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Objective: To determine the reliability and reproducibility of using three-dimensional digital models as an alternative to plaster models for rating dental arch relationships in patients born with unilateral cleft lip and palate. Design: Reliability and reproducibility study. Methods: Study models of 45 patients born with unilateral cleft lip and palate were made available in plaster and three-dimensional digital models. Records were scored a week apart by three examiners using the 5-year-olds' index reference models in the same two formats as the patient models. To assess reproducibility the study was repeated 4 weeks later under similar conditions to minimize the influence of memory bias on the results. The reliability of using the three-dimensional digital models was determined by comparing the scores for each examiner with. the plaster model scores. Results: Weighted kappa statistics indicated repeatability for the plaster models was very good (.83 to .87). For the three-dimensional digital models it was good to very good (.74 to .83). Overall, the use of the three-dimensional digital models showed good agreement with the plaster model scores on both occasions. . Conclusion: Three-dimensional digital models appear to be a good alternative to plaster models for assessing dental arch relationships using the 5-year-olds' index. [ABSTRACT FROM AUTHOR]

Background/Objectives:As low folate status has been implicated in depression, high folate intake, in the form of supplements, during pregnancy might offer protection against depression during pregnancy and postpartum.Subjects/Methods:We examined the association between change in self-reported depressive symptoms (Edinburgh Postnatal Depression Scale) at different timepoints during and following pregnancy and self-reported folic acid supplementation during pregnancy in a prospective cohort of 6809 pregnant women. We also tested whether there was a main effect of methylenetetrahydrofolate reductase (MTHFR) C677T genotype (which influences folate metabolism and intracellular levels of folate metabolites and homocysteine) on change in depression scores, and carried out our analysis of folic acid supplementation and depression stratifying by genotype.Results:We found no strong evidence that folic acid supplementation reduced the risk of depression during pregnancy and up to 8 months after pregnancy. However, we did find evidence to suggest that folic acid supplements during pregnancy protected against depression 21 months postpartum, and that this effect was more pronounced in those with the MTHFR C677T TT genotype (change in depression score from 8 months to 21 months postpartum among TT individuals was 0.66 (95% CI=0.31-1.01) among those not taking supplements, compared with −1.02 (95% CI=−2.22-0.18) among those taking supplements at 18 weeks pregnancy, Pdifference=0.01).Conclusions:Low folate is unlikely to be an important risk factor for depression during pregnancy and for postpartum depression, but may be a risk factor for depression outside of pregnancy, especially among women with the MTHFR C677T TT genotype. [ABSTRACT FROM AUTHOR]

Background: Interferon beta has not been demonstrated to be effective in exploratory phase 2 clinical trials in primary progressive multiple sclerosis. However, using more sensitive indicators of a treatment response, such as biomarkers, might help to identify sub-groups of patients who may benefit from therapy.Objective: To assess the utility of measuring urinary neopterin and nitric oxide metabolite excretion for monitoring interferon β-1a (IFNβ-1a) treatment in patients with primary progressive multiple sclerosis.Methods: Fifty patients from a phase II trial of IFNβ-1a (Placebo n = 20; Avonex® 1 × 30 μg/week (IFN-30), n = 15; Avonex® 1 × 60 μg/week (IFN-60), n = 15), were enrolled. Patients were assessed using the Expanded Disability Status Scale. Urine samples were collected on each visit, 3 months apart, for a period of 24 months. Nitric oxide metabolites, nitrite/nitrate (NOx), were measured by colorimetric assay and neopterin and creatinine (Cr) were assayed using a high-performance liquid chromatography technique. NOx/creatinine ratio (NOxCR) and urinary neopterin/creatinine ratio (UNCR) quotients were calculated.Results: There was no significant difference between pre-dose, baseline levels of UNCR or NOxCR between the study groups. On the intention-to-treat analysis, there was a significant difference in UNCR levels between the placebo compared with IFN-30 (p = 0.03) or IFN-60 (p = 0.002) groups. The IFN-30 and IFN-60 groups did not differ. Within IFNβ-1a-treated patients with primary progressive multiple sclerosis, median UNCR values were significantly higher in clinically stable (no Expanded Disability Status Scale change) compared with progressive patients (p = 0.002). IFNβ-1a treatment did not significantly influence NOx excretion in patients with primary progressive multiple sclerosis.Conclusions: Urinary neopterin is a potential biomarker to monitor the in vivo effects of IFNβ-1a in primary progressive multiple sclerosis and other multiple sclerosis sub-types. [ABSTRACT FROM PUBLISHER]

What power, meaning and value may exist within a soldier's firstperson war story? Former Marine captain Tyler Boudreau, quoted below, suggests that constructing a personal narrative of the traumas of war and homecoming, then ''asking questions'' of the story, can provide a veteran with a ''chart.'' If this is so, can that chart help one along the road to healing from those traumas, especially when that story is shared with others? Could there be dangerous turns or pitfalls on the journey? How can a public sharing of narratives of wartime experiences help audiences to better respond to those veterans and families whomust cope with a difficult transition fromthe battlefield to home? What guidelines can be used effectively to train and prepare storytellers for their role? In this collaborative article, strengthened by the clinical wisdomof various consulting clinicians, we examine these questions through the lenses of two programs that provide veterans opportunities to share their war stories publicly. They include the Veterans Education Project (VEP) and the ''100 Faces of War Experience'' project (100 Faces). [ABSTRACT FROM AUTHOR]

Objective: To examine factors in early life (up to age 5 years) that are associated with objectively measured physical activity in 11-12 year olds.Design: Prospective cohort study.Setting: Avon longitudinal study of parents and children, United Kingdom.Participants: Children aged 11-12 years from the Avon longitudinal study of parents and children.Main Outcome Measure: Physical activity levels in counts per minute (cpm) and minutes of moderate to vigorous physical activity for seven days measured with a uniaxial actigraph accelerometer.Results: Valid actigraph data, defined as at least three days of physical activity for at least 10 hours a day, were collected from 5451 children. Several factors were associated with physical activity at ages 11-12 years. Regression coefficients are compared with the baseline of "none" for categorical variables: maternal brisk walking during pregnancy (regression coefficient 5.0, 95% confidence interval -8.5 to 18.5; cpm for < 1 h/wk and > or = 2 h/wk of physical activity 17.7, 5.3 to 30.1), maternal swimming during pregnancy (21.5, 10.9 to 32.1 and cpm for < 1 h/wk and > or = 2 h/wk of physical activity 24.2, 7.8 to 40.7), parents' physical activity when the child was aged 21 months (28.5, 15.2 to 41.8 and cpm of physical activity for either parent active and both parents active 33.5, 17.8 to 49.3), and parity assessed during pregnancy (2.9, -7.6 to 13.4 and cpm of physical activity for 1 and > or = 2 parity 21.2, 7.1 to 35.3).Conclusions: Few factors in early life predicted later physical activity in 11-12 year olds. Parents' physical activity during pregnancy and early in the child's life showed a modest association with physical activity of the child at age 11-12 years, suggesting that active parents tend to raise active children. Helping parents to increase their physical activity therefore may promote children's activity. [ABSTRACT FROM AUTHOR]

Interferon-beta (IFNβ) is a biological therapy which is immunogenic, inducing anti-IFN-β neutralizing antibodies (Nabs) in some subjects. The frequency of Nabs varies depending on IFN-β product and the Nab assay used. Objective Assess frequency of Nabs using novel Luciferase assay, evaluate association with relapses, frequency of side effects and to compare results with published data. Methods Serum samples at 12 and 24 months and a follow up sample were tested for binding and Nabs. Titre >20 NU was considered positive. Charts were reviewed retrospectively for clinical data. Results Out of 327 subjects included, 130 subjects (40%) were binding antibody positive, 89 (27%) were Nab +ve at anytime. Risk at 12 months for being Nab +ve: Avonex 8%, Betaferon 39%, Rebif 33%, P < 10-5; at 24 months 8, 31 and 27% respectively, P = 0.002. Nab titres were highest in Rebif Nab +ve subjects - 50% >320 NU. Annualized relapse rate was 1.53 pre-treatment, after treatment relapse rate was higher in Nab +ve group 0.67 (95% CI 0.38-0.97) versus 0.5 (0.38-0.61) Nab -ve P = 0.04. Nab status at 12 and 24 months was significantly associated with risk of subsequent relapse, risk being greatest in those with highest titres. Side effects were also significantly associated with Nab -ve status. [ABSTRACT FROM AUTHOR]

Objective:To study associations of size and body proportions at birth, and growth during infancy and childhood, to body composition and cardiovascular disease (CVD) risk factors at the age of 6 years.Design:The Pune Maternal Nutrition Study, a prospective population-based study of maternal nutrition and CVD risk in rural Indian children.Methods:Body composition and CVD risk factors measured in 698 children at 6 years were related to body proportions and growth from birth.Measurements:Anthropometry was performed every 6 months from birth. At 6 years, fat and lean mass (dual X-ray absorptiometry) and CVD risk factors (insulin resistance, blood pressure, glucose tolerance, plasma lipids) were measured.Results:Compared with international references (NCHS, WHO) the children were short, light and thin (mean weight <−1.0 s.d. at all ages). Larger size and faster growth in all body measurements from birth to 6 years predicted higher lean and fat mass at 6 years. Weight and height predicted lean mass more strongly than fat mass, mid-upper arm circumference (MUAC) predicted them both approximately equally and skinfolds predicted only fat mass. Neither birthweight nor the ‘thin-fat’ newborn phenotype, was related to CVD risk factors. Smaller MUAC at 6 months predicted higher insulin resistance (P<0.001) but larger MUAC at 1 year predicted higher systolic blood pressure (P<0.001). After infancy, higher weight, height, MUAC and skinfolds, and faster growth of all these parameters were associated with increased CVD risk factors.Conclusions:Slower muscle growth in infancy may increase insulin resistance but reduce blood pressure. After infancy larger size and faster growth of all body measurements are associated with a more adverse childhood CVD risk factor profile. These rural Indian children are growing below international ‘norms’ for body size and studies are required in other populations to determine the generalizability of the findings.International Journal of Obesity (2007) 31, 1534–1544; doi:10.1038/sj.ijo.0803679; published online 24 July 2007 [ABSTRACT FROM AUTHOR]

Elevated blood pressure (BP) in children is an early risk factor for cardiovascular disease and is positively associated with body mass index (BMI). However, BMI does not distinguish between fat and lean masses, and the relationship of BP in children to different elements of body composition is not well established. BP, BMI and body composition were measured in 6863 children enrolled in the Avon Longitudinal Study of Parents and Children. Fat mass, lean mass and trunk fat were assessed using dual-energy X-ray absorptiometry. After full adjustment for confounders, total body fat and BMI were positively associated with systolic blood pressure (SBP) (β=3.29, 95% confidence interval CI 3.02, 3.57 mm Hg/standard deviation (s.d.) and β=3.97, 95% CI 3.73, 4.21 mm Hg/s.d., respectively) and diastolic blood pressure (DBP) (β=1.26, 95% CI 1.05, 1.46 mm Hg/s.d. and β=1.37, 95% CI 1.19, 1.54 mm Hg/s.d., respectively). SBP was also positively associated with lean mass (β=3.38, 95% CI 2.95, 3.81 mm Hg/s.d.), and weakly associated with trunk fat (β=1.42, 95% CI −0.06, 2.90 mm Hg/s.d., independent of total fat mass), which was robust in girls only. The association between lean mass and SBP remained even after accounting for fat mass. SBP in 9-year-old children is independently associated with fat mass and lean mass and, to a lesser extent, trunk fat in girls. In this analysis, because both fat and lean masses are associated with BP, BMI predicts BP at least as well as these components of body composition.Journal of Human Hypertension (2007) 21, 283–290. doi:10.1038/sj.jhh.1002152; published online 1 February 2007 [ABSTRACT FROM AUTHOR]

The association between lower birthweight and metabolic syndrome may result from fetal undernutrition (fetal programming hypothesis) and/or genes causing both low birthweight and insulin resistance (fetal insulin hypothesis). We studied associations between the birthweight of parents and metabolic syndrome in the offspring. We identified men and women (aged 35–68 years), who had been born in Holdsworth Memorial Hospital, Mysore, India. We also identified the offspring (20–46 years) of these men and women. In total, 283 offspring of 193 mothers and 223 offspring of 144 fathers were studied. Investigations included anthropometry, oral glucose tolerance, plasma insulin and lipid concentrations and blood pressure. The metabolic syndrome was defined using WHO criteria. Among the offspring, lower birthweight was associated with an increased risk of glucose intolerance (impaired glucose tolerance, impaired fasting glucose or type 2 diabetes) and higher cholesterol and triacylglycerol concentrations ( p < 0.05 for all adjusted for sex and age). Most outcomes in the offspring, including most individual components of the metabolic syndrome, were unrelated to parental birthweight. However, both maternal and paternal birthweight were inversely related to offspring metabolic syndrome (odds ratio [OR] 0.36 [95% CI: 0.13–1.01] per kg, p = 0.053 for mother–offspring pairs; OR 0.26 [0.07–0.93], p = 0.04 for father–offspring pairs, adjusted for offspring age, sex, BMI and socioeconomic status). Maternal birthweight was inversely related to offspring systolic blood pressure ( β = −2.5 mmHg [−5.00 to 0.03] per kg maternal birthweight; p = 0.052). Factors in both parents may influence the risk of metabolic syndrome in their offspring. There are several possible explanations, but the findings are consistent with the fetal insulin (genetic) hypothesis. [ABSTRACT FROM AUTHOR]

Objective: To investigate the prevalence, outcome and multidisciplinary management of incontinence in patients with acquired brain injury. Design: Retrospective case notes review. Setting: Regional neurological rehabilitation unit. Subjects: Two hundred and thirty-eight patients with acquired brain injury. Main measures: Bladder and bowel subscores of the Barthel Index and Functional Independence Measure; number of multidisciplinary goals addressing bladder and bowel function. Results: Fifty per cent of patients (n = 112) had impaired bladder or bowel subscores on admission. Significant improvement was seen at discharge but 36% of patients (n = 77) still had some degree of impairment. Over 90% of patients were set multidisciplinary goals addressing self-care (n = 213) and mobility (n = 205) but only 3.5% (n = 8) were set multidisciplinary goals addressing bladder and bowel function. Conclusions: Incontinence was common in patients with brain injury on a neurological rehabilitation unit. Significant improvement was seen following rehabilitation. Bladder and bowel management was not well incorporated into the multidisciplinary management process. [ABSTRACT FROM AUTHOR]

Aims Research into early life and childhood determinants of insulin resistance and Type 2 diabetes are complicated by requirements for fasting blood samples and glucose tolerance tests. We investigated haemoglobin A1c (HbA1c), a marker of glycaemia measured in non-fasting blood, as an alternative. Methods HbA1c was measured in 1645 children aged 9–11 years without diabetes from the Avon Longitudinal Study of Parents and Children. Thirty-nine children had two HbA1c measurements. Data on parental, child and potential confounding factors were collected prospectively from questionnaires, medical records and direct examination. Data from a shortened 30-min oral glucose tolerance test were available for 431 children at age 8 years. Body composition was measured by dual-energy X-ray absorptiometry. Results Mean (sd) HbA1c was 4.91(0.29)%. HbA1c increased with age and was higher in boys compared with girls, non-white compared with white children, and in children with anaemia. Mean difference between repeated HbA1c measurements was 0.01%. HbA1c was weakly positively associated with fasting glucose (β = 0.066%/mmol/l, P = 0.05), but was not associated with 30-min glucose, fasting or 30-min insulin, or homeostasis model assessment-insulin resistance. HbA1c was weakly inversely associated with weightsd score (β =−0.02%/unit, P = 0.004), body mass indexsd score (β = −0.02%/unit, P = 0.002), and total body fat (β = −0.003%/kg, P = 0.06) and lean mass (β = −0.011%/kg, P = 0.01), but was not associated with birthweight or breastfeeding. Conclusions HbA1c is not a good marker of fasting or post-load glucose and insulin measures in healthy children, and is not a viable alternative to these measures for investigating the determinants of insulin resistance and Type 2 diabetes in children. [ABSTRACT FROM AUTHOR]

Objective: To assess the effect of intrathecal baclofen on spastic dysarthia in cerebral palsy. Design: Single case study. Methods: Functional outcome measures, including the Assessment of Intelligibility of Dysarthric Speech, were performed before and after a trial of intrathecal baclofen in an adult patient with spastic dysarthria due to cerebral palsy. The patient proceeded to intrathecal baclofen pump implantation and was reassessed after six months of continuous intrathecal baclofen therapy. Results: Improvement in function including speech intelligibility was seen following the intrathecal baclofen trial. The improvement was sustained at six months post pump implantation. Conclusions: Intrathecal baclofen improved functional intelligibility of speech in a carefully selected subject. The Assessment of Intelligibility of Dysarthric Speech was found to be a useful quantitative tool to assess the effect of intrathecal baclofen on spastic dysarthria. [ABSTRACT FROM AUTHOR]

Associations between maternal age in pregnancy and offspring blood pressure (BP) at age 7½ were investigated in 7623 singletons from the Avon Longitudinal Study of Parents and Children (ALSPAC). In models adjusted for age and sex there was an inverse relationship between maternal age and BP in children: β=−0.06 mmHg per year of maternal age (95% CI −0.10 to −0.01, P=0.02) for systolic BP and β=−0.04 (95% CI −0.07 to −0.01, P=0.02) for diastolic BP. However, this association disappeared after adjustment for confounding factors: β=−0.02 mmHg per year of maternal age (95% CI −0.07 to 0.04, P=0.5) for systolic BP and β=−0.03 (95% CI −0.07 to 0.01, P=0.2) for diastolic BP. We conclude that there is no evidence of a relationship between maternal age in pregnancy and childhood BP in this contemporary birth cohort.Journal of Human Hypertension (2005) 19, 893–900. doi:10.1038/sj.jhh.1001915; published online 11 August 2005 [ABSTRACT FROM AUTHOR]

Study objective: Low birth weight predicts cardiovascular disease in adulthood, and one possible explanation is that children with lower birth weight consume more fat than those born heavier. Therefore, the objective of this study was to investigate associations between birth weight and childhood diet, and in particular, to test the hypothesis that birth weight is inversely related to total and saturated fat intake. Design: Prospective cohort study. Setting: South west England. Participants: A subgroup of children enrolled in the Avon longitudinal study of parents and children, with data on birth weight and also diet at ages 8, 18, 43 months, and 7 years (1152, 998, 848, and 771 children respectively). Main results: Associations between birth weight and diet increased in strength from age 8 to 43 months, but had diminished by age 7 years. Fat, saturated fat, and protein intakes were inversely, and carbohydrate intake was positively associated with birth weight at 43 months of age, after adjusting for age, sex, and energy intake. After adjustment for other confounders, all associations were weakened, although there was still a suggestion of a relation with saturated fat (-0.48 (95% Cl -0.97, 0.02) g/day per 500 g increase in birth weight. Similar patterns were seen in boys and girls separately, and when the sample was restricted to those with complete data at all ages. Conclusions: A small inverse association was found between birth weight and saturated fat intake in children at 43 months of age but this was not present at 7 years of age. This study therefore provides little evidence that birth weight modifies subsequent childhood diet. [ABSTRACT FROM AUTHOR]

Objective: To examine the association between childhood diet and cardiovascular mortality. Design: Historical cohort study. Selling: 16 centres in England and Scotland. Participants: 4028 people (from 1234 families) who took part in Boyd Orr's survey of family diet and health in Britain between 1937 and 1939 followed up through the National Health Service central register. Exposures studied: Childhood intake of fruit, vegetables, fish, oily fish, total fat, saturated fat, carotene, vitamin C, and vitamin E estimated from household dietary intake. Main outcome measures: Deaths from all causes and deaths attributed to coronary heart disease and stroke. Results: Higher childhood intake of vegetables was associated with lower risk of stroke. After controlling for age, sex, energy intake, and a range of socioeconomic and other confounders the rate ratio between the highest and lowest quartiles of intake was 0.40 (95% confidence interval 0.19 to 0.83, P for trend 0.01). Higher intake of fish was associated with higher risk of stroke. The fully adjusted rate ratio between the highest and lowest quartile of fish intake was 2.01 (95% confidence interval 1.09 to 3.69, p for trend 0.01). Intake of any of the foods and constituents considered was not associated with coronary mortality. Conclusions: Aspects of childhood diet, but not antioxidant intake, may affect adult cardiovascular risk. [ABSTRACT FROM AUTHOR]

Multiple sclerosis is an inflammatory demyelinating disease of the central nervous system that may result in a wide range of neurological symptoms and accumulating disability. Its course is unpredictable resulting in a changing pattern of clinical need. Diagnostic criteria for multiple sclerosis require objective evidence for dissemination in space and time. The diagnostic and management process should follow good practice guidelines with the person at the centre ot the process. Appropriate support and information should be available from the time of diagnosis. Continuing education is key in enabling the person to actively participate in their management. In the event of an acute relapse the person should have direct access to the most appropriate local service. Provided medical causes have been excluded, corticosteroid treatment to hasten the recovery from the relapse should be considered. Management of an acute relapse should be comprehensive addressing any medical, functional, or psychosocial sequelae. [ABSTRACT FROM AUTHOR]