The cost of baby-led vs. parent-led approaches to introducing complementary foods in New Zealand.

Baby-led approaches to complementary feeding promote intake of family foods rather than infant specific foods, from the start of the complementary feeding period, which advocates suggest should be less expensive. However, this has never been formally examined. We recently completed a 2-year randomised controlled trial comparing baby-led (BLISS) and traditional spoon-feeding (Control) approaches to complementary feeding in 206 infants. Perceived expense was assessed at infant 7, 8, 9 and 12 months of age. The actual cost of intake (food offered, consumed and left over) was calculated from 3-day weighed diet records at 7 and 12 months of age. BLISS was perceived as less expensive than traditional feeding (P = 0.002), but comparisons of actual costs showed only small differences in total daily cost for food offered (NZ$0.20 and NZ$0.10 at 7 and 12 months, respectively), consumed (NZ$0.30, NZ$0.20) or left over (NZ$0.10, NZ$0.20). Baby-led approaches are not cheaper for families than traditional spoon-feeding.

Diagnosis of mitochondrial disease: assessment of mitochondrial DNA heteroplasmy in blood.

Mitochondrial DNA (mtDNA) mutations are an important cause of neurological disease. The identification of causative mtDNA mutations may be particularly troublesome in blood where there are often low levels of mutant mtDNA. This is evident from a recent study in which heteroplasmic mtDNA mutations in cytochrome c oxidase genes were incorrectly thought to be linked to Alzheimer's disease. We wished to explore whether analysis of blood mtDNA, prepared by a number of DNA extraction procedures, influenced the diagnosis of mtDNA disease. DNA was extracted by different procedures from 4 patients with heteroplasmic mtDNA mutations, and the level of heteroplasmy investigated by radioactive PCR-RFLP analysis. Whilst there was no consistent decrease in the level of mtDNA heteroplasmy, we observed the coamplification of a novel mtDNA pseudogene from DNA samples extracted by a simple 'boiling' procedure using primers designed to screen for the tRNALeu(UUR) A3243G mutation. This pseudogene was readily amplified from DNA extracted from rho degrees (mtDNA-less) cells, confirming its nuclear location. We believe that mtDNA pseudogenes may therefore present significant difficulties in the accurate identification of pathogenic heteroplasmic mtDNA mutations in blood.

Succinate-cytochrome c reductase: assessment of its value in the investigation of defects of the respiratory chain.

Defects of the respiratory chain are important causes of human disease and one of the most commonly used assays in the investigation of these patients is the measurement of succinate-cytochrome c reductase. However, this assay measures several components of the respiratory chain and the ability to detect a partial defect in one enzyme complex will depend on the amount of control exerted by that enzyme step on overall electron flux. We show that measurement of succinate-cytochrome c reductase activity may fail to detect partial defects of complex III and therefore is of limited diagnostic value in the identification of complex III defects. However, complex II is a major point of control of flux through succinate-cytochrome reductase and it is likely that measurement of the latter will detect defects of complex II.

Factors that influence minority dental students' career plans.

Questionnaires were mailed to all 443 minority senior dental students and to a randomly selected control group of 200 nonminority seniors. Questions were asked about background income, debt, and future plans. Minorities reported lower family income, but similar debt levels. Minorities were more likely to locate in a minority community, less likely to enter solo practice. About one-third of each group stated that debt influenced practice plans. However, only the minority plans appeared to vary with debt: as debt increased, minorities were less likely to plan a solo private practice.

Society of Critical Care Medicine Critical Care Self-Assessment Program III.

Critical Care Medicine encompasses an extremely broad scope. Examination questions were, therefore, chosen to cover a wide variety of critical care topics. A near Gaussian distribution of scores was found for all physician groups studied. We believe the low mean score of 15% reflects the general difficulty of the examination as well as the tendency of many critical care practitioners to master knowledge poorly outside his or her primary specialty. Hopefully, this examination with rationales and references will expose the practitioner to topics and literature with which he or she has not been previously familiar. Only by integrating knowledge from each of the primary specialities can the practitioner provide optimal care for the critically ill. It is our hope that this examination represents a positive learning experience for its past and future participants. If we have stimulated thought, discussion, and further study in the area of critical care medicine, then our efforts in the preparation of this program have been worthwhile.

Ethnic differences in perinatal mortality--a challenge.

The perinatal mortality rates of mothers who delivered at St. Thomas's Hospital from 1969 to 1976 have been examined. The rate in the West Indian population was significant higher than in the United Kingdom white population. The increased West Indian mortality was confined to infants with a birth weight of more than 2.0 kg and a gestational age of more than 37 weeks. The relative risk of perinatal death for West Indian mothers compared with UK white mothers was 1.4 at birth weights of 2.5 kg to 2.9 kg, rising to 4.3 at 4.0 + kg. West Indian perinatal mortality in term babies of normal birth weight was higher in all maternal age and parity groups except parity 3, but the difference was greatest in women aged 30 or over. The African perinatal mortality rate was not significantly greater than the UK white rate although it followed the West Indian trends. Pre-eclampsia and forceps delivery were associated with a greatly increased perinatal mortality in West Indian babies. The excess West Indian mortality could not be explained completely by differences in the proportions of stillbirths and early neonatal deaths nor by the distribution of births by parity, maternal age, or social class. Possible explanations for the differences in mortality are discussed.

Assessment of oestrogen and progestin effects on epithelium and stroma from pre- and postmenopausal endometria.

PIP: The efficacy of commercially available progestin preparations were investigated with a view toward determining the optimum type, dose, duration, and route of administration required to protect the endometrium. Biochemical indices of estrogen and progestin action in endometria from postmenopausal women receiving various hormone therapies were monitored. The premenopausal samples obtained during the proliferative and secretory phases of the cycle can be compared with physiologically normal activities. Estrogen effects were monitored by nuclear estradiol receptor (REN) and soluble progesterone receptor (RP) content and DNA synthesis by autoradiography after [3-H]-thymidine labelling. Progestin action was assayed by inhibition of estrogen-induced REN and DNA synthesis by induction of isocritic and estradiol dehydrogenases and by morphological criteria. Postmenopausal patients were attending the menopause clinics at King's College Hospital or the Chelsea Hospital for Women in London for symptoms associated with the climacteric. Premenopausal samples were obtained from women attending the above hospitals as well as St. Thomas Hospital in London. There are no differences in REN or estradiol receptor content (RET) between epithelium and stroma for any of the groups. Progestins, regardless of whether they are derived from exogenous (postmenopausal) or endogenous (premenopausal sources, decrease REN and RET in both fractions. Progestins also decreased DNA synthesis in both cell types and this suppression correlates with the fall in REN. The RP content of epithelium is greater than stroma, but the 2 enzymes are markedly stimulated by progestins in epithelium but not stroma. The lower RP content of the stromal fraction could be because of cellular heterogeneity, differential loss of receptor during processing, or to genuine differences between epithelium and stroma. Estrogen induced DNA synthesis is inhibited by progestins in both epithelium ans stroma but the induction of some enzymes is dissimilar in the 2 cell populations. Marked increases in activity of isocitric and estradiol dehydrogenases take place in epithelium but not stroma under the influence of progestins. Enzymes such as acid and alkaline phosphatase do not exhibit this uneven cellular distribution. For the clinical studies on progestin effects, it was decided to analyze DNA synthesis, REN, and estradiol and isocritric dehydrogenase activities. All estrogenic medications in clinical use in the U.K. produce levels of REN and RP that are at least equivalent to those found in the proliferative phase of the premenopausal endometrium. No differences in REN, RP, or DNA synthesis were observed between the 0.625 and 1.25 mg doses of Premarin so it appears that even the low dose of estrogen is maximally stimulating the endometrium. The study results strongly indicate that the addition of a progestin to estrogen medication is efficacious in preventing continued cell multiplication of both epithelium and stroma. They also show that unnecessarily high doses of progestin are in current use.^ieng