Fetal, infant and childhood growth: relationships with body composition in Brazilian boys aged 9 years.

BACKGROUND: Early growth rate has been linked to later obesity categorised by body mass index (BMI), but the development of body composition has rarely been studied. METHODS: We tested the hypotheses that (1) birthweight and weight gain in (2) infancy or (3) childhood are associated with later body composition, in 172 Brazilian boys followed longitudinally since birth. Growth was assessed using measurements of weight and height at birth, 6 months, and 1 and 4 y. Measurements at 9 y comprised height, weight and body composition using foot-foot impedance. RESULTS: Birthweight was associated with later height and lean mass (LM), but not fatness. Weight gain 0-6 months was associated with later height and LM, and with obesity prevalence according to BMI, but not with fatness. Weight gain 1-4 y was associated with later fatness and LM. Weight gain 4-9 y was strongly associated with fatness but not LM. Early growth rate did not correlate positively with subsequent growth rate. CONCLUSIONS: Early rapid weight gain increased the risk of later obesity, but not through a direct effect on fatness. Childhood weight gain remained the dominant risk factor for later obesity. The reported link between early growth and later obesity may be due partly to hormonal programming, and partly to the contribution of LM to obesity indices based on weight and height. Whether our findings apply to other populations requires further research.

Sickle cell disease and age at menarche in Jamaican girls: observations from a cohort study.

AIMS: (1) To investigate the distribution of age at menarche in a representative sample of 99 patients with homozygous sickle cell (SS) disease, 69 with sickle cell haemoglobin C (SC) disease, and 100 controls with a normal haemoglobin (AA) genotype followed in a cohort study from birth. (2) To explore the determinants of the age at menarche. METHODS: Children ascertained in a newborn screening programme were followed prospectively from birth to age 18-26.5 years with regular assessments of height, weight, pubertal stage, and haematological indices at the Sickle Cell Clinic of the University Hospital of the West Indies. RESULTS: All subjects have now reached menarche and the mean age in normal controls (13.0 years) was significantly earlier than in SC disease (13.5 years) or SS disease (15.4 years). Greater weight and earlier age at menarche was the only association significant across all genotypes although additional contributions occurred from fetal haemoglobin and red cell count in SS disease. Alpha thalassaemia, which ameliorates many of the effects of SS disease, had no discernible effect on menarche. CONCLUSIONS: Mean age at menarche is delayed by 0.5 years in SC disease and by 2.4 years in SS disease. Weight appears to be the principle determinant of age at menarche.

Social uses of commercial soap operas: a conversation with Miguel Sabido.

PIP: This paper presents an interview with Miguel Sabido, a writer-producer-director of theater and soap operas in Mexico concerning the social uses of commercial soap operas. According to Sabido, television soap operas can play multiple roles in educating the public: 1) melodramatic soap operas represent a mediation between good and bad; 2) soap operas allow people to gossip on different characters, their dilemmas, and create a climate for social change, especially if it centers on key social issues; and 3) soap operas provide role models to emulate. Sabido stressed the importance of a theory-based method for producing drama and mentioned how theoreticians Bentley, Bandura, Maclean, and Jung influenced his writing and production of soap operas. According to Sabido, the social uses of commercial television are possible with socially responsible soap operas.^ieng

Is there an energy deficiency in homozygous sickle cell disease?

The low weight, low height-for-age, delayed skeletal maturation, and retarded puberty in children with homozygous sickle cell disease are consistent with chronic malnutrition. Voluntary energy intake in sickle cell patients (SS) appears to be similar to that of control subjects with a normal hemoglobin genotype (AA) despite a higher resting metabolic rate (RMR), which suggests a suboptimal nutritional state. Patients may therefore conserve energy by reducing physical activity; this hypothesis was tested by comparing RMR, total daily energy expenditure (TDEE), and physical activity level (TDEE:RMR) in 16 postpubertal boys with sickle cell disease with those in 16 normal control subjects matched for age, sex, and pubertal stage. The RMR of sickle cell patients measured by indirect calorimetry (mean +/- SD: 7.0 +/- 0.9 MJ/d) significantly exceeded that of the normal control subjects (6.3 +/- 0.5 MJ/d; P = 0.018) but TDEE measured by the heart rate method was greater in the control subjects (13.8 +/- 4.9 MJ/d) than in the sickle cell patients (10.5 +/- 2.2 MJ/d; P = 0.034). Physical activity level was 46% greater in control subjects (2.2 +/- 0.8) than in sickle cell patients (1.5 +/- 0.3; P = 0.006). Adjustment for genotype differences in body weight reduced the genotype difference in physical activity level from 0.70 (95% CI: 0.3, 1.1) to 0.6 (95% CI: -0.06, 1.2). Reducing physical activity is a compensatory mechanism in children with an energy deficiency and a similar adaptive response may occur in sickle cell disease.

Psychiatric complications of homozygous sickle cell disease among young adults in the Jamaican Cohort Study.

BACKGROUND: This study aimed to determine the prevalence of psychiatric disorder in young adults with homzygous sickle cell (SS) disease and in controls with normal haemoglobin, and to examine factors associated with psychiatric disorder. METHOD: The study design was cross-sectional. Subjects were aged 18-20 years: 63 with SS disease and 89 controls. The Psychiatric Assessment Schedule was used to determine psychiatric disorder at index of Definition level 5. RESULTS: Psychiatric disorder was identified in 18 (29%) SS disease patients and in 22 (25%) controls. In SS patients, psychiatric disorder was not related to illness severity but was associated with leaving school early, difficulties in social adjustment, impaired cognitive function and having previous psychiatric difficulties. Male SS patients with psychiatric disorder all had low body mass index (BMI < 17.60). In controls, psychiatric disorder was associated with female gender, unemployment and difficulties in social adjustment. CONCLUSIONS: The prevalence of psychiatric disorder was similar in patients and controls, although associated factors tended to be different. The association with low BMI in SS men merits further study.

Factors affecting prepubertal growth in homozygous sickle cell disease.

OBJECTIVE: To investigate the role of haematological indices, socioeconomic status, and morbidity in prepubertal growth in homozygous sickle cell (SS) disease. METHOD: Height, weight, and haematology were serially recorded in a cohort study of 315 children with SS disease from birth to 9 years at the sickle cell clinic of the University Hospital of the West Indies, Kingston, Jamaica. RESULTS: Height increment between 3 and 9 years correlated positively with total haemoglobin at age 7 years in boys but not girls. Attained height and weight at age 7 years correlated positively with haemoglobin and fetal haemoglobin in boys but not girls. Only the correlation between haemoglobin and weight showed a significant gender difference. Partial correlation analysis suggested that the effect of haemoglobin was accounted for by the effect of fetal haemolglobin and further analysis indicated that height correlated with F reticulocyte count (a measure of fetal haemoglobin production) in both sexes but not with the ratio of F cells to F reticulocytes (a measure of F cell enrichment). Growth was not significantly related to mean red cell volume, proportional reticulocyte count, alpha thalassaemia, socioeconomic status, or morbidity. CONCLUSION: A high concentration of fetal haemoglobin in boys with SS disease is associated with greater linear growth. It is postulated that in boys, low concentrations of fetal haemoglobin increase haemolysis and hence metabolic requirements for erythropoiesis, putting them at greater risk of poor growth. Differences in the relationship of haematology and growth between boys and girls with SS disease dictate that future analyses of growth take gender into account.

Factors associated with lowered intelligence in homozygous sickle cell disease.

The intelligence quotient (IQ) of 60 patients with homozygous sickle cell (SS) disease and 60 age and sex matched controls with a normal haemoglobin (AA) genotype aged 15-18 years, followed up in a cohort study from birth, was assessed by the Wechsler intelligence scales for children or for adults. IQ appeared to be normally distributed in both genotypes but mean values in SS disease were 5.6 points (95% confidence interval (CI) 1.0 to 10.2) lower than in AA controls (p = 0.016). The difference occurred in both verbal (5.5 points, p = 0.017) and performance (5.0 points, p = 0.044) subscales of the IQ score and the IQ defect in SS disease was associated with a significantly lower attention factor score (p = 0.005) but not with other factor scores. The genotype difference in IQ was not accounted for by differences in parental occupational level, school absenteeism, or school drop out, or reported activity level. In SS disease, IQ was not related to mean steady state haemoglobin, fetal haemoglobin, or mean cell haemoglobin concentration, or clinical severity as judged by the frequency of painful crises, hospital admission, or sick visits. IQ, at age 15-18 years, correlated with the patients' height at all ages from 1 to 10 years (partial correlations increasing from 0.14 (p = 0.15) at age 1 to 0.27 (p = 0.004) at age 10). Adjusting for height reduced the mean genotype difference in IQ to 5.5 (95% CI 0.6 to 10.3) points at age 1 and to 2.6 points (95% CI to -2.3, 7.5) at age 10. Prepubertal height therefore accounted for much of the genotype difference in IQ. It is speculated that early factors, possible nutritional, contribute to both impaired growth and mental development in sickle cell disease.

Testosterone deficiency and extreme retardation of puberty in homozygous sickle-cell disease.

Homozygous sickle-cell (SS) disease is associated with retardation of physical and sexual development but most Jamaican SS children commence their adolescent growth spurt before 16 years of age. Analysis of growth data from children in the Jamaican Cohort Study noted extreme growth retardation, defined as absence of the adolescent growth spurt and pre-pubertal sexual development (Tanner stage 1 or 2) at age 16 years, in 8/52 (15%) SS boys. These and two boys from the general sickle-cell clinic with a similar growth pattern provided a study group of 10 boys who were investigated for a possible endocrine explanation for their extreme retardation of physical maturation. A sub-optimal testosterone response (< 10 nmol/l) to human chorionic gonadotrophin and an exaggerated gonadotrophin response to gonadotrophin hormone releasing hormone was consistent with poor testicular function in 5 boys. Retardation of adolescent growth and development is common in boys with SS disease but, when extreme, requires early investigation to identify potentially correctable mechanisms.

Acceleration in linear growth after splenectomy for hypersplenism in homozygous sickle cell disease.

Chronic hypersplenism in homozygous sickle cell (SS) disease markedly increases haemolysis and the resulting erythropoietic expansion is likely to have a high metabolic cost. Splenectomy for hypersplenism in SS disease is followed by highly significant changes in haematological indices and an increase in height, but not weight, velocity. This pattern is similar to that observed in the trichuris dysentery syndrome after treatment, and differs from the increases in both height and weight velocity that follow nutritional supplementation of severely malnourished children. It is postulated that accelerated linear growth after the reduction in erythropoietic stress may implicate a specific nutrient deficiency in hypersplenic children with SS.

Pro-socially shareable entertainment television programmes: a programming alternative in developing countries?

PIP: Over the period 1975-82, the Mexican television network created and aired seven entertainment soap operas promoting educational-development themes like adult literacy, smaller family size norms, and an higher social status for women. These emissions earned high ratings in Mexico and in other Latin American countries where they were subsequently broadcast. Evidence suggests that many of the social objectives of the soaps were met. In light of such success, the authors investigated the potential of pro-socially shareable entertainment television programs in developing countries. These programs use entertaining media formats to carry pro-social messages to a wide, yet culturally-proximate audience group. Entertainment television genres such as melodramatic soap operas offer certain advantages for carrying pro-socially shareable messages to audiences. The possibility of using other television genres and media channels, however, also needs to be seriously considered. Pro-socially shareable entertainment programs do have their limitations and problems, with a certain degree of message dilution invariably accompanying the quest for shareability. Targeting specific problems in specific audience groups is difficult and the identity of a relatively small homogeneous group can be threatened in a larger culturally proximate group. The value-laden nature of pro-social content can also be problematic.^ieng

The painful crisis of homozygous sickle cell disease: clinical features.

The details of onset, perceived precipitating factors, associated symptoms, and pain distribution in the painful crisis of homozygous sickle cell (SS) disease have been prospectively recorded in 183 painful crises in 118 patients admitted to a day-care centre in Kingston, Jamaica. Painful crises developed most frequently between 3 p.m. and midnight, most commonly affected patients aged 15-29 years, affected the sexes equally, and were not obviously influenced by menstrual cycle. Of the perceived precipitating factors, skin cooling occurred in 34%, emotional stress in 10%, physical exertion in 7%, and pregnancy in 5% of women of child-bearing age. Cold as a precipitant was not less common in patients with more subcutaneous fat. Pain affected the lumbar spine in 49%, abdomen in 32%, femoral shaft in 30%, and knees in 21%. There was a highly significant excess of bilateral involvement in limb and rib pain. Recurrent painful crises occurred in 40 patients but showed no evidence of involving similar sites on successive occasions. Abdominal painful crises were associated with abdominal distention in 18 (31%) and with referred rib pain in a further 15 (26%) of crises. Fever was common even in apparently uncomplicated painful crises, suggesting that fever is characteristic of the painful crisis itself and not necessarily indicative of infection. Following investigation and treatment in a day-care centre, over 90% of patients returned home.

The clinical significance of serum transferrin receptor levels in sickle cell disease.

Serum transferrin receptor (TfR) levels were measured in 182 children with homozygous sickle cell (SS) disease, 47 with sickle cell-haemoglobin C (SC) disease and 41 normal (AA) controls on their eighth birthday. Highly significant elevations occurred in SS compared to SC disease and in SC disease compared to AA controls. Females had higher levels than males in controls but lower levels than males in SS and SC disease. In SS disease, serum TfR levels tended to rise with age from 2 to 8 years, the change within individuals correlating with a change in reticulocyte count (r = 0.38, P = 0.017) and fall in fetal haemoglobin levels (r = -0.51, P = 0.004). Serum TfR levels did not change with infection or painful crisis but were markedly elevated in hypersplenism and fell following splenectomy in these subjects. In the aplastic crisis, serum TfR levels tended to rise following clinical presentation and then fall, reflecting the reticulocyte counts. These observations are consistent with serum TfR levels being a useful indicator of the degree of erythropoietic expansion in sickle cell disease.

Resting metabolic rate in homozygous sickle cell disease.

The resting metabolic rate in 20 patients with homozygous sickle cell (SS) disease was 19% higher than in 20 age- and sex-matched control subjects with a normal hemoglobin genotype (AA). The difference was not accounted for by differences in lean body mass. It is postulated that this increased energy expenditure reflects the energy expenditure of erythropoietic hyperplasia and leads to a marginal nutritional state that may contribute to the abnormal growth in SS disease.

Empyema of gallbladder in a child with homozygous sickle-cell disease.

A 13-year-old boy with homozygous sickle-cell (SS) disease followed from birth in a cohort study of sickle-cell disease developed empyema of the gallbladder after a known 3-year history of gallstones. At this age, gallstones occur in 30% of cohort study children with SS disease but this is the first patient with specific symptoms.

Empyema of gall bladder in a child with homozygous sickle-cell disease

A 13-year-old boy with homozygous sickle-cell (SS) disease followed from birth in a cohort study of sickle-cell disease developed empyema of the gallbladder after a known 3-year history of gallstones. At this age, gallstones occur in 30%of cohort study children with SS disease but this is the first patient with specific symptoms

Pro-development soap operas: a novel approach to development communication.

PIP: Soap operas have their roots in 18th century English romance novels. These evolved into serialized radio dramas. In their current form, they were developed primarily to attract large audiences in order to sell consumer products. Hence the name soap which refers to the soap manufacturers who commonly advertise on such programs. In the world of soap operas there are 2 kinds. Those that function primarily to entertain and sell consumer products, and those that primarily entertain, but infuse positive social messages. The former are found everywhere, but are the only kind in America. The latter are found exclusively in developing countries. American soap operas have conveyed pro-social messages in the past, but they differ fundamentally from pro-development soap operas in their theoretical foundations. American soap operas are created by people who want to sell consumer goods. Development soap operas are created by people who want to convey pro-social messages that will aid their country's development. Both must be popular in order to be successful, but the former lack moral coherency, are unrealistic, erode values, and are created through a process of a theoretical development; while the latter have moral coherency, are realistic, promote values, and are created through a process of theoretical development. The 1st pro-development soap opera was Ven Conmigo (Come With Me) and was produced in Mexico between 1975-76. Its primary purpose was to increase adult literacy. During the year it ran, applicants at adult literacy centers rose by 600,000 or 63% compared to 7% the year before, and 2% the year after. The 2nd pro-development soap opera was Acompaname (Accompany Me) and it primary purpose was to promote family planning. It ran from 1977-78 and during that time the number of family planning adopters rose by 560,000 and contraceptive sale sin Mexico rose sharply. The question of what are pro-social messages and who should control them must be answered by each country in its effort to increase development.^ieng