Cerebral palsy and socioeconomic status: a retrospective cohort study.

AIMS: To study the relation between risk of cerebral palsy and socioeconomic status. METHODS: A total of 293 children with a diagnosis of cerebral palsy out of 105,760 live births between 1 January 1982 and 31 December 1997 were identified from the special conditions sub-file of the West Sussex Computerised Child Health System. RESULTS: There was a linear association between risk of cerebral palsy and socioeconomic status (SES) measured by the Registrar General's social class (RGSC) and enumeration district (ED) ranked into quintiles by the Townsend Deprivation Index derived from 1991 census data. Fifty one per cent and 30% of cases of cerebral palsy were statistically "attributable" to inequality in SES using the RGSC and ED quintile respectively. A linear association was also noted for singleton live births. The association between risk of cerebral palsy and ED quintile persisted in a logistic regression model that included birth weight and gestational age, although that between RGSC and cerebral palsy no longer reached conventional levels of statistical significance after adjustment. CONCLUSIONS: A strong association was observed between socioeconomic status and the risk of cerebral palsy, which was only partly accounted for by the known social gradients in birth weight and gestational age.

Adrenaline autoinjectors and schoolchildren: a community based study.

Sixty schoolchildren prescribed adrenaline autoinjectors were identified by surveying schools in Hounslow, London; the 25 families who consented were interviewed. There was inconsistency in prescription and use of autoinjectors with poor training, absence of written instructions, and lack of follow up. It is recommended that national guidelines should be developed.

An unknown combination of infantile spasms, retinal lesions, facial dysmorphism and limb abnormalities.

A female patient is presented with infantile spasms, punched-out retinal lesions, facial dysmorphism, short upper arms, short thumbs, left lower limb hypoplasia with foot deformity, a hemivertebra, atrial septal defect, growth retardation and severe developmental delay. There is some similarity to patients with Aicardi syndrome (AS), but the retinal lesions in our patient are different and she does not have agenesis of the corpus callosum, one of the diagnostic features of AS. She might represent an atypical form of this syndrome with additional features, usually not present in AS. As there is no diagnostic test for AS yet, this diagnosis cannot be confirmed nor rejected with certainty. However, it might be more likely that our patient has another, possibly unique, condition.

Characteristics of bronchial hyperresponsiveness in smokers with chronic air-flow limitation.

The characteristics of bronchial hyperresponsiveness (BHR) were studied in 18 smokers with mild chronic air-flow limitation (CAL) by measuring responsiveness to inhaled histamine, methacholine (high dose), methoxamine (an alpha-adrenergic agonist), and histamine after ipratropium bromide. The response of the smokers to histamine was reproducible and in the same range as that found in asthmatics. The smokers were significantly less responsive to methacholine than to equimolar doses of histamine (p less than 0.001). The dose-response curves to methacholine reached a plateau or maximal effect after a 30 to 50% fall in FEV1 in 14 of the 16 smokers challenged. Only 1 of the subjects responded to alpha-adrenoreceptor stimulation, and pretreatment with ipratropium bromide had no effect on the histamine dose-response curve. By comparing these results with previously published data from similar studies performed on asthmatic subjects, it is concluded that BHR in smokers with CAL has characteristics different from those that occur in subjects with asthma.

Increased responsiveness to methacholine and histamine after challenge with ultrasonically nebulised water in asthmatic subjects.

Responsiveness to inhaled methacholine was compared before and 40-60 minutes after a challenge with ultrasonically nebulised water (UNH2O) in 16 asthmatic patients. The sensitivity to methacholine increased after UNH2O challenge (p less than 0.001). The mean dose of methacholine producing a 20% fall in forced expiratory volume in one second was 0.4 (95% confidence limits 0.2, 0.8) mumol, compared with 0.9 (95% confidence limits 0.5, 1.6) mumol in the first methacholine challenge. When the study was repeated in six asthmatic patients with histamine substituted for methacholine, five of the patients were significantly more sensitive to histamine after UNH2O challenge. It is concluded that challenge with UNH2O produces an increase in airway responsiveness.

The role of models in planning.

PIP: A model is a miniature of an economy which simplifies the immense complexity of the real world by focusing on a few variables of major interest in a given context. A concern of recent models has been to show that "slower population growth, produced by declining fertility, translates directly into a more rapid growth of gross national product per capita." Models can be a useful part of population and development planning in developing countries. 1 of their most important functions is to convince planners to make their current decisions by taking greater account of the probable consequences over the longer term. Models can be very effective in this function by quickly working out such long-term consequences of alternative policy choices. Even simple models can handle such exercises, and with the simple models the planners can more easily appreciate the assumptions underlying the working of the models.^ieng