Stimulus-governance and the hyperkinetic syndrome

The hypothesis that hyperkinetic children are stimulus-governed was tested. In a sample of 39 nonmedicated hyperkinetic boys 26 were found to be stimulus-governed. In a control sample of 20 nonmedicated boys 6 were found to be stimulus-governed. An association was found between the hyperkinetic syndrome and stimulus-governance. The hypothesis is raised that response to methylphenidate is related to stimulus-governance. Several issues raised by the research are discussed.     

Shock-induced aggression and reactivity following raphe lesion in rats. Effects of physostigmine (author''s transl)

The hyperkinetic syndrome, such as it is abundantly described in the literature of American authors, is clearly defined by the association in a young child, essentially at the beginning of schooling, of hyper-activity, psycho-motor instability, affective and learning disorders, emotional lability, immaturity, etc. It would appear that psycho-stimulants (in particular amphetamines) bring about a spectacular improvement in these children, representing a therapeutic test that confirms the diagnosis. In America, insistence is placed on the physiopathogeny of the disorders, and on the minimal cerebral dysfunction. This pathology, which, it would appear, does not seem to have been recognised in France, where the psychomotor instability is only one among many symptoms. We report here a synthetic clinical study of hyperkinetic children observed over a period of several years. They are particular in that they were seen at an early age (between 18 months and 4 years old). The psychopathological study of the early stages (which is usually missing in the literature) makes it possible to objectify a preliminary phase dominated by negative signs, of the "silent series": depressive and regressive tendencies, later hidden by agitation. We underline the importance of the early distorsion of the mother-child link, which appears to be a determining factor in the appearance of the hyperkinetic syndrome. These date (which tend to contradict many studies) lead one to reject the chemotherapy solution, and in particular psychostimulants for the greater majority of cases, and rather to intervene at an early stage, and ideally speaking preventively, to instigate above all a psychotherapy of the child and often of the mother (co-therapy), to restore a good level of communication, and the mother-child link. This in-depth approach should make it possible to avoid a purely symptomatic treatment, with its uncertain effects, and its often undersirable evolution.     

Assessment of problem situations in the family

Goal of the study is the analysis of the German version of Barkle's Home Situations Questionnaire. The analysis is accomplished in a clinical sample of N = 76 children at the age of six to ten years with the diagnosis of a hyperkinetic disorder according to ICD-10 or an Attention deficit-/hyperactivity disorder according to DSM-III-R and in a representative sample of N = 263 children aged seven to ten years. Parents of hyperkinetic children experience many family situations with their child as very problematic which is essentially more often than parents in the representative sample. Analyses of the factorial structure of the questionnaire yielded no clear and well interpretable solutions. The instrument has a good internal consistency. The HSQ-D scores correlate significantly with other parent questionnaires for the assessment of behaviour problems, the highest correlations were found with scales for the assessment of hyperkinetic behaviour problems and social problems. In the clinical practice the instrument has proven helpful within symptom-specific assessment of children with hyperkinetic and oppositional behavior disorders and for the planning of interventions.     

Occurrence of Listeria and listeriosis in Hungary

Type A behaviour has been associated with coronary heart disease, but little is known about how Type A behaviour relates to diet. As part of a cross-sectional epidemiological study in Northern Ireland, Type A behaviour was assessed using a validated questionnaire and diet assessed using weighed records. Diet was described in terms of nutrient intake, food intake and dietary pattern. The study population comprised 245 men and 306 women aged 16 to 64 years. The relation between Type A behaviour and diet was examined by calculating partial correlation coefficients between A-type score and dietary variables, controlling for age and household socio-economic group. In men Type A score showed a weak but significant association with fat and protein intake, and intake of beef, cheese, yoghurt and chips. In women, Type A score showed a weak positive association with sugar and alcohol intake. In both men and women, Type A score was positively associated with the "convenience" dietary pattern. These relationships are discussed in the context of the dominant food ideology and coronary risk.     

Concentration of lead in the blood of children with hyperkinesis

The concentration of lead in bloods of 25 hyperkinetic children was compared to that found in a corresponding number of healthy children of the same age group. It was found that 3 hyperkinetic children showed levels above 40 mug/100 ml. The findings are discussed and the importance of substances containing this element bears on the child's environment are pointed out. Besides, stress is placed on the consequence that a high concentration of lead in the blood may show on mental development and it is suggested that through studies be carried out in every child with the habit of pica added to hyperkinesia.     

Persistent diarrhoea: management in algorithmic approach using a low-cost rice-based diet in severely malnourished Bangladeshi children

Easy and successful dietary management of persistent diarrhoea has been a long desired goal. Finding an efficient diet which is economically feasible, and easy to prepare in poor homes of developing countries, has not been easy. A dietary algorithm was followed to test the clinical efficacy of an inexpensive and easy to prepare diet made up with rice powder, egg white, glucose, and soya oil. We studied a cohort of 100 severely malnourished children aged between 3 and 36 months with persistent diarrhoea in Dhaka Shisu (children's) Hospital, Bangladesh, during 1990. Initially on a milk-based diet, 26 children (26 per cent) improved while on a subsequent rice-based diet; 65 (88 per cent) of the remaining 74 children improved within a week, with a mean recovery period of 4 days. Patients who did not improve with the rice-based diet were weaned earlier than those who improved. Nine patients failed to improve on the rice-based diet. They were given a soya formula, and only two improved. The remaining seven patients finally improved when a comminuted chicken diet was given. Eight patients died in the hospital with secondary infections of septicaemia and bronchopneumonia. This study offers a simple and effective algorithm on the management of persistent diarrhoea and also demonstrates the success of a rice-based diet, showing promising and feasible means of management of persistent diarrhoea in patients with severe malnutrition.     

Mapping of globus pallidus and ventral pallidum lesions that produce hyperkinetic treading

The purpose of this study was to identify sites where striatopallidal lesions produce two distinct sensory-triggered hyperkinetic syndromes: (1) exaggerated forelimb treading alone to oral taste infusions and (2) sensorimotor exaggerated treading plus enhanced aversive reactions to taste infusions. The behavioral characteristics of these syndromes have been described previously (Berridge, K.C. and Cromwell, H.C., Behav. Neurosci., 104 (1990) 778-795). Bilateral excitotoxin lesions were made using quinolinic acid (10 micrograms in 1 microliter) in the caudate/putamen, nucleus accumbens, globus pallidus or ventral pallidum/substantia innominata. In order to identify the precise center, borders, severity and size of lesion sites that caused these hyperkinetic treading syndromes, neuron counts (modified fractionator technique) and glial fibrillary acidic protein immunoreactivity (GFAP-IR) densitometry were used in a stereological mapping analysis. The site of lesions that produced the hyperkinetic treading syndrome without enhanced aversion was found to be restricted to the globus pallidus (GP). Damage exceeding 60% neuron loss bilaterally within a 0.8 x 1.0 x 1.0 mm subregion of the ventromedial GP produced this syndrome. The site of lesions that produced the combined syndrome of hyperkinetic treading and aversive enhancement was ventral to the globus pallidus, within the ventral pallidum/substantia innominata (VP/SI). Damage exceeding 70% neuron loss bilaterally within a 1.0 x 0.5 x 1.0 mm diameter subregion of the ventromedial ventral pallidum/substantia innominata produced this syndrome. This subterritory was located immediately lateral to the border of the lateral hypothalamus. Bilateral lesions to the caudate/putamen or nucleus accumbens did not produce either hyperkinetic treading syndrome. These results are discussed in terms of the connectivity of the ventral pallidal/substantia innominata and globus pallidus regions and in terms of neuropathological models of hyperkinetic disorders.     

Management of phenylketonuria: South Australian experience of 13 cases

The management and present status of 13 children with phenylketonuria detected on the fifth day of life, who have been treated by diet thereafter for five to eight years, are discussed. In all 10 cases in which there has been continuous adequate dietary control of blood phenylalanine levels, the physical, social and mental development of the children has been normal. In some of these cases there is an unexplained discrepancy between the verbal and performance IQ scores. The present policy is to continue restricting the diet indefinitely, relaxation being permitted conditionally only after the age of seven years.     

Nutritional factors and colon cancer

During the last 2 decades, substantial progress has been made in understanding the relationship between dietary constituents and the development of colon cancer in man. Unlike studies of cancer among smokers and nonsmokers, nutritional epidemiologic studies are confronted with the inherent difficulty of assessing reasonably precise exposures. The lack of consistency between international correlation studies and case-control studies does not necessarily negate a dietary etiology of colon cancer because these inconsistencies may have arisen, at least in part, from methodological limitations. Some of these deficiencies in epidemiological studies of diet and cancer have been corrected; recent case-control studies demonstrated that high dietary fat is a risk factor for colon cancer development and that an overall increase in intake of foods high in fiber might decrease the risk for colon cancer. The results of epidemiologic studies may be assumed to present conservative estimates of the true risk for cancer associated with diet. The populations with high incidences of colon cancer are characterized by high consumption of dietary fat, which may be a risk factor in the absence of factors that are protective, such as whole-grain cereals and of other high fiber. Laboratory-animal model studies have shown that certain dietary lipids and fibers influence tumorigenesis in the colon. The data of metabolic epidemiological and laboratory-animal model studies are sufficiently convincing with respect to the enhancement of colon cancer by type of fat and protection by certain dietary fibers.     

History of patient education in rheumatic diseases in Croatia]

OBJECTIVE: This report examined the acceptability to mothers of a dietary educational and behavioral intervention for preadolescent children with elevated levels of serum low-density lipoprotein cholesterol (LDL-C) who were enrolled in the Dietary Intervention Study in Children (DISC). DESIGN: DISC is a randomized, controlled clinical trial. Subjects were randomly assigned to either an intervention or usual-care (control) group. SUBJECTS/SETTING: To be eligible for the study, participants were required to have the average of 2 fasting LDL-C values fall between the 80th and 98th sex-specific percentiles. Three hundred thirty-four 8-to 10-year-old children and their families were randomly assigned to an intervention group, and 329 were assigned to a usual-care (control) group. This study examined data from 232 subjects in the intervention group. Data were collected at 6 intervention sites around the United States. INTERVENTION: Those assigned to the intervention group participated in a multidisciplinary dietary intervention that included a series of group and individual sessions over a 3-year period. Children and their caretakers were taught to follow a nutritionally adequate diet that was low in total fat, saturated fat, and cholesterol and high in polyunsaturated fat. MAIN OUTCOME MEASURES: Three nonconsecutive 24-hour diet recalls were collected at baseline and at 1 year by trained and certified dietitians. A questionnaire designed to assess diet acceptability was administered at months 4, 8, 11, and 15. Demographic measures were collected at the onset of the study. STATISTICAL ANALYSIS PERFORMED: Statistical procedures included factor analysis and regression analysis. RESULTS: Regression analysis suggested that perceived effectiveness of the dietary intervention and mothers' having few concerns about disadvantages of the diet were significantly related to higher overall fat intake in children in one-parent families. Maternal willingness to implement the diet was significantly related to lower saturated fat intake. APPLICATIONS/CONCLUSIONS: In attempts to change eating behavior of children, interest and cooperation of the parents are essential to achieving successful results. These analyses further suggest that maternal acceptability translates into willingness to implement the diet and may facilitate changes that are associated with reduced saturated fat intake in children.     

Nutrient intake and obesity in prepubescent children with Down syndrome

OBJECTIVE: The aim of this study was to measure nutrient intake and body composition in prepubescent children with Down syndrome to understand dietary barriers involved in the prevention and treatment of obesity. DESIGN: Dietary intake was determined from parent-reported 3-day diet records for children with Down syndrome and control subjects. Energy intake was compared with energy expenditure measured by the doubly labeled water method. Body composition was determined by deuterium dilution, bioelectrical impedance analysis, and skinfold thickness measurements. SUBJECTS/SETTING: Ten prepubescent children with Down syndrome and 10 control subjects were recruited from the hospital community. The study was conducted in the Clinical Research Center of the University of Chicago Medical Center. MAIN OUTCOME MEASURES: Nutrient intakes were compared with the Recommended Dietary Allowances (RDAs) to estimate risk for nutrient deficiency. Fat-free mass values determined by bioelectrical impedance analysis and measurement of skinfold thicknesses were compared with values determined using the deuterium dilution method. STATISTICAL ANALYSES PERFORMED: Unpaired t tests were used for comparisons between subjects groups and the Wilcoxon signed-rank test was used for comparison of nutrient intakes with RDAs. RESULTS: The subjects with Down syndrome were significantly shorter (P < .01) than control subjects; however, body composition did not differ between the groups. Reported energy intake was lower in subjects with Down syndrome. In addition, several micronutrients were consumed, especially among nonobese subjects with Down syndrome, at less than 80% of the RDA. APPLICATIONS: To avoid lowering already inadequate intakes of several vitamins and minerals, we suggest that treatment of obesity in children with Down syndrome combine a balanced diet without energy restriction, vitamin and mineral supplementation, and increased physical activity.     

Metabolic insights and nutrition of poultry

Excessive specialization and high production requirements place high demands on the metabolism of poultry. A number of metabolic problems, such as disturbances of energy metabolism (affecting mainly hens) and mineral balance (affecting mainly laying hens), affect performance. Nearly all these problems are multifactorial in nature, but diet, and in particular the interaction between diet and phenotype, plays an important role. The problem of ascites in broiler hens is discussed in relation to external and genetic causative factors. Genetic factors can be further subdivided into structural and functional causative factors. This distinction has important consequences. For example, sudden death syndrome can be distinguished as a separate entity. Fatty liver syndrome in laying hens, and gout and urolithiasis in chicks and hens are briefly discussed. Finally, some of the most important or most common skeletal problems affecting poultry, namely, tibial dyschondroplasia, battery fatigue, rickets, and chondrodystrophy, are briefly discussed in the context of the dietary factors that underlie these disorders or which can be used as treatment.     

Fibers in the Mediterranean diet. An epidemiological study of the Campania Region

BACKGROUND: The authors have evaluated: a) the survival of the "mediterranean diet" as way of life; b) the comparison between fiber content in the diet of adult or school children of the Campania Region. METHODS: To study nutritional epidemiology of adults, a new method consisting of publishing a 24-hour recall dietary chart in a new paper with big regional circulation, Il Mattino, and analyzing all the charts from the different towns of Campania was used. For that, the ZIP code of the subject was used as an informatics button. Data were housed in a computer using Food Meter (an informatics program by Bayer-Medimatica). RESULTS: Differences statistically significant were found between adults or children residing in various district of the Campania Region and Naples town. CONCLUSIONS: Finally, it is important to underline that the amount of fibers of children's diets was higher than adult diets.     

In defense of pediatric nursing undergraduate education

This is a report of 3 Chinese children with intestinal lymphangiectasia in Malaysia. Two children responded to a low fat diet and medium-chain triglyceride supplement. The third child has recurrent chylous ascites. None of the children has recurrent infections despite low CD4+ cells and low levels of IgG and IgA. Intestinal lymphangiectasia is a rare congenital disorder of the mesenteric lymphatic that leads to the obstruction of the lymphatics of the intestine and protein losing enteropathy. Restriction of dietary fat intake will usually result in remission. Recurrent chylous ascites is a problem and management can be difficult.     

HMG-17, a chromosomal non-histone protein, shows developmental regulation during organogenesis

A significant portion of patients who present with non-muscle invasive "superficial" bladder cancer develop the muscle "invasive" life-threatening form of the disease during subsequent follow-up. In clinical studies, overexpression of the epidermal growth factor receptor (EGFR) and the p21 ras oncogene have been strongly associated with this phenotypic tumor transition. The marked difference in incidence of invasive bladder cancer in Asia compared to the United States has made us hypothesize that, among other factors, dietary influences have an impact on such tumor progression. A significantly higher dietary consumption of soy products exists in Asia and has led to the notion that the isoflavones present in this diet may contribute to a reduction in the number of invasive transitional cell bladder cancers. In this regard, we sought to determine the effect of genistein, a naturally occurring dietary protein tyrosine kinase (PTK) inhibitor, on the growth and motility of human bladder cancer cell lines with diverse EGFR and p21ras expression phenotypes and corresponding invasive behaviors. These effects were compared with those of tyrphostin, a pure synthetic EGFR inhibitor. Our results indicate that both genistein and tyrphostin are effective inhibitors of bladder cancer motility and growth, key factors in the development of muscle invasive disease. In addition, the growth and motility inhibitory effects of genistein and tyrphostin are observed preferentially in cells that overexpress the EGFR. Cells that have a mutated p21ras but do not overexpress the EGFR are less inhibited by these 2 compounds, suggesting that their effect is primarily directed at the EGFR signal transduction pathways proximal to the p21ras gene. Our results would seem to corroborate the notion that a high dietary intake of isoflavones is a likely explanation for the decreased incidence of invasive bladder cancer.     

Hyperkinetic syndrome (attention deficit-/hyperactivity disorder) in adulthood

The clinical picture of adult hyperkinetic syndrome (HKS) or attention deficit/hyperactivity disorder is nearly unknown in Germany. It can be estimated, that approximately one third of affected children also show symptoms as adults. In the combined type of the syndrome symptoms of inattention as well as of hyperactivity and impulsivity are present, a predominantly inattentive or hyperactive-impulsive type is possible. Retrospective diagnosis of HKS in childhood can be difficult. Disorganization, emotional disturbances and stress intolerance are common in adults with HKS as well as residual symptoms of learning disorders like dyslexia, dyscalculia and dysgraphia. In differential diagnosis especially affective, anxiety and antisocial personality disorders have to be considered, for which on the other side a frequent comorbidity with HKS is known. There is strong evidence for genetic transmission. Neurobiological findings revealed dysregulation of neurotransmitters. For treatment stimulants as pemoline and methamphetamin are effective, in addition tricyclic antidepressants or beta blockers; positive effects are probable for moclobemide, bupropion, fluoxetine and venlafaxine.     

Carbohydrate versus fat in the dietary treatment of short-bowel syndrome

The importance of the human colon in energy salvage has been documented again in a recent clinical study. Patients with short-bowel syndrome can be divided into two groups: those with colon and those without colon in continuity. While a high-carbohydrate, low-fat diet appears to be of nutritional benefit to the former group, dietary restrictions and reduction of fat intake are not effective in reducing intestinal energy loss in the latter group.     

Protein energy malnutrition, vitamin A deficiency and night blindness in Bangladeshi children

The occurrence of night blindness and serum vitamin A concentrations among children in rural Bangladesh were studied in relation to protein energy malnutrition, dietary habits and intake of vitamin A capsules. In 1992, 124 night-blind children were registered in a cross-sectional survey in the northern part of Bangladesh, and age-, sex- and neighbourhood-matched controls were selected. Of these, the first reported night-blind child from a household (n = 105) and their controls were included in the analyses. Our results showed that night blindness was associated with protein energy malnutrition when using the mid-upper arm circumference (MUAC) as a measure of nutritional status. The odds ratio for a confirmed diagnosis of night blindness among children with a MUAC < 80% of the reference versus normal children was 5.4 (CI 1.9-15.5). Low MUAC was associated with low intake of beta-carotene-rich and vitamin A-containing foods as well as with low serum vitamin A in the total series of cases and controls. This may indicate that night blindness is only one aspect of the general protein energy malnutrition problems in this population. We therefore suggest that measures to prevent vitamin A-related morbidity and mortality should include improvement of the general diet with increased consumption of dietary vitamin A.     

Development and characterization of a purified diet to identify obesity-susceptible and resistant rat populations

A purified moderately high fat diet has been developed to examine diet-induced obesity in rats. Male Sprague-Dawley rats were fed this or an AIN-76A diet for 15 wk and energy metabolism indices were monitored. Food intake, body weight and water balance indices were recorded on a weekly or daily basis. Over the 15-wk period, rats fed the experimental diet diverged into two groups differing in the rate of body weight gain. Animals were labeled as "gainers" or "resisters" depending on their susceptibility to obesity. Following the dietary period, rats were decapitated and trunk blood was collected for glucose and insulin measurements. Gainers consumed slightly more energy than resisters over the experimental period (P < 0.05), but due to greater fecal energy loss, absorbed energy did not differ. Hence gainers became obese without significantly altered energy retention. Urinary creatinine, urea nitrogen and water balance were not different between the groups and consequently could not explain body weight differences. Further, gainers had significantly greater plasma glucose concentration than controls, indicating a potential for these animals to become diabetic. Results suggest metabolic differences must account for the divergence in weight gain observed in the two groups. The dietary model characterized in this study should provide a useful tool to study diet-induced obesity and to determine its underlying mechanism.     

Dietary patterns associated with a low-fat diet in the national health examination follow-up study: identification of potential confounders for epidemiologic analyses

To identify systematically the nutrient and food group intakes associated with a low-fat diet, the authors used the detailed dietary information collected from 10,306 individuals aged 32-86 years in the 1982-1984 National Health Epidemiologic Follow-up Study. Intakes of vitamin C and percentages of calories from carbohydrates, dietary fiber, poultry, low-fat dairy products, fruits, vegetables, cereals, and whole grains were markedly higher, while intakes of protein, total fat, saturated fat, oleic and linoleic acids, cholesterol, sodium, all red meats, high-fat dairy products, eggs, nuts, white bread, fried potatoes, desserts, fats, and oils were much lower in the quartile with the lowest percentage of calories from fat. These dietary patterns associated with a low-fat diet were essentially constant across strata of age, sex, race, and socioeconomic status. This study suggests that individuals on a low-fat diet substitute certain carbohydrate-rich foods such as fruits and vegetables for fat. Given these associations between low-fat diets and other dietary factors independently associated with certain cancers, these dietary factors should be considered potential confounders in studies of dietary fat and these cancers.