Sheila Williams

Bone Mineral Density in Girls with Forearm Fractures

In childhood, the most common site of fracture is the distal forearm. To determine whether young girls with these fractures have low bone density more commonly than fracture‐free controls, we measured bone density at the radius, spine, hip, and whole body and total body bone mineral content, lean tissue mass, and fat mass by dual‐energy X‐ray absorptiometry in 100 Caucasian girls aged 3–15 years with recent distal forearm fractures and 100 age‐ and gender‐matched controls. Bone density (age‐adjusted ratios of all cases:controls with 95% confidence intervals) was lower in cases at the ultradistal radius 0.963 (0.930–0.996), 33% radius 0.972 (0.945–0.999), lumbar spine 0.945 (0.911–0.980), hip trochanter 0.952 (0.918–0.988), and total body 0.978 (0.961–0.995). Moreover, osteopenia (defined as Z score below −1), was more common in cases than controls (p < 0.05) in the forearm, spine, and hip, with one third of fracture cases having low spinal density. Odds ratios (95% confidence intervals) for low bone density were: ultradistal radius, 2.2 (1.1–4.6); lumbar spine, L2‐L4, 2.6 (1.3–4.9); and femur trochanter, 2.0 (1.0–3.9). Fracture patients aged 8‐10 years weighed more (mean ± SD) than age‐matched controls (37.2 ± 8.0 kg vs. 32.5 ± 6.6 kg, p < 0.01) while older patients reported lower current and past calcium intakes than matched controls (p < 0.05). We conclude that low bone density is more common throughout the skeleton in girls with forearm fractures than in those who have never broken a bone, supporting the view that low bone density may contribute to fracture risk in childhood.

More Broken Bones: A 4‐Year Double Cohort Study of Young Girls With and Without Distal Forearm Fractures

Predictors of childhood fractures have not been investigated previously. This study was undertaken to determine whether a previous history of forearm fracture, low bone mineral density (BMD; both areal bone mineral density [aBMD, g/cm2] and volumetric bone mineral apparent density [BMAD, g/cm3]), or anthropometry, influence fracture risk in young girls. At baseline, two cohorts of girls, aged 3–15 years, were evaluated: 100 had recently broken a forearm (group 1) and 100 were fracture free (group 2). Four years later we restudied 170 of these girls (82 from group l and 88 from group 2). We now report the relationships of previous fracture history, baseline BMD (measured by dual‐energy X‐ray absorptiometry), baseline weight, and height to risk of new fracture. More new fractures occurred in group l (37 fractures in 24 girls) than in group 2 (8 fractures in 7 girls; p = 0.0007). The independent predictors for occurrence of a new fracture at any skeletal site in a multivariate model adjusting for age, weight, total body aBMD, and fracture history were previous fracture (hazard ratio [HR], 3.28; 95% CI, 1.41‐7.64); age (HR per l‐year increase, 0.91; 95% CI, 0.84‐0.99); total body aBMD (HR per l SD decrease, 1.92; 95% CI, 1.31‐2.81); and body weight (HR per l SD increase, 1.49; 95% CI, 1.06‐2.08). Girls with two risk factors together had substantially greater fracture risk: previous fracture and low spinal BMAD (HR, 9.4; 95% CI, 2.8‐32.0), previous fracture and high body weight (HR, 10.2; 95% CI, 2.8‐37.6), or previous fracture and low total body aBMD (HR, 13.0; 95% CI, 3.9‐43.1). We conclude that previous forearm fracture, low total body aBMD, low spinal BMAD, and high body weight each increase risk of new fractures within 4 years in young girls. Interventions to reduce the risk of fractures, particularly forearm fractures, in girls warrant further study.

Overweight and obese children have low bone mass and area for their weight

OBJECTIVES: To determine whether girls and boys categorized from body mass index (BMI) values as overweight or obese for their age have lower bone mineral content (BMC) or lower bone area in relation to total body weight than children of normal adiposity.DESIGN: Cross-sectional study in a university bone research unit.SUBJECTS: Two hundred girls and 136 boys aged 3–19 y recruited from the general population by advertisement.MEASUREMENTS: Total body BMC (g) and bone area (cm2) measured by dual energy X-ray absorptiometry (DXA) in relation to body weight (kg), lean tissue mass (kg) and fat mass (kg) in boys and girls of three different BMI percentile groupings: normal weight (BMI<85th percentile); overweight (85 to 94th BMI percentile); obese (≥95th BMI percentile).RESULTS: Obese children had higher BMC, bone area, and fat mass for chronological age than those of normal body weight (P<0.001). In spite of this the observed values for age-adjusted total body BMC and bone area relative to body weight were each lower than predicted values, in both overweight and obese children (2.5–10.1% less, P<0.05) than in children of lower adiposity.CONCLUSION: In overweight and obese boys and girls there is a mismatch between body weight and bone development during growth: their bone mass and bone area are low for their body weight.

Psychometric properties of the Centre for Epidemiologic Studies Depression Scale (CES-D) in a sample of women in middle life.

The Centre for Epidemiologic Studies Depression Scale (CES-D) was completed by 675 women taking part in a longitudinal investigation of health-related issues. The data were submitted to confirmatory factor analysis using LISREL 7 and a 4-factor model was found to fit the data moderately well. A second-order depression factor was also identified. The results provide support for the construct validity of the total and subscale scores from this measure. The scale was found to have good reliability. Evidence was found that scores on the subscale measuring somatic features of depression may be inflated in women who have experienced a chronic health problem in the past 12 months.

A Longitudinal Study Of Children With Developmental Language Delay At Age Three: Later Intelligence, Reading And Behaviour Problems

A large sample of Dunedin (New Zealand) children were assessed at age three to identify those with language delay. 2.6 per cent were defined as delayed in verbal comprehension only, 2.3 per cent as delayed in verbal expression only, and 2. 3 per cent as delayed in both (‘general language delay’).Most of these children, and the remainder of the sample, were assessed for intelligence, reading and behaviour problems at ages seven, nine and 11. Those in every language‐delay group had significantly lower mean IQs and lower mean reading scores than the remainder of the sample. They also more often had a low IQ or a lower reading score at ages seven and nine and a lower Verbal and Full‐scale IQ at 11. The groups with delayed verbal comprehension and general language delay had significantly more behaviour problems than the remainder of the sample. The group with general language delay was consistently the most disadvantaged in later intelligence, reading and behaviour. Two of the language‐delay groups (comprehension and general language) had significantly higher scores on a family disadvantage index. The results of this study confirm the importance of early language delay as a predictor of lower than average intelligence and reading ability and increased behaviour problems.

DSM-III Disorders from Age 11 to Age 15 Years

Although research into the continuity of disorder from childhood to adolescence is sparse, results from both longitudinal and cross sectional studies suggest that the prevalence of disorder increases for girls but may remain more stable for boys. In this paper, the methodologies of two assessment phases of the Dunedin longitudinal study have been equated to estimate the continuity of DSM-III disorder from ages 11 to 15. Although the overall prevalence of disorder doubled between the ages, this was primarily because of an increase in nonaggressive conduct disorder and major depressive episode. The sex ratios in disorder had largely reversed from a male predominance at 11 to a female predominance at 15. In terms of persistence, over 40% of those with disorder at age 11 were also identified at age 15. However, over 80% of those identified with disorder at 15 did not have a history of disorder at 11. Significant sex differences were also found in the continuity of internalizing and externalizing disorders, with externalizing disorders showing more continuity for boys, and internalizing for girls. Logistic regression models were employed to evaluate the roles family background, academic and social competence, and early histories of behavior problems may play in the determination of disorder continuity.

Bone and body composition of children and adolescents with repeated forearm fractures.

DXA measurements in 90 children and adolescents with repeated forearm fractures showed reduced ultradistal radius BMC and BMD values and elevated adiposity, suggesting site‐specific bone weakness and high body weight increase fracture risk. Symptoms to cow milk, low calcium intakes, early age of first fracture, and overweight were over‐represented in the sample.

DSM-III-R disorders in New Zealand 18-year-olds.

The one-year prevalence and correlates of selected DSM-III-R disorders were determined in a sample of 93018-year-olds. Using both diagnostic and impairment criteria 340 individuals (36.6%) were considered to have disorder. The most prevalent disorders were major depressive episode (16.7%), alcohol dependence (10.4%) and social phobia (11.1%). There was a high degree of co-morbidity among disorders; 46% of those with disorder had two or more. The prevalence of disorders was greater for females, with the exception of conduct disorder and alcohol or marijuana dependence. A variety of characteristics were associated with disorder, including poor social competence, disadvantage and self-rated health status. A third of those with disorder had their problems recognised by a “significant-other”. The results are presented within the context of a perceived need for research in the area of adolescent and early adult mental health in order to minimise the toll of mental disorder in later life.

How Many Children Remain Fracture-Free During Growth? A Longitudinal Study of Children and Adolescents Participating in the Dunedin Multidisciplinary Health and Development Study

Abstract: While much is known regarding the incidence and pattern of fractures during growth, information is sparse as to how many children fracture repeatedly and how many remain fracture-free during growth. The Dunedin Multidisciplinary Health and Development Study, a birth cohort, whose members were questioned regularly throughout growth (at ages 5, 7, 9, 11, 13, 15 and 18 years) concerning injuries including fractures, has provided a unique opportunity to answer these questions. Life-table analysis showed that approximately half the children remained fracture-free throughout growth [girls 60.1%, (95% CI 54.7–65.0) and boys 49.3% (95% CI 44.0–54.4)]. Data on fracture history, for participants seen at every phase, was available for 601 members through to the age of 18 years (61.1% of the cohort seen at age 5 years). Two hundred and ninety-one of these 601 participants reported 498 fractures, with 172 sustaining a single fracture, and 119 more than one fracture (15.8% girls and 23.4% boys). The most common site of fracture was the wrist/forearm (24.1% of all fractures). We conclude that although bone fractures are a common adverse event in childhood, half of all children remain fracture-free throughout growth.

The long‐term significance of teacher‐rated hyperactivity and reading ability in childhood: findings from two longitudinal studies

BACKGROUND The aims of this study were twofold: first, to examine behavioural and academic outcomes of children with hyperactivity, using data from two longitudinal studies; and second, to examine comparable psychosocial outcomes for children with early reading difficulties. METHODS Measures of teacher-rated persistent hyperactivity, and reading ability obtained during early primary school were available for children from the Australian Temperament Project and the Dunedin Multidisciplinary Health and Development Study. Both samples were followed up to assess behavioural and academic outcomes during the adolescent and early adult years. Family background, antisocial behaviour and literacy were controlled in the first set of analyses to examine the influence of early hyperactivity. RESULTS There were strong linear relationships between early hyperactivity and later adverse outcomes. Adjustment for other childhood variables suggested that early hyperactivity was associated with continuing school difficulties, problems with attention and poor reading in adolescence. Early reading difficulties, after controlling for early hyperactivity, predicted continuing reading problems in high school and leaving school with no qualifications. CONCLUSIONS The findings suggest that there are dual pathways from early inattentive behaviours to later inattention and reading problems, and from early reading difficulties to substantial impairments in later academic outcomes.