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Biomedical subjects

N Spencer

Publications and source records attributed to N Spencer.

At least 19 recordsLinked to original sources
PubMed2005

Audit of local performance compared with standards recommended by the national guidelines for aetiologic investigation of permanent childhood hearing impairment.

BACKGROUND: National guidelines for aetiologic investigation of childhood deafness were developed as the Newborn Hearing Screening Program (NHSP) was being implemented in the United Kingdom. This guidance document was expected to be incorporated into the operational procedure of the NHSP. METHOD: This criterion-based audit compared local care set against developed guidelines that can be used to assess the appropriateness of specific investigations, services and outcomes. Data on children diagnosed to have sensorineural deafness from March 2002-2004 were extracted from an established computerized database for analysis. RESULTS: Forty-seven children were included; 17 have bilateral severe to profound hearing loss, 25 have bilateral mild to moderate loss and 5 with unilateral loss. A high proportion of Pakistani children were from consanguineous marriages with a family history of deafness. Total 29.8% of children were diagnosed through newborn screening and 70.2% detected through hearing surveillance programmes. For children with bilateral severe to profound deafness, 53.0% accepted, 5.9% declined and 41.2% were not offered imaging of their inner ears. A total of 47.1% accepted and 52.9% declined electrocardiograph (ECG) evaluation. Total 70.6% accepted and 29.4% declined connexin mutations testing. Parental requests were required for those with lesser degree of hearing loss. Total 24% accepted, 28% declined and 48% were not offered connexin testing. None were offered ECG and imaging. Testing for congenital infections was inappropriate for children over 1 year old. Ten subjects accepted and five declined this investigation. In the total group, 63.8% accepted, 17.0% declined and 19.1% were not offered referral to the ophthalmic service. Total 46.8% accepted, 44.7% declined and 8.5% were not offered referral to genetics service. Investigations resulted in two connexin-positive children with moderate loss. CONCLUSION: Our study identified key areas where guidelines were not followed. These were related to lack of funding and parental choice. This sample has a higher connexin 'hit' rate for lesser degree deafness.

Child↗
PubMed2005

Cerebral palsy and socioeconomic status: a retrospective cohort study.

AIMS: To study the relation between risk of cerebral palsy and socioeconomic status. METHODS: A total of 293 children with a diagnosis of cerebral palsy out of 105,760 live births between 1 January 1982 and 31 December 1997 were identified from the special conditions sub-file of the West Sussex Computerised Child Health System. RESULTS: There was a linear association between risk of cerebral palsy and socioeconomic status (SES) measured by the Registrar General's social class (RGSC) and enumeration district (ED) ranked into quintiles by the Townsend Deprivation Index derived from 1991 census data. Fifty one per cent and 30% of cases of cerebral palsy were statistically "attributable" to inequality in SES using the RGSC and ED quintile respectively. A linear association was also noted for singleton live births. The association between risk of cerebral palsy and ED quintile persisted in a logistic regression model that included birth weight and gestational age, although that between RGSC and cerebral palsy no longer reached conventional levels of statistical significance after adjustment. CONCLUSIONS: A strong association was observed between socioeconomic status and the risk of cerebral palsy, which was only partly accounted for by the known social gradients in birth weight and gestational age.

Cerebral Palsy↗
PubMed2005

Families affected by deafness: hospital services uptake in a multiethnic population.

AIMS: To examine the uptake of relevant hospital services by families with deaf children and to compare use of these services between Pakistani and white families. METHODS: A total of 214 deaf children with amplification aids who attended their paediatric outpatient and school medical appointments from October 2000 to March 2003 were studied in an observational cohort study. RESULTS: The demographic profile of both the Pakistani and white families was similar. Pakistani children had a statistically significant excess of the following risk factors: consanguineous marriages (86.4% Pakistani, 1.5% white), family history of deafness (66.4% Pakistani, 38.8% white), and family size (birth order >5: 12.8% Pakistani: 4.5% white). White children were more likely to have had post-meningitis deafness (1.4% Pakistani, 13.4% white) and congenital infections, or have dysmorphic features (5.0% Pakistani, 13.4% white). Overall the uptake of relevant hospital services by Pakistani and white families was very similar irrespective of an early or late diagnosis. There was an increased likelihood of white families declining cochlear implantation (17.6% Pakistani, 75.0% white). CONCLUSIONS: This study did not show significant differences in hospital service uptake despite different risk profiles for childhood deafness for both Pakistani and white families in Bradford. Among specialist services offered, cochlear implantation was more likely to be accessed by Pakistani families.

Child↗
PubMed2005

Parent reported home smoking bans and toddler (18-30 month) smoke exposure: a cross-sectional survey.

AIMS: To study the relation between the use of parent reported home smoking bans and smoke exposure among children aged 18-30 months. METHODS: A total of 309 smoking households with children aged 18-30 months, who were part of the Coventry Cohort study, consented to participate in this cross-sectional survey. RESULTS: Although parents in almost 88% of smoking households reported using harm reduction strategies to protect their toddlers from smoke exposure, only 13.9% reported smoking bans in the house. Mean log urinary cotinine:creatinine ratio was significantly lower for those children whose parents reported no smoking in the house (1.11, 95% CI 0.64 to 1.49) compared with none/less strict strategies (1.87, 95% CI 1.64 to 2.10). In linear regression models fitted on log cotinine:creatinine ratio, no smoking in the house was independently associated with a significant reduction in cotinine:creatinine ratio (B = -0.55, 95% CI -0.89 to -0.20) after adjusting for mother's and partner's average daily cigarette consumption, housing tenure, and overcrowding. The final model accounted for 44.3% of the variance. CONCLUSIONS: Not smoking in the house was associated with a reduction in mean urinary cotinine:creatinine ratio in children aged 18-30 months; the relation persisted after adjustment for levels of mother's and partner's daily cigarette consumption and sociodemographic factors. Results suggest that home smoking bans in this age group have a small but significant effect on smoke exposure independent of levels of parental tobacco consumption.

Child, Preschool↗
PubMed2004

Treatment of peripheral sensorineural hearing loss: gene therapy.

Noise, chemicals and genetic defects are all common causes of irreversible hearing loss, which at present have no cure. Gene therapy may soon be utilized in both the protection and the treatment of these exogenous and endogenous sources of hearing loss. Gene therapy technology is rapidly developing and the inner ear is a particularly feasible model for gene therapy. This review outlines our current understanding of the mechanisms behind deafness and prospects for treatment, discusses the inner ear model in detail and reviews the efforts that have been made in inner ear gene therapy. Finally, the proposed next steps will be discussed. The viral mediated delivery of neurotrophins and antioxidants offers imminent promise in preventing and treating exogenous hearing loss and improving cochlear implant therapy.

Animals↗
PubMed2004

The effect of income inequality and macro-level social policy on infant mortality and low birthweight in developed countries--a preliminary systematic review.

OBJECTIVE: To carry out a preliminary systematic review of literature to address the question - among rich nations (or states within nations) what is the evidence that income inequality and differences in macro-level social policy affect rates of infant mortality and low birthweight (LBW)? STUDY DESIGN: A systematic literature review. SEARCH STRATEGY: Medline database (1968-August 2003) was searched for empirical studies of the relationship between macro-level economic and social policies in rich nations and rates of infant mortality (IMR) and LBW. Cross-national comparison of infant mortality and LBW that did not compare the effects of macro-level economic and social policies was excluded from the review as were studies including less developed countries. Keywords representing IMR and LBW were entered into Medline along with exposures related to international comparison and macro-level policy. Abstracts obtained from the initial search were reviewed for relevant studies. Full papers of potentially relevant studies were obtained and reviewed for inclusion. Secondary search of papers cited in included papers was undertaken. For this review, papers were not excluded on the basis of quality although methodological limitations were commented on and taken into account in interpreting the results. Summary statistics were not estimated. RESULTS: Twelve studies, fulfilling the inclusion criteria, were identified. Ten studies examined the association of IMR with income inequality, eight of which reported a statistically significant positive association with higher levels of inequality after adjustment for a range of variables. Six studies reported significant positive associations of IMR with other indicators of less re-distributive social and economic policy. Associations with LBW were reported in four studies; three showed significant positive associations with higher levels of income inequality and one showed no association with low levels of parental leave entitlement. Methodological differences, particularly the wide range of variables used to adjust for confounding, make interpretation of the findings difficult. CONCLUSIONS: The results of this review represent a preliminary attempt to summarize the literature linking macro-level economic and social policies in rich nations with IMR and LBW. The findings, taking account of the methodological limitations of the review and of the included studies, suggest a statistically significant association between IMR and higher income inequality and other indicators of less re-distributive social policy. Only three studies examined the association of income inequality with LBW and, although they suggest a significant association, further studies will be needed to confirm this finding.

Developed Countries↗
PubMed2004

Sudden unexpected death in infancy and socioeconomic status: a systematic review.

This paper aimed to systematically review observational studies documenting the relation between sudden unexpected death in infancy and socioeconomic status. A search of two electronic databases (Medline 1966 to November 2002; Embase 1981 to November 2002) yielded 52 case-control or cohort studies meeting the inclusion criteria. An increased risk of sudden unexpected death in infancy was reported in 51 studies and 32 of 33 studies reporting graded measures of socioeconomic status showed a dose-response relation of sudden death with socioeconomic status. Of the 10 studies in which adjustment was made for maternal smoking, socioeconomic status retained an independent effect on infant death in nine. The effect of socioeconomic status was also independent of birth weight in 10 of 11 studies and independent of sleeping position in two. The included studies reported a significant association of socioeconomic status with sudden unexpected death in infancy with risk of infant death increasing with greater exposure to adverse social circumstances. The findings support a significant role for adverse social circumstances in the pathways to sudden unexpected death in infancy.

Birth Weight↗
PubMed2003

Family and carer smoking control programmes for reducing children's exposure to environmental tobacco smoke.

BACKGROUND: Exposure to other people's cigarette smoke (environmental tobacco smoke, or ETS) is an important child health issue. OBJECTIVES: To determine the effectiveness of interventions aiming to reduce exposure of children to ETS. SEARCH STRATEGY: The Tobacco Addiction Group register of studies was searched. MEDLINE, EMBASE and four other health and psychology databases were searched electronically, bibliographies of retrieved primary studies were checked and specialists in the area consulted. SELECTION CRITERIA: Controlled trials with or without random allocation were included in this review if they addressed participants (parents and other family members, child care workers and teachers) involved with the care and education of infants and young children (aged 0-12 years). All mechanisms for reduction of children's environmental tobacco smoke exposure, and smoking prevention, cessation, and control programmes targeting these participants are included. These include smoke free policies and legislation, health promotion, social-behavioural therapies, technology, education and clinical interventions. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed studies and extracted data. Due to heterogeneity of methodologies and outcomes, no summary measures were possible and results were synthesised using narrative summaries. MAIN RESULTS: Nineteen studies met the inclusion criteria, one of which was subsequently excluded. Three interventions were targeted at populations or community settings, seven studies were conducted in the well child health care setting and eight in the ill child health care setting. Twelve of these studies are from North America. In 12 of the 18 studies there was reduction of ETS exposure for children in both intervention and comparison groups. In only four of the 18 studies was there a statistically significant intervention effect. Three of these successful studies employed intensive counselling interventions targeted to smoking parents. There is little difference between the well infant, child respiratory illness and other child illness settings as contexts for parental smoking cessation interventions. The fourth successful intervention was in the school setting targeting the ETS exposure of children from smoking fathers. REVIEWER'S CONCLUSIONS: Brief counselling interventions, successful in the adult health setting when coming from physicians, cannot be extrapolated to adults in the setting of child health. There is limited support for more intensive counselling interventions. There is no clear evidence for differences between the respiratory, non-respiratory ill child, well child and peripartum settings as contexts for reduction of children's ETS exposure.

Age Factors↗
PubMed2003

The effects of work on the growth of Jordanian boys.

OBJECTIVE: To examine the effects of work on growth among boys aged 10-16 years in Jordan. STUDY DESIGN: Cross-sectional health survey comparing working and non-working boys. MAIN OUTCOMES: Height for age z-score; weight for age z-score. METHODS: One hundred and thirty-five working and 405 non-working boys aged 10-16 years were studied in the Jordanian areas of Irbid, Jarash and North Jordan Valley. The boys and their mothers were interviewed and data collected on work status, child's smoking status, and family socio-economic characteristics including per capita income, family size, maternal and paternal education, area of the house in square metres and expenditure on household durables. Height and weight were obtained at the time of interview. Linear regression models were fitted on height for age z-score and weight for age z-score. RESULTS: In bivariate analysis, child's work status (r = -0.221), household per capita income (r = 0.104), family size (r = -0.102), house m2 per capita (r = 0.090) and monthly expenditure on durables (r = 0.086) were significantly correlated with height z-score. Work status (P < 0.0001) and household m2 per capita (P = 0.002) were retained in the regression model fitted on height z-score which explained 9.8% of the variance. The model fitted on weight z-score explained 6.5% of the variance and work status (P < 0.0001), household per capita income (P = 0.041) were retained. CONCLUSIONS: The results of this study suggest that, independent of a range of socio-economic factors, work has a negative effect on child growth. Given the extent of child labour internationally these findings have profound implications for global child well-being and for global social and economic policy.

Adolescent↗
PubMed2003

Social patterning and prediction of parent-reported behaviour problems at 3 years in a cohort study.

OBJECTIVE: To study the determinants of parent-reported behaviour problems at 3 years and the value of behaviour problems reported at 8 and 18 months as predictors of behaviour at 3 years STUDY DESIGN: A whole year birth cohort SETTING: Coventry MAIN OUTCOMES: Parent-reported behaviour problems at 3 years PARTICIPANTS: A total of 2580 infants were enrolled into the Coventry Cohort Study at the birth visit by their family health visitor. Data on parent-reported behaviour at all three ages (8 months, 18 months and 3 years) were available on 775 infants. RESULTS: Living in rented accommodation [adjusted OR 2.38 (95% CI 1.36, 4.21); OR, odds ratio; CI, confidence intervals] and living in a smoking household [adjusted OR 2.47 (95% CI 1.53, 3.99)] were independently associated with parent-reported behaviour problems at 3 years after controlling for other sociodemographic variables in logistic regression. The risk of behaviour problems at 3 years was increased in those reporting behaviour problems at 8 months [OR 3.77 (95% CI 1.73, 8.20)] and 18 months [OR 5.84 (95% CI 3.34, 10.23)] after adjustment for sociodemographic variables and other health problems. Behaviour at 8 months as a predictor of behaviour at 3 years had a sensitivity of 13.9%, a specificity of 95.7%, a positive predictive value of 32.6%, and positive and negative likelihood ratios of 3.23 and 0.90. For behaviour at 18 months, the sensitivity was 35.6%, the specificity 92.9%, the positive predictive value 42.9%, and positive and negative likelihood ratios 5.01 and 0.69. CONCLUSIONS: Parent-reported behaviour problems at 8 and 18 months are highly specific but not particularly sensitive as predictors of behaviour problems at 3 years. Assuming the availability of an effective early intervention, use of a question such as that in the Warwick Child Health and Morbidity Profile at 8 and 18 months will identify, respectively, 21% and 36% of children at risk of parent-reported behaviour problems at 3 years.

Child Behavior Disorders↗
PubMed2003

Services for pre-school children with behaviour problems in a Midlands city.

OBJECTIVES: To study the services for pre-school children with behaviour problems in a Midlands city and the level of co-ordination and co-operation between providers. SETTING: A socially and ethnically diverse Midlands city in the UK. METHODS: Survey methods were employed with city health visitors in order to determine their role and identify service providers. Service providers from different agencies were interviewed and data collected related to service offered, materials used, theoretical basis of interventions, referrals to and from the service, inclusion and exclusion criteria and co-ordination and co-operation with other providers. Themes were identified related to the content and process of the services using qualitative data analysis methods. Frequencies of themes were estimated for different provider groups. RESULTS: Health visitors and nursery nurses working in the primary care services were the primary point of contact for children with pre-school behaviour problems. Nursery nurses were one of the major sources of referral for children with pre-school behaviour problems and a significant majority of these providers had not received any specific training for this role. The majority of the providers used evidence-based programmes but few adhered strictly to a particular programme and instead used a mixture of materials drawn from different programmes. Many health service providers in particular offered interventions to parents on a one-to-one basis only. Most providers used behaviour modification approaches. While many providers claimed to have knowledge of other local providers and have good links, there was little evidence of co-ordination within and between agencies. CONCLUSIONS: While there appears to be high levels of activity by providers from both statutory and voluntary sectors in providing services for pre-school children with behaviour problems, there is evidence to suggest that some of the main providers of services are not being adequately prepared and supported in the role. There is a lack of co-ordination within and between services, and indication that evidence-based programmes are being modified and used in an ad hoc manner. It is concluded that surveys of this nature may be an important preliminary step in establishing co-ordinated services for the primary and secondary prevention of pre-school behaviour problems.

Attitude to Health↗
PubMed2003

Parent reported longstanding health problems in early childhood: a cohort study.

AIM: To study changing prevalence and correlates of longstanding health problems across early childhood. METHODS: Of 2576 infants enrolled in the Coventry Cohort Study at birth, parents of 2157 at 8 weeks, 1752 at 8 months, 1521 at 18 months, and 1182 at 3 years completed the Warwick Child Health and Morbidity Profile. RESULTS: The prevalence of parent reported longstanding health problems was 4.3% at 8 months, 6.9% at 18 months, and 9.7% at 3 years. Congenital anomalies accounted for 42.1% of longstanding health problems at 8 months, 40.0% at 18 months, and 27.8% at 3 years. The proportion accounted for by asthma was 17.1% at 8 months, 21.9% at 18 months, and 24.3% at 3 years. In each age period, children reported to have longstanding health problems were at increased risk of impaired functional health, poorer general health, and reduced health related quality of life. Low birthweight infants were most at risk of longstanding health problems at 8 months. By 3 years, risk of longstanding health problems was associated with living in rented accommodation and living in a smoking household. CONCLUSIONS: The prevalence of parent reported longstanding health problems increased across early childhood. Congenital anomalies constituted the major cause, particularly in infancy, with asthma and developmental delay becoming more prominent by 3 years of age. Social patterning of longstanding health problems and the association with smoking were clearly established by 3 years of age but the relation may have been mediated by low birth weight earlier in infancy.

Asthma↗
PubMed2003

Effect of work related variables on growth among working boys in Jordan.

OBJECTIVE: To study the effect of work related variables on the height, weight, and body mass index (BMI) of working boys aged 10-16 years. DESIGN: Cross sectional survey. SETTING: Irbid, Jarash, and North Jordan Valley in Jordan. PARTICIPANTS: 135 working boys aged 10-16 years and their mothers. OUTCOME MEASURES: Height for age z score; weight for age z score; BMI for age z score. RESULTS: In bivariate analysis, child's duration of work (r=-0.20), maternal height (r=0.26), and household per capita income (r=0.23) were significantly correlated with height for age z score and duration of work (r=-0.24), maternal height (r=0.24), and household per capita income (r=0.19) with weight for age z score. Duration of work (p<0.001), child's monthly income (p=0.044), maternal height (p=0.002), and household per capita income (p=0.005) were retained in the regression model fitted on height z score that explained 20.1% of the variance. The regression model fitted on weight z score explained 20.1% of the variance and duration of work (p<0.001), child's monthly income (p=0.022), household per capita income (p=0.017), and maternal height (p=0.004) were retained. Only duration of work (p=0.001) was retained in the model fitted on BMI for age z score. CONCLUSION: The results of this study suggest that the length of time children have been working and low monthly income have a detrimental effect on growth of working boys independent of the effects of low household per capita income and small maternal stature. Relevance of these findings for social policy and health care of working boys in Jordan and elsewhere is discussed.

Adolescent↗
PubMed2002

Nanochemical surface analyzer in CMOS technology.

We have developed an atomic force microscopy (AFM) cantilever system, fabricated using a standard CMOS process and a few post-processing steps, capable of detecting the difference between hydrophilic and hydrophobic samples for the purpose of nanochemical surface analysis. The fully integrated cantilever comprises a thermal actuator for cantilever deflection and a Wheatstone bridge to sense cantilever bending, thus obviating the need for cumbersome laser detection and external piezoelectric drives. Glass microspheres have been affixed to the cantilevers and, were either modified with a self-assembled monolayer to form hydrophobic tips, or left unmodified for hydrophilic tips. Force-distance curves have been used to measure the force between the functionalized/unfunctionalized tips and hydrophobic/hydrophilic sample surfaces. In an optimization step three different Wheatstone bridge sensors have been designed and characterized; best Wheatstone bridge sensitivity is 8.0 microV/nm with a 713 nm/mW actuator efficiency.

Journal Article↗
PubMed2002

Growth of working boys in Jordan: a cross-sectional survey using non-working male siblings as comparisons.

OBJECTIVES: To study the effects of work on growth of Jordanian boys, aged 10-16 years, using non-working male siblings as controls. SETTING: The Jordanian areas of Irbid, Jarash and the North Jordan Valley. STUDY DESIGN: Cross-sectional survey of working boys and their non-working brothers. MAIN OUTCOMES: Height-for-age z-score; weight-for-age z-score. METHODS: Working boys (103) and non-working male siblings (103) (nearest in age to the working child) were interviewed, with their mothers, in the family home. Heights and weights of the working boys and their non-working male siblings were measured, and capillary blood was taken for packed-cell volume estimation. Heights and weights were converted to z-scores, and means for all three outcomes were compared between working boys and non-working siblings, using independent sample t-tests. The effect of the proportion of household income contributed by the working child's income on the main outcomes, among non-working siblings, was estimated by simple linear regression. RESULTS: Means for height-for-age z-score (p < 0.001), weight-for-age z-score (p < 0.001), and packed-cell volume (p < 0.001) among working boys were significantly lower than means for their non-working siblings. The main outcomes among non-working siblings were not significantly correlated with the proportion of household income contributed by the working child. CONCLUSIONS: The results of this study suggest that work among boys aged 10-16 years in Jordan puts them at increased risk of stunting, wasting and anaemia. Previous studies have suggested this relationship but have suffered from confounding by socioeconomic status. Comparison with non-working siblings reduces the chances of socioeconomic status confounding.

Adolescent↗