A randomized targeted amino acid therapy with behaviourally at-risk adopted children.

BACKGROUND: Increasing numbers of children are at-risk for behavioural and emotional disorders, a phenomenon contributing to increased use of pharmacological interventions for paediatric clients. Adverse side effects and other risks associated with pharmacological approaches have helped fuel interest in nutritional interventions for behaviourally at-risk children. METHODS: The current randomized clinical trial evaluates the efficacy of a neurochemical intervention involving the glutamine and glutamate analogue L-theanine and 5-hydroxytryptophan, the precursor for serotonin, with children adopted from traumatic backgrounds. RESULTS: Results include significant increases in urinary levels of the biomarkers for serotonin and gamma-aminobutyric acid, coupled with significant decreases in parent reports of the children's behaviour problems. CONCLUSIONS: While further research is needed, these initial findings are encouraging and are consistent with a growing number of studies indicating the efficacy of nutritional approaches to help behaviourally at-risk children.

Understanding of literal truth, ironic criticism, and deceptive praise following childhood head injury.

Children with closed head injury (CHI) have semantic-pragmatic language problems that include difficulty in understanding and producing both literal and nonliteral statements. For example, they are relatively insensitive to some of the social messages in nonstandard communication as well as to words that code distinctions among mental states. This suggests that they may have difficulty with comprehension tasks involving first- and second-order intentionality, such as those involved in understanding irony and deception. We studied how 6- to 15-year-old children, typically developing or with CHI, interpret scenarios involving literal truth, ironic criticism, and deceptive praise. Children with severe CHI had overall poorer mastery of the task. Even mild CHI impaired the ability to understand the intentionality underlying deceptive praise. CHI, especially biologically significant CHI, appears to place children at risk for failure to understand language as externalized thought.

Worker exposure and health risks from volatile organic compounds utilized in the paint manufacturing industry of Kenya.

This study provides a means for the evaluation of cleaner manufacturing and the provision of cost-effective worker health improvements in developing nations. Individual worker exposure to volatile organic compounds was measured in the paint manufacturing plants of Nairobi, Kenya. A variety of different paint production jobs were monitored, including laboratory researchers, mixers, tinters, fillers, cleaners, raw materials deliverers, and resins producers. Exposure levels were calculated based on a time-weighted average over an entire 8-10 hour workday. The paint solvents used can cause both acute and chronic health problems for the workers exposed. For example, over half of the organics monitored, i.e. benzene, styrene, and xylene, exhibit carcinogenic properties. The lifetime cancer risk from exposure to these paint solvents was estimated utilizing published cancer potencies, and the risks range from 1.90 x 10(-4) for raw materials deliverers to 2.60 x 10-2 for cleaners. The highest exposure tasks included cleaning the mixing vats and mixing the paint product, ranging from risks of 8.5 x 10(-4) to 2.6 x 10(-2), providing evidence that solvent exposure occurs due to point sources. Because of this, simple and inexpensive technologies should significantly reduce the excess exposure of workers in these manufacturing facilities. The cost of minor-innovations in the plants themselves, such as fans, drum and mixing vat covers, and respirators, could amount to as much as five times less than the estimated cost of treating workers who develop cancer due to paint solvent exposure.

Phonological processing, not inhibitory control, differentiates ADHD and reading disability.

OBJECTIVE: To test for the distinctiveness of attention-deficit hyperactivity disorder (ADHD) and reading disability (RD) and the independence of the cognitive domains, inhibition and phonological processing, which are proposed as central to ADHD and RD, respectively, using a classic double dissociation design. METHOD: A 2 (ADHD versus no ADHD) x 2 (RD versus no RD) model was used to examine the cognitive profile of 4 groups of children, aged 7 to 11 years. Two measures of inhibitory control and 3 phonological processing measures were used. RESULTS: The 2 RD groups (RD, ADHD + RD) were significantly impaired relative to the 2 non-RD groups (controls, ADHD) on all phonological processing measures. The 2 ADHD groups were significantly impaired on simple go-task responding relative to the non-ADHD groups and in inhibition. Contrary to predictions, an RD effect on inhibitory control was found on one inhibition measure. The comorbid group (ADHD + RD) generally exhibited the deficits of both single groups in an additive fashion. CONCLUSIONS: These findings question the role of inhibitory control as a unique cognitive marker for ADHD and suggest true comorbidity for children with both ADHD and RD.

A comparison of the Kennedy Axis V and the Global Assessment of Functioning Scale.

In this article, the authors evaluate two brief clinician-scored global assessment instruments used to measure the functioning of adult clients who have a serious mental illness: the Global Assessment of Functioning (GAF) Scale and the relatively new Kennedy Axis V (K Axis). Although both instruments are brief and easy to score, the K Axis provides a multi-dimensional evaluation, while the GAF provides a single, unidimensional picture of a client's functioning. Statistical analyses indicated that both instruments have adequate validity and reliability if the clinicians using them are sufficiently trained. Correlations between the two instruments were high where expected. Statistically significant differential functioning was found for various subgroups. The K Axis was better able to pinpoint this specific differential functioning.

Intracavernosal therapy for erectile failure--impact of treatment and reasons for drop-out and dissatisfaction.

OBJECTIVES: To examine the impact of intracavernosal therapy on libido, ejaculatory control, quality of life and treatment dependency in men with erectile failure. Furthermore to assess the drop-out rate and reasons for dissatisfaction with the technique. SUBJECTS AND METHODS: Questionnaires were sent to 1116 subjects with erectile failure who had previously elected to use intracavernosal therapy in the period 1995-1997. RESULTS: The response rate was 72.5%. The majority of erections lasted 30-60 min, 10-20% of the erections were considered unsatisfactory for intercourse and 15% of subjects reported erections lasting longer than 5 h on at least 10% of the occasions. Bleeding at the injection site occurred in 60% on at least 10% of the occasions and various degrees of deformation of the penis shaft were reported by 10%. The latter was related to the age of the subject and not the type of medication employed. Forty percent experienced at least partially improved control over ejaculation and almost 50% experienced some degree of increase in libido. One quarter retained penile rigidity after ejaculation but this was age-dependent. In those satisfied with intracavernosal treatment, 80% admitted that it had improved the quality of their lives. Sixty percent did not feel that their dependency on intracavernosal treatment had lessened during the treatment period. Approximately 40% of subjects admitted to dropping out of the programme, the majority within the first six months. The age of the subject did not influence the decision and the type of medication or the mode of injection had only a minor impact on drop-out rate. Of those currently using IC therapy, 87% were either fully or partly satisfied with this form of treatment. The corresponding figure for those discontinuing treatment was 58%. Dissatisfaction was higher in the younger age groups and could not be clearly related to the mode of injection. The major reasons for drop out or dissatisfaction were inadequate penile rigidity, the expense of the treatment, penile discomfort and the lack of spontaneity it necessitated. Penile discomfort was more associated with younger age groups, whilst an inadequate response to medication was more often experienced by men over 60 y. Deformation of the penile shaft was observed in 5% of those dissatisfied with IC therapy and was four times more often reported by those over 70 compared to subjects younger than 40 y. In 6% of cases, a return of spontaneous erections was given as reason for drop-out. This was more often associated with younger subjects. In 16% of the subjects, the partner had expressed dissatisfaction with the technique primarily because of inadequate rigidity, lack of spontaneity or the complicated nature of the treatment. CONCLUSIONS: Intracavernosal treatment for erection failure is associated with side-effects such as penile fibrosis and bleeding at the injection site but has advantages including increased libido, an increase in the quality of life and ejaculatory control. Only a small proportion of men reduce their dependency on the technique with time. The therapy has a relatively high attrition rate. In many cases, the reasons for subject and partner dissatisfaction are potentially correctable e.g. by altering the medication used, by the use of injector devices or by obtaining financial support for IC medication from medical welfare.

Utility of the sperm chromatin structure assay as a diagnostic and prognostic tool in the human fertility clinic.

The sperm chromatin structure assay (SCSA) was used to measure over 500 human semen samples from two independent studies: Study I, 402 samples from 165 presumably fertile couples wishing to achieve pregnancy over 12 menstrual cycles; Study II, samples from 115 patients seeking fertility counselling. The SCSA measures susceptibility to DNA denaturation in situ in spermatozoa exposed to acid for 30 s, followed by acridine orange staining. SCSA data from the male partners of 73 couples (group 1) achieving pregnancy during months 1-3 of Study I were used as the standard of 'sperm chromatin compatible with high fertility' and were significantly different from those of 40 couples (group 3) achieving pregnancy in months 4-12 (P < 0.01) and those of male partners of 31 couples (group 4) not achieving pregnancy (P < 0.001). Group 2 contained couples who had a miscarriage. SCSA values for Study II were almost twice that of the Study I fertility standards. Within-couple repeatability tended to be less for group 3 than for groups 1, 2 or 4. Based on logistic regression, spermatozoa with denatured DNA (cells outside the main population, COMP alpha t) were the best predictor for whether a couple would not achieve pregnancy. Some 84% of males in group 1 had COMP alpha t < 15%, while no couples achieved pregnancy in group 1 with > or = 30% COMP alpha t, a threshold level considered not compatible with good fertility. Using selected cut-off values for chromatin integrity, the SCSA data predicted seven of 18 miscarriages (39%).

Selenium in human male reproductive organs.

The objective of the study was to obtain information on the concentration and distribution of selenium throughout the human male reproductive tract. Material was removed at autopsy from 41 men who had died suddenly and unexpectedly. Semen samples were also provided from 184 men attending an andrology clinic for fertility investigation and from 32 healthy volunteers. Significant positive correlations in the selenium concentration were demonstrated between the different reproductive organs, the testis having the highest concentrations. No correlation was found between the concentration of selenium in the genital organs and liver, kidney or blood, suggesting that its uptake and/or biochemical activity in the reproductive organs may be controlled by similar mechanisms not shared by the other organs. No significant age-dependent changes could be detected in tissue selenium concentrations. In a group of men under fertility investigation, a significant positive correlation was obtained between seminal plasma concentrations of selenium and concentrations of spermatozoa in the same ejaculate. A significant positive correlation between concentrations of zinc and selenium in the same ejaculates indicated that selenium may arise largely from the prostate gland.

An evaluation of the 1993-94 Bangladesh Demographic and Health Survey within the Matlab area.

PIP: The 1993-94 Bangladesh Demographic and Health Survey (DHS) reported substantial declines in vital rates, especially the fertility rate, which needed confirmation. The demographic database of the International Center for Diarrheal Disease Research, Bangladesh (ICDDR,B) contains the birth and death records for 200,000 people whose households have been visited every 2 weeks since 1966. In addition, the system kept records on the pregnancy and contraceptive use status of women of reproductive age since 1977. A validation study was conducted, which entailed the comparison of fertility and infant mortality rates from a special DHS survey conducted in the Matlab treatment area in 1994, with rates obtained by the Demographic Surveillance System (DSS) over the 5 years prior to the survey and also the comparison of the current contraceptive use rate. The records of 2628 women were examined. The Matlab DHS was found to be accurate in estimating fertility both in the treatment and comparison areas. The Matlab DHS infant mortality rates for the 5 years prior to the survey were also consistent with the estimates derived from the DSS. However, the Matlab DHS seemed to have underestimated contraceptive prevalence, which underestimate was substantial for modern temporary methods, especially pills and injectables. Since contraceptive prevalence may also be higher at the national level as a result of this, the total fertility rate for Bangladesh of 3.4 children/woman may be plausible. Although the Matlab DHS figures on vital rates seem to be reliable, the national level DHS estimates may not be as reliable, because women elsewhere in the country may not have reported their children's births and deaths as accurately as did women in the Matlab area.^ieng

Language abilities in children with attention deficit hyperactivity disorder, reading disabilities, and normal controls.

Research has demonstrated a high prevalence of language impairments (LI) and reading disabilities (RD) in children with attention deficit hyperactivity disorder (ADHD). Since RD is also associated with LI, it is unclear whether the language impairments are specific to ADHD or associated with comorbid RD. The language abilities of ADHD children with and without RD were investigated in a task requiring recall of a lengthy narrative, and in tests assessing knowledge of the semantic aspects of language. The study was conducted with 50 boys--14 ADHD, 14 ADHD + RD, 8 RD, and 14 normal controls, aged 7 to 11. Children with ADHD (ADHD-only, ADHD + RD) exhibited difficulties in organizing and monitoring their story retelling. Children with RD (RD-only, ADHD + RD) demonstrated deficits in receptive and expressive semantic language abilities on the language processing tests. The comorbid group (ADHD + RD) exhibited the deficits of both ADHD and RD children. The deficiencies of ADHD children are consistent with higher-order executive function deficits while the deficits of RD children are consistent with deficits in the basic semantics of language processing.

Determinants of satisfactory rigidity after intracavernosal injection with prostaglandin E1 in men with erectile failure.

The study examines the erectile response of intracavernosal injection with increasing doses of prostaglandin E1 (PGE) and papaverine/phentolamine (PP) in 516 men with erectile failure. The response was correlated to age, the duration of erectile failure, the quality of spontaneous erections, tobacco consumption and medicine use. In addition, the erectile response was related to penile brachial index (PBI) the free testosterone index and various hormonal parameters. Over 60% of the subjects obtained satisfactory rigidity of at least 30 min duration with 7-15 micrograms PGE. A further 15% (PGE non-responders at the doses tested) obtained rigidity with PP. The average dose necessary to achieve rigidity was 8.8 micrograms for PGE and 0.94 ml (papaverine: 15 mg/ml; phentolamine 0.5 mg/ml) for PP. The average duration of rigidity was 2.2 h and 2.3 h for PGE and PP, respectively. Tobacco consumption, the duration of erectile failure and the age of the subject did not influence the response to intracavernosal injection. Moreover the PBI, the free testosterone index or libido of the subject, did not appear to be generally important for obtaining satisfactory rigidity. In contrast, chronic medication, especially antihypertensive drugs, was associated with significantly higher numbers of poor responders, a shorter duration of erection in the responders and higher doses of PGE necessary to achieve a satisfactory response. The combination of increasing age and antihypertensive medication was predictive for a poor intracavernosal response. In general, a reduced incidence of morning erections was predictive of a weaker response to PGE. The proportion of men with a PBI lower than 0.75 increased with age. These subjects more often took chronic medication, had a lower frequency of morning erections and exhibited a significantly weaker reaction to PGE than subjects with higher PBI. In summary, a large number of men with erectile failure can obtain satisfactory rigidity with intracavernosal injection. In men taking antihypertensive medication, especially in higher age groups, the dose of the intracavernosal medication had to be increased. A reduced sensitivity to intracavernosal medication could be predicted from a lower PBI and a reduced frequency of spontaneous erections.

[Male infertility. Significance of life and occupation]. / Mannlig infertilitet. Betydning av livsstil og yrke.

A retrospective study was carried out which focused on the impact of lifestyle and exposure to different external factors on sperm quality. A questionnaire was sent to 312 men who had previously attended our laboratory for semen analysis. Their answers were correlated to sperm quality. Men exposed to a relatively high degree of X-rays were found to have significantly reduced sperm count. A previous symptomatic genital infection did not significantly influence the sperm quality, but an earlier sexually transmitted disease in the female partner was associated with a reduced rate of pregnancy. Frequency of ejaculation was significantly positively correlated to sperm motility and inversely related to both semen volume and proportion of sperm with abnormal morphology. Information on exposure to the remaining factors was not related to reduced sperm quality or fertility.

Seminal plasma lead, cadmium and zinc in relation to tobacco consumption.

The total quantity of zinc in the ejaculates of smokers was significantly lower than in non-smokers. This was not related to a significant increase in the quantities of seminal cadmium or lead, or to a decrease in sperm quality in the smoking group. It appears that tobacco consumption may have to exceed 20 cigarettes/day before a noticeable increase in seminal cadmium can be recorded. It is suggested that this reduction in zinc secretion may jeopardize the content of chromatin zinc, and thereby the stability of the sperm chromatin. This may then contribute to reproductive failure or have consequences for fetal development.

Concentrations of lead, cadmium and zinc in the tissues of reproductive organs of men.

The concentrations of lead in blood and the concentrations of lead, cadmium and zinc in tissues were determined in various reproductive organs, liver and kidney removed at necropsy from 41 men who had died suddenly. None of the reproductive organs specifically accumulated lead and no significant correlation could be demonstrated between blood and organ concentrations or between concentrations and age, occupation or urban/rural background of the subject. Unlike lead, the tissue concentrations of cadmium increased with increasing age in all of the reproductive organs examined. Of these, the epididymides and seminal vesicles contained the highest concentrations. Whereas prostatic zinc also exhibited a significant age-dependent increase, the concentrations in the testes declined with age. The age-dependent increase in testicular cadmium did not become apparent until after the fourth decade, when any potentially deleterious impact on male fertility has less relevance. It is concluded that measurable amounts of lead and cadmium are present in all of the human reproductive organs but their organ and age distribution do not offer strong support for their involvement in the aetiology of male infertility or in the genesis of glandular neoplasms.

Characteristics of women under fertility investigation with IgA/IgG seropositivity for Chlamydia trachomatis.

Chlamydial serology was performed in a group of 100 consecutive women and their partners under fertility investigation. Over one-quarter of the women had evidence of an ongoing, asymptomatic chlamydial infection. A significantly higher incidence of IgA-positivity was associated with women with evidence of tubal pathology, verified by hysterosalpingography and/or laparoscopy and with previous users of intrauterine devices. The male partners of IgA-positive women had a significantly higher incidence of IgA-positivity than the other men. However, this was not associated with an increase in sperm pathology relative to the controls. The study indicates that chlamydial serology should be integrated into the routine screening of women under fertility investigation regardless of previous history and that IgA serology provides more information about tubal pathology than IgG serology.

DNA flow cytometry of sperm from normozoospermic men in barren couples and men of proven fertility.

OBJECTIVE: To determine the extent to which sperm chromatin varies in its degree of condensation in 53 apparently normozoospermic men and in 14 men of proven fertility. METHODS: DNA flow cytometry after staining of spermatozoa with ethidium bromide and mithramycin. RESULTS: Normozoospermic men could be divided into four subgroups according to the fluorescence pattern of their sperm DNA. More than half of the normozoospermic group and all of those of proven fertility shared a similar profile with a narrow symmetrical peak of haploid fluorescence without significant sub-populations. Deviations from this pattern were generally not associated with any major differences in sperm quality. CONCLUSIONS: (a) Current criteria for normozoospermia should be expanded to include additional tests of biochemical integrity. (b) Fertilizing ability appears to be associated with a relatively homogeneous profile of sperm DNA condensation.

Use of particle filters for increased practicability in sperm processing: application to the indirect immunobead test.

The use of sterile particle filters is described for the washing and incubation of living sperm before the indirect IBT. The filters greatly simplify the technique, shorten its duration, and remove all centrifugation steps that have potentially detrimental effects on the sperm. The same filters have a variety of applications and can be used whenever sperm have to be washed or incubated before biochemical tests including acrosome binding studies and flow cytometry.

Segmental distribution of alpha-glucosidase, ornithine decarboxylase and polyamines in the human epididymis.

Regional differences in the total activities of the epididymal secretory parameter, alpha-glucosidase, were demonstrated in the 20,000 g supernatants of human epididymal homogenates. A comparison of the enzymic activities in the supernatants and the washings from 12 one centimetre segments of human epididymides indicated an activity peak in segments 3-4 which appeared to be largely intracellular and which presumably reflects the acidic isoenzyme. A second peak in the caudal region, the segmental localization of which was more variable and differed in post-mortem and operation specimens, appeared to be primarily intraluminal. The activities of ornithine decarboxylase (ODC), the rate-limiting enzyme in the polyamine pathway, also exhibited regional differences with higher activities in relatively short segments in both caput and caudal portions. Corresponding alterations were also found in the tissue concentrations of the enzyme products, spermidine and spermine. The increased intracellular activities of ODC and alpha-glucosidase in the distal caput segments presumably reflect the transition of epithelium from the efferent to the epididymal ducts.