Hermione Lovel

Geographical variation in relationships between parental body size and offspring phenotype at birth

Background. Size and body proportions at birth are partly determined by maternal body composition, but most studies of mother–baby relationships have only considered the effects of maternal height and weight on offspring birth weight, and few have examined the size of effects. Paternal size and body composition also play a role, primarily through the fetal genome, although few studies have investigated relationships with neonatal phenotype. Methods. Data from the UK, Finland, India, Sri Lanka, China, DR Congo, Nigeria and Jamaica were used to investigate the effects of maternal measures (derived at 30 weeks’ gestation, n=16,418), and also paternal size (n=3,733) on neonatal phenotype, for singleton, live‐born, term births. Results. After accounting for variation in maternal size and shape across populations, differences in neonatal phenotype were markedly reduced. Mother–baby relationships were similar across populations, although some were stronger in developing countries. Maternal height was generally the strongest predictor of neonatal length, maternal head circumference of neonatal head and maternal skinfold thickness of neonatal skinfolds. Relationships with maternal arm muscle area were generally weak. Effects of paternal height and body mass index were weaker than the equivalent maternal measurements in most studies. Conclusions. Differences in maternal body composition account for a large part of the geographical variation in neonatal phenotype. The size of the effects of all maternal measures on neonatal phenotype suggests that nutrition at every stage of the mothers life cycle may influence fetal growth. Further research is needed into father–baby relationships and the genetic mechanisms that influence fetal growth.

Geographical variation in neonatal phenotype

Background. Recent studies have shown associations between size and body proportions at birth and health outcomes throughout the life cycle, but there are few data on how neonatal phenotype varies in different populations around the world. Methods. Data from the UK, Finland, India, Sri Lanka, China, DR Congo, Nigeria, and Jamaica (n=22,067) were used to characterize geographical differences in phenotype in singleton, live‐born newborns. Measurements included birth weight, placental weight, length, head, chest, abdominal and arm circumferences, and skinfolds. Results. Neonates in Europe were the largest, followed by Jamaica, East Asia (China), then Africa and South Asia. Birth weight varied widely (mean values 2,730–3,570 g), but in contrast, head circumference was similar in all except China (markedly smaller). The main difference in body proportions between populations was the head to length ratio, with small heads relative to length in China and large heads relative to length in South Asia and Africa. Conclusions. These marked geographical differences in neonatal phenotype need to be considered when investigating determinants of fetal growth, and optimal phenotype for short‐term and long‐term outcomes.

Computer-based support for patients with limited English

The paper describes a proposal for computer-based aids for patients with limited or no English. The paper describes the barriers to health-care experienced due to linguistic problems, then suggests some computer-based remedies incorporating a multi-engine machine translation system based on a corpus of doctor-patient interviews which provides a dialogue model for the system. The doctors and patients interfaces are described. Ideas from Augmentative and Alternative Communication and in particular picture-based communication are incorporated. The initial proposal will focus on Urdu- and Somali-speaking patients with respiratory problems.

A computer-based aid for communication between patients with limited English and their clinicians, using symbols and digitised speech

BACKGROUND Problems of communication are an important barrier on the pathway to healthcare for patients with limited or no ability in the majority language of the country in which they live. Solutions involving interpreters who have to be booked in advance, or using unqualified friends or family members to translate, are highly unsatisfactory. AIM This paper describes a computer-based approach to alleviating the situation. DESIGN/METHOD A computer-based communication aid was developed and tested. The communication aid is designed to permit an English-speaking healthcare practitioner to select a series of questions which are then presented along with a range of possible answers for the patient to choose from. The questions and answers are presented in the patients own language in both text and digitised speech accompanied by symbols as well as English text. As a test-case we focused on Somali patients with asthma. RESULTS 26 simulated consultations with Somali asthma sufferers and healthcare practitioners (three GPs and six nurses) with experience of asthma treatment with this patient group were held with the system implemented either on a laptop with mouse pad, or a tablet with stylus. All the consultations were successfully completed with a high satisfaction rate on the part of both practitioners and patients. CONCLUSION Feedback questionnaires suggest some areas for improvement. The proposed system is a practical way of addressing the problem of communication with patients with limited English in the context of clinician-led question-answer dialogues.

Severe placental malaria and maternal shortness, thinness, and small skeletal size in rural Congo: cohort study

Despite global partnerships that aim to eradicate malaria, few studies have investigated susceptibility to severe placental malaria infection (apart from in primigravida1). Reduced fetal growth1 and maternal anaemia sequelae2 are known, however, to have serious consequences. We measured mothers at antenatal booking and later explored severe placental malaria as part of a study on factors affecting fetal growth. We investigated a cohort of 436 consecutive rural Bantu women with a singleton pregnancy, with a gestation of less than 24 weeks at booking (determined by ultrasonography), and planning to deliver in Kasaji Hospital in this remote but settled rural area of Katanga province in the Democratic Republic of Congo. A third (31%, 135) were primigravida.3 RMN followed them all through pregnancy to delivery, between 1996 and 1998 (unaware of their placental malaria status at this stage). RMN took placental impression smears using a rigorous protocol. HC later examined them and counted parasites per field (without antenatal measurements) at the Tropical Diagnostic Laboratory …