Effect of dietary egg on variability of plasma cholesterol levels and lipoprotein cholesterol.

The effects of dietary cholesterol on plasma cholesterol levels, its distribution among lipoproteins, and apoproteins of high-density lipoprotein subclasses in individuals who did and did not demonstrate response in plasma cholesterol levels were studied in 21 healthy middle-aged men for 3 mo. After consumption of 3 eggs/day in addition to their habitual diets for 28 days, 21 subjects were divided into 8 hyper- and 13 hypo-responders. The average plasma cholesterol level of the 21 subjects was changed from 188 +/- 36 to 199 +/- 36 mg/100 ml over the 28-day classification period. During the same period the mean plasma cholesterol level of the hyper-responders was significantly increased (p less than 0.025) from 170 +/- 41 to 199 +/- 29 mg/100 ml while that of the hypo-responders fell slightly. The addition of six eggs to the daily diet of the hypo-responders did not alter the mean plasma cholesterol level but resulted in a wide difference in response of plasma cholesterol concentration. The 13 hypo-responders were divided into hypo-hyper-responders (n = 6) and hypo-hypo-responders (n = 7) depending upon the degree of change in plasma cholesterol level. The present study illustrated the variabilities of plasma cholesterol level among free-living subjects who demonstrated two-stage thresholds of response to dietary intake of cholesterol.

Pyridoxine supplementation: effect on lymphocyte responses in elderly persons.

The effect of pyridoxine supplementation on lymphocyte responsiveness was investigated in 15 persons aged 65-81 y. Eleven subjects received 50 mg/d pyridoxine HCl (PN). Four subjects received a placebo. Lymphocyte proliferation to T and B cell mitogens, lymphocyte subpopulations with monoclonal antibodies, and plasma pyridoxal 5'-phosphate (PLP) were measured before and after 1 and 2 mo of supplementation. After 1 and 2 mo plasma PLP levels increased by 195 +/- 88 nM and 201 +/- 84 nM, respectively, in subjects receiving PN. With PN supplementation, lymphocyte proliferation increased significantly in response to phytohemagglutinin (p less than 0.01), pokeweed mitogen (p less than 0.01), and Staphylococcus aureus (Cowain I) (p less than 0.05). For PN-treated subjects with low presupplement plasma PLP levels, lymphocyte blastogenesis also increased significantly (p less than 0.01) in response to concanavalin A. Percentages of T3+ and T4+ but not T8+ cells increased significantly (p less than 0.05) in PN-treated subjects. These results suggest that improving vitamin B-6 status is important in stimulating immunocompetence in the elderly.

Changes in vitamin B-6 status indicators of women fed a constant protein diet with varying levels of vitamin B-6.

Changes in vitamin B-6 status indicators were evaluated in vitamin B-6-replete subjects. Ten young women consumed diets providing 85 g protein/d and 1.03, 1.33, 1.73, and 2.39 mg vitamin B-6/d for 12 or 15 d during four successive diet periods; in a second study, six women were fed diets providing 85 g protein/d and 0.84, 1.14, and 2.34 mg vitamin B-6/d for 10 or 12 d during three successive diet periods. Vitamin B-6 status indicators showing significant differences among intakes included urinary excretion of 4-pyridoxic acid and total vitamin B-6, pyridoxal 5'-phosphate and total vitamin B-6 in plasma, and xanthurenic acid excretion after a 2-g L-tryptophan load. Significant correlations were found between vitamin B-6 intake and 4-pyridoxic acid, total vitamin B-6, plasma pyridoxal 5'-phosphate, plasma total vitamin B-6, erythrocyte alanine aminotransferase percentage stimulation and postload excretion of xanthurenic acid and volatile amines (kynurenine plus acetylkynurenine). Depending on the indicator, between 20% and 70% of the subjects had inadequate values for 4-pyridoxic acid, total vitamin B-6, plasma pyridoxal 5'-phosphate, and erythrocyte alanine aminotransferase percentage stimulation at a vitamin B-6 intake of 1.33 mg/d (0.016 mg vitamin B-6/g protein). A ratio of dietary vitamin B-6 to protein > 0.016 mg/g is required for adequate vitamin B-6 status in women.

Effect of oral contraceptives and pyridoxine on the metabolism of vitamin B6 and on plasma tryptophan and alpha-amino nitrogen.

The effect of supplementary pyridoxine on the metabolism of vitamin B6 as well as plasma tryptophan and alpha-amino nitrogen was determined in women using oral contraceptive agents. Ten women who were taking oral contraceptive agents and 11 who had never taken them served as subjects. Blood from the various biochemical measurements was drawn from fasting subjects before and after they had received an oral dose of 50 mg of pyridoxine-HCl daily fo 2 days. The use of oral contraceptive agents had no effect on the levels of blood vitamin B6, plasma pyridoxal phosphate, and plasma tryptophan. The activity of erythrocyte glutamic oxaloacetic transaminase was higher (P less than 0.05) in the oral contraceptive agent users than in the nonusers but the stimulation in vitro by pyridoxal phosphate was similar for the two groups. Plasma alpha-amino nitrogen was slightly lower in the oral contraceptive agent users than in the nonusers, but the difference was not statistically significant. The rise in blood vitamin B6 in response to pyridoxine was similar in the two groups, but the rise in plasma pyridoxal phosphate tended to be lower in the oral contraceptive agent treated subjects. Following pyridoxine supplementation, the basal activity of erythrocyte glutamic oxalocetic transaminase increased (P less than 0.01) in both groups of subjects and the stimulation in vitro by pyridoxal phosphate decreased correspondingly. Plasma tryptophan and alpha-amino nitrogen were unaffected by the supplementary pyridoxine.

Vaccine storage practices in pediatric offices.

Fifty pediatric offices and clinics in the metropolitan Los Angeles area were visited to assess vaccine storage practices. Questionnaires were administered to the personnel responsible for vaccine storage and the vaccine refrigerators were inspected. Only 16% of vaccine storage coordinators could cite appropriate storage temperatures for vaccines and 18% were unaware that heat can harm certain vaccines. Refrigerator thermometers were checked at least weekly in only 20% of offices, and 22% of the refrigerators had inappropriately high temperatures. Vaccines were routinely stored outside of the refrigerator uninsulated during the practice day in 16% of the offices visited. It is concluded that vaccine storage errors occur in pediatric offices at an unacceptably high frequency. Pediatricians should familiarize themselves with the guidelines for optimal vaccine storage in order to minimize the potential for vaccine failure in primary care practice.

Reflex sympathetic dystrophy in children: treatment with transcutaneous electric nerve stimulation.

During the past 6 years, ten children with reflex sympathetic dystrophy were treated. Pain in an extremity was the initial complaint in all patients. The pain was unilateral in 90% of the patients; upper and lower extremities were affected with equal frequency. Tenderness to palpation, extreme hyperesthesia, and dysesthesia were other dominant features. All patients had some evidence of autonomic nervous system dysfunction in the affected extremity (swelling, color change, decreased temperature, and/or hyperhidrosis). The median duration of symptoms prior to referral and diagnosis was 5 months. All children were treated as outpatients with a transcutaneous electric nerve stimulator and home-based physical therapy. With this regimen, seven patients had complete remission within 2 months. Two other patients improved with transcutaneous electric nerve stimulation therapy, and one patient had no response to transcutaneous electric nerve stimulation. Reflex sympathetic dystrophy is frequently underdiagnosed in children. Increased awareness of this syndrome is important because accurate diagnosis is crucial and transcutaneous electric nerve stimulation offers a safe, simple, and effective outpatient therapy for reflex sympathetic dystrophy in children.

Developmental changes in speed of information processing in young children.

This study investigated developmental increases in processing speed in young children, relative to adults, with only nonverbal stimuli. R. Kail's (1991) model of the rate of change in processing speed from childhood to adulthood was evaluated. Processing speed was measured in 34 children at 4 years, 37 at 5 years, and 38 at 6 years and in 43 adults, with a battery of 8 computer-administered tests. Results showed clear age-related increases in processing speed that cannot be attributed to increased accuracy and error rate monitoring. Kail's model adequately accounted for the observed rate of developmental change in processing speed; however, the parameter estimates of R. Kail and Y. Park (1992) provided more accurate predictions than did the meta-analytically derived estimates of Kail (1991). Findings support the global developmental trend hypothesis and suggest that this trend extends beyond the range of verbal skills evaluated in previous research.

Development and validation of a telephone questionnaire to characterize lymphedema in women treated for breast cancer.

BACKGROUND AND PURPOSE: Accurate and economical characterization of lymphedema is needed for population-based studies of incidence and risk. The purpose of this study was to develop and validate a telephone questionnaire for characterizing lymphedema. SUBJECTS: Forty-three women who were treated previously for breast cancer and who were recruited from physical therapy practices and a cancer support organization were studied. METHODS: Questionnaire assessment of the presence and degree of lymphedema was compared with physical therapists' diagnoses, based primarily on circumferential measurements. Twenty-five of the 43 subjects were measured independently by 2 physical therapists to assess interobserver agreement. RESULTS: Interobserver agreement on clinical assessments of the presence and degree of lymphedema was high (20/25, weighted kappa=.80); all of the disagreements were between judgments of whether there was no lymphedema or mild lymphedema. For the diagnosis of at least moderate lymphedema (differential in the circumferences of the upper extremities greater than 2 cm), sensitivity of the questionnaire varied from 0.86 to 0.92 and specificity was 0.90. However, sensitivity (varying from 0.93 to 0.96) was higher than specificity (varying from 0.69 to 0.75) for the diagnosis of any lymphedema. DISCUSSION AND CONCLUSION: A few straightforward questions exhibited excellent agreement with physical therapists' assessments for identifying at least moderate lymphedema.

The search for subtypes of DCD: is cluster analysis the answer?

Studies using cluster analysis as a method to identify distinct subtypes of developmental coordination disorder (DCD) have been inconclusive leading some authors to conclude that the method of cluster analysis should be abandoned while others call for the validation of previously defined subtypes. The objective of the current study was to examine the use of cluster analysis as a method of searching for subtypes of DCD to gain a better understanding of how different samples and different measures influence the interpretation of results. The paper provides a detailed review of three commonly cited cluster analytical studies and then explores the possible reasons for the discrepant results by replicating the approach with a different clinical sample. The results highlight the impact of different measures on cluster structure and the importance of adoption of a common standard to facilitate interpretation across studies.

A pilot trial of a cognitive treatment for children with developmental coordination disorder.

This pilot study compared a new treatment approach, the Cognitive Orientation to daily Occupational Performance (CO-OP) to the Contemporary Treatment Approach (CTA) to treating children with Developmental Coordination Disorder (DCD). CO-OP emphasises problem-solving strategies and guided discovery of child and task specific strategies. CTA encompasses a variety of approaches, such as neuromuscular, multi-sensory, and biomechanical, focusing on motor aspects of skill acquisition. Twenty children with a mean age of 9.05 years (S.D. = 1.23) participated in the study. All children had normal intelligence, scored below the 15th percentile on a standardised test of motor ability, and demonstrated motor difficulties significant enough to warrant referral for treatment. Pre- and post-measures included the Canadian Occupational Performance Measure (COPM), the Vineland Adaptive Behavior Scales (VABS), the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP), the Developmental Test of Visual-Motor Integration-Revised (VMI), the motor items of the Self-Perception Profile for Children (SPPC), and the Performance Quality Rating Scale (PQRS). In both groups, treatment goals were child-chosen. Both treatments lead to improved COPM self-ratings of performance and satisfaction; however, improvements in the CO-OP group were greater than those in the CTA group. These results were paralleled by PQRS scores, and the Motor scores on the VABS, but not on the BOTMP measures. This outcome still needs replication as no control group was involved and because of the occurrence of pre-treatment differences between the CO-OP and CTA groups on relevant measures. Follow-up data indicated that children who received CO-OP tended to experience greater long-term maintenance of their motor goals and acquired strategies; follow-up parent-report rated CO-OP treatment as more useful than CTA treatment. Self-report, observer report, standardised assessment, and follow-up all demonstrated the effectiveness of the CO-OP approach, supporting the use of CO-OP and suggesting further investigation of this new cognitive intervention.

Clinical description of children with developmental coordination disorder.

Occupational therapists working within School Health Support Services are receiving increasing numbers of referrals, relative to past rates, for children who are experiencing motor problems and may have developmental coordination disorder. Based upon clinical experience, therapists indicate that these children are typically referred in the early school years and that most have handwriting difficulties; to date, however, there has been little empirical evidence to support these observations. In this paper, descriptive information is presented for 556 children who may be presumed to have developmental coordination disorder and who had been referred to school-based health services in two centres. Typical reasons for referral, co-morbidity information, and assessment practices are presented. Findings confirmed the presence of many occupational performance issues in this population, including handwriting difficulties, and challenge therapists to broaden the current scope of school health assessment and intervention practices.

Do oral contraceptive agents affect nutrient requirements--vitamin B-6?

PIP: Although vitamin B-6 depletion and repletion studies conducted in the 1970s in small samples indicated that oral contraceptive (OC) use does not increase the requirement for this vitamin, there remain 2 reasons for concern about this issue. The 1st is that concentrations of plasma pyridoxal 5'-phosphate (PLP), the single best indicator of vitamin B-6 status, are depressed in the majority of OC users. This consistent finding is independent of dietary intake of the vitamin. The 2nd reason for concern is the potential effect of longterm OC use on the vitamin B-6 status of pregnant and lactating women. OC use exceeding 30 months has been associated with significantly lower serum concentrations of vitamin B-6 at 5 months gestation and at delivery and with lower Apgar scores; in addition, concentrations of vitamin B-16 in breast milk are lower in OC users than in nonusers. These 2 observations indicate that the requirement for vitamin B-6 is increased, even if only slightly, among OC users. Thus, the vitamin B-6 status should be continually evaluated in OC users, especially those who later desire pregnancy and plan to breastfeed. In addition, efforts should made to improve dietary intake of vitamin B-6 in women of childbearing age.^ieng