Maternal Accommodation of Adolescent Body Dysmorphic Disorder: Clinical Correlates and Association with Treatment Outcomes.

Family accommodation (FA) is widely-recognised as an important clinical phenomenon in obsessive-compulsive disorder (OCD) and anxiety disorders, and is related to poorer treatment outcomes. However, FA has not been quantitatively explored in Body Dysmorphic Disorder (BDD). The aim of this study was to investigate the patterns and correlates of maternal accommodation in adolescent BDD, and its association with treatment outcomes. Participants were 131 adolescents with BDD and their mothers who completed the Family Accommodation Scale-Parent Report (FAS-PR) as part of routine clinical practice in a National and Specialist Service for Young People at the Maudsley Hospital, London. Seventy-six (58%) young people received specialist cognitive behavioural therapy for BDD and had post-treatment data available. All mothers engaged in at least one form of accommodation. Providing reassurance (98.5%) and assisting avoidance (88.5%) were the most commonly endorsed behaviours. Levels of accommodation were positively associated with clinician-rated BDD symptom severity (r = 0.18, p = 0.041) and maternal symptoms of anxiety, depression and stress (r = 0.41, p < 0.001), and negatively associated with child global functioning (r = -0.38, p < 0.001). Maternal accommodation did not predict treatment outcomes (ß = 0.055, p > 0.05). The findings indicate that maternal accommodation is common and has important clinical correlates, but does not impact on treatment response. Consequently, the relationship between maternal accommodation and BDD symptoms may differ to that evidenced in paediatric OCD. Future longitudinal research exploring maternal and paternal accommodation, and assessing variables of interest at multiple time-points throughout treatment, is needed to advance understanding of the role of FA in adolescent BDD.

'What will I be like' after my diagnosis of head and neck cancer?

Consequences of treating head and neck cancer are reflected in health-related quality of life (HRQOL) patient-reported outcomes. HRQOL is an important outcome alongside survival and recurrence. However, relatively little HRQOL information is in a format that patients and oncology teams can easily interpret as a guide to likely outcomes following curative treatment. The study aim was to collate University of Washington Quality of Life (UW-QOL) questionnaires collected 1995-2012 at the Regional Head and Neck Surgical Unit with a view of summarizing key clinical-demographic influences on HRQOL outcomes at 2 years following diagnosis. Patients completing UW-QOL questionnaires at 9-60 months had their record closest to 2 years selected for cross-sectional analyses, while all questionnaires were analyzed to assess temporal trends. 65 % (1,134) of survivors to 9 months had a UW-QOL record in the cross-sectional analysis (median 23 months). Overall 1,349 completed 5,573 UW-QOL questionnaires. Various associations were seen, notably late overall clinical staging and treatment adversely associated with UW-QOL physical functioning domains. Logistic regression was used to better understand the predictive factors of UW-QOL outcome and determined the final formatting of tables for results. These tables provide important reference data about UW-QOL outcome at 2 years relevant to patients at the outset of their cancer journey. The increasing amount of HRQOL data allows for quite detailed subgroup analysis, which can help give patients and the clinical team a better understanding of likely long-term HRQOL outcomes. How this is best utilized in clinical care needs further evaluation.

The effect on the T-14 paediatric throat disorders outcome score of delaying adenotonsillectomy surgery due to COVID-19.

INTRODUCTION: Adenotonsillectomy is commonly performed for recurrent tonsillitis and obstructive sleep apnoea. These conditions may improve with age. The COVID-19 pandemic led to all UK elective surgery being suspended. This study aimed to determine whether delaying surgery had any effect on a patient's symptoms using the validated T-14 paediatric throat disorders outcome test. METHODS: Patients completed a T-14 questionnaire when the child was listed for surgery; this was repeated on the revised surgery date and a paired t test was used to compare the responses. RESULTS: Questionnaires were completed by 29 patients a mean of 6.4 months apart. There was a significant improvement in scores (p<0.02) for five domains: eating habits, visits to a doctor/A&E, antibiotics for less than 2 weeks, chronic infections and school missed due to sore throats. CONCLUSIONS: This study demonstrates that following delays resulting from the COVID-19 pandemic, paediatric patients experienced an improvement in some aspects of their quality of life while awaiting tonsillectomy and/or adenoidectomy. This was most apparent in quality-of-life measures relating to recurrent tonsillitis, namely visits to a doctor/A&E, antibiotics for less than 2 weeks, chronic infections and school missed due to sore throats. Patients may experience an improvement in some of their individual symptoms, in particular their infective symptoms, during an observation period.

Hearing outcomes in children with single sided deafness: Our experience at a tertiary paediatric otorhinolaryngology unit.

INTRODUCTION: Hearing rehabilitation options for single sided deafness (SSD) include contralateral routing of sound (CROS) aids and bone conduction devices (BCDs). This study aimed to review the management of children with SSD at our tertiary paediatric otolaryngology unit over the last 15 years. MATERIAL AND METHODS: A retrospective cohort study was performed. Primary hearing outcomes were measured using the Children's Home Inventory for Listening Difficulties (CHILD) questionnaire score and secondary hearing outcomes were measured using hearing thresholds for speech in noise. Outcomes were measured pre and post bone conduction device (BCD) trial. RESULTS: 49 patients with SSD were identified. 20 children had trial of a BCD. 16 patients had pre- and post- BCD trial CHILD scores available for analysis. There was a statistically significant improvement in CHILD scores and speech in noise testing at +5 dB and +0 dB following amplification with a BCD. The mean use of BCD was 1.3 h per day. DISCUSSION: We have described the management of children with SSD in our unit. This study demonstrated a statistically significant benefit of BCD use on hearing outcomes. However, device compliance is low suggesting hearing advice choice in the population is complex and further research is warranted.

Recurrent acute otitis media: a survey of current management in England.

OBJECTIVE: Recurrent acute otitis media is common in children. The preferred treatment measures for recurrent acute otitis media have a mixed evidence base. This study sought to assess baseline practice across ENT departments in England. METHODS: A national telephone survey of healthcare staff was conducted. Every ENT centre in England was contacted. A telephone script was used to ask about antibiotic and grommet use and duration in recurrent acute otitis media cases. RESULTS: Ninety-six centres (74 per cent) provided complete information. Recurrent acute otitis media treatment across England by ENT departments varied. The antibiotic first- and second-line prophylaxis offered varies, with trimethoprim used in 33 centres and 29 centres not offering any antibiotics. The timing or choice about when to use grommets also varies, but 87 centres (91 per cent) offer grommet surgery at one stage. CONCLUSION: The treatments received by children in England for recurrent acute otitis media vary by centre; collaborative research in this area is advised.

Increased incidence of idiopathic paediatric facial palsy during the coronavirus disease 2019 pandemic.

BACKGROUND: Bell's palsy is a lower motor neurone facial weakness of unknown aetiology, although reactivation of a virus within the facial nerve has been proposed. METHODS: A prospective study was conducted of Bell's palsy cases presenting to our paediatric ENT unit over a 19-week period, from February to June 2020. Patients were invited for severe acute respiratory syndrome coronavirus-2 antibody testing. A text-message questionnaire was sent to other ENT centres to determine their observational experience. RESULTS: During the study period, 17 children presented with Bell's palsy, compared with only 3 children in the same time period in the previous year (p < 0.0001). Five patients underwent severe acute respiratory syndrome coronavirus-2 antibody testing, the results of which were all negative. Four out of 15 centres questioned perceived an increased incidence in paediatric Bell's palsy. CONCLUSION: Clinicians are encouraged to be vigilant to the increase in paediatric Bell's palsy seen during the coronavirus disease 2019 pandemic, which may represent a post-viral sequela of coronavirus disease 2019.

Growth-climate relationships vary with height along the stem in lodgepole pine.

This study tests the hypothesis that ring growth in the upper stem portion of trees is affected by climatic conditions differently than rings formed at breast height (1.3 m). A total of 389 trees from a network of 65 lodgepole pine (Pinus contorta Dougl. ex Loud. var. latifolia Engelm.) sites in Alberta were examined using detailed stem analysis in order to examine interannual patterns of basal area increment and volume increment at different positions along the stem. Growth at lower sections of the bole was mainly driven by temperature and moisture conditions in the seasons prior to the growing season in the year of ring formation, while upper stem growth was more related to conditions during the year of growth, i.e., temperature in the early summer, or moisture in late winter to early spring. This translates into increased allocation of wood to the lower stem when prior late summer conditions are cool and wet, prior winters are mild (warm with little snow) and early summer conditions in the year of ring formation are hot and dry.

The negative impact of wearing personal protective equipment on communication during coronavirus disease 2019.

BACKGROUND: Coronavirus disease 2019 personal protective equipment has been reported to affect communication in healthcare settings. This study sought to identify those challenges experimentally. METHOD: Bamford-Kowal-Bench speech discrimination in noise performance of healthcare workers was tested under simulated background noise conditions from a variety of hospital environments. Candidates were assessed for ability to interpret speech with and without personal protective equipment, with both normal speech and raised voice. RESULTS: There was a significant difference in speech discrimination scores between normal and personal protective equipment wearing subjects in operating theatre simulated background noise levels (70 dB). CONCLUSION: Wearing personal protective equipment can impact communication in healthcare environments. Efforts should be made to remind staff about this burden and to seek alternative communication paradigms, particularly in operating theatre environments.

The role of Personal KinetiGraph™ fluctuator score in quantifying the progression of motor fluctuations in Parkinson's disease.

Motor fluctuations (MF) are important determinants of quality of life in Parkinson's disease (PD). To determine whether the Personal Kineti Graph (PKG), a wearable motion tracking device, can define MF progression, we correlated PKG fluctuator scores (FS) with clinical motor fluctuator profiles in a case-control cohort study. 54 subjects completed a 6-day PKG trial and completed a standardized motor diary. We distinguished non-fluctuators (NF), early (EF), moderate (MF) and troublesome fluctuators (TF), based on Wearing Off Questionnaire and Movement Disorders Society-Unified Parkinson's Disease Rating Scale scores. PKG FS significantly differentiated EF and TF, as well as dyskinetic and non-dyskinetic subjects. Motor diaries could not distinguish the four study groups on the basis of average OFF time, while average time with dyskinesia distinguished NF and MF. In conclusion, PKG FS can distinguish EF from TF, as well as dyskinetic from non-dyskinetic patients, but cannot discriminate subtler MF. PKG may provide objective MF measures for routine PD management and clinical trials.

A high-fidelity, fully immersive simulation course to replicate ENT and head and neck emergencies.

BACKGROUND: Simulation-based training has a fundamental role in medical education as it allows the learner to gain experience managing emergencies in a safe, controlled environment. METHODS: This 1-day course consisted of eight high-fidelity simulation scenarios, followed by a video-assisted debrief focusing on the technical and non-technical (communication skills, teamwork, leadership and situational awareness) aspects of managing ENT and head and neck emergencies. RESULTS: Eight courses have run since June 2014. Post-course questionnaires demonstrated that candidates' confidence scores in managing airway and head and neck emergencies increased following completion of the course (p < 0.0001). CONCLUSION: This was the first fully immersive ENT simulation course developed in the region. The learning objectives for each scenario were mapped to the ENT Intercollegiate Surgical Curriculum Programme. Feedback from the course indicated a continued demand for this style of training, leading to its inclusion in the training calendar.

Functional xylem anatomy of aspen exhibits greater change due to insect defoliation than to drought.

The study of tree rings can reveal long-term records of a tree's response to the environment. This dendroecological approach, when supplemented with finer-scale observations of the xylem anatomy, can provide novel information about a tree's year-to-year anatomical and hydraulic adjustments. Here we use this method in aspen (Populus tremuloides Michx.) to identify xylem response to drought and insect defoliation. Surprisingly, we found that precipitation influenced vessel diameter mostly in the trees' youth, while this correlation was less pronounced at maturity. This is likely due to a reduction in stress the stand experiences as it ages, and reflects an ability to mediate drought stress as trees mature. Defoliation events caused consistent and profound changes in fiber anatomy likely leading to reduced structural support to vessels. We therefore expect that in years of defoliation trees may be vulnerable to drought-induced cavitation when leaf area recovers. This study highlights how the inclusion of cellular level measurements in tree ring studies provides additional information on how stress events may alter tree functioning through alterations in structure.

The use of health related quality of life data to produce information sheets for patients with head and neck cancer.

INTRODUCTION: Health related quality of life information gives patients and carers an indication of how they will be affected following treatment. Such knowledge can promote realistic expectations and help patients come to terms with their outcome. The aim of this paper is to describe the background development of patient information sheets produced at our unit. METHODS: The data were compiled using a common head and neck cancer specific quality of life questionnaire (University of Washington Quality of Life [UW-QOL]). There are 12 domains comprising activity, appearance, anxiety, chewing, mood, pain, recreation, saliva, shoulder, speech, swallowing and taste. The data were collected over 19 years at our unit and focus on follow-up records at around 2 years as this gives a good indication of health related quality of life in survivorship. UW-QOL questionnaires were available from 1,511 patients treated following primary diagnosis of head and neck cancer, and there were 24 subgroups based on cancer site, stage and treatment. There were 2 other subgroups: 132 having transoral laser resection and 176 having laryngectomy. RESULTS: The patient and carer research forum helped to design the information sheets, which display overall quality of life, percentages with 'good' outcome and 'significant problem' by domain, and the most important domains. Three examples are included in this paper: early stage oral cancer treated by surgery alone, early laryngeal cancer treated by surgery alone, and late stage oropharyngeal cancer treated by surgery and postoperative radiotherapy. All 26 subgroup information sheets are available in booklet form and on the internet. CONCLUSIONS: How the surgical community best utilises this type of resource needs further research.

Effects of alcohol ingestion on lipids and lipoproteins in normal men: isocaloric metabolic studies.

To investigate metabolic relationships between alcohol ingestion and fasting plasma high density lipoprotein cholesterol (C-HDL) and triglycerides, seven young normal males were assessed with isocaloric substitution of alcohol for carbohydrate in the diet. For a 5-week study period, an isocaloric low cholesterol diet containing 20% of the calories as protein, 40% as fat, and 40% as carbohydrate, with < 300 mg cholesterol per day, P/S 1.5/1, was ingested. In weeks 2 and 3, 35 and 53 g/day of 100 proof Vodka were ingested, with isocaloric substitution of alcohol for dietary carbohydrate during these study weeks. In week 5, 1.35 g/day of lecithin linoleate was added to assess another putative nutritional approach to increasing C-HDL levels. By two-way analysis of variance and Scheffe's paired t tests, there were no significant differences in either C-HDL or triglyceride levels for any of the five metabolic diet, alcohol substitution diet periods; additionally, there were no significant effects of lecithin on plasma lipids or lipoproteins. The general question asked, "Does alcohol affect C-HDL levels?" is answered negatively for isocaloric alcohol substitution, on a cholesterol-poor, high P/S, and relatively carbohydrate restricted diet, for a 2-week period of moderate alcohol intake. Alcohol's effect on C-HDL and triglyceride probably involves an interaction with total calories, and perhaps with dietary composition (cholesterol, saturated fat, carbohydrate content), as well as the amount of ethanol ingested, and duration of intake.

Influence of polyunsaturated and saturated fats on plasma lipids and lipoproteins in man.

The effects of varying polyunsaturated/saturated (P/S) fat ratios on the plasma levels of lipids, lipoproteins, and apolipoprotein A-I were assessed in six normal healthy subjects (three males, three females) with a particular focus on the P/S ratio which would offer optimal concentrations of both low-(LDL) and high-density lipoproteins (HDL). The isocaloric experimental diets contained 40% of calories as carbohydrate, 40% fat, and 20% protein; dietary cholesterol was 400 mg/day. The P/S ratio for the diets was 0.4, 1.0, or 2.0. Each diet was sequentially consumed for periods of 2 wk each. At the end of each 2-wk study period, plasma lipid, apolipoprotein A-I, and LDL and HDL cholesterol concentrations were determined; HDL were fractionated by zonal ultracentrifugation and lipid and protein composition determined. Compared to the P/S = 0.4 diet, mean plasma total cholesterol fell by approximately 6 and 12% on the P/S = 1.0 or P/S = 2.0 diets, respectively; plasma concentrations of LDL-cholesterol, HDL-cholesterol, and apolipoprotein A-I were also decreased on the polyunsaturated fat diets. The mean +/- SEM concentration (mg/dl) of HDL-cholesterol was 49.0 +/- 5.2 (P/S = 0.4), 44.0 +/- 3.8, (P/S = 1.0) and 41.0 +/- 3.7 (P/S = 2.0). As a result of a reduction in both LDL- and HDL-cholesterol on the polyunsaturate-rich diets, the ratios of HDL-cholesterol to plasma total cholesterol and HDL- to LDL-cholesterol were not significantly changed on the three diets.(ABSTRACT TRUNCATED AT 250 WORDS)

Sucrose polyester: substitution for dietary fats in hypocaloric diets in the treatment of familial hypercholesterolemia.

In five obese women heterozygous for familial hypercholesterolemia, we assessed the combination of weight loss and sucrose polyester (SPE) in lowering low-density lipoprotein cholesterol (LDLC). After a 10-day basal hypocaloric (1426 cal/day), 270 mg cholesterol, P/S 1.2:1 diet, an average of 36 g of dietary fat/day was replaced by 36 g of an 80/20 SPE-hydrogenated palm oil mixture, providing 30 g SPE for 30 days; during the SPE substitution period mean dietary cholesterol and P/S were unchanged, mean caloric intake was 1104 cal/day. During the hypocaloric basal diet, mean weight fell 1.2 kg, p less than 0.02, total plasma cholesterol fell 8% from 358 +/- 46 to 330 +/- 47 mg/dl, p less than 0.01, LDLC fell 4% from 264 +/- 37 to 254 +/- 44 mg/dl, p greater than 0.1, and mean high-density lipoprotein cholesterol fell 11%, from 52 +/- 4 to 46 +/- 4, p less than 0.05. Over the 30-day SPE substitution, mean cholesterol fell 20% from 330 +/- 47 at the end of the basal diet to 265 +/- 42 mg/dl, p less than 0.001; mean LDLC fell 23%, from 254 +/- 44 to 195 +/- 41 mg/dl (p less than 0.01); weight fell 4%, p less than 0.01, from 91 +/- 7 to 87 +/- 7 kg, and mean high-density lipoprotein cholesterol fell 11% from 46 +/- 4 to 41 +/- 2, p less than 0.05. Hypocaloric removal of dietary fat by SPE, an artificial fat with culinary properties of conventional dietary fats, effectively reduces LDLC (by 23%) in familial hypercholesterolemia subjects, with additive effects of SPE and weight loss.

Effect of sucrose polyester on fecal bile acid excretion and composition in normal men.

The effects of sucrose polyester (SPE) (a nonabsorbable mixture of hex-a, hepta,- and octa-fatty acid esters of sucrose with physical properties similar to those of common dietary fats) on fecal bile acid excretion and composition were assessed in 24 healthy, nonobese, normolipemic male volunteers, in a 40-day, inpatient, metabolic balance study. Isocaloric diets provided either 800, 300, or less than 50 mg of cholesterol/day (P/S ratios respectively 0.4, 1.0, and 1.5). After diet-only perids of 10 days (for the 800 and 300 mg cholesterol regimens), and 21 days (for the 50 mg diet), the diets were continued for 30 days, with addition of SPE to diets over three successive treatment periods of 10 days each, with 8, 16, and 35 g of liquid SPE/day, or 15, 30, and 50 g SPE/day in a SPE-hydrogenated palm oil mix. On both the liquid SPE and SPE-hydrogenated palm oil mix, there were no significant changes in fecal bile acid excretion as a function of dietary SPE, at any level of cholesterol intake, P > 0.1. In most subjects SPE changed fecal bile acid composition; lithocholic acid was decreased, and in most instances this was accompanied by the appearance and increase in chenodeoxycholic acid. In one subject, both deoxycholic and 3 beta, 12 alpha-dihydroxycholanic acid were reduced, with an accompanying increase in cholic acid. The hypocholesterolemic effect of SPE appears to be mediated through its reduction of intestinal absorption of cholesterol, not through effects on bile acid excretion.

Alimentary lipemia: plasma high-density lipoproteins and apolipoproteins CII and CIII in healthy subjects.

Three healthy male and three female inpatient volunteers consumed isocaloric diets for 4 wk. At weekly intervals, a fatty meal (100 g fat) was consumed by each fasting subject and blood drawn at 2 h intervals for 12 h. Of the four oral fat loads, two contained saturated fat (polyunsaturated/saturated fat ratio = 0.34) and two contained unsaturated fat (polyunsaturated/saturated fat = 2.21). The magnitude of alimentary lipemia, expressed as area under the plasma triglyceride curve, was 3- to 4-fold higher in males than females. Alimentary lipemia was inversely related to the subjects' fasting plasma high-density lipoprotein (HDL)-cholesterol, HDL apolipoprotein (apo) CIII and directly related to plasma triglycerides. The P/S ratios of the daily diet or the fat meal did not significantly influence the plasma triglyceride curve. After fat intake, mean (+/- SEM) plasma total apoCII and CIII fell to 54 +/- 20% and 73 +/- 5% of base-line, respectively, at 12 h in five of six subjects. After oral fat, an initial fall and a subsequent rise in apoCII and CIII in HDL was associated with reciprocal changes in apoC concentrations in very low-density lipoproteins. We speculate from the data that 1) plasma HDL and their apoC concentrations are important determinants of chylomicron clearance and 2) transfer of apoCs from HDL to triglyceride-rich lipoproteins in the early phase of fat absorption does not result in the total recycling of apoCs from these lipoproteins to HDL during the late phase of alimentary lipemia.

Sucrose polyester and covert caloric dilution.

Total daily caloric intake was measured in 10 obese subjects when sucrose polyester (SPE), a nonabsorbable synthetic fat, covertly replaced conventional fats in a single crossover study consisting of three periods: a period of 7 to 14 days to determine baseline caloric intake and two 20-day study periods. An average of 60 g SPE/day replaced conventional fat in one of the two study periods. During both study periods, 60% of the base line caloric intake was "required intake" at mealtime; an additional 60% of base line caloric intake was allowed as "free choice" foods at a specified snacktime. It was thus possible during both study periods to consume more than 100% of the base line caloric intake. In the SPE study period, 40 g SPE replaced 40 g conventional fat for every 1200 kcal of required intake, resulting in a 30% reduction in mealtime caloric intake. Mean total caloric intake (meal and snack) fell 23% during the SPE period (p less than 0.05), despite an average daily weight loss of 0.18 kg. Snack caloric intake did not increase significantly to compensate for caloric dilution of the meals during the SPE period. These results indicate that the obese may not detect or may not compensate for covert dilution of fat calories with SPE. In addition, during the SPE period, there was a 10% reduction in total plasma cholesterol, a 14% reduction in low-density lipoprotein cholesterol, and a 10% reduction in triglyceride concentration. Thus, fat replacement with SPE may benefit weight reduction regimens in obese subjects by facilitating decreased caloric intake and by improving the circulating lipoprotein profile as well.

Effects of drinking water monochloramine on lipid and thyroid metabolism in healthy men.

The purpose of this study was to determine whether a 4-week consumption of 1.5L per day of drinking water containing monochloramine at a concentration of 2 ppm (ppm = mg/L) or 15 ppm under controlled conditions would alter parameters of lipid or thyroid metabolism in healthy men. Forty-eight men completed an 8-week protocol during which diet (600 mg cholesterol per day, 40% calories as fat) and other factors known to affect lipid metabolism were controlled. During the first 4 weeks of the protocol, all subjects consumed distilled water. During the second 4 weeks, one-third of the subjects were assigned randomly to drink 1.5 L per day of water containing 2 ppm of monochloramine, to drink 1.5 L per day of water containing 15 ppm monochloramine, or to continue drinking distilled water. Four blood samples were collected from each subject at the end of each 4-week study period. Subjects drinking monochloramine at a concentration of 2 ppm showed no significant changes in total cholesterol, triglycerides, HDL cholesterol, LDL cholesterol, apolipoproteins A1, A2, or B when compared to the distilled water group. Parameters of thyroid function also were unchanged by exposure to monochloramine at this concentration. However, subjects drinking monochloramine at a concentration of 15 ppm experienced an increase in the level of apolipoprotein B. Other parameters of lipid and thyroid metabolism did not change. We conclude that consumption of drinking water containing 2 ppm of monochloramine does not alter parameters of lipid and thyroid metabolism in healthy men. Consumption of water containing 15 ppm monochloramine may be associated with increased levels of plasma apolipoprotein B.

Lack of effect of drinking water chlorine on lipid and thyroid metabolism in healthy humans.

Animal studies and a single human epidemiological study have suggested that chlorine in drinking water may raise the level of blood cholesterol. The purpose of this study was to determine whether a 4-week exposure to drinking water chlorine (1.5 L per day) at a concentration of 20 ppm (ppm = mg/L) under controlled conditions would alter circulating parameters of lipid metabolism in healthy humans. Thirty men and thirty women each completed an 8-week protocol during which diet (600 mg cholesterol per day, 40% calories as fat) and other factors known to affect lipid metabolism were controlled. For the first 4 weeks of the protocol, all subjects consumed distilled water. For the second 4 weeks, half of the subjects were assigned randomly to drink 1.5 L per day of chlorinated water (20 ppm), while the others continued drinking distilled water. Four blood samples were collected from each subject at the end of each 4-week study period. Compared to the control group, those subjects given chlorine showed no significant changes in total plasma cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol, or apolipoproteins A1, A2, or B. There was a trend toward low serum thyroxine and triiodothyronine levels in men given chlorine, though thyroid-stimulating hormone levels were unchanged. This trend, if real, was not clinically significant. Thus, short-term exposure to chlorinated drinking water at 20 ppm appears to have no significant impact on parameters of lipid or thyroid metabolism in healthy humans.