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Biomedical subjects

J Golding

Publications and source records attributed to J Golding.

At least 55 records · Page 3Linked to original sources
PubMed1999

Early surgery compared with watchful waiting for glue ear and effect on language development in preschool children: a randomised trial.

BACKGROUND: Otitis media with effusion (OME) is the most common cause of hearing loss in children and is generally treated by elective surgery. We compared in children with persistent OME the effect on speech and language development of immediate surgery (ventilation-tube insertion) and watchful waiting before surgery. METHODS: We did a randomised controlled trial with masked outcome assessment in Bristol Children's Hospital, Bristol, UK. We included 186 children born between April 1, 1991, and Dec 31, 1992, who had confirmed bilateral OME and bilateral hearing impairment of 25-70 dB of at least 3 months' duration. Children were randomly assigned surgery within 6 weeks (n=92), or 9 months of watchful waiting (n=90), after which bilateral tube insertion was done if required. We assessed hearing loss, expressive language, and verbal comprehension at 9 months and 18 months. FINDINGS: At 9 months, standardised scores for expressive language and verbal comprehension differed between groups with marginal significance after adjustment for baseline differences (p=0.04 and p=0.028, respectively). At 9 months, verbal comprehension and expressive language skills in the watchful-waiting group were 3.24 months behind those in the early-surgery group. The watchful-waiting group was delayed on these two measures compared with their age-expected levels. 18 months after randomisation, 85% of children in the watchful-waiting group had received surgery and groups did not differ significantly. INTERPRETATION: There is some benefit from ventilation-tube insertion for expressive language and verbal comprehension but the timing of surgery is not critical.

Acoustic Impedance Tests↗
PubMed1999

The effects of economic circumstances on British students' mental and physical health.

Three-hundred sixty British university students completed a questionnaire providing information on demographic characteristics, financial circumstances, smoking, and drug and alcohol use. A 14-item inventory of physical symptoms, the short form 36 health survey (SF-36), and the General Health Questionnaire (GHQ-12) were used to assess their physical and psychological well-being. Except for physical functioning, all subscales of the SF-36 and the GHQ indicated levels of health significantly below population norms matched for age and sex. Poorer mental health was related to longer working hours outside the university and difficulty in paying bills. Students who had considered abandoning study for financial reasons had poorer mental health, lower levels of social functioning and vitality, and poorer physical health as indicated by variables on the SF-36. They were also heavier smokers. Students' personal debt was significantly associated with their knowing people involved in prostitution, crime, or drug dealing to help support themselves financially.

Adult↗
PubMed1999

Haemoglobin and ferritin concentrations in children aged 12 and 18 months. ALSPAC Children in Focus Study Team.

AIMS: To define the normal ranges and investigate associated factors for haemoglobin and ferritin in British children at 12 and 18 months of age, and to estimate correlations between both haemoglobin and ferritin concentrations at 8, 12, and 18 months of age. SUBJECTS AND METHODS: Subjects were part of the "children in focus" sample, randomly selected from the Avon longitudinal study of pregnancy and childhood. Capillary blood samples were taken from 940 children at 12 months and 827 children at 18 months of age. RESULTS: Haemoglobin was distributed normally and ferritin was distributed log normally at 12 and 18 months of age. Ninety five per cent reference ranges were established from empirical centiles of haemoglobin and ferritin. Haemoglobin concentrations at 18 months were associated with sex and maternal education. Concentrations of ferritin at 12 and 18 months of age were associated with birth weight and current weight. Girls at 12 months, but not at 18 months, had 8% higher ferritin concentrations than boys. Haemoglobin and ferritin concentrations were significantly correlated over time (8-12 months: rHb = 0.26, rFer = 0.46; 12-18 months: rHb = 0.37, rFer = 0.34; 8-18 months: rHb = 0.22, rFer = 0.24). CONCLUSION: Iron stores are depleted by rapid growth in infancy. A definition of anaemia based on the fifth centile gives cut off points at 12 and 18 months of age of haemoglobin < 100 g/l, and for iron deficiency of ferritin < 16 micrograms/l and < 12 micrograms/l, respectively. Because children below the fifth centile at one time point differ from those six months later, it is unclear whether screening would be effective.

Age Factors↗
PubMed1999

Pacifier use and sudden infant death syndrome: results from the CESDI/SUDI case control study. CESDI SUDI Research Team.

OBJECTIVES: To investigate the relation between pacifier use and sudden infant death syndrome (SIDS). DESIGN: Three year population based, case control study with parental interviews for each death and four age matched controls. SETTING: Five regions in England (population > 17 million). SUBJECTS: 325 infants who had died from SIDS and 1300 control infants. RESULTS: Significantly fewer SIDS infants (40%) than controls (51%) used a pacifier for the last/reference sleep (univariate odds ratio (OR), 0.62; 95% confidence interval (CI), 0.46 to 0.83) and the difference increased when controlled for other factors (multivariate OR, 0.41; 95% CI, 0. 22 to 0.77). However, the proportion of infants who had ever used a pacifier for day (66% SIDS v 66% controls) or night sleeps (61% SIDS v 61% controls) was identical. The association of a risk for SIDS infants who routinely used a pacifier but did not do so for the last sleep became non-significant when controlled for socioeconomic status (bivariate OR, 1.39 (0.93 to 2.07)). CONCLUSIONS: Further epidemiological evidence and physiological studies are needed before pacifier use can be recommended as a measure to reduce the risk of SIDS.

Breast Feeding↗
PubMed1999

Cord blood leptin is associated with size at birth and predicts infancy weight gain in humans. ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood.

Recent discoveries of human genetic leptin deficiency have demonstrated its importance in regulating weight gain in early childhood. To investigate whether normal variation in leptin and insulin levels in cord blood could influence infancy growth, we assayed samples from 197 infants from a representative birth cohort, who were measured at birth, 4, 8, 12 and 24 months. Cord leptin levels correlated most closely with weight and ponderal index (kg/m3) at birth, but also with length and head circumference (all p<0.0005). Independent of birth size, females had higher leptin levels than males (p<0.0005). Cord levels of leptin, but not insulin, were negatively related to weight gain (p<0.005) from birth to 4 months, and accounted for 9.4% of the variance in weight gain, compared with breast/bottle feeding (3.5%) and early/late introduction of solids (1%). The effect of leptin levels on weight gain was independent of birthweight, and was still evident at 24 months. The wide variation in infancy growth ('catch-up' or 'catch-down') may be partly determined by leptin levels preset in utero. Our data support a role for leptin in the regulation of infancy weight gain, and suggest a mechanism whereby infants may 'catch-up' in growth postnatally following an adverse intrauterine environment.

Birth Weight↗
PubMed1999

Pacifier use and morbidity in the first six months of life.

OBJECTIVE: To assess the prevalence of pacifier use and whether this habit adversely affects the health of 6-month-old infants. DESIGN: Data collected via self-completion questionnaires from mothers forming part of the prospective, population-based Avon Longitudinal Study of Pregnancy and Childhood. METHODS: The mothers of 10 950 infants gave information on their child's use of a pacifier at 4 weeks and 6 months of age and the presence of specific health symptoms. Adjusted logistic regression was performed to identify any associations between pacifier use and ill health. RESULTS: Two thirds of the sample had been given a pacifier at some point, with 42% being reported as having one at both ages. Younger, lower educated mothers, mothers who smoked, those living in council and overcrowded accommodation, and those reporting financial difficulties were significantly more likely to give their infant a pacifier. Pacifier use was associated significantly with a higher risk of symptoms such as wheezing, earache, vomiting, fever, diarrhea, and colic as well as with the general practitioner being called to the home and hospital admission. CONCLUSIONS: Although significant differences exist in the risk of experiencing several health symptoms between infants who do and infants who do not use a pacifier, stronger and more detailed evidence is required before recommendations can be made to discourage the use of pacifiers based purely on reducing occurrences of these symptoms.

England↗
PubMed1999

Epidemiology of SIDS and explained sudden infant deaths. CESDI SUDI Research Group.

OBJECTIVES: To establish whether epidemiologic characteristics for sudden infant death syndrome (SIDS) have changed since the decrease in death rate after the "Back to Sleep" campaign in 1991, and to compare these characteristics with sudden and unexpected deaths in infancy (SUDI) from explained causes. DESIGN: Three-year, population-based, case-control study. Parental interviews were conducted soon after the death and for 4 controls matched for age and date of interview. All sudden unexpected deaths were included in the study and the cause of death was established by a multidisciplinary panel of the relevant health care professionals taking into account past medical and social history of the mother and infant, the circumstances of death, and a full pediatric postmortem examination. Contributory factors and the final classification of death were made using the Avon clinicopathologic system. SETTING: Five regions in England, with a total population of >17 million people, took part in the study. The number of live births within these regions during the particular time each region was involved in the study was 473 000. STUDY PARTICIPANTS: Three hundred twenty-five SIDS infants (91.3% of those available), 72 explained SUDI infants (86.7% of those available), and 1588 matched control infants (100% of total for cases included). RESULTS: Many of the epidemiologic features that characterize SIDS infants and families have remained the same, despite the recent decrease in SIDS incidence in the United Kingdom. These include the same characteristic age distribution, few deaths in the first few weeks of life or after 6 months, with a peak between 4 and 16 weeks, a higher incidence in males, lower birth weight, shorter gestation, and more neonatal problems at delivery. As in previous studies there was a strong correlation with young maternal age and higher parity and the risk increased for infants of single mothers and for multiple births. A small but significant proportion of index mothers had also experienced a previous stillbirth or infant death. The majority of the SIDS deaths (83%) occurred during the night sleep and there was no particular day of the week on which a significantly higher proportion of deaths occurred. Major epidemiologic features to change since the decrease in SIDS rate include a reduction in the previous high winter peaks of death and a shift of SIDS families to the more deprived social grouping. Just more than one quarter of the SIDS deaths (27%) occurred in the 3 winter months (December through February) in the 3 years of this study. In half of the SIDS families (49%), the lone parent or both parents were unemployed compared with less than a fifth of control families (18%). This difference was not explained by an excess of single mothers in the index group. Many of the significant factors relating to the SIDS infants and families that distinguish them from the normal population did not distinguish between SIDS and explained SUDI. In the univariate analysis many of the epidemiologic characteristics significant among the SIDS group were also identified and in the same direction among the infants dying as SUDI attributable to known causes. The explained deaths were similarly characterized by the same infant, maternal, and social factors, 48% of these families received no waged income. Using logistic regression to make a direct comparison between the two index groups there were only three significant differences between the two groups of deaths: 1) a different age distribution, the age distribution of the explained deaths peaked in the first 2 months and was more uniform thereafter; 2) more congenital anomalies were noted at birth (odds ratio [OR] = 3.14; 95% confidence intervals [CI]: 1.52-6. (ABSTRACT TRUNCATED)

Age Distribution↗
PubMed1999

Parental divorce and adjustment in adulthood: findings from a community sample. The ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood.

The current study examines the link between the experience of divorce in childhood and several indices of adjustment in adulthood in a large community sample of women. Results replicated previous research on the long-term correlation between parental divorce and depression and divorce in adulthood. Results further suggested that parental divorce was associated with a wide range of early risk factors, life course patterns, and several indices of adult adjustment. Regression analyses indicated that the long-term correlation between parental divorce and depression in adulthood is explained by quality of parent-child and parental marital relations (in childhood), concurrent levels of stressful life events and social support, and cohabitation. The long-term association between parental divorce and experiencing a divorce in adulthood was partly mediated through quality of parent-child relations, teenage pregnancy, leaving home before 18 years, and educational attainment.

Adolescent↗
PubMed1999

Siblings, parents, and partners: family relationships within a longitudinal community study. ALSPAC study team. Avon Longitudinal Study of Pregnancy and Childhood.

Links between sibling relationships, mother-partner, and parent-child relationships were studied in a longitudinal community sample of 3681 sibling pairs. Individual differences in sibling relationship quality were related to mother-partner affection and hostility assessed 4 years earlier, to contemporary parent-child negativity, and to indices of social adversity. Evidence for both direct and indirect pathways (via parent-child relations) linking mother-partner and sibling relations were found. Comparisons of prediction for non-stepfamilies and stepfather families showed similarities in patterns of association, but also differences: In stepfather families, mother-partner hostility was unrelated to parent-child negativity and sibling relationship quality. Both positivity and negativity towards young siblings decreased with the age of older siblings, and older sisters were more positive than older brothers.

Adult↗
PubMed1998

Long-term intellectual and behavioral outcomes of children with febrile convulsions.

BACKGROUND: Hospital-based studies have reported that children with febrile convulsions have subsequent mental retardation and behavior problems. In contrast, population-based studies have reported a better outcome. METHODS: We identified 398 children with febrile convulsions among 14,676 children enrolled in the Child Health and Education Study, a national population-based study in the United Kingdom of children born in one week in April 1970. The children were comprehensively assessed at the age of 10. After excluding 16 children who had neurodevelopmental problems before their first febrile convulsion and 1 child whose case was atypical, we studied 381 children, 287 with simple febrile convulsions and 94 with complex febrile convulsions. We compared them with the rest of the cohort using measures of academic progress, intelligence, and behavior that included questionnaires, standardized tests, and formal tests. RESULTS: At the 10-year assessment, only 4 of 102 measures of academic progress, intelligence, and behavior differed significantly between the entire group of children with febrile convulsions and the group without febrile convulsions -- no more than would be expected by chance. Similar results were found when children with simple febrile convulsions and those with complex febrile convulsions were analyzed separately. The children with recurrent episodes of febrile convulsions had outcomes similar to those of the children with only one episode each. Special schooling was required for more children who had febrile convulsions in the first year of life than for those who had had them later in life (5 of 67, or 7.5 percent, vs. 4 of 265, or 1.5 percent; P=0.02), but these numbers were small. CONCLUSION: Children who had febrile convulsions performed as well as other children in terms of their academic progress, intellect, and behavior at 10 years of age.

Age Factors↗
PubMed1998

Association of the INS VNTR with size at birth. ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood.

Size at birth is an important determinant of perinatal survival and has also been associated with the risk for cardiovascular disease and type 2 diabetes in adult life. Common genetic variation that regulates fetal growth could therefore influence perinatal survival and predispose to the development of adult disease. We have tested the insulin gene (INS) variable number of tandem repeats (VNTR) locus, which in Caucasians has two main allele sizes (class I and class III; ref. 3), as a functional candidate polymorphism for association with size at birth, as it has been shown to influence transcription of INS (refs 3-5). In a cohort of 758 term singletons (Avon Longitudinal Study of Pregnancy and Childhood; ALSPAC) followed longitudinally from birth to 2 years, we detected significant genetic associations with size at birth: class III homozygotes had larger mean head circumference (P=0.004) than class I homozygotes. These associations were amplified in babies who did not show postnatal realignment of growth (45%), and were also evident for length (P=0.015) and weight (P=0.009) at birth. The INS VNTR III/II genotype might have bestowed a perinatal survival during human history by conferring larger size at birth. Common genetic variation of this kind may contribute to reported associations between birth size and adult disease.

Birth Weight↗
PubMed1998

Financial difficulties, smoking habits, composition of the diet and birthweight in a population of pregnant women in the South West of England. ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood.

OBJECTIVE: To investigate the relationships between self-assessed financial difficulties, diet in pregnancy and birthweight. DESIGN: Information on diet composition, difficulty in affording food, smoking habits and parity was collected by self-completion questionnaires at 32 weeks of pregnancy. Information on birthweights was obtained from hospital records. SUBJECTS: A geographically defined population 11833 pregnant women resident in the South-West of England. MAIN OUTCOME MEASURES: Nutrient intakes, food choices and birthweight. RESULTS: Women with greater difficulty in affording food had lower intakes of protein, fibre, vitamin C, niacin, pyridoxine, iron, zinc, magnesium and potassium than did women with little or no difficulty. They were more likely to use cooking and spreading fats with a high saturates content, and less likely to eat fish, fruit, vegetables and salad. In a multivariate analysis including parity and smoking status, financial difficulty was found to have no significant relationship with birthweight. CONCLUSION: The quality of diet in pregnancy falls with increasing difficulty in affording food. However, this does not appear to affect mean birthweight of infants born after 32 weeks gestation.

Adolescent↗
PubMed1998

Prenatal and perinatal antecedents of febrile convulsions and afebrile seizures: data from a national cohort study.

The assumption is often made that brain damage during the perinatal period is likely to result in neurological abnormalities such as epilepsy and cerebral palsy. However, there has been accumulating evidence that cerebral palsy is rarely, if ever, a result of intrapartum events, but few studies of other neurological abnormalities have been undertaken. We analysed data on 16,163 children from the 1970 British national cohort study and followed to age 10, focusing on the 378 who developed febrile convulsions (FCs) and 63 children with idiopathic afebrile seizures (IAS). Children with IAS were significantly more likely not to have been breast fed (P < 0.001), and this was independent of features such as birthweight and maternal disorder. A similar finding was apparent for FCs (P < 0.05). Although children with low birthweight were at increased risk of both conditions, there was no association with maternal smoking in pregnancy. No associations were found between indications of fetal distress during labour and later febrile convulsions or afebrile seizures. There was no evidence that intervention during labour would have improved these outcomes. However, associations were found with abnormalities earlier in pregnancy, suggesting a prenatal rather than an intrapartum aetiology.

Adult↗
PubMed1998

A randomised trial of low dose aspirin for primiparae in pregnancy. The Jamaica Low Dose Aspirin Study Group.

OBJECTIVE: To investigate whether low dose aspirin medication given to primiparous women provides benefit in preventing pre-eclampsia or intrauterine growth retardation. DESIGN: Randomised double-blind controlled trial of low dose aspirin and placebo in pregnancy. POPULATION: Residents of the parishes of Kingston and St Andrew, Jamaica; 6275 primiparae enrolled between 12 and 32 weeks of gestation. MAIN OUTCOME MEASURES: Hypertensive disorders of pregnancy (including pre-eclampsia and eclampsia), preterm delivery, and low birthweight. In addition, to assess whether enrollment early, rather than late had more beneficial effect. Possible adverse effects on the woman and her infant were monitored. RESULTS: Of enrolled primiparae, 97% were followed throughout pregnancy. There were no differences between those on aspirin and those on placebo in the development of hypertensive disorders (e.g. for a rise in diastolic pressure of 25 mmHg the odds ratio [OR] was 1.02 [95% CI 0.86-1.21]; for proteinuric pre-eclampsia OR 1.15 [95% CI 0.92-1.44]; eclampsia OR 0.82 [95% CI 0.44-1.53]); except for oedema which was significantly less prevalent in those on aspirin (OR 0.85 [95% CI 0.75-0.96]). Women on aspirin were no significantly less likely to deliver preterm (OR 0.93 [95% CI 0.79-1.09]) or have a larger fetus (mean birthweight difference 18 g [95% CI -9 to 45]). They were, however, significantly more likely to suffer from bleeding disorders antenatally, intrapartum and postpartum; for postpartum haemorrhage OR 1.40 (95% CI 1.13-1.73). CONCLUSIONS: This trial shows that low dose aspirin has no consistent beneficial effect in primiparae.

Aspirin↗
PubMed1998

Family structure and depressive symptoms in men preceding and following the birth of a child. The Avon Longitudinal Study of Pregnancy and Childhood Study Team.

OBJECTIVE: The prevalence and etiology of pre- and postpartum depressive symptoms in women in a variety of family forms have been well documented, but relatively little research has been conducted on the adjustment of their male partners. The authors' goals in this study were 1) to estimate rates of depression during the pregnancy and 8 weeks following the birth of a child in a large representative community sample of fathers in different family structures and 2) to explore the role of stressful life events, social and emotional support, the quality of the partner relationship, and socioeconomic circumstances. METHOD: This study describes the relations of family setting and other correlates to men's depressive symptoms during the pregnancies (18 weeks gestation, on average) and 8 weeks after the births of children for 7,018 partners of female participants in the Avon Longitudinal Study of Pregnancy and Childhood. RESULTS: Men living in stepfamilies had-significantly higher levels of depressive symptoms before and after the birth than did men in more traditional families. The effect of stepfamily status on depression was mediated by education, life events, social support, social network, and level of aggression in the partnership. CONCLUSIONS: There are similarities in the patterns and correlates of depression after the birth of a child for men and women. These findings point to the importance of family and partnership ecology in the adjustment of men before and after the birth of a child.

Adult↗