Objective: To produce representative cross-sectional blood pressure reference centiles for children and young people living in Great Britain. Design: Analysis of blood pressure data from seven nationally representative surveys: Health Surveys for England 1995-8, Scottish Health Surveys 1995, and National Diet & Nutrition Survey 1997. Methods: Blood pressure was measured using the Dinamap 8100 with the same protocol throughout. Weight and height were also measured. Data for 11 364 males and 11 537 females aged 4-23 years were included in the analysis, after excluding 0.3% missing or outlying data. Centiles were derived for systolic, diastolic, mean arterial and pulse pressure using the latent moderated structural (LMS) equations method. Results: Blood pressure in the two sexes was similar in childhood, rising progressively with age and more rapidly during puberty. Systolic pressure rose faster and was appreciably higher in adult men than in adult women. After adjustment for age, blood pressure was related more to weight than height, the effect being stronger for systolic blood pressure. Pulse pressure peaked at 18 years in males and 16 years in females. Conclusions: These centiles increase our knowledge of blood pressure norms in contemporary British children and young people. High blood pressure for age should be defined as blood pressure above the 98th centile, and high-normal blood pressure for age as blood pressure between the 91st and 98th centiles. The centiles identify children and young people with increased blood pressure, and will be of benefit to both clinical practice and research.T here is no satisfactory definition of hypertension in children.1 As a result, blood pressure is often not measured in paediatric clinical practice, and understanding the clinical significance of blood pressure readings in children is hampered by the lack of satisfactory reference data with which to interpret them.Reference blood pressure centiles should therefore improve the understanding of blood pressure variation in childhood. In Britain and worldwide, there have been many studies of childhood blood pressure, but all are of limited use in Great Britain owing to the use of non-representative populations, limited age ranges and mixed methodologies for blood pressure measurement. Accordingly, we have developed representative cross-sectional blood pressure references for children and young people living in Great Britain. METHODSBlood pressure data from seven national health and social surveys carried out between 1995 and 1998 were obtained from the UK Data Archive (http://www.data-archive.ac.uk/)( The survey samples were obtained by stratified multistage sampling techniques to ensure that there was a proportional representation of the population at large by sex, age, geographical region and social class.2 In brief, the demographic characteristics of a geographical area are known from census and other data. Using this information, a representative sample of individuals from the target age groups for each survey was obtained....

Insulin degludec (IDeg) once-daily was compared with insulin detemir (IDet) once- or twice-daily, with prandial insulin aspart in a treat-to-target, randomized controlled trial in children 1–17 yr with type 1 diabetes, for 26 wk (n = 350), followed by a 26-wk extension (n = 280). Participants were randomized to receive either IDeg once daily at the same time each day or IDet given once or twice daily according to local labeling. Aspart was titrated according to a sliding scale or in accordance with an insulin:carbohydrate ratio and a plasma glucose correction factor. Randomization was age-stratified: 85 subjects 1–5 yr. (IDeg: 43), 138 6–11 yr (IDeg: 70) and 127 12–17 yr (IDeg: 61) were included. Baseline characteristics were generally similar between groups overall and within each stratification. Non-inferiority of IDeg vs. IDet was confirmed for HbA1c at 26 wk; estimated treatment difference (ETD) 0.15% [−0.03; 0.32]95%CI. At 52 wk, HbA1c was 7.9% (IDeg) vs. 7.8% (IDet), NS; change in mean FPG was −1.29 mmol/L (IDeg) vs. +1.10 mmol/L (IDet) (ETD −1.62 mmol/L [−2.84; −0.41]95%CI, p = 0.0090) and mean basal insulin dose was 0.38 U/kg (IDeg) vs. 0.55 U/kg (IDet). The majority of IDet treated patients (64%) required twice-daily administration to achieve glycemic targets. Hypoglycemia rates did not differ significantly between IDeg and IDet, but confirmed and severe hypoglycemia rates were numerically higher with IDeg (57.7 vs. 54.1 patient-years of exposure (PYE) [NS] and 0.51 vs. 0.33, PYE [NS], respectively) although nocturnal hypoglycemia rates were numerically lower (6.0 vs. 7.6 PYE, NS). Rates of hyperglycemia with ketosis were significantly lower for IDeg vs. IDet [0.7 vs. 1.1 PYE, treatment ratio 0.41 (0.22; 0.78)95%CI, p = 0.0066]. Both treatments were well tolerated with comparable rates of adverse events. IDeg achieved equivalent long-term glycemic control, as measured by HbA1c with a significant FPG reduction at a 30% lower basal insulin dose when compared with IDet. Rates of hypoglycemia did not differ significantly between the two treatment groups; however, hyperglycemia with ketosis was significantly reduced in those treated with IDeg.

Human growth is a nonlinear process with marked variation in growth rate during the short-term. It is not known how long-term height gain or stature is influenced by short-term changes in height and weight. This study has addressed these issues by using thrice weekly height and weight measurements during 1 year in 43 normal prepubertal children (aged 5.7-7.7 y) to construct individual height and weight velocity curves by regression analysis. The former were comprised of 3 to 6 growth spurts separated by stasis, whereas the latter were characterized by 2 to 5 periods of weight gain separated by periods of weight loss. Stepwise regression analysis to determine characteristics of these curves that influence stature and growth showed that height SD score was correlated to the mean absolute weight velocity amplitude (+), the mean length of height velocity peaks (-), and the number of periods of weight gain (-) (r2 = 38%). In contrast, change in height SD score (delta height SD score) was correlated to the number (+) and mean amplitude (+) of the periods of weight gain and the mean height velocity peak amplitude (+) (r2 = 44%). Examination of changes in height relative to weight during the year in the whole group revealed that height increased relative to weight in autumn and spring, whereas the reverse occurred during the winter months. We conclude that 1) both height and weight velocities during 1 year show a biphasic pattern, 2) there is seasonal variation in the short-term change in height relative to weight, and 3) prepubertal stature and the amount grown through the year are related to short-term changes in height and weight. Our data indicate that large but infrequent changes in weight with growth spurts of short duration are found in tall children. Good growth during the year was related to large but frequent gains in weight and large individual spurts in height.

We examined symptoms of post-traumatic stress disorder (PTSD) in mothers of very low birth weight (VLBW) infants 2-3 years post-partum, compared with mothers of term, normal weight infants. Mothers were asked to report current symptoms relating specifically to the birth of their infant using The Impact of Event Scale-Revised (IES-R). Mothers of VLBW infants recorded significantly higher levels of PTSD symptoms overall (median scores: VLBW 25 [range 2-82], versus controls: 0 [range 0-5], P < 0.001), and in all sub-categories (p < 0.001). These findings suggest that mothers of VLBW infants have a relatively high prevalence of symptoms of PTSD at 2-3 years postnatal.

Growth over the short term is a highly complex non-linear process. Contrasting models of short term growth have been proposed which include periodic growth cycles versus abrupt growth spurts with intervening growth arrest ('saltation and stasis'). The variability of short term growth has been characterised from a study of 46 healthy prepubertal children measured three times a week over one academic year using a combination of descriptive statistical approaches and regression modelling. Growth in childhood over one year is represented by a biphasic process comprising three to six unpredictable growth spurts, each of mean length 56 days (range 13-155 days), separated by periods of stasis (less than or equal to 0.05 cm height increment over more than seven days), each lasting a mean of 18 days (range 8-52 days) and accounting for at least 20% of the period of observation. This is superimposed on strong seasonal trends in growth with a declining growth rate over the autumn months reaching a nadir in midwinter, followed by a growth spurt in the spring. Human growth over short periods is therefore a discontinuous, irregular, and unpredictable process. (Arch Dis Child 1996;75:427-431) Keywords: growth, prepubertal, mathematical models.Studies have attempted to address this key issue by frequent measurements on a small numbers of subjects. For instance, weekly height measurements taken by parents on 10 short children were found to be described by linear trends.4 In contrast, weight gain in growth retarded infants,' catch-up growth in infants with treated coeliac disease,6 and growth in normal children78 and those with cystic fibrosis' may be described by 10 day, 60 day, and annual cycles, respectively. Using the knemometer to obtain highly accurate weekly measurements of the lower leg, minigrowth spurts occurring at 30-55 day intervals have also been described.'0 In contrast, accurate measurements of limb growth in rabbits using metal pins inserted into the tibia" have shown growth to be a continuous process. All height gained in childhood has been proposed to occur in irregular growth spurts or saltations over one day with intervening periods of no discernible growth (stases) based on studies of infants'2 and one adolescent child.'3 It has also been suggested that growth may be proceeding in a chaotic manner.2 There is therefore a wide range of putative models of human growth.Our aim in this study has been to define short term growth in a large cohort of normal children by mathematical techniques that do not impose an artificial form to the growth pattern. By gaining an insight into normal growth we may anticipate a better understanding of pathological growth and the influence of treatment, so that growth promoting treatments may be used more appropriately and effectively. Conventionally, growth in childhood is considered to be a relatively smooth and orderly process: rapid growth in infancy gives way to 'linear' growth in mid-childhood, finally culminating in the adolescent growth spurt. The familiar shape ...