Biomedical subjects

R Drewett

Publications and source records attributed to R Drewett.

9 recordsLinked to original sources

PubMed2006

Postnatal factors associated with failure to thrive in term infants in the Avon Longitudinal Study of Parents and Children.

OBJECTIVE: To assess the contribution of postnatal factors to failure to thrive in infancy. METHODS: 11 900 infants from the Avon Longitudinal Study of Parents and Children (ALSPAC), born at 37-41 weeks' gestation, without major malformations and with a complete set of weight measurements in infancy (83% of the original ALSPAC birth cohort) were studied. Conditional weight gain was calculated for the periods from birth to 8 weeks and 8 weeks to 9 months. Cases of growth faltering were defined as those infants with a conditional weight gain below the 5th centile. RESULTS: Analysis yielded 528 cases of growth faltering from birth to 8 weeks and 495 cases from 8 weeks to 9 months. In multivariable analysis, maternal factors predicting poor infant growth were height <160 cm and age >32 years. Growth faltering between birth and 8 weeks was associated with infant sucking problems regardless of the type of milk, and with infant illness. After 8 weeks of age, the most important postnatal influences on growth were the efficiency of feeding, the ability to successfully take solids and the duration of breast feeding. CONCLUSIONS: The most important postnatal factors associated with growth faltering are the type and efficiency of feeding: no associations were found with social class or parental education. In the first 8 weeks of life, weak sucking is the most important symptom for both breastfed and bottle-fed babies. After 8 weeks, the duration of breast feeding, the quantity of milk taken and difficulties in weaning are the most important influences.

Age Factors↗

PubMed2001

Malnutrition and mental development: is there a sensitive period? A nested case-control study.

To examine the possibility that there is an early sensitive period for the effects of malnutrition on cognitive development, three groups of children (N = 197) were recruited from a birth cohort with known growth characteristics in south-west Ethiopia (N = 1,563). All had initial weights > or = 2,500 g. Early growth falterers dropped in weight below the third centile (z < -1.88) of the NCHS/WHO reference population in the first 4 months. Late growth falterers were children not in the first group whose weights were below the third centile at 10 and 12 months. Controls were a stratified random sample with weights above the third centile throughout the first year. All children were tested blind at 2 years using the Bayley Scales of Infant Development, adapted for use in Ethiopia. Mean (SD) scores on the psychomotor scale were 10.2 (3.7) in the controls, 6.6 (4.2) in the early growth falterers, and 8.5 (4.3) in the late growth falterers. For the mental scale they were 28.9 (5.8), 22.6 (6.2), and 26.6 (6.1) respectively. Both overall differences were statistically significant at p < .001, and planned comparisons between the control and the combined growth faltering groups, and between the early and later growth faltering groups, showed that each difference was statistically significant for both scales. However, early weight faltering was associated with weight at the time of testing (r = .33), which was associated with scores both on the psychomotor (r = .53) and the mental scale (r = .49). After taking weight at the time of testing into account there was no additional effect attributable to the timing of growth faltering. In this population, therefore, early malnutrition does not have specific adverse effect beyond the contribution that it makes to enduring malnutrition over the first 2 years.

Age Factors↗

PubMed2000

Eating behaviour and its variability in 1-year-old children.

As part of a longitudinal study of the development of eating behaviour, the naturally occurring meals of 30 12 month old children were videotaped on four occasions, all in their own homes. Their mealtime behaviour was coded using a scheme developed for the analysis of feeding behaviour over the weaning period, and summarised as counts of coded actions. Thirty of these meals were coded independently by a second observer. With one exception, the reliability of the counts was high (r> 0.9). The median duration of the meals was 17 min (range 1-50) and the median number of times the mother directly gave the child food was 42 (0-172). The median number of food refusals by the child was 11 (0-89), and self feeding actions, 12 (0-101). Counts of eating behaviour for the main and sweet courses during the same meal were only modestly correlated. Between subject variance for different behaviour counts comprised 41% to 54% of the total variance. These results show that 1 year old children are relatively variable in their eating behaviour from meal to meal, so measures taken from a single meal will not reliably summarise children's feeding characteristics. Food refusal is a common feature of eating behaviour in normal children at this age.

Feeding Behavior↗

PubMed1998

Traditional nutritional and surgical practices and their effects on the growth of infants in south-west Ethiopia.

A 1-year birth cohort of 1563 infants was seen bi-monthly for the first year of life. They comprised all identified infants born in Jimma town, south-west Ethiopia, in the year starting 1 Meskren 1985 in the Ethiopian calendar (11 September 1992). Growth in infancy is poor in this town, as it is in Ethiopia more generally: mean z-scores for both weight and length were more than 1.5 SD below the median of the NCHS/WHO reference population by 1 year of age, and infant mortality was 115/1000. In this paper we examine the weight gain of singletons in relation to background variables and to traditional nutritional and surgical practices in the families. Confirming work in other areas, sanitation, water supply, the income of the family and the mother's literacy were important determinants of weight gain. Almost all the infants were initially breast fed, and about 80% were still breast fed at 1 year. Many were also given cows' milk from 4 months onwards. Breast feeding had beneficial effects up to 8 months of age, and cows' milk had beneficial effects after 6 months of age. Supplementary feeds of solids and semi-solids were given at appropriate ages, but had no detectable benefit. Water was given inappropriately early, but did no detectable harm. Episodes of diarrhoea, fever or persistent cough each reduced weight gain. Catch-up in weight then took up to 8 months, probably because of the poor nutritional quality of supplementary feeds. The incidences of local traditional operations in the first year were: circumcision 63% in males and 4% in females, uvulectomy 35% and the extraction of milk teeth 38%. Although circumcision had no detectable adverse effect on weight, uvulectomy and milk teeth extraction both reduced weight gain.

Breast Feeding↗

PubMed1996

An Ethiopian birth cohort study.

A one-year birth cohort was studied in Jimma town, South West Ethiopia, in 1992-93. We report here on the design and on the methods used in the study and describe the principal health outcomes. Infants were visited bimonthly until their first birthday. Background data on the physical, cultural and economic environment of the home were collected at the first visit, and data on nursing and weaning on traditional surgical and other practices, and on vaccination at the first visit and at each subsequent visit. Length, weight and mid upper arm circumference were measured, and details of the mother's handling of illness episodes recorded. Of 1563 children born, 86% were successfully followed to the end of their first year or to an earlier death. There were 141 deaths, indicating an infant mortality of 115/1000 (estimated probability of surviving to 1 year 0.8851, with s.e. 0.0101). The mean length and weight of the singleton infants at the end of their first year was -1.41 and -1.52 SD from the median of the NCHS/WHO reference population. Weights throughout the first year were analysed in more detail using a Reed model, fitted as a random coefficient regression model in ML3-E. There were clear differences in growth across the different ethnic groups, with the best growing group weighing on average about 1 kg more at the end of the first year than the groups growing least well.

Chi-Square Distribution↗

PubMed1994

Effectiveness of knee replacement surgery in arthritis.

This study examined the effectiveness of knee replacement surgery in an elderly population suffering from arthritis. Four questionnaires which measured pain, mobility, anxiety, depression and social isolation were completed by the study group before and after surgery to assess changes in physical function, psychological state, social interaction and somatic sensation. A statistically significant difference was found in pain which was reduced from a median score of 3 before the operation to 0 afterwards on an intensity scale of 0-5. Statistically significant improvements were also found in the mobility/dependency scores and in the level of anxiety and depression following the operation. It was concluded that knee replacement is a highly effective treatment for arthritis of the knee, reducing pain, increasing mobility and improving the persons emotional state, thus improving the quality of life of the recipient. The use of separate questionnaires to measure single dimensions of quality of life as opposed to a single health profile is also discussed.

Activities of Daily Living↗

PubMed1993

Nursing frequency and the energy intake from breast milk and supplementary food in a rural Thai population: a longitudinal study.

A group of 60 infants representative of a rural Thai population were studied longitudinally over the first year of life. Their breast milk intake, supplementary food intake and nursing patterns were measured for 2 consecutive days at about 15, 45, 90, 180, 270 and 360 days of age. For the sample as a whole, the estimated peak value for energy intake from breast milk was 529 kcal (2213 kJ) and occurred at 34 days post-partum. Thereafter milk intake declined, with 40% of infants fully weaned by the end of the first year. Supplements were introduced early, with 15% of infants supplemented by 2 weeks and 68% by 6 weeks. Higher levels of supplementation were associated with lower breast milk intake. In addition there was an independent positive effect of nursing patterns (number of breast feeds per day). Interaction terms show that both supplementary feeding and number of feeds have quantitatively different effects at different ages: breast milk intake varies more with level of supplementation in younger infants than in older infants, and varies more with number of feeds in older infants than in younger infants. Higher peak levels of breast milk intake were followed by a steeper decline, and infants who took more breast milk at 15 days were more likely to be fully weaned by their first birthday.

Age Factors↗

PubMed1992

Cost-benefit analysis of hip fracture treatment.

We have determined the quality-adjusted-life-years and cost of such in several types of hip fracture and various treatment options. Operative treatment proved more cost-effective than other methods for displaced subcapital fractures and for extracapsular fractures. For undisplaced subcapital fractures conservative treatment was almost as cost-effective as surgery.

Aged↗

PubMed1991

The Chiang Mai lactation project: study design and implementation.

The Chiang Mai lactation project is a longitudinal field study of human lactation carried out among northern Thai women living in the Sanpatong area of Chiang Mai Province. Its aim was to measure the volume and composition of breast milk transferred from mothers to their infants in the first year postpartum, and to relate it to predictors of milk production, and to the growth of the child. Breast milk and supplementary food intake, and nursing patterns, were recorded over two consecutive 24-hour periods six times during the first year. Samples of breast milk and of supplementary foods were analysed for energy and protein. Supplementary foods were also analysed for bacterial contamination. The growth of the child was measured, and health assessed using a combination of health diaries and examination by a physician. Recruitment to the study was excellent. After recruitment, two subjects left the study area, but otherwise only two dropped out, so complete sets of data covering these variables are available for 58 of the 62 recruited subjects.

Body Weight↗