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R Morley

Publications and source records attributed to R Morley.

At least 55 records · Page 3Linked to original sources
PubMed1995

Should doctors be more proactive as advocates for victims of violence?

Currently the management of adult victims of violence by general practitioners and accident and emergency departments is reactive, concerned almost exclusively with the management of physical injuries. Professor Jonathan Shepherd outlines some ideas for a more proactive approach on the part of doctors to improve the protection and support of vulnerable people; to deal with psychological sequelae; to take the responsibility of making an official complaint to the police away from seriously injured people, who are unable to give or withhold consent to disclosure; and to prevent assailants inflicting further injuries. We asked a sociologist, a psychiatrist, a moral philosopher, and a police surgeon for their comments.

Adult↗
PubMed1995

Comparison of cerebral blood flow velocity estimation with cranial ultrasound imaging for early prediction of outcome in preterm infants.

Seventy-four low birth weight infants underwent serial measurements of cerebral blood flow velocity (CBFV) using Doppler ultrasound together with ultrasound imaging of the brain. Surviving infants were examined and assessed using the Bayley scales of mental and motor development at 18 months post-term. There were no significant differences in mean CBFV between normal and impaired infants. Infants with abnormal neurological signs (n = 6) or developmental delay (n = 3) did not show the usual steady rise in CBFV during the first few days of life. Four of nine had a rise, then a fall in CBFV compared with 4 of 31 with complete data in the normal group. This difference is significant (chi 2 = 4.3, p = 0.03). The magnitude of the percentage increase between day 1 and day 3 was also smaller in the abnormal group (median 0% vs. 39%, Mann-Whitney p = 0.03). A structural abnormality seen on the cranial ultrasound image was a better predictor of adverse outcome than an abnormal CBFV pattern, with a better sensitivity and specificity (66% and 97% for imaging compared to 44% and 87% for CBFV). The addition of serial ultrasound Doppler measurements of CBFV did not improve the prediction of outcome obtained using ultrasound imaging alone.

Blood Flow Velocity↗
PubMed1995

Maternal smoking and blood pressure in 7.5 to 8 year old offspring.

Reduced fetal growth in babies born preterm may be associated with reduced later blood pressure, but in children born at term, higher blood pressure. It was hypothesised, therefore, that maternal smoking in pregnancy, associated with reduced fetal growth, programmes later blood pressure differentially according to length of gestation. Six hundred and eighteen children born preterm and now aged 7.5 to 8 years were studied prospectively. Systolic blood pressure in children from smoking compared with non-smoking mothers was significantly lower in those born before 33 weeks' gestation and significantly higher in those born at 33 or more weeks. Within the range 0-40 cigarettes per day until delivery (after adjusting for potentially confounding factors, including social class and current weight) each 10 was associated with a 1.5 mm Hg fall and 2.9 mm Hg rise in pressure for children born below or above 33 weeks' gestation respectively. Similar though smaller differences were seen in diastolic pressure. These data support our hypothesis that later effects of insults impairing fetal growth are gestation dependent, and provide the first evidence that maternal smoking may have long term consequences for blood pressure in children.

Blood Pressure↗
PubMed1994

Does early nutrition in infants born before term programme later blood pressure?

OBJECTIVES: To test whether nutrition early in infants' development programmes later blood pressure and whether the reported relation between low birth weight and later high blood pressure is due to poor nutrition or growth before full term. DESIGN: Prospective randomisation of preterm infants to early diets differing greatly in nutrient content in four parallel multicentre trials, with blinded follow up 7.5-8 years later. SETTING: Neonatal units at Cambridge, Ipswich, King's Lynn, Norwich, and Sheffield. SUBJECTS: 758 children weighing under 1850 g at birth. MAIN OUTCOME MEASURE: Blood pressure at age of 7.5-8 years. RESULTS: There were major differences in nutrient intake from randomised diets (preterm formula v standard formula and preterm formula v donor breast milk; in each case with or without mother's milk), but follow up showed no differences in later blood pressure. Individual subjects showed large variation in protein and energy intakes and in growth performance, including degrees of growth failure seldom seen in utero, but these factors were also unrelated to later blood pressure. CONCLUSION: Extremes of nutritional intake and growth performance in preterm infants do not programme later blood pressure at 7.5-8 years of age. These findings do not support the hypothesis that high blood pressure has early nutritional origins. We suggest that the long term rise in blood pressure reported in individuals who had low birthweight (at full term) is not, as previously speculated, due to poor fetal nutrition or growth as such.

Blood Pressure↗
PubMed1994

Handedness in blood donors: no association with blood group or twinning.

There has been considerable interest in the contribution of inheritance to determination of handedness and in observed associations between hand laterality and twinning, gender and age. Unpublished data from a study of children born preterm suggested an association between AB0 blood group and handedness. A questionnaire filled in by 3815 blood donors, gave information on blood group, age, gender, whether they were a twin, hand used for writing and perceived handedness. There was no association between AB0 blood group or rhesus group and handedness. Significantly more females than males considered themselves right handed (82.5% versus 79.9%) and more subjects aged 50+ wrote with the right hand (90.6% versus 87.6% if younger). Twins did not differ from other subjects in this study and we hypothesise that the generally inconsistent findings relating to twins may be explained by population differences in the proportion of twins born preterm.

Adult↗
PubMed1994

Flexible cystoscopy in men: is topical anaesthesia with lignocaine gel worthwhile?

OBJECTIVE: The value of 2% lignocaine gel as a topical anaesthetic for flexible cystoscopy in men was tested in a prospective, randomized, double-blind, placebo controlled trial. PATIENTS AND METHODS: A total of 138 patients were entered into the study. Group A patients (n = 75) received 10 ml of 2% lignocaine gel intraurethrally whilst 10 ml of plain lubricating gel was instilled in the remaining 63 patients (Group B). Patient discomfort was recorded by means of a four-point descriptive pain scale (completed by both surgeon and patient) and a 100 mm non-graphic rating visual analogue scale (patient only). RESULTS: The results showed no significant difference between the two treatments irrespective of the method of recording. CONCLUSION: This study shows that 2% lignocaine gel offers no advantage over plain lubricating gel in providing analgesia for flexible cystoscopy. In this situation good lubrication may be a more important factor than topical anaesthesia.

Aged↗
PubMed1994

Influence of early diet on outcome in preterm infants.

Despite intensive research in infant nutrition over the past 50 years, uncertainty exists in nearly every major area of practice. A key factor in this uncertainty has been the lack of knowledge on whether diet or nutritional status in early life has a long-term or permanent influence on health, growth or performance. The possibility that early nutrition has long-term consequences in man has been much debated. There have been limited opportunities to perform formal randomized studies on the effect of early nutrition in humans and many studies have been flawed by problems with study design. Infants born preterm are a special group. At the start of our study in 1982, evidence on which to base choice of diet was inconsistent and related only to short-term outcome, and diets available for such babies differed greatly in nutrient content. In this group it was both ethical and practical to conduct a formal, randomized trial of early diet and outcome and the results were clearly needed for management decisions. We have undertaken a long-term prospective outcome study on 926 preterm infants randomly assigned to the diet received in the neonatal period. Surviving children have been followed at 9 months, 18 months and now 7.5-8 years of age. Our findings suggest that human milk may contain factors which promote brain growth or development and also bone mineralization later in childhood. Outcome data from the randomized trials show that a very brief period of dietary manipulation (on average for the first 4 weeks of life) influences later development.

Bone Density↗
PubMed1994

Size at birth and later blood pressure.

Adults who were small at birth have been reported to have higher systolic blood pressure and risk of ischaemic heart disease in later life. Conversely, in 616 subjects of less than 34 weeks' gestation and 1850 g birth weight, systolic and diastolic blood pressures at 7.5 to 8 years of age decreased with decreasing weight for gestational age and were not related to birth weight. These data do not support the view that fetal growth retardation before 34 weeks programmes for increased blood pressure in later life.

Blood Pressure↗
PubMed1994

A randomised multicentre study of human milk versus formula and later development in preterm infants.

Whether breast milk influences later neurodevelopment has been explored in non-randomised studies, potentially confounded by social and demographic differences between feed groups. Here in a strictly randomised prospective multicentre trial, Bayley psychomotor and mental development indices (PDI and MDI) were assessed at 18 months postterm in survivors of 502 preterm infants assigned to receive, during their early weeks, mature donor breast milk or a preterm formula. These diets were compared as sole enteral feeds or as supplements to the mother's expressed breast milk. No differences in outcome at 18 months were seen between the two diet groups despite the low nutrient content of donor milk in relation to the preterm formula and to the estimated needs of preterm infants. These results contrast with those reported from our parallel two centre study that compared infants randomly assigned a standard term formula or the preterm formula during their early weeks; those fed standard formula, now regarded as nutritionally insufficient for preterm infants, were substantially disadvantaged in PDI and MDI at 18 months post-term. It is shown here that infants from that study fed solely on standard formula had significantly lower developmental scores at 18 months than those fed on donor breast milk in the present study; yet the standard formula had a higher nutrient content than the donor milk. Thus, donor milk feeding was associated with advantages for later development that may have offset any potentially deleterious effects of its low nutrient content for preterm infants. As these outcome advantages were not confounded by the social and educational biases usually associated with mothers' choice to breast feed, our data add significant support to the view that breast milk promotes neurodevelopment.

Child Development↗
PubMed1992

Breast milk and subsequent intelligence quotient in children born preterm.

There is considerable controversy over whether nutrition in early life has a long-term influence on neurodevelopment. We have shown previously that, in preterm infants, mother's choice to provide breast milk was associated with higher developmental scores at 18 months. We now report data on intelligence quotient (IQ) in the same children seen at 7 1/2-8 years. IQ was assessed in 300 children with an abbreviated version of the Weschler Intelligence Scale for Children (revised Anglicised). Children who had consumed mother's milk in the early weeks of life had a significantly higher IQ at 7 1/2-8 years than did those who received no maternal milk. An 8.3 point advantage (over half a standard deviation) in IQ remained even after adjustment for differences between groups in mother's education and social class (p less than 0.0001). This advantage was associated with being fed mother's milk by tube rather than with the process of breastfeeding. There was a dose-response relation between the proportion of mother's milk in the diet and subsequent IQ. Children whose mothers chose to provide milk but failed to do so had the same IQ as those whose mothers elected not to provide breast milk. Although these results could be explained by differences between groups in parenting skills or genetic potential (even after adjustment for social and educational factors), our data point to a beneficial effect of human milk on neurodevelopment.

Age Factors↗
PubMed1991

Attitudes of relatives of Afro-Caribbean patients: do they affect admission?

This pilot study explored suggestions made in the literature that high rates of Afro-Caribbean patients compulsorily admitted to hospital can be explained by the attitudes of relatives. In particular relatives who hold negative attitudes towards psychiatric services and adopt non-medical explanations for the onset of illness might delay in contacting hospital services. This could delay the process of admission and make a compulsory admission more likely. The attitudes and experiences of relatives of 15 patients admitted compulsorily and 10 admitted informally were compared. The relatives' attitudes did not differ between the two groups. There was also no difference in the severity of current symptoms or the relative's assessment of dangerousness. Neither group was characterised by the sorts of attitudes to illness that had been hypothesised. In fact the group were very similar to the relatives of white psychiatric patients. The data suggest that future research should concentrate on the interaction between families and the services. In particular attention needs to be paid to the possibility that compulsory admissions are occurring because relatives' need for help is not being met and because there is an over-expectation of dangerousness on the part of the services.

Adolescent↗
PubMed1991

Birthweight ratio.

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Birth Weight↗
PubMed1990

Early diet in preterm babies and developmental status at 18 months.

424 preterm infants were randomly assigned a standard "term" formula or a nutrient-enriched "preterm" formula as sole diets (trial A) or as supplements to mother's own expressed milk (trial B) for a median of 4 weeks postnatally. 18 months post term, blind evaluation of 377 survivors showed that those previously fed preterm rather than term formula had major developmental advantages, more so in motor than mental function; the advantages, in both mental and motor scores, were especially striking in small-for-gestational-age infants and in males. For motor development index in trial A, this advantage was 15 points; in infants born small for gestation, it was 23 points (nearly 1.5 SD). Moderate developmental impairment (developmental index less than 85), notably motor impairment, was considerably more common in the group fed term formula. Infants fed preterm formula also had a small benefit in social maturity quotient. Thus, a short period of early dietary manipulation in preterm infants had major consequences for later development, which suggests that the first weeks may be critical for nutrition.

Age Factors↗
PubMed1990

Early diet of preterm infants and development of allergic or atopic disease: randomised prospective study.

OBJECTIVE: To study the effect of early diet on the development of allergic reactions in infants born preterm. DESIGN: Two randomised prospective trails. In trail A infants were randomly allocated banked donor milk or preterm formula as their sole diet or (separately randomised) as a supplement to their mother's expressed breast milk. In trial B infants were allocated term or preterm formula. A blind follow up examination was done 18 months after the expected date of birth. SETTING: Neonatal units of hospitals in Cambridge, Ipswich, King's Lynn, Norwich, and Sheffield. Outpatient follow up. PARTICIPANTS: 777 Infants with a birth weight less than 1850 g born during 1982 to 1984. MAIN OUTCOME MEASURES: Development of eczema, allergic reactions to food or drugs, and asthma or wheezing by nine and 18 months after term. Whenever possible the observations were confirmed by rechallenge or clinical examination. RESULTS: At 18 months after term there was no difference in the incidence of allergic reactions between dietary groups in either trial. In the subgroup of infants with a family history of atopy, however, those in trial A who received preterm formula rather than human milk had a significantly greater risk of developing one or more allergic reactions (notably eczema) by 18 months (odds ratio 3.6; 95% confidence interval 1.4 to 9.1). CONCLUSIONS: Feeding neonates on formulas based on cows' milk, including those with a high protein content, did not increase the overall risk of allergy. Nevertheless, in the subgroup with a family history of atopy early exposure to cows' milk increased the risk of a wide range of allergic reactions, especially eczema.

Animals↗
PubMed1990

Birthweight ratio and outcome in preterm infants.

The association between birthweight ratio and outcome was investigated in 429 infants born before 31 weeks' gestation. Birthweight ratio was calculated in each case as birth weight divided by mean birth weight for gestation (from reference data). It was shown that a given ratio corresponded to the same birth centile across the gestational age range studied; a ratio of 0.8 corresponding to the 10th centile. There was a linear relationship between birthweight ratio and requirement for mechanical ventilation and postneonatal mortality. Birthweight ratio was also strongly and linearly related to body weight, length, and head circumference at 18 months' corrected age. Overall, there was no association between this ratio and neurodevelopmental outcome to 18 months. However, the subgroup with the largest weights for gestation (birthweight ratio greater than or equal to 1.1), had significantly higher language subscores than all the other children. Our data show that conventional dichotomous categorisation of preterm infants into small or appropriate for gestation is inadequate when exploring the association between size for gestation and outcome.

Birth Weight↗