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Biomedical subjects

C D Florey

Publications and source records attributed to C D Florey.

At least 19 recordsLinked to original sources
PubMed1996

Should obstetricians see women with normal pregnancies? A multicentre randomised controlled trial of routine antenatal care by general practitioners and midwives compared with shared care led by obstetricians.

OBJECTIVE: To compare routine antenatal care provided by general practitioners and midwives with obstetrician led shared care. DESIGN: Multicentre randomised controlled trial. SETTING: 51 general practices linked to nine Scottish maternity hospitals. SUBJECTS: 1765 women at low risk of antenatal complications. INTERVENTION: Routine antenatal care by general practitioners and midwives according to a care plan and protocols for managing complications. MAIN OUTCOME MEASURES: Comparisons of health service use, indicators of quality of care, and women's satisfaction. RESULTS: Continuity of care was improved for the general practitioner and midwife group as the number of carers was less (median 5 carers v 7 for shared care group, P<0.0001) and the number of routine visits reduced (10.9 v 11.7, P<0.0001). Fewer women in the general practitioner and midwife group had antenatal admissions (27% (222/834) v 32% (266/840), P<0.05), non-attendances (7% (57) v 11% (89), P<0.01) and daycare (12% (102) v 7% (139), P<0.05) but more were referred (49% (406) v 36% (305), P<0.0001). Rates of antenatal diagnoses did not differ except that fewer women in the general practitioner and midwife group had hypertensive disorders (pregnancy induced hypertension, 5% (37) v 8% (70), P<0.01) and fewer had labour induced (18% (149) v 24% (201), P<0.01). Few failures to comply with the care protocol occurred, but more Rhesus negative women in the general practitioner and midwife group did not have an appropriate antibody check (2.5% (20) v 0.4% (3), P<0.0001). Both groups expressed high satisfaction with care (68% (453/663) v 65% (430/656), P=0.5) and acceptability of allocated style of care (93% (618) v 94% (624), P=0.6). Access to hospital support before labour was similar (45% (302) v 48% (312) visited labour rooms before giving birth, P=0.6). CONCLUSION: Routine specialist visits for women initially at low risk of pregnancy complications offer little or no clinical or consumer benefit.

Clinical Protocols↗
PubMed1995

Infant feeding and mental and motor development at 18 months of age in first born singletons.

OBJECTIVE: To determine the relationship between type of infant feeding and mental and psychomotor development at age 18 months. METHOD: A follow-up study of children born to primigravidae living in Dundee and booked into antenatal clinics in the City of Dundee (Local Authority District) from 1 May 1985 to 30 April 1986. The study population was 846 first born singletons, of whom 592 attended for developmental assessment at age 18 months. The main outcome measures were the Bayley Scales of Infant Mental and Motor Development. RESULTS: Higher mental development was significantly related to breast feeding on discharge from hospital and according to the health visitors' notes at about 2 weeks after discharge after allowing for partner's social class, mother's education, height, alcohol and cigarette consumption; placental weight and the child's sex, birth weight and gestational age at birth. After adjustment for statistically significant variables, the difference in Bayley mental development index between breast and bottle fed infants was between 3.7 and 5.7 units depending on the source of feeding data. No differences were found for psychomotor development or behaviour. CONCLUSION: The study provides further evidence of a robust statistical association between type of feeding and child intelligence. However, the literature is replete with suggestions for potential confounding variables which offer alternative causal explanations. To unravel what is an important clinical and public health question, further research should concentrate on randomized trials of supplemented formula feeds for children of mothers opting for bottle feeding and on epidemiological studies designed to disentangle the relation between method of feeding, parental intelligence and social environment.

Bottle Feeding↗
PubMed1994

Is antenatal care apportioned according to obstetric risk? The Scottish antenatal care study.

A retrospective cohort study of case records of antenatal care was carried out to describe and compare antenatal services in Scotland according to type of hospital and risk category of women. The study took place at 15 randomly selected maternity hospitals which were divided into teaching hospitals (n = 5), rural catchment hospitals (n = 2), and district general hospitals divided by size as those with 1000-1699 deliveries per year (n = 4), and those with > or = 1700 deliveries per year (n = 4). The subjects were 3574 (87.7 per cent) of 4069 eligible women who delivered in the last quarter of 1989 at these hospitals. Of those 3574, 19 per cent (675) were considered to be high risk at booking, 64 per cent (2899) continued low risk throughout their pregnancy and the remaining 17 per cent (608) changed from low risk to high risk during pregnancy. The main outcome measures were the number, timing, location and supervision of antenatal visits and antenatal admissions in relation to hospital types and obstetric risk categories, and adverse pregnancy outcomes in relation to risk categories. It was found that 97 per cent of all women had care shared by general practitioner (GP) and hospital specialist agreement. The majority (64 per cent) of antenatal visits took place away from the hospital of delivery, with GPs responsible for the largest proportion of all antenatal visits (43.5 per cent) compared with specialist hospital doctors (36 per cent) and midwives (11.5 per cent). Wide variations in the use of different personnel groups to deliver antenatal care were observed between hospitals, particularly in the use of midwives to supervise visits (4-34 per cent). The median number of antenatal visits was 14 (mean 13.9, SD 3.9). Within hospital types the differences in the mean number of antenatal visits between the three risk categories were small (one to two visits) and the direction inconsistent. In all types of hospital, outset high-risk women and those who changed to high risk were more likely to have hospital admission than those who continued as low risk. Significantly more women in the high-risk categories experienced adverse pregnancy outcomes than women who continued at low risk.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1994

Smoking and drinking habits before and during pregnancy in Spanish women.

STUDY OBJECTIVE: To investigate possible changes in smoking and drinking habits during pregnancy and to elucidate the sociodemographic factors associated with these changes in Spanish women. DESIGN: A cross-sectional survey. PARTICIPANTS AND SETTING: A total of 1004 pregnant women of between 12 and 18 weeks of gestation who were attending the antenatal clinic of the main regional hospital of Valencia (Spain) during 1989 were studied. All participants completed the study and only one eligible woman refused to participate when approached. MEASUREMENTS AND MAIN RESULTS: Information was obtained by structured questionnaire (Euromac questionnaire), which included items on age, educational level, marital status, occupation, parity, previous and present smoking habits, and previous and present alcohol consumption. Women were asked about the consumption of cigarettes and alcohol for a typical week before they knew they were pregnant, and details of current consumption were obtained for the week before the interview. The number of drinks taken per week was later converted to the amount of absolute alcohol (in g). Sixty per cent of the women smoked and 72% drank alcohol before pregnancy. Forty eight per cent of smokers stopped smoking and 37% of drinkers stopped drinking alcohol during pregnancy. No sociodemographic factor showed an independent association with either smoking or drinking cessation. Only the number of cigarettes and the amount of alcohol consumed before pregnancy were identified as significant independent predictors for stopping. CONCLUSIONS: Pregnant Spanish women seemed to stop smoking at about three times the rate found in Spanish women in the reproductive years. The sociodemographic variables usually associated with stopping smoking could not account for the high rate of quitting in these Spanish women, a rate higher than that in women from other developed countries. The high prevalence of smoking before pregnancy might explain not only the high rate of stopping smoking but also the absence of a well defined profile of "quitters". In our study, high levels of alcohol consumption were limited to a small group of pregnant women, and preventive efforts should be focused on this group.

Adolescent↗
PubMed1994

The relation between antenatal care and birth weight.

The relation between gestational age at first antenatal visit and infant's birth weight was investigated in a cohort study of 846 primiparas living in the City of Dundee, Scotland, whose first antenatal visit was between 1 May 1985 and 30 April 1986. The earlier in pregnancy the first antenatal visit the greater the infants' birth weights tended to be (p < 0.01). The relation was independent of gestational age at birth, mother's age and height, social class, tobacco and alcohol consumption and the child's sex. The result supports similar findings elsewhere, but is more robust in that, in contrast to other studies, all birth weights were measured on a single electronic scale and the effects of maternal tobacco and alcohol consumption on birth weight were taken into account in the analysis. The mechanism of the effect remains to be determined but needs to be identified as it may indicate possible preventive measures for the benefit of future children.

Adult↗
PubMed1993

Relation between early introduction of solid food to infants and their weight and illnesses during the first two years of life.

OBJECTIVE: To assess the relations between early introduction of solid food and infant weight, gastrointestinal illness, and allergic illnesses during the first two years of life. DESIGN: Prospective observational study of infants followed up for 24 months after birth. SETTING: Community setting in Dundee. PATIENTS: 671 newborn infants, of whom 455 were still available for study at 2 years of age. MAIN OUTCOME MEASURES: Infants' diet, weight, and incidence of gastrointestinal illness, respiratory illness, napkin dermatitis, and eczema at 2 weeks and 2, 3, 4, 6, 9, 12, 15, 18, 21, and 24 months of age. RESULTS: The infants given solid food at an early age (at < 8 weeks or 8-12 weeks) were heavier than those introduced to solids later (after 12 weeks) at 4, 8, 13, and 26 weeks of age (p < 0.01) but not at 52 and 104 weeks. At their first solid feed those given solids early were heavier than infants of similar age who had not yet received solids. The incidence of gastrointestinal illness, wheeze, and nappy dermatitis was not related to early introduction of solids. There was a significant but less than twofold increase in respiratory illness at 14-26 weeks of age and persistent cough at 14-26 and 27-39 weeks of age among the infants given solids early. The incidence of eczema was increased in the infants who received solids at 8-12 weeks of age. CONCLUSION: Early introduction of solid food to infants is less harmful than was previously reported. Longer follow up is needed, but, meanwhile, a more relaxed approach to early feeding with solids should be considered.

Body Weight↗
PubMed1993

Sample size for beginners.

The common failure to include an estimation of sample size in grant proposals imposes a major handicap on applicants, particularly for those proposing work in any aspect of research in the health services. Members of research committees need evidence that a study is of adequate size for there to be a reasonable chance of a clear answer at the end. A simple illustrated explanation of the concepts in determining sample size should encourage the faint hearted to pay more attention to this increasingly important aspect of grantsmanship.

Analysis of Variance↗
PubMed1993

The effect of moderate maternal alcohol consumption on birth weight and gestational age in a low risk population.

We analyzed the relationship between moderate maternal alcohol consumption during pregnancy and both birth weight corrected for gestational age and preterm delivery in 3447 women. Information on alcohol consumption in the first and second trimester was obtained during mid pregnancy and information about third trimester drinking was obtained a few days after delivery. After adjustment for possible confounders we found that for most women alcohol consumption was unrelated to birth weight corrected for gestational age and preterm delivery. However, in the subgroup of women smoking 20 cigarettes or more a day, drinking more than 120 g alcohol a week in early pregnancy was associated with a 7.2% (95% CI 0.2% to 14.2%) decrease in birth weight. We conclude that the effect of alcohol use on birth weight corrected for gestational age and gestational age is limited. However, in women who smoke heavily, a reported consumption of about two drinks or more a day in early pregnancy may be an additional risk factor for impaired fetal growth.

Alcohol Drinking↗
PubMed1992

Perinatal mortality in Jeddah, Saudia Arabia.

The objective of the study was to estimate the perinatal mortality rate and to determine the antenatal and intrapartum risk factors associated with perinatal mortality in Jeddah, Saudi Arabia. A hospital-based, case-control study was carried out in a 40-week period in 1987-1988 in Jeddah at the Maternal and Child Health Hospital (MCH). The subjects comprised 323 perinatal deaths and 486 controls. The perinatal mortality rate (PMR) for Jeddah showed a decline from 42.5 in Islamic Calendar Year 1393H (1973) and 49.5 in 1400H (1979-1980) to 31.4 per 1000 live and stillbirths in 1408H (1987-1988). The risk factors independently associated with perinatal death included low birth weight, complications during labour, ethnic origin and mother's age being 35 and over. In addition to lethal deformities, direct causes of perinatal death were related to low birthweight, mechanical causes, antepartum haemorrhage and neonatal infection. No antenatal care was received by 36.5% of both cases and controls. The high mortality and the failure to attend for antenatal care suggest a need for closer surveillance of women throughout their pregnancies and for improvements in both obstetric services and neonatal management.

Case-Control Studies↗
PubMed1992

Maternal alcohol consumption and child development.

Studies of development and behaviour from shortly after birth up to the age of 7 years are reviewed. Maternal alcohol consumption above 150-200 g/week is related to behaviour in many studies, but below this level there is little epidemiological evidence of association. There is no evidence that the levels of consumption associated with adverse behaviour are lower than those associated with adverse pregnancy outcome.

Alcohol Drinking↗
PubMed1991

Reported social alcohol consumption during pregnancy and infants' development at 18 months.

OBJECTIVE: To determine the relation between mothers' self reported drinking habits before, during, and after pregnancy and infants' mental and motor development at 18 months of age. DESIGN: Follow up study of all singleton live births born to primigravidas living in Dundee and booked into antenatal clinics from 1 May 1985 to 30 April 1986. SETTING: District of Dundee. SUBJECTS: 846 children aged 18 months, of whom 592 attended for assessment. MAIN OUTCOME MEASURES: Scores on Bayley scales of infant mental and motor development. RESULTS: For full term children, maternal alcohol consumption was not significantly related to any adverse effect on the children's mental or motor development measures at age 18 months. After confounding factors had been controlled for, alcohol consumption before pregnancy and after pregnancy was significantly related to better motor performance and mental performance. CONCLUSION: Pregnant women probably need not abstain from alcohol altogether as no detectable adverse relation was found between the child's mental and physical development and the mother's weekly consumption at levels in excess of 100g absolute alcohol. However, to allow for a margin of safety and taking into account the findings of an earlier phase of this study on the immediate effects on the newborn, it is recommended that pregnant women should drink no more than eight units of alcohol a week, the equivalent of about one drink a day.

Alcohol Drinking↗
PubMed1990

Effect of vitamin and mineral supplementation on verbal and non-verbal reasoning of schoolchildren.

In a randomised controlled trial the effect of vitamin and mineral supplementation for seven months on performance in tests of reasoning was studied in 86 schoolchildren aged 11-13. A small, non-significant difference between the control and supplementation groups was found in a non-verbal test. The net difference in change in scores between the active and placebo groups was 2.4 units (95% CI-1.5 to 6.3). This direction of effect was not consistently seen with three other tests of non-verbal reasoning. Vitamin and mineral supplementation does not improve the performance of schoolchildren in tests of reasoning.

Administration, Oral↗
PubMed1990

Protective effect of breast feeding against infection.

OBJECTIVE: To assess the relations between breast feeding and infant illness in the first two years of life with particular reference to gastrointestinal disease. DESIGN: Prospective observational study of mothers and babies followed up for 24 months after birth. SETTING: Community setting in Dundee. PATIENTS: 750 pairs of mothers and infants, 76 of whom were excluded because the babies were preterm (less than 38 weeks), low birth weight (less than 2500 g), or treated in special care for more than 48 hours. Of the remaining cohort of 674, 618 were followed up for two years. INTERVENTIONS: Detailed observations of infant feeding and illness were made at two weeks, and one, two, three, four, five, six, nine, 12, 15, 18, 21, and 24 months by health visitors. MAIN OUTCOME MEASURE: The prevalence of gastrointestinal disease in infants during follow up. RESULTS: After confounding variables were corrected for babies who were breast fed for 13 weeks or more (227) had significantly less gastrointestinal illness than those who were bottle fed from birth (267) at ages 0-13 weeks (p less than 0.01; 95% confidence interval for reduction in incidence 6.6% to 16.8%), 14-26 weeks (p less than 0.01), 27-39 weeks (p less than 0.05), and 40-52 weeks (p less than 0.05). This reduction in illness was found whether or not supplements were introduced before 13 weeks, was maintained beyond the period of breast feeding itself, and was accompanied by a reduction in the rate of hospital admission. By contrast, babies who were breast fed for less than 13 weeks (180) had rates of gastrointestinal illness similar to those observed in bottle fed babies. Smaller reductions in the rates of respiratory illness were observed at ages 0-13 and 40-52 weeks (p less than 0.05) in babies who were breast fed for more than 13 weeks. There was no consistent protective effect of breast feeding against ear, eye, mouth, or skin infections, infantile colic, eczema, or nappy rash. CONCLUSION: Breast feeding during the first 13 weeks of life confers protection against gastrointestinal illness that persists beyond the period of breast feeding itself.

Bottle Feeding↗