reconstruction with an anterolateral ligament (ALL) reconstruction results in significant advantages including reduced graft rupture rates, a lower risk of reoperation for secondary meniscectomy, improved knee stability, and higher rates of return to preinjury levels of sport. Indications: The previously reported indications for combined ACL and ALL reconstruction are as follows: ACL reconstruction revision; high-grade pivot shift test; long-term ACL rupture; young patients; pivoting activities; concomitant medial meniscus repair, and, specifically, regarding the ALL repair, it must be an acute surgery (within 15 days from injury). Technique Description: Several modern techniques have been described to repair and reconstruct the ALL. This technical note details a number of these techniques performed by the Scientific Anterior Cruciate Ligament Network International (SANTI) Study Group. Results: First, we describe a combined ACL reconstruction and double-bundle ALL reconstruction using hamstring autograft. Secondly, we describe a single-bundle ALL reconstruction using gracilis autograft. Thirdly, we describe an ALL reconstruction technique using a knotless soft anchor, which provides shallow fixation and prevents tunnel convergence. Finally, we describe a technique for ALL repair. Conclusion: Several techniques have been described to repair and reconstruct the ALL, all offering significant advantages over an isolated ACL reconstruction. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication
Robust automated detection of microstructural white matter degeneration in Alzheimer’s disease using machine learning classification of multicenter DTI data
No full textDiffusion tensor imaging (DTI) based assessment of white matter fiber tract integrity can support the diagnosis of Alzheimer’s disease (AD). The use of DTI as a biomarker, however, depends on its applicability in a multicenter setting accounting for effects of different MRI scanners. We applied multivariate machine learning (ML) to a large multicenter sample from the recently created framework of the European DTI study on Dementia (EDSD). We hypothesized that ML approaches may amend effects of multicenter acquisition. We included a sample of 137 patients with clinically probable AD (MMSE 20.6±5.3) and 143 healthy elderly controls, scanned in nine different scanners. For diagnostic classification we used the DTI indices fractional anisotropy (FA) and mean diffusivity (MD) and, for comparison, gray matter and white matter density maps from anatomical MRI. Data were classified using a Support Vector Machine (SVM) and a Naïve Bayes (NB) classifier. We used two cross-validation approaches, (i) test and training samples randomly drawn from the entire data set (pooled cross-validation) and (ii) data from each scanner as test set, and the data from the remaining scanners as training set (scanner-specific cross-validation). In the pooled cross-validation, SVM achieved an accuracy of 80% for FA and 83% for MD. Accuracies for NB were significantly lower, ranging between 68% and 75%. Removing variance components arising from scanners using principal component analysis did not significantly change the classification results for both classifiers. For the scanner-specific cross-validation, the classification accuracy was reduced for both SVM and NB. After mean correction, classification accuracy reached a level comparable to the results obtained from the pooled cross-validation. Our findings support the notion that machine learning classification allows robust classification of DTI data sets arising from multiple scanners, even if a new data set comes from a scanner that was not part of the training sample
Helicobacter pylori infection is not associated with failure to thrive: a case–control study
No full textNan-Chang Chiu,1,2,* Chien-Yu Lin,3,* Hsin Chi,1 Chun-Yan Yeung,1,2 Wei-Hsin Ting,1 Wai-Tao Chan,1 Chuen-Bin Jiang,1 Sung-Tse Li,3,4 Chao-Hsu Lin,3 Hung-Chang Lee1,2 1Department of Pediatrics, MacKay Children’s Hospital, 2Department of Medicine, MacKay Junior College of Medicine, Nursing and Management, Taipei, 3Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu City, 4Department of Statistics and Information Science, Fu Jen Catholic University, New Taipei, Taiwan *These authors contributed equally to this work Purpose: The long-term impact of Helicobacter pylori infection is complex, and concerns about the need for eradication exist. We conducted this case control study to investigate the association between H. pylori infection and failure to thrive (FTT).Patients and methods: From January 2009 to December 2011, 53 children with FTT group and matched children with the same sex and age and similar socioeconomic status without FTT (control group) were enrolled. A questionnaire was administered to the parents/guardian, and a 13C-urea breath test was performed to detect H. pylori infection.Results: We found that the total prevalence of H. pylori infection was 29.2% and that there was no association between FTT and H. pylori infection (FTT group: 32%; control group: 26.4%; P=0.67). Short stature was more common in the FTT group and abdominal pain in the control group (FTT group: 37.7%; control group: 11.3%; P=0.003). In a comparison between the H. pylori-positive and -negative groups, abdominal pain (87.1% vs 64%; P=0.032) and the frequency of endoscopy (74.2% vs 32%; P<0.001) were significantly more common in the H. pylori-positive group.Conclusion: We found that children with H. pylori infection are at an increased risk for abdominal pain and that FTT is not associated with H. pylori infection. The decision for eradication should be evaluated carefully and individualized. Keywords: Helicobacter pylori, 13C-urea breath test, failure to thrive, growth retardation, childre
Effectiveness of brief schema group therapy for borderline personality disorder symptoms : a randomized pilot study
No full textBackground and objectives Schema group therapy is a potentially cost-effective treatment for borderline personality disorder (BPD). We piloted the feasibility and effectiveness of a 20-session schema group therapy without individual therapy among psychiatric BPD outpatients in a randomized pilot study registered as a clinical trial (ISRCTN76381242). Methods Altogether 42 psychiatric outpatients diagnosed with BPD were randomized 2:1 to a 20-session weekly schema group therapy plus treatment as usual (TAU) (n = 28) vs. a control group with TAU alone (n = 14). The primary outcome was decline of BPD symptoms in the short Borderline Symptom List (BSL-23) score. Secondary outcomes were decline in symptoms of anxiety, depression, alcohol use, and improvement in functioning and schema modes. Two external experts evaluated validity of the intervention based on videotaped sessions. Results Overall, 23 schema group therapy patients (82%) and 12 controls (86%) completed their treatment. Treatment validity good or very good. However, no significant differences emerged in the primary outcome mean BSL-23 decline (6.95 [SE 5.91] in group schema therapy vs. 12.55 [4.85] in TAU) or in any of the secondary outcome measures. Limitations Despite randomization, the TAU subgroup had non-significantly higher baseline scores in most measures. Small sample size predisposing to type II errors; reliance on self-reported outcomes. Conclusions Schema group therapy was feasible for psychiatric outpatients with BPD. However, in this small pilot study we did not find it more effective than TAU. Effectiveness of this short intervention remains open.Peer reviewe
Intelligence and reading abilities in eight year old children who failed to thrive in infancy
No full textThe aim of the work reported in this thesis was to investigate intelligence and reading ability at school age in a population based sample of children who failed to thrive in the first two years of life. Weights for an annual cohort of term infants, retrieved from clinic records, were compared with weight expected conditional upon early weight. Those with weights in the lowest 5% in two or more age bands (3, 6, 9, 12 and 18 months) were identified as cases (n =136). Cases were stratified by age, sex and deprivation level of their area of residence at eighteen months of age, and the same number of controls selected from each stratum. Two controls were later omitted as they were found to have been born preterm (< 37 weeks). Between ages 7 and 9 years 79% of cases and 82% of controls were traced and studied. Height, head circumference and weight were measured, and an IQ and reading test administered. Information about socio-economic status, family structure and medical history was gathered during a home visit. The mother's height was measured, the father's being reported by the mothers, and the mother's IQ tested. All testing was carried out blind to the child’s case or control status. The child's medical records were retrieved where admission to a hospital or outpatient clinic was reported and the conditions diagnosed were coded blind for their probable effects on cognitive outcomes or growth. At eight years of age mothers in the case group reported more feeding problems in infancy and more organic conditions. Cases were shorter, lighter, thinner and had a smaller head circumference than controls. These anthropometric differences were all statistically significant and remained so after allowing for parental stature. There were no statistically significant differences in IQ and reading ability either before or after adjusting for maternal IQ, organic condition or the few covariates found to differ between the groups
- …
