Growth hormone prescribing and initial BMI SDS: Increased biochemical adverse effects and costs in obese children without additional gain in height

BACKGROUND: Recombinant human growth hormone (rhGH) treatment in children is usually prescribed using actual body weight. This may result in inappropriately high doses in obese children. METHODS: Retrospective audit of all paediatric patients treated with rhGH 2010-14 at a tertiary paediatric hospital in the UK. Change in height SDS and IGF-I SDS during the first year of treatment was stratified by initial BMI SDS in a mixed cohort, and a subgroup of GH deficient (GHD) patients. Alternative doses for those BMI SDS ≥2.0 (Obese) were calculated using BSA, IBW and LBW. RESULTS: 354 patients (133 female) received rhGH, including 213 (60.2%) with GHD. Obesity was present in 40 patients (11.3%) of the unselected cohort, and 32 (15.0%) of the GHD cohort. For GHD patients, gain in height SDS was directly related to BMI SDS, except in obese patients (p<0.05). For both the entire cohort, and GHD patients only, IGF-1 SDS was significantly higher in obese patients (p<0.0001 for both groups). Cross sectional data identified 265 children receiving rhGH, 81 (30.5%) with a BMI-SDS ≥1.75. Alternate prescribing strategies for rhGH prescribing in obese patients suggest a saving of 27% - 38% annually. CONCLUSIONS: Gain in IGF-I SDS is greater in obese children, and is likely to be related to relatively higher doses of rhGH. Additional gain in height was not achieved at the higher doses administered to obese children. Alternative dosing strategies in the obese patient population should be examined in rigorous clinical trials

Technological enhancements in the teaching and learning of reflective and creative practice in dance

This is an electronic version of an article published in Huxley, M., Doughty, S., Francksen, K. and Leach, M. (2008) Technological enhancements in the teaching and learning of reflective and creative practice in dance. Research in Dance Education. 9 (1), pp.129-146.A team of researchers at De Montfort University’s Centre for Excellence in Performance Arts has explored uses of technology in dance education. The wider context of dance and technology pedagogy includes research into dance, technologies, learning and teaching and the relationships between teaching and research. The paper addresses all of these themes. Three pedagogic research projects are reported on. They address dance and technology in terms of: (i) teaching the Alexander Technique for dancers, (ii) improvisation, (iii) interactive practice using the software environment Isadora. Two main themes are highlighted: (1) use of technology as a means of enabling reflection, and (2) technology as a means of both engaging in the creative process and as a creative tool. It is argued that student-centred autonomous learning in dance can be significantly enhanced by an informed application of technologies

The impact of community engagement on health and social outcomes: a systematic review

Community engagement is central to national strategies for promoting health, yet there have been few attempts to systematically review the evidence on the impact of initiatives that aim to engage communities. This rapid review fills this gap by exploring the population impact of initiatives which sought to address social determinants of health. It took a novel approach to synthesizing a sample of the enormous UK literature on community engagement. The synthesis found no evidence of positive impacts on population health or the quality of services, but initiatives did have positive impacts on housing, crime, social capital and community empowerment. Methodological developments are needed to enable studies of complex social interventions to provide robust evidence of population impact in relation to community engagement

The Malaria in Pregnancy Library: a bibliometric review

BACKGROUND: The Malaria in Pregnancy (MiP) Library is a bibliographic database that was created by the MiP Consortium in 2005 and is updated every four months using a standardized search protocol. A bibliometric review was conducted of the contents of the Library to determine dynamics in the type, content and volume of literature on malaria in pregnancy over time. METHODS: Data on year of publication, type, language, country of first-author affiliation and content (topic) were extracted from entries in the MiP Library and plotted over time. RESULTS: By January 2012, the MiP Library contained 5,346 entries, consisting of 3,721 journal articles (69.6%), 697 reports (13.0%), 219 academic theses (4.1%), 92 books or book chapters (1.7%), 487 conference proceedings (9.1%), 68 registered studies (1.3%) and 62 'other' (1.2%). Most of the sources were in English language (87.3%), followed by French (7.5%) and Spanish (1.5%). Over 40% of source material was publicly available online (42.4%) and the remaining with restricted access (35.0%) or otherwise unavailable (22.7%). The number of journal articles related to malaria in pregnancy increased from 41 in the 1960s, to 708 in the 1990s, and 1,895 between 2000 and 2009, and the variety of themes has increased over time. English-language articles were sourced from 737 different journals. The top three journals were the American Journal of Tropical Medicine and Hygiene (184), Malaria Journal (158) and the Transactions of the Royal Society of Tropical Medicine and Hygiene (131). CONCLUSION: The last decade has seen a dramatic increase in publications related to malaria in pregnancy, and an increasing proportion of these are publically available online. The MiP Library is a useful, scholarly source for literature and systematic reviews related to malaria in pregnancy