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Biomedical subjects

J Golding

Publications and source records attributed to J Golding.

At least 19 recordsLinked to original sources
PubMed1992

Epilepsy in the first 10 years of life: findings of the child health and education study.

OBJECTIVES: To identify children with afebrile seizures in a national cohort, classify the seizures, and document progress in the first 10 years of life. DESIGN: Population based birth cohort study. SETTING: The child health and education study, which includes 16,004 neonatal survivors (98.5% of infants born in the United Kingdom during one week of April 1970). SUBJECTS: 14,676 children for whom relevant information was available. MAIN OUTCOME MEASURES: Responses to parental and general practitioner questionnaires and hospital records at 5 and 10 years after birth. RESULTS: 84 children (42 boys, 42 girls) had had one or more afebrile seizure (incidence 5.7/1000). 63 children (31 boys, 32 girls) had epilepsy (incidence 4.3/1000). 49 of 55 children had a second seizure within a year of the first. The commonest seizure types were tonic-clonic (42) and complex partial (25). A greater proportion of children with complex partial seizures had recurrences. Children who had infantile spasms or a mixed seizure disorder had a poor outcome. All six children who died had symptomatic seizures in the first year, but seizures were not the direct cause of death. CONCLUSIONS: The results of this study are probably representative of seizure patterns in the general population. Outcome after seizures is determined more by the underlying disease than by the seizures themselves.

Age Factors↗
PubMed1992

Childhood cancer, intramuscular vitamin K, and pethidine given during labour.

OBJECTIVE: To assess unexpected associations between childhood cancer and pethidine given in labour and the neonatal administration of vitamin K that had emerged in a study performed in the 1970 national birth cohort. DESIGN AND SETTING: 195 children with cancer diagnosed in 1971-March 1991 and born in the two major Bristol maternity hospitals in 1965-87 were compared with 558 controls identified from the delivery books for the use of pethidine during labour and administration of vitamin K. MAIN OUTCOME MEASURES: Odds ratios for cancer in the presence of administration of pethidine or of intramuscular vitamin K. Both logistic regression and Mantel-Haenszel techniques were used for statistical analyses. RESULTS: Children of mothers given pethidine in labour were not at increased risk of cancer (odds ratio 1.05, 95% confidence interval 0.7 to 1.5) after allowing for year and hospital of delivery, but there was a significant association (p = 0.002) with intramuscular vitamin K (odds ratio 1.97, 95% confidence interval 1.3 to 3.0) when compared with oral vitamin K or no vitamin K. There was no significantly increased risk for children who had been given oral vitamin K when compared with no vitamin K (odds ratio 1.15, 95% confidence interval 0.5 to 2.7). These results could not be accounted for by other factors associated with administration of intramuscular vitamin K, such as type of delivery or admission to a special care baby unit. CONCLUSIONS: The only two studies so far to have examined the relation between childhood cancer and intramuscular vitamin K have shown similar results, and the relation is biologically plausible. The prophylactic benefits against haemorrhagic disease are unlikely to exceed the potential adverse effects from intramuscular vitamin K. Since oral vitamin K has major benefits but no obvious adverse effects this could be the prophylaxis of choice.

Administration, Oral↗
PubMed1992

Can the fall in Avon's sudden infant death rate be explained by changes in sleeping position?

OBJECTIVE: To examine the impact of changing practice with regard to infant sleeping position on mortality from the sudden infant death syndrome. DESIGN: A population based study of all infants dying suddenly and unexpectedly during February 1990 to July 1991, and two groups of controls; one comprising every 125th baby born to Avon residents and the other comprising pairs of infants matched to each index case for age, neighbourhood, and date of study. Information about sleeping position was collected at home visits soon after the index baby's death or, for the population based controls, on several occasions in the first six months of life. The design was comparable to that of an earlier study of the same population. SETTING: County of Avon. SUBJECTS: 35 infants who died suddenly and unexpectedly (32 of the sudden infant death syndrome), 70 matched controls, and 152 population based controls. RESULTS: The prevalence of prone sleeping in the matched controls was much lower than that found in an earlier study in Avon (28% (18/64) 1990-1 v 58% (76/131) 1987-9; p less than 0.001) and was comparable with the prevalence in population based controls (29%). This would be expected to lead to a reduction in the incidence of the sudden infant death syndrome to 2.0/1000 live births (95% confidence interval 1.8/1000 to 2.5/1000). The actual mortality fell from 3.5/1000 in 1987-9 to 1.7/1000. CONCLUSION: The fall in mortality can be almost entirely accounted for by the reduction in prone sleeping, suggesting a causal relation exists between them. Side and supine positions confer protection but the side position is unstable and the infant may roll prone. We therefore recommend supine as the safest sleeping position for babies.

Case-Control Studies↗
PubMed1992

Evaluation of the Oxford and Sheffield SIDS risk prediction scores.

STUDY OBJECTIVE: To evaluate the clinical usefulness (sensitivity and specificity) of the Oxford and Sheffield birth scores for prospective identification of infants at high risk of SIDS. DESIGN: Retrospective medical record reviews of prospectively identified, autopsy-validated SIDS and living control infants. STUDY SUBJECTS: Consecutive sample of 140 infants, born between 1/1/83 and 12/31/87, who died suddenly and unexpectedly in the Avon Area Health Authority in southwest England between 1/1/84 and 12/31/88. Seventeen of the cases were excluded: 6 because they lacked adequate clinical records, 11 because they were not SIDS. The 637 control infants were comprised of every 80th delivery between 1/1/83 and 12/31/87 in the three major hospitals in the area. RESULTS: SIDS incidence was 2.85/1,000 live births. Using standard cut scores to define high SIDS risk (2.0 for Oxford and 500 for Sheffield), sensitivities were 0.55 and 0.35 and specificities were 0.78 and 0.89 for the Oxford and Sheffield scores, respectively. SIDS risk for infants in the high risk group was 7.3/1,000 (Oxford) and 9.3/1,000 (Sheffield). CONCLUSIONS: Since there is no intervention with proven efficacy for SIDS prevention, and since approximately one half of SIDS cases occur in low risk groups, clinical use of these scoring systems for allocation of health care resources or personnel for the sole purpose of SIDS prevention is not justified.

Cohort Studies↗
PubMed1991

Risk of epilepsy after febrile convulsions: a national cohort study.

OBJECTIVE: To identify children with febrile convulsions, classify their febrile convulsions into simple and complex, and determine the number and type of subsequent afebrile seizures in those children. DESIGN: National population based study. SETTING: United Kingdom. SUBJECTS: 16,004 neonatal survivors born during one week in April 1970. MAIN OUTCOME MEASURES: Information about febrile and afebrile seizures obtained from questionnaires at 5 and 10 years of age and from hospital records. RESULTS: Information was available for 14,676 of the cohort children. 398 (2.7%) of them had had at least one febrile convulsion. 16 children were known to be neurologically or developmentally abnormal before the first attack. Of the remaining 382 children, 305 had had a simple first febrile convulsion and 77 a complex first febrile convulsion. Thirteen of the 382 had had one or more afebrile seizures, nine of whom had developed epilepsy (recurrent afebrile seizures). A higher proportion of children with complex febrile convulsions (6/95) rather than simple febrile convulsions (3/287) developed epilepsy, the risk being highest for those who had had focal febrile convulsions (5/17; chi 2 = 39.9, p less than 0.001). Three of the 32 children who had prolonged febrile convulsions developed afebrile complex partial seizures. CONCLUSIONS: The risk of epilepsy after febrile convulsions is much less than reported in many hospital studies, and if febrile convulsions cause brain damage that leads to later epilepsy this is a rare occurrence.

Age Factors↗
PubMed1991

Complications of pregnancy and delivery in relation to psychosis in adult life: data from the British perinatal mortality survey sample.

OBJECTIVE: To evaluate whether events occurring at or around the time of birth contribute to the onset of psychotic illness in adult life. DESIGN-Pregnancy and birth complications as possible causes of adult mental illness were studied in the population sample of the British perinatal mortality survey. Subsequent psychiatric admissions were independently identified through the Mental Health Enquiry and records of regional and special health authorities. Logistic regression was used to compare data on perinatal deaths with those on survivors to determine factors independently associated with perinatal death, and this equation was then used to calculate the risk of perinatal death for each survivor. SUBJECTS: 16,980 people born in a single week in 1958 (the British perinatal mortality survey sample), including 252 patients admitted to psychiatric care; case notes of 235 patients were supplied. MAIN OUTCOME MEASURES AND RESULTS: Patients with a schizophrenic illness (whether defined by "broad" (n = 57) or "narrow" (n = 35) diagnostic criteria) did not have a greater mean risk of perinatal death than the population in general, but there was some evidence of increased liability (relative risk 2.43; 95% confidence interval 1.17 to 5.05) for those with affective psychosis (n = 32). Specific high risk variables for affective psychosis were decreased gestation time (273.9 v 281.2 days; mean difference 7.3 days, 95% confidence interval 3.1 to 11.5; p less than 0.002) and prescription of vitamin K to the child in the first week of life (19% of patients v 5% of controls, p = 0.016). CONCLUSIONS: The findings give no support to theories that factors predicting perinatal mortality contribute significantly to causation of schizophrenic illness. Further investigation of decreased gestation length in relation to affective disorder is required.

Adult↗
PubMed1991

Aluminium sulphate in water in north Cornwall and outcome of pregnancy.

OBJECTIVE: To determine whether the excess aluminum sulphate accidentally added to the local water supply in north Cornwall in July 1988 had an adverse effect on the outcome of pregnancies. DESIGN: Outcomes of all singleton pregnancies in the affected area at the time of the incident (n = 92) were compared with those in two control groups: pregnancies in this area completed before the incident (n = 68) and pregnancies in a neighbouring area (n = 193). SUBJECTS: Mothers in the three groups, among whom there were 13 miscarriages, five terminations of pregnancy, and 336 live births. MAIN OUTCOME MEASURES: Fetal and perinatal loss, birth weight, gestation, obstetric complications, neonatal condition, and congenital defects. RESULTS: Among 88 pregnancies in women exposed to excess aluminum sulphate there was no excess of perinatal deaths (n = 0), low birthweight (n = 3), preterm delivery (n = 4), or severe congenital malformations (n = 0). There was, however, an increased rate of talipes in exposed fetuses (four cases, one control; p = 0.01). CONCLUSIONS: Because of small numbers it is not possible to say that high doses of aluminum sulphate are safe in pregnancy, but there is no evidence from this study of major problems apparent at birth.

Abnormalities, Drug-Induced↗
PubMed1991

Comparison of prevalence of depression in mothers of twins and mothers of singletons.

OBJECTIVE: To determine whether the apparent additional and exceptional stresses associated with bearing and parenting twins affect the emotional wellbeing of mothers. SETTING: Great Britain, 1970-5. DESIGN: Cohort study of 13,135 children born between 4 April and 11 April 1970. Mothers of all children, both singletons and twins, were interviewed by health visitors (providing demographic data) and completed a self report measure of emotional well-being (the Rutter malaise inventory) when the child was 5 years of age. The malaise scores of mothers of twins were compared with those of all mothers of singletons and then with those of mothers categorised by the age spacing of their children (only one child, widely spaced, or closely spaced), taking account of maternal age, social class, and whether the study child had a disability, by using logistic regression. SUBJECTS: 139 mothers of twins--122 pairs of twins and 17 twins whose cotwin had died--and 12,573 controls, who were mothers of singletons. RESULTS: A significantly higher proportion of mothers of twins at 5 years had malaise scores indicative of depression than mothers of singletons at the same age. Mothers who had borne twins, one of whom had subsequently died, had the highest malaise scores and were three times more likely than mothers of singletons to experience depression. Both mothers of twin pairs and mothers of singletons closely spaced in age were at significantly higher risk of experiencing depression than mothers of children widely spaced in age or mothers of only one child (p less than 0.0001). Odds ratios indicated that the risk of depression in mothers of twins was higher than that in mothers of closely spaced singletons. CONCLUSION: Mothers of twins are more likely to experience depression. This suggests a relation between the additional and exceptional stresses that twins present and the mother's emotional wellbeing.

Adult↗
PubMed1991

Maternal mortality in Jamaica: health care provision and causes of death.

Details of 62 maternal deaths occurring in 1986/1987 were compared with a control population. The incidence was 11.5 per 10,000 livebirths. The major cause of maternal mortality was hypertension followed by hemorrhage and infection. There were trends with advanced maternal age and high parity. The risk of maternal death varied with hospital facilities available, being lowest in areas with access to a specialist hospital and highest in areas where there were no obstetricians available.

Adolescent↗
PubMed1991

Delayed antenatal care: does it effect pregnancy outcome?

Information on 13,127 mothers who were certain of the date of their last menstrual period (LMP) and who delivered in one week of April 1970, was analysed to assess whether delayed attendance for antenatal care (defined as not attending prior to 28 weeks of gestation) was associated with adverse outcome of pregnancy. Background factors that had been found to be predictive of delayed attendance were as follows: region of residence, region of birth of the child's father, marital status and contraceptive use in the 18 months prior to conception for primigravidae and the same four variables together with parity, maternal age and interpregnancy interval for multigravidae. Both before and after these factors had been taken into account, there was no evidence of any association between delay in attendance for care and severe pre-eclampsia, perinatal mortality, pre-term delivery and birthweight, although after adjustment for the background factors the length of gestation in delayed attenders was, on average, 2 days longer.

Adult↗
PubMed1991

Antenatal care received and its association with preterm birth in Greece.

A total population sample of singleton births to mothers with certain dates of last menstrual period (LMP) was identified from the Greek National Perinatal Survey of April 1983. Two groups of mothers were considered separately, 3116 primigravidae and 6524 multigravidae, with preterm birth rates of 5.9% and 8.4% respectively. Of all the antenatal care factors tested, primigravidae showed significant associations (unadjusted) with haematocrit level and with drugs taken during pregnancy. The logistic regression analysis which followed showed that the only factor independently associated with preterm delivery for that group of mothers was drugs taken during this period: women taking no drugs (including vitamins and iron) had the highest risk of preterm delivery. In contrast, multigravidae showed significant unadjusted associations with a great variety of parameters of antenatal care. Nevertheless, in the logistic regression analysis only three proved to have independent significant associations: drugs taken during pregnancy (reduced risk among mothers taking vitamins and iron), hospital admission during pregnancy (mainly for cervical cerclage) and the pattern of antenatal care during the first two trimesters (those attending the recommended number of times having least risk).

Cross-Sectional Studies↗
PubMed1991

Hospice home care.

This has turned out to be a remarkable adventure into the human condition. It has been most rewarding to see that it is quite possible to overcome the most difficult clinical situations by knowledge, patience and the sort of natural sympathy which should be part of the personality of every physician. Once these facts have been experienced, what at first must appear to be a repulsive subject becomes a happy and, in many ways, beautiful illustration of how a natural process should proceed with dignity.

Critical Illness↗
PubMed1990

Incidence of anencephaly in Jamaica.

Information was collected on 2,197 stillbirths and neonatal deaths on the island of Jamaica during the 12 month period September 1986 to August 1987 as part of the population based nationwide Jamaican Perinatal Morbidity and Mortality Survey. There were 14 cases of anencephalus giving an incidence of 0.26 per 1,000 total births. One of these cases was associated with the amniotic band syndrome; excluding this, the incidence would be even lower (0.24 per 1,000). There was no apparent association with social class, maternal age, or parity. The rate found in Jamaica is considerably lower than found in any other national population study.

Anencephaly↗
PubMed1990

Previous obstetric history and subsequent preterm delivery in Greece.

A total population sample of 6524 multigravid women who were certain of the date of their last menstrual period was obtained from the population-based Greek National Perinatal Survey of April 1983. The sample was used to determine the associations between features of the maternal obstetric history and preterm delivery. There were significant associations between preterm delivery and previous fetal losses, whether early (miscarriages and/or induced abortions) or late (stillbirths). For mothers who had experienced miscarriage(s), induced abortion(s) or stillbirth(s) the odds ratios were 1.40, 1.36 and 1.15, respectively, compared with mothers without any fetal loss. The odds ratio increased substantially with the increasing number of losses and reached 5.60 for the small group of mothers who had had prior miscarriage, termination and stillbirths. The results changed very little when the socioeconomic characteristics of the family were taken into account.

Cross-Sectional Studies↗