Subject(s)
Attention Deficit Disorder with Hyperactivity/drug therapy , Central Nervous System Stimulants/therapeutic use , Parents , Patient Education as Topic , Attention Deficit Disorder with Hyperactivity/diagnosis , Attention Deficit Disorder with Hyperactivity/psychology , Behavior Therapy , Child , Child Behavior , Child, Preschool , Diagnosis, Differential , Humans , Randomized Controlled Trials as Topic , Research DesignABSTRACT
UK health policy requires child and adolescent mental health service providers to demonstrate that their services are effective. The FOCUS project has been developed to improve the availability and accessibility of research evidence and innovation, to support purchasers in the effective commissioning of services and to help providers base service provision on evidence of effectiveness and develop methods of evaluation.
Subject(s)
Adolescent Health Services/standards , Child Health Services/standards , Mental Health Services/standards , Quality Assurance, Health Care/organization & administration , Adolescent , Child , Cost-Benefit Analysis , Evidence-Based Medicine , Health Services Accessibility/standards , Humans , Information Services , Organizational Objectives , Program Development , United KingdomABSTRACT
In infants, sleeping metabolic rate (SMR) is used as a proxy for basal metabolic rate (BMR). BMR can be predicted from anthropometry using published equations. Our study was intended to evaluate the ability of these equations to predict measured SMR in infants aged 6 weeks to 12 months. SMR was measured in a mixed longitudinal study using the Douglas bag technique (n = 105). Measured SMR values were compared with BMR predicted from weight (BMR-1) or weight and length (BMR-2). These equations were not successful in predicting SMR in this age group. Percentage error of predicted BMR was related to infant weight (BMR-1: r = 0.26; p < 0.005; BMR-2: r = 0.18; p < 0.06). Alternative logarithmic equations were derived from this study (R = 0.84-0.87; SEE = 0.159-0.168). We conclude that the new equations, relating to contemporary infants, are more suitable but actual measurements remain preferred.
Subject(s)
Basal Metabolism , Body Constitution/physiology , Sleep/physiology , Anthropometry , Female , Humans , Infant , Longitudinal Studies , Male , Models, TheoreticalABSTRACT
The wide hepatic distribution, high cytosolic concentration, and short in vivo plasma half-life of serum alpha-glutathione s-transferase are properties which may make monitoring this enzyme more clinically useful than conventional biochemical liver function tests as a marker of hepatocellular damage associated with acute liver allograft rejection. In a prospective longitudinal study of 58 liver transplants in 45 patients, serum alpha-glutathione S-transferase concentrations rose significantly more consistently and more rapidly than conventional liver function tests in association with acute rejection. However, a rise in alpha-glutathione S-transferase was less specific for rejection than conventional liver function tests although none of the tests had a positive predictive value for rejection of greater than 32%. Compatible with the particularly short in vivo plasma half-life of this enzyme, alpha-glutathione S-transferase concentrations fell to or toward normal more rapidly than conventional liver function test measurements following uncomplicated transplantation as well as during high-dose steroid treatment of rejection. This may be valuable, both in improving the resolution of biochemical changes associated with early rejection episodes and in determining when treatment of rejection has been successful. Further studies are warranted, however, to assess whether the fall in GST during rejection treatment does genuinely reflect the histological resolution of rejection.
Subject(s)
Glutathione Transferase/blood , Graft Rejection/blood , Graft Rejection/pathology , Liver Transplantation/immunology , Liver/pathology , Adolescent , Adult , Aged , Biomarkers/blood , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Predictive Value of Tests , Radioimmunoassay , Transplantation, HomologousABSTRACT
The contribution of reduced levels of physical activity to the positive energy balance found in most individuals with Prader-Willi syndrome is not known. We assessed total energy expenditure using stable isotopes and resting energy expenditure using open circuit indirect calorimetry in a group of 10 children with this syndrome. The difference between these two measures is primarily the energy cost of activity and is often called a physical activity level. After adjusting for age, we found that the physical activity level values of these children were significantly reduced in comparison to children who did not have Prader-Willi syndrome. Increasing activity levels in children with Prader-Willi syndrome will raise total energy expenditure and may help to control their development of weight gain.
Subject(s)
Body Water/physiology , Calorimetry, Indirect/methods , Energy Metabolism/physiology , Motor Activity/physiology , Prader-Willi Syndrome/physiopathology , Adolescent , Anthropometry , Body Composition/physiology , Child , Female , Humans , Male , Prader-Willi Syndrome/diagnosis , Prader-Willi Syndrome/psychology , Reference ValuesABSTRACT
The accurate assessment of body composition is of importance in the Prader-Willi syndrome. Many techniques are not applicable due to ethical or practical reasons. However, the bioelectrical impedance technique is a rapid, painless, noninvasive method of estimating total body water and hence, fat-free mass in obese children and adolescents. We have compared estimates of total body water derived from bioelectrical impedance with actual measurements taken, using H2 18O dilution, in 14 children with Prader-Willi syndrome. Existing equations for predicting total body water from impedance showed a bias to underestimate actual measures of body water. There were positive correlations between the degree of underestimation with age and body fatness. It is possible that changes in body shapes influence bioelectrical impedance measurements in obese individuals, and that a prediction equation based upon a normal population will not be applicable to obese individuals.
