ISSN:0803-5253    

DOI:10.1111/j.1651-2227.1996.tb14287.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

The response to growth hormone (GH) therapy was studied in children born small for gestational age (SGA;n= 593) and in those with Silver–Russell syndrome (SRS;n= 127) using data from KIGS (Kabi International Growth Study). For the SGA patients, median birth weight was ‐2.6 SD scores (SDS), treatment was started at a median age of 9.2 years, at a time when median height was ‐2.8 SDS while median target height was ‐1.4 SDS. For the SRS patients, median birth weight was ‐3.1 SDS, treatment was started at a median age of 7.0 years, at a time when median height was ‐3.4 SDS with a median target height of ‐0.1 SDS. GH treatment increased height SDS in both SGA children and patients with SRS; in 16 SGA patients treated to (near) final height with GH (median dose, 0.7 IU/kg/week), height minus target height SDS was ‐2.0 at the start of treatment and ‐1.0 at final height. In conclusion, the results obtained in KIGS indicate that GH treatment of short children born SGA is effective in increasing final height above the predicted height and in achieving

ISSN:0803-5253    

DOI:10.1111/j.1651-2227.1996.tb14288.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

We have prospectively studied forearm trabecular and cortical bone mineral density gain (ΔBMD) in relation to nutrient intake, weight‐bearing physical activity (WPA) and daylight exposure (DE) in 470 healthy boys and girls aged 8.2‐16.5 years at the baseline. BMD was assessed using single photon absorptiometry (SPA). Cortical ΔBMD peaked at the age of 14.0 ± 0.3 and 16.0 ± 0.3 (SD) years in girls and boys, respectively. Girls had achieved adult premenopausal values of trabecular BMD by the age of 15 years and cortical BMD values by the age of 16.5 years. WPA, BMD, body height, height gain, weight, weight gain, dietary polyunsaturated fat and sodium were correlated with ΔBMD. WPA, predicting cortical as well as trabecular ΔBMD, had the greatest effect on trabecular ΔBMD in the presence of a high calcium intake in children below 11 years of age. In conclusion, our results indicate that physical activity and calcium intake should be encouraged at a prepubertal age in order to increase bo

ISSN:0803-5253    

DOI:10.1111/j.1651-2227.1996.tb13884.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Celiac disease is a common cause of malabsorption in western countries, with significant geographic variation in incidence. Recent epidemiological studies using serology tests, however, suggest that the disease is more common than previously realized and homogeneously distributed in Europe. These studies have also demonstrated that the clinical presentation of the disease may greatly vary even between neighboring countries. Celiac disease remains a rare diagnosis in the United States. Whether the disease is underdiagnosed or is truly rare remains to be established. We have conducted preliminary studies, both on pediatric patients and adult blood donors, that seem to suggest that the prevalence of positive screening tests for celiac disease in the USA is equivalent to that reported in similar screening studies conducted in Europe. These data also suggest that the dimensions of the American celiac disease iceberg seem to be similar to those of the European one. The visible tip of the American iceberg, however, appears to be much smaller, since most of it still remains submerged. The reasons for these divergences remain unknown and may only be partially related to the limited attention to the disease by the American scientific community. Large, multicenter serological screening studies are needed to define the true prevalence of celiac disease in the United States.

ISSN:0803-5253    

DOI:10.1111/j.1651-2227.1996.tb14242.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

The individual infant's neurodevelopmental process provides an integrative framework for the delivery of medical care needed to assure the infant's survival and quality of outcome. The infant's neurobehavioral functioning and expression provides an opportunity for caregivers to estimate the individual infant's current strengths, vulnerabilities and threshold to disorganization, as well as to identify the infant's strategies in collaborating in his or her best progression. This perspective supports caregivers in seeing themselves in a relationship with the infant, and in considering opportunities to enhance the infant's strengths and reduce apparent stressors in collaboration with the infant and the family. The results of several randomized studies supporting the effectiveness of such a neuro developmental approach to NICU care will be presented, and suggest implications for staff education and nursery‐wide implementatio

ISSN:0803-5253    

DOI:10.1111/j.1651-2227.1996.tb14273.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Gluten has recently been introduced into the diet of the Mediterranean and European population, but a considerable proportion has not adapted to this change and has developed intolerance to gluten. At least one million EEC citizens are gluten intolerant. In Italy each year 12 million ECU is spent in the diagnosis of uncomplicated gluten intolerance, 10 million ECU for complex diagnosis and 32 million ECU for long‐term complications and malignancies. The total financial load of gluten intolerance, in its present state, is about ISO million ECU/year in Italy. Four million ECU is actually needed to develop a genetic probe, which may make the population screening feasible. A National Task Force “Free from Gluten” has been set up by the Italian Coeliac Society to stimulate fund‐raising activities supporting genetic and basic research on gluten into

ISSN:0803-5253    

DOI:10.1111/j.1651-2227.1996.tb14243.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Episodes of diarrhoea and nutritional status of 113 children in East Bhutan were recorded monthly from 7 to 36 months of age. A re‐examination was carried out 20 months later. The load of diarrhoeal diseases in early childhood was negatively associated with the parameters of children's long‐term nutritional status 20 months later. Also, when early nutritional status and socioeconomic factors are included in the model, the diarrhoea variable explains a significant part of the variation in height for age (p=0.04, delta R2=0.035), weight for age (p=0.03, delta R2=0.030) and head circumference (p= 0.0007, delta R2= 0.077). This is not so for the variation in weight for height or mid‐upper arm circumference (p>0.1, delta R2<0.005). Stunting is widespread in the area, and the erects of diarrhoea on nutritional status are more likely to be sustained in settings where dietary intake is mar

ISSN:0803-5253    

DOI:10.1111/j.1651-2227.1996.tb13885.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

A minority of children born small for gestational age (SGA) fail to achieve sufficient catch‐up growth during infancy and remain short throughout childhood, apparently without being growth hormone (GH) deficient. The effect of GH administration was evaluated over 2 years in short prepubertal children born SGA. The children (n= 244), who were taking part in four independent multicentre studies, had been randomly allocated to groups receiving either no treatment or GH treatment at a daily dose of 0.1, 0.2 or 0.3 IU/kg (0.033, 0.067 or 0.1 mg/kg) s.c. At birth, their mean length SD score (SDS) was ‐3.6 and their mean weight SDS ‐2.6; at the start of the study, mean age was 5.2 years, bone age 3.8 years, height SDS ‐3.3, height SDS adjusted for parental height ‐2.4, weight SDS ‐4.7 and body mass index (BMI) SDS ‐1.4. The untreated children had a low‐normal growth velocity and poor weight gain. Although bone maturation progressed more slowly than chronological age, final height prognosis tended to decrease, according to height SDS for bone age. GH treatment induced a dose‐dependent effect on growth, up to a near doubling of height velocity and weight gain; BMI SDS was not altered. Bone maturation was also accelerated differentially; however, final height prognosis increased in all GH treatment groups. The more pronounced growth responses were observed in younger children with a lower height and weight SDS. In conclusion, GH administration is a promising therapy for normalizing short stature and low weight after insufficient catch‐up growth in children born SGA. Long‐term strategies incorporating GH therapy now rem

ISSN:0803-5253    

DOI:10.1111/j.1651-2227.1996.tb14289.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Two well‐characterized patients with congenital, generalized lipodystrophy have been studied by the euglycaemic hyperinsulinaemic clamp technique in combination with indirect calorimetry. Furthermore, glycogen synthase in muscle biopsies was studied in one patient with regard to enzyme activity, immunoreactive protein and mRN A levels. The patients had fasting hyperinsulinaemia, and the rate of total glucose disposal was severely impaired, primarily due to a decreased non‐oxidative glucose metabolism. In the patient studied with muscle biopsy, the expected activation of glycogen synthase by insulin did not occur. In both patients there was severely increased hepatic glucose output in the basal state, suggesting a failure of insulin to suppress hepatic gluconeogenesis. During insulin infusion a substantially elevated rate of lipid oxidation remained in the patients, in contrast to the almost completely suppressed lipid oxidation in the controls. It is concluded that patients with congenital generalized lipodystrophy may present severe insulin resistance with regard to hepatic glucose production as well as muscle glycogen synthesis and lipid oxidation. The results suggest a postreceptor defect in the action of insulin in congenital generalized lipodystrophy. The further localization of such a defect is hampered by the still incomplete understanding of the pathways that link insulin‐stimulated tyrosine phosphorylation to the ultimate action of insulin upon target

ISSN:0803-5253    

DOI:10.1111/j.1651-2227.1996.tb14263.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Comments at discharge from the neonatal intensive care unit tend to concern porencephalic cysts or ventricular dilatation rather than clinical neurological findings. This neglect in collecting clinical information can be understood during the acute stage of neonatal adaptation due to the non‐specificity and lability of many neurological signs. However, it does not seem justified when the infant has recovered, can breathe on his/her own and can tolerate handling. To define optimal Central Nervous System function at 40 weeks (just born or corrected), a simple basic assessment composed of nine variables is proposed, with descriptions and illustrations. Rationale for the timing and selection of variables is discussed. The benefit of this clinical approach is to subdivide children with normal ultrasound imaging into two subgroups according to non‐optimal or optimal responses. Prospective follow‐up of children with non‐optimal responses will reduce the number of late diagnoses of developmental disabilities. Rational optimism for the others will diminish parents’anxiety and neurologic clinics,

ISSN:0803-5253    

DOI:10.1111/j.1651-2227.1996.tb14274.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY