Relationship between physical growth and motor development in the WHO Child Growth Standards

Aim: To examine relationships among physical growth indicators and ages of achievement of six gross motor milestones in the WHO Child Growth Standards population. Methods: Gross motor development assessments were performed longitudinally on the 816 children included in the WHO Child Growth Standards. Six milestones (sitting without support, hands-and-knees crawling, standing with assistance, walking with assistance, standing alone, walking alone) were assessed monthly from 4 until 12 mo of age and bimonthly thereafter until children could walk alone or reached 24 mo. Failure time models were used 1) to examine associations between specified ages of motor milestone achievement and attained growth z scores and 2) to quantify these relationships as delays or accelerations in ages of milestone achievement. Results: Statistically significant associations were noted between ages of achievement of sitting without support and attained weight-for-age, weight-for-length and BMI-for-age z scores. An increase of one unit z score in these indicators was associated with 3 to 6 d acceleration in the respective achievement age. Statistically significant associations also were noted between various milestone achievement ages and growth when 3- or 6-mo and birth length-for-age z scores were entered jointly in the failure time models. In these analyses, one unit z-score increase in length-for-age was associated with 1 to 3 d delay in the respective achievement age.
Conclusion: Sporadic, significant associations were observed between gross motor development and some physical growth indicators, but these were quantitatively of limited practical significance. These results suggest that, in healthy populations, the attainment of these six gross motor milestones is largely independent of variations in physical growth.     

Reproducibility of Two Four-Point Clinical Severity Scores for Lateral Canthal Lines (Crow''s Feet)

BACKGROUND: Several clinical scoring systems have been used to evaluate the efficacy of botulinum toxin A in the treatment of hyperkinetic wrinkles. So far very few have been investigated for their reproducibility. OBJECTIVE: The aim of this study was to investigate the reproducibility of two clinical four-point scales for lateral canthal lines (crow's feet), at rest and at maximum smile. MATERIAL AND METHODS: Based on standardized photographs, a consensus atlas depicting the different severity grades [from 0 (none) to 3 (severe)] was developed. After training based on the atlas, 49 photographs at rest and 48 at maximum smile were graded by the same group of investigators on 2 consecutive days (n=9 on Day 1; n=8 on Day 2). The scores were compared for reproducibility using kappa statistics. RESULTS: Overall, reproducibility was good for both scales. Interobserver reproducibility showed an agreement of 0.6 at rest and 0.58 at maximum smile (unweighted kappa). Intraobserver reproducibility showed an agreement between 0.47 and 0.86 at rest and between 0.62 and 0.81 at maximum smile (unweighted kappa). Using weighted kappa analysis, the agreement ranged between 0.63 and 0.91 at rest and between 0.71 and 0.85 at maximum smile. CONCLUSION: The clinical scales using scores of 0 to 3 for crow's feet, both at rest and at maximum smile, show a good inter- and intraobserver reproducibility. The use of these scores in clinical trials can be recommended.     

Effect of metoprolol on death and cardiac events during a 2-year period after coronary artery bypass grafting

PURPOSE: To evaluate the effect of long-term treatment with metoprololafter coronary bypass grafting on death and cardiac events. METHODS: Patients in western Sweden on whom coronary artery bypass graftingwas performed between June 1988 and June 1991 were evaluatedfor inclusion during the first 3 weeks after surgery. Majorexclusion criteria were age >75 years, concomitant valvesurgery, traditional contraindications to beta-blockers andunwillingness to participate. Patients were randomized in adouble-blind fashion to 100 mg of metoprolollplacebo daily for2 weeks and thereafter 200 mg daily for 2 years. RESULTS: Of 2365 patients who were operated on, 967 were randomized toeither metoprolol (n=480) or placebo (n=487). Primary end points(death, non-fatal myocardial infarction, unstable angina pectoris,need for coronary artery bypass grafting or percutaneous transluminalangioplasty), were reached by 42 patients in the metoprololgroup (8·8%) as compared with 39 in the placebo group(8·0%) (P=0·73). Of all the patients randomizedto metoprolol, 34% withdrew from blind treatment prematurelycompared with 44% for placebo (P<0·01) CONCLUSION: Prophylactic treatment with metoprolol over a 2-year periodafter coronary artery bypass grafting did not reduce death orthe development of cardiac events. However, the 95% confidencelimits ranged from the possibility of a 30% reduction in eventsto a 68% increase in events if patients were treated with metoprololas compared with placebo.     

Endocrine therapy with or without radical prostatectomy for T1b-T3N0M0 prostate cancer

BACKGROUND: We retrospectively compared the 5-year survival rates of T1b-T3N0M0 prostate cancer patients treated either by endocrine therapy plus radical prostatectomy or endocrine therapy alone. METHODS: Clinical T1b-T3N0M0 prostate cancer patients were enrolled at 104 institutions in Japan. They were assigned to study 1 (n = 176), if they were indicated to prostatectomy, if not indicated, they were assigned to study 2 (n = 151). The indication of prostatectomy was based on the clinical judgement of physicians and/or patients. Those assigned to study 1 underwent prostatectomy and adjuvant endocrine therapy with or without preoperative androgen deprivation. Those assigned to study 2 were treated with leuprorelin acetate with or without chlormadinone acetate. They were followed-up every 3 months until death or for 5 years and over. RESULTS: Those assigned to study 1 were younger (mean age 67.2 vs 75.7 years), less advanced in clinical stage, and had lower prostate specific antigen levels (mean 43.8 vs 103.6 ng/mL). Death for any reason was observed less frequently in study 1 (n = 29, 16%) than study 2 (n = 50, 33%), and the 5-year overall survival rate was higher in study 1 (87 vs. 68%). However, prostate cancer deaths were comparatively seldom (9% in study 1 and 7% in study 2), resulting in the identical 5-year cause specific survival rate in both study groups (91%). In both study groups the overall survival was almost equal to the natural survival of age-matched men. CONCLUSIONS: Endocrine therapy offers a reasonable survival rate in T1b-T3 prostate cancer patients within a 5-year follow-up. Observation will be extended to determine 10-year outcomes.     

General Practitioners' Use of Health Education Material. Results From a Nationwide Survey in Denmark in 1991

In November 1991 69% of a random sample of 998 Danish generalpractitioners (GPs) participated in a survey by anonymouslyfilling in a mailed questionnaire concerning the way in whichthey use health education in their practices. Among the participatingGPs, 97% used health education material. The study showed differencesin attitudes towards and use of health education material. Thematerial most often used by GPs at the consultation concerneddiet/overweight, allergy and pregnancy. Pamphlets and postersin the waiting room mainly dealt with vaccination, alcohol andsmoking. The female practitioners were generally most sympatheticto the use of health education material, but they are also thosemost critical, of material advertising for medicine. The malepractitioners thought that there was too much material and thatthey did not have enough time to use it.     

ECAT angina pectoris study: baseline associations of haemostatic factors with extent of coronary arteriosclerosis and other coronary risk factors in 3000 patients with angina pectoris undergoing coronary angiography

The ECAT Angina Pecioris Study is a European multicentre studyinvestigating the pathogenetic and possibly predictive roleof the haemostatic system in the progress of coronary heartdisease. In this paper we report the cross-sectional analysisof haemostatic factors in 3043 patients, who underwent coronaryangiography due to angina pectoris. Fibrinogen levels were higherin patients with one or more coronary stenoses of at least 50%than in patients without, by an average of 0.16 g. l^–1(P <0.0001). Depressed fibrinolytic activity due to higherlevels of PAI was also associated with the presence of coronarystenoses. There was no association with the extent of coronaryarteriosclerosis, as assessed by the number of involved arteries,except that patients who had more vessels with total occlusionshad higher fibrinogen levels. Depressed fibrinolytic activitywas also clearly associated with diabetes, obesity, higher triglyceridelevels, smoking and impaired cardiac pump function as assessedby ejection fraction. Cholesterol levels were particularly correlatedwith protein C and plasminogen.     

HLA-DR4 SUBTYPE AND -B ALLELES IN DQB1*0302-POSITIVE HAPLOTYPES ASSOCIATED WITH IDDM

We determined the distribution of DR4 subtypes in 309 DQB1*0302-positive haplotypes found in insulin-dependent diabetes mellitus (IDDM) patients and 70 control haplotypes present only in healthy family members. An increased frequency of DRB1*0401 allele (74.4% vs. 55.7%, P = 0.003) and a decrease of DRB1*0404 allele (23.6% vs. 40.0%, P = 0.0064) was revealed. A further analysis of extended haplotypes demonstrated strong linkages between various B alleles and DRB1*04 subtypes. HLA-B39 was more frequent in DRB1*0404–DQB1*0302-positive IDDM haplotypes compared with control ones (37.0% vs. 14.3%, P = 0.049), suggesting an involvement of the region telomeric to HLA-DRB1 in the susceptibility to IDDM.     

Evolution of coronary stenoses is related to baseline severity--a prospective quantitative angiographic analysis in patients with moderate coronary disease

A correlation of the angiographic evolution of coronary stenoses(stenosis diameter 20%) with morphological stenosis parametersat baseline could help to identify the risk of progressive stenoses.Therefore, the data of the prospective INTACT study (InternationalNifedipine Trial on Antiatherosclerotic Therapy) were reviewed.In 348 patients with moderate coronary artery disease, standardizedcoronary angiograms were taken 3 years apart and were quantitativelyanalysed. Changes in the minimal diameter of the 1063 preexistingcoronary stenoses compared between both angiograms were setin relation to a number of conventional stenosis parametersat baseline. Regression analysis demonstrated a significantcorrelation of the changes in minimal diameter with baseline% diameter stenosis (r=0.30; P<0.001), minimal diameter (r=—0.28;P<0.001) and reference diameter of stenoses (r=–0.14;P<0.001). The changes were not correlated with stenosis lengthand plaque area. The baseline parameters of 22 preexisting stenosesprogressing to occlusions differed from those remaining patentonly with regard to the % diameter stenosis (43 ± 9%vs 39 ± 11%; P<0.05). Additional progression of coronarydisease became manifest through development of 228 stenosesand 19 occlusions at arterial sites free from definitive stenosesin the baseline angiograms. Thus, progression of atherosclerosis predominantly occurredin mild preexisting coronary stenoses and developed at previouslyangiographically normal sites. Since the conventional angiographicparameters analysed in this study failed to identify individualarterial sites with an increased risk for progression, definitionof new angiographic parameters or application of new techniquesseem mandatory to this end.     

Reliability of anthropometric measurements in the WHO Multicentre Growth Reference Study

Aim: To describe how reliability assessment data in the WHO Multicentre Growth Reference Study (MGRS) were collected and analysed, and to present the results thereof.
Methods: There were two sources of anthropometric data (length, head and arm circumferences, triceps and subscapular skinfolds, and height) for these analyses. Data for constructing the WHO Child Growth Standards, collected in duplicate by observer pairs, were used to calculate inter-observer technical error of measurement (TEM) and the coefficient of reliability. The second source was the anthropometry standardization sessions conducted throughout the data collection period with the aim of identifying and correcting measurement problems. An anthropometry expert visited each site annually to participate in standardization sessions and provide remedial training as required. Inter- and intra-observer TEM, and average bias relative to the expert, were calculated for the standardization data.
Results: TEM estimates for teams compared well with the anthropometry expert. Overall, average bias was within acceptable limits of deviation from the expert, with head circumference having both lowest bias and lowest TEM. Teams tended to underestimate length, height and arm circumference, and to overestimate skinfold measurements. This was likely due to difficulties associated with keeping children fully stretched out and still for length/height measurements and in manipulating soft tissues for the other measurements. Intra- and inter-observer TEMs were comparable, and newborns, infants and older children were measured with equal reliability. The coefficient of reliability was above 95% for all measurements except skinfolds whose R coefficient was 75–93%.
Conclusion: Reliability of the MGRS teams compared well with the study's anthropometry expert and published reliability statistics.