Biomedical subjects
Publications and source records attributed to D G Altman.
1. Continuous monitoring of arterial pressure was performed via an indwelling cannula over 24 h in 12 hypertensive patients before treatment and again 2-4 months after starting metoprolol (100 mg twice daily). 2. During treatment, heart rate and systolic and diastolic pressures were significantly reduced. 3. The circadian patterns of heart rate and blood pressure changes were similar before and during therapy.
In a quest for a objective assessment of synovitis of the knee, the value of circumferential measurements of the knee at two levels has been tested. Measurement 1 cm above the patella was shown to be more precise and to correlate better with the quantity of synovial fluid aspirated than measurement at mid-patellar level. The size of change necessary for statistical significance frequently exceeded the change likely to be found in clinical practice. The precision of measurement is greater in normal than in rheumatoid knees, and can be increased by using the mean of duplicate measurements rather than a single measurement. In clinical trials, the use of one observer throughout will increase the reliance that can be placed on the changes in measurements.
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The effect is investigated of availability of free school milk on height gain in one year of six- and seven-year-old primary schoolchildren in England and Scotland, using data collected annually from 1972 to 1976. The height gain of children for whom milk was available for the whole year of observation was compared with that of children who had no milk. Out of 16 sex-country-year-specific analyses for children from manual social classes only, 13 showed no significant evidence of greater height gain in children who had milk. Comparison of children from Social Classes IV and V (semi-skilled and unskilled) showed no greater increase in height for those who had milk, nor was there a difference in height gain between manual social class children according to the number of glasses of milk they drank a day at home or at school. We concluded that, given the standard of living at the time of the survey, the drinking of free school milk did not increase the growth rate of six- and seven-year-old children.
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Resting metabolic rate was measured in 22 women with varying degrees of obesity. Body composition was estimated from total body potassium and from total body water, and creatinine excretion in urine was measured over a period of three weeks while the patients were on a creatinine and creatine-free reducing diet. Resting metabolic rate was highly significantly correlated with body weight, surface area, creatinine excretion and lean body mass calculated either from potassium or water measurements (P less than 0.001). Correlation with adipose tissue was less strong, and when multiple regression of both fat and lean on metabolic rate was performed, the relationship was seen to depend mostly on the mass of lean rather than adipose tissue. In obese people the water content of fat-free tissue is greater than that in normal subjects, so it is not valid to assume that fat content can be calculated accurately from a measurement of total body water.
In 1972 the height of 7601 children aged five to 11.5 years in England and of 2214 in Scotland was measured. Their parents were asked to complete a questionnaire to provide social and antrhopometric information. A sequence of linear models was fitted to the data to assess the associations between social and biological factors and height. At the time of the study it was found that sibship size, father's social class, and his employment status all had a significant relationship with child's height; however, parents' height and child's birthweight both accounted for relatively more of the variance in child's height than father's social class and employment status. In England, sibship size significantly influenced the height of children of manual workers, but not that of nonmanual workers' children. In Scotland, sibship size was associated with height in all social groups. Surveillance and possibly intervention in a wide range of activities should be directed at socially more deprived groups; for example, in Social Class V, in which there are more large families and unemployment is more common.
Investigations were undertaken, using the mouse as an animal model, to study the effect of Escherichia coli on fetal development. The i.v. injection of 7.5 X 10(6) bacteria, originally obtained from a suspected case of human pyelonephritis, caused only a mild and transient disturbance of maternal health but caused severe fetal wastage. Groups of mice were examined 4, 7 and 11 days after infection and the numbers of organisms were determined in the spleen, liver, kidneys, placentas and resorptions. From the findings obtained, it was concluded that the Esch. coli grew preferentially in the placentas. By the 7th day the placentas showed marked degenerative and necrotic changes and the bacteria could be recovered from the majority of fetuses at this time. Histologically, no significant changes were seen in the spleen, liver and kidneys. As a result of these findings in an animal model, and taking into consideration the observations of other workers, it is suggested that coliform bacteraemia in human pregnancies may also cause infections of the placenta and bring about abortion or premature delivery.
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A four-year longitudinal study of the prevalence of respiratory symptoms and disease in schoolchildren and related environmental and socio-economic factors is in progress. We report results for the first year of this study (1973). A total of 5758 children aged 6 to 11 years from 28 randomly selected areas of England and Scotland were examined. In an analysis of the effects on health of possible indoor pollutants, boys and girls from homes in which gas was used for cooking were found to have more cough, "colds going to the chest", and bronchitis than children from homes where electricity was used. The girls also had more wheeze if their families used gas for cooking. This "cooking effect" appeared to be independent of the effects of age, social class, latitude, population density, family size, overcrowding, outdoor levels of smoke and sulphur dioxide and types of fuel used for heating. It was concluded that elevated levels of oxides of nitrogen arising from the combustion of gas might be the cause of the increased respiratory illness.
The National Study of Health and Growth (NSHG) was set up in 1972 to monitor growth in primary schoolchildren. Each year 8000 children in England (most parts except the south-east) and 2500 in Scotland are measured. Data from the first year have been used to obtain standards of height, weight and triceps skinfold for ages 5 to 11 inclusive, and ellipse contours of weight by height for each year of age. The distributions of weight and triceps skin fold were positively skew; logarithmic transformations led to satisfactory Normalized distributions. Centiles within each age group, calculated from the mean and standard deviation of the transformed variables, were closely similar to the observed centiles. Scottish children were lighter and shorter than English children in all age-sex groups. The heights and weights of English children in the NSHG were very similar to those published by Tanner, Whitehouse and Takaishi (1966). Triceps skinfold agreed closely with the data of Tanner and Whitehouse (1975) for the 50th and 97th centiles in boys, but our 3rd centile was well above its counterpart. Girls had higher skinfolds than girls in Tanner's data at the 3rd and 50th centiles. The triceps skinfolds of Scottish children were lower than those of English children throughout the age range and for all the centiles in both sexes. An example is given of the use of our ellipse contours of height and weight for surveillance of a population of children. Children's height is discussed in relation to variability over time and between different parts of the country.
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1. The contribution of school milk to the nutrition of 396 Kent primary schoolchildren aged 8-11 years was assessed using information collected in a survey which included a weighed-diet record, a socio-economic questionnaire and a medical examination. 2. Over half the children (59% for boys, 54% for girls) drank school milk every school day of the diet-record week. 3. Children who drank school milk every school day, when compared with those not drinking it, had a significantly higher mean daily intake of liquid milk, a higher total daily intake of several important nutrients including animal protein, calcium, thiamin and riboflavin, and a diet richer in Ca and riboflavin (boys) and animal protein and Ca (girls). They were also less likely to have intakes of Ca and riboflavin below the recommended daily intakes for these nutrients, (Department of Health and Social Security, 1969). 4. The increased nutritional intake associated with school milk consumption was not related to any differences in height, weight, arm circumference or skinfold thickness. 5. There was no evidence that school milk consumption was associated with obesity (as assessed clinically).
Only children had significantly higher intakes of many nutrients and nutrients/1000 kcal than other children. A higher proportion of only children was found to be obese. There were no significant differences according to birthrank in intakes by children. There were more obese children among the fatherless than those with fathers, in particular among those whose mothers were widowed. However, this was not accounted for by the present dietary findings, since fatherless children had lower intakes of carbohydrate and added sugar. There were no differences in nutrient intake or intake/1000 kcal by mother's country of origin or her level of education, or by disposable income.
The contribution of school meals to the nutrition of 778 primary and secondary schoolchildren attending schools in Kent was assessed using information collected during a survey made in 1968-70 which included a weighed diet record, a socioeconomic questionnaire, and a medical examination. Younger children, those from larger families, those without fathers, and those whose mothers worked were more likely to take school meals. Significantly more children from lower social classes and without fathers received them free. School meals made an important contribution to the nutrition of schoolchildren. Children who took them had higher weekday lunchtime nutrient intake during term-time. Children in lower social classes, larger families, and without fathers who took school meals obtained a higher proportion of their weekday intake of nutrients from lunchtime than other children. This applied in particular to nutrients important for growth. School meals consumed by children in the study broadly met the standard set by the Department of Education and Science. The mean energy and protein content of school meals consumed in the study was slightly lower and the mean fat content higher than the standard set for the meal. The mean sugar content was about one-third higher than the suggested amount of sugar to be included in a school meal. There was no evidence that children who took school meals were taller, heavier, had greater skinfold thickness, or were more likely to be assessed as obese than other children.
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