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Biomedical subjects

L D Voss

Publications and source records attributed to L D Voss.

At least 37 records · Page 2Linked to original sources
PubMed1998

Short stature at school entry--an index of social deprivation? (The Wessex Growth Study).

This study was carried out to examine the biological and environmental variables associated with non-organic short stature. We observed an unselected population of very short normal children (SN) and their age- and sex-matched controls (C) within the community. All 14,346 children in two health districts entering school during 2 consecutive years were screened for short stature, and those whose height lay below the 3rd centile, according to Tanner and Whitehouse standards (n = 180) were identified. Excluding 32 with pathology, five from ethnic minorities and three who refused to take part, the remaining SN children (mean height SDS-2.26) were matched with 140 age- and sex-matched controls (C) of average height (mean height SDs 0.14). Birth weight, target height and predicted adult height (based on parental height and bone age respectively), medical and social background (obtained from parental interviews), and school performance (assessed by class teachers) were the main outcome measures. Mean birth weight of the SN children was significantly lower than C (SN = 2845 g, C = 3337 g, P < 0.001). Mean mid-parental target height was also very different (SN = 162.0 cm, C = 170.9 cm, P < 0.001). Thirty-five per cent of SN children (C = 6%) had height SD scores below parental target range, though only 10% had predicted heights below target range (mean delay in bone age 0.68 years). There was a significant difference between SN children and C in the number of children in the household (SN = 2.8, C = 2.4 (P = 0.007) and in socio-economic status (P < 0.002). Many more SN children were in social classes IV and V (SN = 31%, C = 13%, P < 0.002), and had an unemployed father (SN = 22%, C = 10%, P < 0.010), highlighting the importance of environmental influences on growth. One in four SN children was judged to have serious psychosocial problems. However, the lower the socio-economic class, the less likely the SN children were to be inappropriately short for parents. Significantly more SN children were reported to have asthma (SN = 18%, C = 7%, P < 0.007) and eczema (SN = 19%, C = 5%, P < 0.001), though only the latter was significantly associated with stature below target height for both SN and C groups. Biological variables are often insufficient to explain short stature. No child, whatever the parental height, should be dismissed as normal without careful evaluation, as poor growth in the early years may be an important pointer to an adverse but potentially remediable environment.

Adult↗
PubMed1998

Growth monitoring: testing the new guidelines.

OBJECTIVE: To assess the impact of recent guidelines from the UK joint working party of child health surveillance recommending that all children be measured at age 5 and again between 7 and 9 years of age to determine how many normal school age children are likely to be referred for specialist assessment. METHODS: The longitudinal data of 486 children measured by school nurses in a community setting were examined and compared with measurements made in a research setting by a single, skilled observer. MAIN OUTCOME MEASURES: Number of children identified as having abnormal stature (< 0.4th or > 99.6th centile) and abnormal growth rate height standard deviation score (HSDS) change > 0.67). RESULTS: The community survey identified seven (1.4%) children as having abnormal stature (four short, three tall), 11 (2.3%) were identified as "slow growing", and nine (1.9%) increased their HSDS by more than 0.67. These results were comparable to data collected in ideal research conditions. CONCLUSIONS: Following the recommendations would not result in an excess number of inappropriate referrals. However, this study highlights several unresolved issues such as interobserver variability and time interval between measurements. A large scale prospective study should be considered to establish realistic and cost-effective criteria before implementation of a national screening programme.

Body Height↗
PubMed1998

Normal growth in the short normal prepubertal child: the Wessex Growth Study.

OBJECTIVE: The study aimed at defining the normal rate of growth for short, prepubertal children, and comparing their pattern of growth with those of average stature. SETTING: Community based. DESIGN: Observation of an unselected population of 109 very short, normal prepubertal children (< 3rd height centile) and 107 controls matched for age and sex (10th to 90th centile). MAIN OUTCOME MEASURES: Height, velocity, change in height standard deviation score, from 6 to 9 years of age. RESULTS: The absolute mean rate of growth was significantly different between groups--short normal 5.3 cm/year, controls 5.9 cm/year--corresponding to velocities on the 25th and 50th centiles, respectively. The relative growth rates, however, as shown by the changes in height standard deviation score (short normal 0.10 (SD 0.22), controls 0.10 (SD 0.24) did not differ, and each group remained close to its original 3rd and 50th centiles. Two short children showed "catch up" growth after adoption, but, otherwise, the divergence from their original height centile was the same for short normal and control children. No social or biological factors were found to predict growth rate in the short normal children, and only target height in controls. "Normal" velocity is conditional on height. Short normal children do grow more slowly than children of average stature, but they do not necessarily grow more poorly. From 6 to 9 years of age they are no more likely to fall off their height centiles than children of average stature. The value of height monitoring at this age is questioned.

Body Height↗
PubMed1997

Are short normal children at a disadvantage? The Wessex growth study.

OBJECTIVE: To examine whether short stature through childhood represents a disadvantage at around 12 years. DESIGN: Longitudinal non-intervention study of the physical and psychological development of children recruited from the community in 1986-7 after entry into primary school at age 5-6 years; this is the second psychometric assessment made in 1994-5 after entry into secondary school at age 11-13 years. SETTING: Southampton and Winchester health districts. SUBJECTS: 106 short normal children (< 3rd centile for height when recruited) and 119 controls of average stature (10th-90th centile). MAIN OUTCOME MEASURES: Psychometric measures of cognitive development, self concept development, behaviour, and locus of control. RESULTS: The short children did not differ significantly from the control children on measures of self esteem (19.4 v 20.2), self perception (104.2 v 102.4), parents' perception (46.9 v 47.0), or behaviour (6.8 v 5.3). The short children achieved significantly lower scores on measures of intelligence quotient (IQ) (102.6 v 108.6; P < 0.005), reading attainment (44.3 v 47.9; P < 0.002), and basic number skills (40.2 v 43.5; P < 0.003) and displayed less internalisation of control (16.6 v 14.3; P < 0.001) and less satisfaction with their height (P < 0.0001). More short than control children, however, came from working class homes (P < 0.05). Social class was a better predictor than height of all measures except that of body satisfaction. Attainment scores were predicted by class and IQ together rather than by height. Height accounted for some of the variance in IQ and locus of control scores. CONCLUSIONS: These results provide only limited support for the hypothesis that short children are disadvantaged, at least up until 11-13 years old. Social class seems to have more influence than height on children's psychological development.

Adolescent↗
PubMed1997

Diurnal variation in stature: is stretching the answer?

AIMS: To investigate the extent and timing of diurnal variation in stature and to examine the effectiveness of the stretched technique in reducing the loss in height. SETTING: A Southampton school. DESIGN: Fifty three children, divided into two groups, were measured by two independent auxologists using a Leicester height measure. Each child was measured four times, at 0900, 1100, 1300, and 1500, using both an unstretched and a stretched technique. OUTCOME MEASURES: Height loss after each of the three time intervals for both unstretched and stretched modes. RESULTS: There was a clear decrease in stature during the morning, but no further loss occurred after the subjects had been up for around six hours. The mean height losses for the unstretched (stretched) modes were 0.31 cm (0.34 cm) and 0.20 cm (0.23 cm) for the periods 0900 to 1100 and 1100 to 1300, respectively, but only 0.045 cm (-0.019 cm) from 1300 to 1500. Stretching did not reduce the effects of diurnal variation, but significantly affected the recorded height by an average of 0.28 cm. There was no significant difference in reproducibility using either technique (SD 0.30 cm stretched v 0.31 cm unstretched). CONCLUSIONS: Diurnal variation in stature may substantially affect the reliability of height data and careful consideration should be given to the timing of repeat measurements. As most height loss occurs in the morning, afternoon clinic appointments would be preferable. The standard stretched technique does not appear to reduce diurnal variation, nor does it affect precision. Measurements made using an unstretched method are recommended to avoid interobserver differences, known to occur where different observers are used.

Anthropometry↗
PubMed1996

Psychological response to growth hormone treatment in short normal children.

This study provides a controlled assessment of the psychological (and physical) effects of growth hormone treatment. Fifteen short 'normal' children (height SD score < -2) have been treated with growth hormone since the age of 7/8 years. They, together with untreated short controls and average controls (10th-90th centiles), were assessed at recruitment, after three years, and after five years. Only the treated group showed a significant height increase (SD score -2.44 to -1.21 over five years). No significant differences were found at recruitment, three years, or five years in IQ, attainment, behaviour, or self esteem. Also at five years, there were no significant differences in locus of control, self perception, or parental perceptions of competence. Both short groups displayed less satisfaction with their height than the controls (p < 0.01), though all groups were optimistic of being tall adults. The treated children were no more unrealistic over final height than the untreated children. To date, no psychological benefits of treatment have been demonstrated; but nor have there been any discernible ill effects for either the treated or the untreated children.

Adolescent↗
PubMed1995

Short stature: does it matter? A review of the evidence.

Short stature is widely regarded to be a liability, but despite the importance commonly ascribed to the psychological impact of physique, there is a paucity of methodologically sound research on the topic. The question of growth hormone therapy for a short, but otherwise normal child is still controversial. The justification for such treatment will depend not only on whether a marked improvement in height can be achieved but also on whether short stature can be shown to be an appreciable handicap, either in childhood or later in life. There is some evidence, though much is anecdotal, to suggest that the short statured adult is disadvantaged both socially and economically. There are no conclusive data as yet, however, to suggest that short statured children, either before or during early adolescence have significantly lower scores on conventional psychometric testing than children of average stature. Possibly, the problems associated with short stature will only emerge in the older adolescent, but for the present, alternative, less expensive forms of treatment should be considered for those children apparently unable to cope.

Adult↗
PubMed1995

Can we measure growth?

Poor installation and maintenance of height measuring equipment is a serious problem in the community. With care, however, height can be measured with sufficient precision (+/- 0.5 cm) to identify unusually short or tall stature. Height velocity, on the other hand, is liable to misinterpretation. It cannot be estimated with sufficient precision to identify abnormal growth in the short term. There is no correlation between two successive 12 month velocities. When a trend towards poor velocity is beyond all doubt then it will be apparent on the height chart alone. In addition, "poor" or "excessive" growth is conditional on the height of the child: short children do not grow at the same rate as tall. A diagnosis of abnormal growth requires long term monitoring and is best seen as a series of height measurements crossing the centiles on the height chart. Given the correct equipment and training, height or length can be measured with a fair degree of precision in the youngest of children. The earlier measurements begin, the sooner an abnormal pattern of growth will become evident. The regular monitoring of height should be standard practice and available to each and every child.

Anthropometry↗
PubMed1994

Equipping the community to measure children's height: the reliability of portable instruments.

OBJECTIVE: To compare (1) the reliability of two expensive and two inexpensive measuring instruments, suitable for use in the community and (2) the reliability of experienced compared with inexperienced observers. DESIGN: (1) Ten children aged 5-12 years were each measured three times blindly, and in random order, by two experienced observers using four different portable instruments. (2) Four groups of four children aged 5-11 years were each measured three times blindly, and in random order by four experienced and one inexperienced measurer, using two different portable instruments. MAIN OUTCOME MEASURES: The precision of height measurements made by different observers using different instruments, expressed in each case as the standard deviation of a single height measurement (SDshm). RESULTS: (1) No significant difference in precision was found between instruments, SDshm ranging from 0.22-0.34 cm. The two observers using apparently the same technique, did however record significantly different absolute heights. (2) No significant difference in precision was found between experienced and inexperienced observers. CONCLUSION: Inexpensive height measuring equipment, once accurately installed, is no less reliable than the most expensive. Inexperienced observers can, with care, measure as reliably as those with long experience. Every effort should be made, however, to ensure that the progress of individual children is monitored not only by the same observer, but on a long term basis.

Anthropometry↗
PubMed1994

Growth and metabolic consequences of growth hormone treatment in prepubertal short normal children.

Growth and the metabolic effects of growth hormone were monitored in a randomised, controlled group of 41 short, normal, prepubertal children. The treated group received daily injections of growth hormone as Genotropin (Kabi Pharmacia) 30 IU/m2/week. Fifteen children in the treated group (21 children) have completed three years of treatment, have grown significantly more than 14 (of 20) untreated children, and have a significantly greater adult height prediction. They do, however, remain leaner (body fat 13.5% in the treated group, 18% in the untreated group) and relatively hyperinsulinaemic (insulin 66.7 pmol/l in the treated group, 44.5 in the untreated group) after three years compared with untreated children. Although growth hormone appears to improve the height potential of prepubertal short normal children, the long term outcome is still uncertain.

Body Composition↗
PubMed1992

Poor growth in school entrants as an index of organic disease: the Wessex growth study.

OBJECTIVE: To establish whether poor height or height velocity, assessed during the year of school entry, might identify children with previously undiagnosed organic disease. DESIGN: Observation of a total population and their case controls. SETTING: Community base. SUBJECTS: All 14,346 children in two health districts entering school during two consecutive years were screened for height by school nurses, and those whose height lay below the 3rd centile according to Tanner and Whitehouse standards (n = 180) were identified. After excluding 32 with known organic disease, five from ethnic minorities, and three who refused to take part, the remaining 140 short normal children were matched with 140 age and sex matched controls of average height (10th-90th centile) and their height velocities over 12 months measured. MAIN OUTCOME MEASURES: Height, height velocity, previously diagnosed organic disease, and organic disease diagnosed as a result of blood tests and specialist examination. RESULTS: Twenty five of the 180 short children (14%) were already known to have chronic organic disease which could explain their poor growth. Blood tests and specialist examination revealed a further seven with organic disease, which was acquired rather than congenital in three, and a second cause of short stature in one with known organic disease. These eight conditions had been missed at the school entry medical examination. The shorter the child, the more likely an underlying organic disorder, with seven of the 12 children whose heights were more than 3 standard deviations below the mean having some organic disease. Height velocity measured over 12 months, however, did not distinguish short normal children from those with disease or from their matched controls. CONCLUSIONS: Height, but not height velocity, is a useful index for identifying unrecognised organic disease at school entry. The shorter the stature the greater the prevalence of organic disease. The frequency of newly diagnosed remediable disease in this study (1 in 3-4000) is similar to that of neonatal hypothyroidism, which is routinely screened for. Routine investigation of all very short school entrants is recommended.

Body Height↗
PubMed1991

Short stature and school performance--the Wessex Growth Study.

The relationship between short stature and school performance was examined by comparing an unselected cohort of 140 'normal' short children (below 3rd centile) aged between 7 and 9 years with 140 control children of normal height (10th-90th centiles). The short children had unimpaired self-esteem and normal patterns of behaviour, but a tendency towards hyperactivity and poor concentration. Their IQ scores were normal, but attainment, especially in reading, was low. The underachievement observed in the short children is largely due to the low socio-economic status of this group. All the children in the study were prepubertal and these data will serve as a baseline for further follow-up during and after puberty.

Body Height↗