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Objective: To examine the impact of childhood body mass index (BMI) on timing of puberty, adult stature and obesity. Design: A retrospective school-based cohort follow-up study. Subjects: A total of 1520 men born between 1927 and 1956 with serial height and weight measurements from the age of 9 to 18, followed up in adulthood at a mean age of 63 years. Measurements: Prepubertal (child) BMI; age at peak height velocity (APHV); adult leg length, waist and hip circumference (selfreported), and height and weight (measured). Results: Boys with a higher childhood BMI tended to have an earlier puberty (per s.d. increase in child BMI: À0.31 years, 95% confidence interval (CI): À0.23 to À0.39, Po0.001). Childhood BMI correlated strongly and positively with adult adiposity, as measured by BMI (1.24 kg/m 2 , 95% CI: 1.04-1.45, Po0.001), waist (1.94 cm, 95% CI: 1.50-2.37, Po0.001) and hip (1.91 cm, 95% CI: 1.55-2.28, Po0.001). It correlated inversely with leg length (À0.40 cm, 95% CI: À0.68 to À0.12, P ¼ 0.005), but not significantly with height or trunk length. Boys with a later puberty tended to be taller (per s.d. increase in APHV: 0.57 cm, 95% CI: 0.17-0.97, P ¼ 0.006) and less adipose as adults (À0.55 kg/m 2 , 95% CI: À0.33 to À0.77, Po0.001). Conclusion:The long-term consequences of childhood obesity into adulthood are well known, but the potential impact on early pubertal maturation is less well appreciated. The factors that contribute to the onset and persistence of childhood obesity require more public health focus.

Objective To explore geographical and sociodemographic factors associated with variation in equity in access to total hip and knee replacement surgery. Design Combining small area estimates of need and provision to explore equity in access to care. Setting English census wards. Subjects Patients throughout England who needed total hip or knee replacement and numbers who received surgery. Main outcome measures Predicted rates of need (derived from the Somerset and Avon Survey of Health and EnglishLongitudinal Study of Ageing) and provision (derived from the hospital episode statistics database). Equity rate ratios comparing rates of provision relative to need by sociodemographic, hospital, and distance variables. Results For both operations there was an "n" shaped curve by age. Compared with people aged 50-59, those aged 60-84 got more provision relative to need, while those aged ≥85 received less total hip replacement (adjusted rate ratio 0.68, 95% confidence interval 0.65 to 0.72) and less total knee replacement (0.87, 0.82 to 0.93). Compared with women, men received more provision relative to need for total hip replacement

Hemoptysis is common in patients with cystic fibrosis (CF). Bleeding may vary in severity, ranging from minor blood-streaking of sputum to expectoration of significant quantities of blood. Major hemoptysis, defined as bleeding greater than 240 ml/24 h, represents a medical emergency. Bronchial artery embolization (BAE) is one of the treatment options for hemoptysis. We reviewed the 10-yr experience at the University of North Carolina Hospitals in the treatment of hemoptysis by BAE. Eighteen patients with CF were hospitalized on 29 occasions and underwent 36 BAE procedures for the control of hemoptysis. Most patients (n = 11) had very severe lung disease (FEV1 < 35%) with a high incidence (n = 9, 50%) of multi-drug-resistant bacteria. Fifteen patients (n = 33 procedures) were followed for a mean of approximately 22 mo after BAE. The overall efficacy of BAE for initial control of hemoptysis was 75% (n = 22) after one session, 89% (n = 26) after two sessions, and 93% (n = 27) after three sessions. The overall recurrence rate per episode was 46% (12/26 presentations in four patients) with a mean time for recurrence of approximately 12 mo. There was a high incidence (75%) of bleeding from nonbronchial systemic collateral vessels among patients (n = 7) who had undergone a previous BAE. There were two deaths associated with massive hemoptysis despite BAE. Three patients had transient neurologic deficits during BAE. We concluded that BAE is a relatively safe and effective means of treating significant hemoptysis in patients with CF.