Causes of pediatric mortality in a medieval skeletal series

Critical episodes in the life of prehistoric children can be traced by comprehensive palaeopathological investigations of frequently occurring symptoms like criba orbitalia, porotic hyperostosis and Harris' lines, combined with the evaluation of growth curves. Among the children of a skeletal sample excavated in Schleswig (northern Germany, 11th/12th century AD), two periods of growth retardation were observed. The first one, starting between 1 and 2 years of age, is due to malnutrition already set on in the second part of the first year of life and a high morbidity at weaning age. After a catch-up growth between 6 and 7 years of age, living conditions became even worse for the 8 to 10 year old children. It is presumed that an inadequate nourishment did not fit the requirements of the prepuberal organism, especially regarding the considerable high working-burden of children in medieval times after completing their 7th year of life. The combined effect of malnutrition and diseases is responsible for the high mortality of the children in medieval Schleswig.     

Long-term results with growth hormone therapy in idiopathic hypopituitarism

More than 30 years after its introduction, growth hormone (GH) treatment is well established in children with GH deficiency. Nevertheless, the long-term results of this therapy, expressed as height, are generally considered unsatisfactory. We report on results obtained in a group of GH-deficient children who were treated with daily injections of recombinant GH within the first 5 years of life and who reached an adult height very close to their target height. The full catch-up growth to the target height demonstrated in these patients suggests that replacement therapy should be started early and continued until adulthood. Height at onset of puberty is an important variable which might significantly influence the adult height. The significant and prolonged influence of birth weight on growth response to GH therapy underlines the important role of fetal growth in planning early treatment of GH-deficient children.     

Testing the quality of nonadult Bayesian dental age assessment methods to juvenile skeletal remains: the Lisbon collection children and secular trend effects

Age estimation of nonadult skeletons from archaeological or forensic contexts has relied heavily on modern schedules of dental formation developed on samples of children of affluent populations. Although genetic factors have been considered to have had the greatest influence on population differences in dental development, increased interest has been placed on the role of environmental influences, such as differences in socioeconomic status and secular trends. This study evaluates the quality (i.e., accuracy and reliability) of two Bayesian dental age estimation methods to a sample of identified child skeletons from the Lisbon collection (20th century Portugal). The two Bayesian methods are developed on a reference sample of modern children from France, Ivory Coast, Iran, and Morocco. The test sample from Lisbon, compared to the reference sample, is separated by over 50 years of secular trends and comprises a lower socioeconomic segment. The two Bayesian methods show that the Lisbon children are consistently 1-year behind in dental age compared to the modern children of the reference sample. Environmental factors largely explain the differences between dental and chronological age in historic samples of nonadults.     

Exploring the multidimensionality of stature variation in the past through comparisons of archaeological and living populations

Adult stature variation is commonly attributed to differential stress-levels during development. However, due to selective mortality and heterogeneous frailty, a population's tall stature may be more indicative of high selective pressures than of positive life conditions. This article examines stature in a biocultural context and draws parallels between bioarchaeological and living populations to explore the multidimensionality of stature variation in the past. This study investigates: 1) stature differences between archaeological populations exposed to low or high stress (inferred from skeletal indicators); 2) similarities in growth retardation patterns between archaeological and living groups; and 3) the apportionment of variance in growth outcomes at the regional level in archaeological and living populations. Anatomical stature estimates were examined in relation to skeletal stress indicators (cribra orbitalia, porotic hyperostosis, linear enamel hypoplasia) in two medieval bioarchaeological populations. Stature and biocultural information were gathered for comparative living samples from South America. Results indicate 1) significant (P < 0.01) differences in stature between groups exposed to different levels of skeletal stress; 2) greater prevalence of stunting among living groups, with similar patterns in socially stratified archaeological and modern groups; and 3) a degree of regional variance in growth outcomes consistent with that observed for highly selected traits. The relationship between early stress and growth is confounded by several factors—including catch-up growth, cultural buffering, and social inequality. The interpretations of early life conditions based on the relationship between stress and stature should be advanced with caution. Am J Phys Anthropol 155:229–242, 2014. © 2014 Wiley Periodicals, Inc.     

Association between postnatal catch-up growth and obesity in childhood: prospective cohort study

ObjectiveTo identify predictors of postnatal catch-up growth from birth to two years and its relation to size and obesity at five years.DesignRegional prospective cohort study.SettingAvon longitudinal study of pregnancy and childhood, United Kingdom.Subjects848 full term singletons from a 10% random sample of the Avon longitudinal study of pregnancy and childhood.ResultsSize at birth was representative of the national reference. Overall, 30.7% (260 of 848) of infants showed a gain in SD score for weight greater than 0.67 SD scores between zero and two years, indicating clinically significant catch-up growth. These children had lower weight, length, and ponderal index at birth than other children, and were more often from primiparous pregnancies. They also had taller fathers than other children, and their mothers had lower birth weights and were more likely to smoke during pregnancy. Children who showed catch-up growth between zero and two years were heavier, taller, and fatter (body mass index, percentage body fat, and waist circumference) at five years than other children.ConclusionsIn this contemporary well nourished cohort, catch-up growth was predicted by factors relating to intrauterine restraint of fetal growth. Children who showed catch-up growth between zero and two years were fatter and had more central fat distribution at five years than other children. Mechanisms that signal and regulate early catch-up growth in the postnatal period may influence associations between small size at birth and risks for disease in adulthood.     

Catch-up growth and endocrine changes in childhood celiac disease. Endocrine changes during catch-up growth

Childhood celiac disease may lead to a failure of statural growth. After institution of a gluten-free diet most patients exhibit catch-up growth. Catch-up growth is a remarkable phenomenon characterized by a supranormal height velocity. One of the hypothetical mechanisms of catch-up growth is that an increased activity of the somatotrophic axis is involved. In order to provide further insight in the physiology of catch-up growth, auxological and endocrine changes were prospectively studied in 28 children with newly diagnosed celiac disease. The results demonstrate a malnutrition-like state of the somatotrophic axis at the time of diagnosis and a rapid recovery of this axis towards normal functioning after institution of the gluten-free diet. Although several correlations between these endocrine alterations and auxological parameters were detected, it is questionable whether the endocrine changes are the driving force behind catch-up growth.     

Poor growth prior to early childhood: decreased health and life-span in the adult

Previous studies in animal populations have shown that stunted neural and thymolymphatic growth early in development may result in permanently impaired neural and immune function, decreased body growth, vertebral wedging, and decreased life-span. In the human adult, small vertebral neural canal (VNC) diameters may reflect early stunted neural and immune development and impaired function that leads to decreased health (inferred by greater vertebral wedging) and life-span in the adult. VNC, which complete their growth by early childhood (age 4), are markers of early development in adults. On the other hand, features following general body growth, such as height, weight (represented here by vertebral body height) continues to grow until young adulthood. They are less reliable, because they readily experience catch-up growth (even in chronically stressed populations) and, unlike VNC, may mask poor early growth. To test associations between early growth and adult health and life-span in humans, we measured 2,060 VNC, vertebral heights, vertebral wedging, nerve-root tunnel lengths, severity of vertebral osteophytosis, and ages at death in 90 adult (aged 15-55 years) prehistoric skeletons (950-1300 A.D.). Tibial lengths were also measured in a subsample (n = 30). Multivariate, bivariate, and nonparametric analyses showed that small VNC are significantly associated with greater vertebral wedging and decreased life-span (P less than 0.05-0.00001). VNC are independent of vertebral body heights and tibial lengths (general body growth). VNC, but not statural components, are useful in predicting adult health, presumably because they reflect neural and immune development and do not readily experience catch-up growth. Thus, longitudinal retrospective measures of early growth and adult health were systematically linked within individuals regardless of confounding factors operating over the 350-year time period. Since this research was completed, this model has repeatedly been independently confirmed in four living urban industrial populations. Longitudinal retrospective analysis was employed together with direct measures of VNC, neural and immune function. Together these results suggested that it may be essential to improve growth prior to early childhood in order to maximize adult health and life-span.     

Impact of industrialization: comparative study of child health in four sites from medieval and postmedieval England (A.D. 850-1859)

The morbidity and mortality profiles of 831 non-adult skeletons from four contrasting sites in medieval and postmedieval England were compared to assess whether urbanization and later industrialization, had a detrimental effect on the health of the inhabitants. Failure in the population's ability to adapt to these environments should be evident in the higher rates of mortality, retarded growth, higher levels of stress, and a greater prevalence of metabolic and infectious disease in the urban groups. Non-adult skeletons were examined from Raunds Furnells in Northamptonshire, from St. Helen-on-the-Walls and Wharram Percy in Yorkshire, and from Christ Church Spitalfields in London. Results showed that a greater number of older children were being buried at the later medieval sites and that the skeletal growth profiles of the medieval urban and rural children did not differ significantly. A comparison of the growth profiles of St. Helen-on-the-Walls (urban) and Spitalfields (industrial) showed that the Spitalfields children were up to 3 cm shorter than their later medieval counterparts. At Spitalfields, cribra orbitalia and enamel hypoplasias occurred during the first 6 months of life, and 54% of the non-adults had evidence of metabolic disease. It is argued that differences in the morbidity and mortality of non-adults from urban and rural environments did exist in the past, but that it was industrialization that had the greatest impact on child health. Environmental conditions, urban employment, socioeconomic status, and changes in weaning ages and infant feeding practices contributed to differences in health in rural, urban, and industrial environments.     

Factors associated with height catch-up and catch-down growth among schoolchildren

In developed countries, children with intrauterine growth restriction (IUGR) or born preterm (PT) tend to achieve catch-up growth. There is little information about height catch-up in developing countries and about height catch-down in both developed and developing countries. We studied the effect of IUGR and PT birth on height catch-up and catch-down growth of children from two cohorts of liveborn singletons. Data from 1,463 children was collected at birth and at school age in Ribeirão Preto (RP), a more developed city, and in São Luís (SL), a less developed city. A change in z-score between schoolchild height z-score and birth length z-score≥0.67 was considered catch-up; a change in z-score≤−0.67 indicated catch-down growth. The explanatory variables were: appropriate weight for gestational age/PT birth in four categories: term children without IUGR (normal), IUGR only (term with IUGR), PT only (preterm without IUGR) and preterm with IUGR; infant''s sex; maternal parity, age, schooling and marital status; occupation of family head; family income and neonatal ponderal index (PI). The risk ratio for catch-up and catch-down was estimated by multinomial logistic regression for each city. In RP, preterms without IUGR (RR = 4.13) and thin children (PI<10^th percentile, RR = 14.39) had a higher risk of catch-down; catch-up was higher among terms with IUGR (RR = 5.53), preterms with IUGR (RR = 5.36) and children born to primiparous mothers (RR = 1.83). In SL, catch-down was higher among preterms without IUGR (RR = 5.19), girls (RR = 1.52) and children from low-income families (RR = 2.74); the lowest risk of catch-down (RR = 0.27) and the highest risk of catch-up (RR = 3.77) were observed among terms with IUGR. In both cities, terms with IUGR presented height catch-up growth whereas preterms with IUGR only had height catch-up growth in the more affluent setting. Preterms without IUGR presented height catch-down growth, suggesting that a better socioeconomic situation facilitates height catch-up and prevents height catch-down growth.     

Lack of compensatory body growth in a high performance moose Alces alces population

Considerable work has been done on disentangling important factors determining early development in body size, yet our knowledge of the extent to which animals living under varying conditions can achieve catch-up growth for a bad start in life is limited. Here, we investigated how body mass at the age of 8 months influenced adult body mass in a moose Alces alces population living under excellent environmental conditions on the island of Vega in northern Norway. We also investigated if mother age and birth date effects on calf body mass persisted until adulthood. We show that neither males nor females were able to show compensatory growth before they reached adulthood, and that part of the variation in adult body mass may have been due to variation in mother age and date of birth. The pattern observed in males can be related to their growth strategy in relation to reproduction, while such results were not expected in females where size-dependent start of reproduction is likely to interact with body growth. We suggest that the good environmental conditions experienced on Vega led to females having small somatic costs of an early start of reproduction or that larger females were able to acquire more resources for growth than their smaller conspecifics. In both cases, females that postpone their first reproduction may not be able to achieve catch-up growth for their lower early body mass compared to females that start reproduction at an early age. Our results concur with previous studies indicating that compensatory growth is weak in moose, increasing the likelihood that variation in life history characters are also transferred between generations.     

Epiphyseal union at the innominate and lower limb in a modern Portuguese skeletal sample, and age estimation in adolescent and young adult male and female skeletons

This study documents the timing of epiphyseal union at the innominate, femur, tibia, and fibula in a sample of modern Portuguese skeletons. The sample was taken from the Lisbon documented skeletal collection and it is comprised of 57 females and 49 males between the ages of 9 and 25. Individuals are mostly representative of the middle-to-low socioeconomic segment of the early 20th century Lisbon population. A total of 18 anatomical locations were examined for epiphyseal union using a three-stage scheme: 1) no union; 2) partial union; and 3) completed union, all traces of fusion having disappeared. Results show that females are ahead of males by 1-2 years and provide similar age ranges for the stages of union than previous studies. Some variations between studies can be explained by methodological differences between dry bone and radiographic observations. However, a review of the literature indicates that socioeconomic status of a given population seems to be of decisive importance to the rate of ossification and most of the differences in skeletal maturation across studies and populations can probably be ascribed to different levels of social and economic development of the societies in which the individuals lived. Although the effects of socioeconomic status in skeletal maturation are greater during childhood than in adolescence, as to make the timing of epiphyseal union a reliable estimate of age at death, they are not negligible and age estimates should take into account the likely socioeconomic status of the individual, whose remains are under examination.     

Temporal trends in femoral curvature and length in medieval and modern Scotland

We measured how much the radius of the anterior curvature and the length of the femoral shaft of cadaveric bones have changed from medieval to recent times. Around 20 (x, y) coordinates of a virtual coordinate system were measured at intervals of 1.5 cm along the shaft of the femur to calculate one single radius of a virtual circle in the (x, y) plane. The median radii of curvature were 119, 141, and 158 cm for medieval, early, and late 20th century femora, respectively. Early and late 20th century femora were of similar length (45 cm), but medieval femora were shorter (43.5 cm). Femora have become not only longer but also straighter since the Middle Ages. These findings account in part for the increase in height of modern generations. Size and shape changes may have significant implications for the biomechanical response of the femur to the forces to which it is subjected in everyday life, in trauma, and following surgical intervention.     

Detecting potential regional effects of increased atmospheric CO2 on growth rates of western juniper

Evidence of an atmospheric CO₂ fertilization effect on radial growth rates was uncovered by examining climate–growth relationships for seven western juniper tree‐ring chronologies in central Oregon using multiple regression models. Consistent upward trends of the residuals from dendroclimatic models indicated a decreased ability for climate parameters to predict growth with time. Additionally, an assessment was made of whether enhanced growth was detectable under drought conditions, because a major benefit of elevated atmospheric CO₂ is the reduction of water stress. Mean ring indices were compared between ecologically comparable drought years, when atmospheric CO₂ was lower (1896–1949), and more recent drought years that occurred under higher atmospheric CO₂ concentrations (1950–96/98). The results presented herein show that: (i) residuals from climate/growth models had a significant positive trend at six of seven sites, suggesting the presence of a nonclimatic factor causing increased growth during recent decades; (ii) overall growth was 23% greater in the latter half of the 20th century; (iii) growth indices during matched drought and matched wet years were 63% and 30% greater, respectively, in the later 20th century than the earlier 20th century; and (iv) harsher sites had greater responses during drought periods between early and late periods. While it is not possible to rule out other factors, these results are consistent with expectations for CO₂ fertilization effects.     

Precocious or early puberty and growth failure in girls treated for acute lymphoblastic leukaemia

We have studied 41 children with early or precocious puberty who have been treated for acute lymphoblastic leukaemia with prophylactic cranial irradiation (1,800-2,400 cGy) accompanied by intrathecal methotrexate and systemic chemotherapy. Mean age at radiotherapy was 3.9 years (range 1.7-7.7) in the girls and 4.8 years (range 2.6-7.8) in the boys. Mean age at the onset of puberty was 8.6 years (range 6.7-9.7) in the girls and 9.3 years (range 7.8-10.3) in the boys. Of the 41 children with early puberty (greater than 1.4 SD from the mean) 36 were females and 5 were males. 21 of the 36 girls had an absent or inadequate growth acceleration of puberty. 7 of 12 girls who had a pharmacological test of growth hormone (GH) secretion had GH insufficiency (peak level less than 20 mU/l). Early or precocious puberty combined with GH insufficiency may produce severe growth failure and we have used a treatment regimen of a gonadotrophin-releasing hormone analogue, in order to reduce the rate of epiphyseal maturation, combined with biosynthetic GH to increase or sustain growth rate. We have treated 4 girls in this manner. During a mean treatment period of 0.86 years, height SDS for bone age rose from a mean of -1.06 to -0.59. Longer treatment periods will be required to assess the effect on final height.     

Catch-up growth in Japanese quail (Coturnix Japonica): relationships with food intake, metabolic rate and sex

The effects of early environmental conditions can profoundly affect individual development and adult phenotype. In birds, limiting resources can affect growth as nestlings, but also fitness and survival as adults. Following periods of food restriction, individuals may accelerate development, undergoing a period of rapid “catch-up” growth, in an attempt to reach the appropriate size at adulthood. Previous studies of altricial birds have shown that catch-up growth can have negative consequences in adulthood, although this has not been explored in species with different developmental strategies. Here, we investigated the effects of resource limitation and the subsequent period of catch-up growth, on the morphological and metabolic phenotype of adult Japanese quail (Coturnix japonica), a species with a precocial developmental strategy. Because males and females differ in adult body size, we also test whether food restriction had sex-specific effects. Birds that underwent food restriction early in development had muscles of similar size and functional maturity, but lower adult body mass than controls. There was no evidence of sex-specific sensitivity of food restriction on adult body mass; however, there was evidence for body size. Females fed ad lib were larger than males fed ad lib, while females subjected to food restriction were of similar size to males. Adults that had previously experienced food restriction did not have an elevated metabolic rate, suggesting that in contrast to altricial nestlings, there was no metabolic carry-over effect of catch-up growth into adulthood. While Japanese quail can undergo accelerated growth after re-feeding, timing of food restriction may be important to adult size, particularly in females. However, greater developmental flexibility compared to altricial birds may contribute to the lack of metabolic carryover effects at adulthood.     

Babies born small for gestational age: insulin sensitivity and growth hormone treatment

Epidemiological studies have identified an association between size at birth and adult risk for type 2 diabetes mellitus and cardiovascular disease. In contemporary populations, children who are relatively small at birth and show rapid infancy weight gain are at greatest risk for the development of childhood obesity, increased visceral fat and insulin resistance: possible early markers of adult disease risk. Individuals presenting to growth clinics with short stature and a history of low birthweight will not have shown post-natal catch-up growth and may be a very heterogeneous group. Nevertheless, there are some data to suggest that as a group they are insulin resistant with decreased lean mass. Growth hormone treatment leads to reversible worsening of the insulin resistance, and short-term data do not indicate an increased risk for type 2 diabetes. However, further long-term follow-up is required, and particular care should be taken in monitoring children with a strong family history of type 2 diabetes and those from ethnic groups in which there is a high background prevalence of the disease.     

Pubertal growth as a determinant of adult height in boys with constitutional delay of growth and puberty

In boys with constitutional delay of growth and puberty, adult height may be inconsistent with parental (target) height. We aimed at studying which period of growth was important to account for adult height being above or below target height. In this retrospective study, adult height measured after 20 years in 39 patients was compared with target height and height data obtained at about 6 and 12 years of age and at diagnosis of delayed puberty (mean 14.6 years). Twenty-eight patients were untreated while 11 received testosterone enanthate (50 or 100 mg/month for 6 months). The growth data from both groups were pooled since they were not different. On average, the adult height standard deviation score (-0. 6 +/- 0.8, mean +/- SD) was similar to target height (-0.5 +/- 0.6). There were, however, marked individual differences since adult height varied between 1.7 SD (11 cm) below target height and 1.4 SD (9.5 cm) above target height. Multiple regression analysis showed that the most significant determinant of the difference between adult height and target height was height catch up during puberty (p < 0.002). We conclude that the magnitude of height catch up during puberty is a significant determinant of adult height in boys with constitutional delay of growth and puberty. Thus, optimizing pubertal growth may be a relevant therapeutic aim for adult height in boys with short stature and delayed puberty. Copyrightz1999S. KargerAG,Basel     

Palatine torus in the Greenlandic Norse.

Physical anthropologists have long been intrigued by the distinctive oral tori expressed by the medieval Norse populations of Iceland and Greenland. To assess the temporal and spatial variation of one form of oral tori, palatine torus, observations were made on all available Greenlandic Norse skeletons, as well as on samples of medieval Icelanders and Norwegians. In terms of temporal variation, 12th to 14th century (medieval) Greenlanders from the Eastern and Western settlements exhibited higher frequencies and more pronounced expressions of palatine torus compared with early 11th century Greenlanders. The early Greenlandic sample closely approximated the medieval Icelandic and Norwegian samples for total torus frequency, although the Norwegians exhibited the trait to a less pronounced degree. As degree of expression is the most distinctive aspect of torus variation among the Norse, some combination of environmental factors, including increased masticatory stress and chronic undernutrition, probably accounts for most of the difference between settlement period and medieval Greenlanders. Although palatine torus may be hereditary in part, environmental factors play a significant role in the expression of this trait.     

Beyond the Boss and the Boys: Women and the Division of Labor in <Emphasis Type="Italic">Drosophila</Emphasis> Genetics in the United States, 1934–1970

The vast network of Drosophila geneticists spawned by Thomas Hunt Morgan’s fly room in the early 20th century has justifiably received a significant amount of scholarly attention. However, most accounts of the history of Drosophila genetics focus heavily on the “boss and the boys,” rather than the many other laboratory groups which also included large numbers of women. Using demographic information extracted from the Drosophila Information Service directories from 1934 to 1970, we offer a profile of the gendered division of labor within Drosophila genetics in the United States during the middle decades of the 20th century. Our analysis of the gendered division of labor supports a reconsideration of laboratory practices as different forms of work.     

Brief communication: A proposed osteological method for the estimation of pubertal stage in human skeletal remains

Puberty forms an important threshold between childhood and adulthood, but this subject has received little attention in bioarchaeology. The new application of clinical methods to assess pubertal stage in adolescent skeletal remains is explored, concentrating on the development of the mandibular canine, hamate, hand phalanges, iliac crest and distal radius. Initial results from the medieval cemetery of St. Peter's Church, Barton‐upon‐Humber, England suggest that application of these methods may provide insights into aspects of adolescent development. This analysis indicates that adolescents from this medieval site were entering the pubertal growth spurt at a similar age to their modern counterparts, but that the later stages of pubertal maturation were being significantly delayed, perhaps due to environmental stress. Continued testing and refinement of these methods on living adolescents is still necessary to improve our understanding of their significance and accuracy in predicting pubertal stages. Am J Phys Anthropol 151:302–310, 2013. © 2013 Wiley Periodicals, Inc.