Should dietary fat recommendations for children be changed?
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Child↗
Biomedical subjects
J Dwyer
Publications and source records attributed to J Dwyer.
Noah grows up: transitioning problems from special feeding routes to oral intake.
As more children with special health care needs survive into adulthood, there is an increased need for help with the transition from special feeding routes to oral intakes. In infancy and early childhood, emphasis is often placed on the medical aspects of treatment for these children. As they grow and integrate more fully into the community, attention shifts to their educational needs. Throughout life, however, the need for attention to nutrition issues and needs remains. A case study illustrates the experiences of a young man with special oral intake needs; feeding and related transitions were required for independent functioning as he matured into a young adult. His many struggles are summarized, nutrition implications are outlined, and recommendations are provided for dealing with similar patients.
Adult↗
A review of an outpatient paediatric mental health clinic: what we did and what parents thought of it.
OBJECTIVE: To describe the work of a paediatric mental health (PMH) clinic in terms of the types of clients seen and the nature and intensity of interventions used. Also to survey the opinions of parents on issues such as helpfulness and effectiveness, and to tap into issues relating to acceptability and relevance. DESIGN: Retrospective review of case notes covering a one year period and postal client satisfaction questionnaire. SETTING: Children's wing of a large general hospital. SUBJECTS: The case notes of the 54 children referred were analysed. Postal questionnaires were sent to 53 parents of the 41 children who were treated over the targeted 12 months plus a further 12 families who were treated in the six months following. RESULTS: Forty one children with a broad range of paediatric difficulties were treated with their parents. Families were seen relatively promptly after referral and interventions were typically brief involving advice and counselling for parents and most commonly behavioural work with children. The results from the parent satisfaction questionnaire suggested that despite some initial wariness and uncertainty, parents found the clinic to be helpful. A small, but non significant decrease in rated symptom severity was found following treatment, but even in those cases where symptoms persisted or increased, parents still tended to report their experience as being helpful and from their comments seemed to value the clinic. Although parents seemed somewhat intimidated and uncertain of its relevance before attending, their comments suggested that they had benefited from talking about their child's difficulties and gaining understanding within a supportive and friendly environment. CONCLUSIONS: The PMH clinic was found to provide a brief, focused intervention for children and their families which was regarded as helpful by parents, even when the outcome was not necessarily a reduction in symptom severity.
Adolescent↗
The difficult patient.
The term difficult patient refers to a group of patients with whom a physician may have trouble forming a normal therapeutic relationship. The care of these patients can present many ethical dilemmas, ranging from issues of patient autonomy to questions of appropriate use of resources, which the emergency physician must be prepared to handle. Encounters with these patients also challenge physicians to explore and cultivate many of the character traits and virtues necessary to being a humane, caring, and ethical practitioner.
Adult↗
Phenotypic and functional characterization of lymphocytes derived from normal and HIV-1-infected human lymph nodes.
Lymph nodes are the major site of cell-to-cell transmission and replication of HIV-1. Trafficking of CD4+ T lymphocytes into lymph nodes provides a continual supply of susceptible target lymphocytes, and conversely, recruitment of CD8+ T lymphocytes may be critical for the host response that attempts to control HIV-1 replication. The present study was undertaken as no detailed assessment of lymphocyte subpopulations in HIV-1-infected lymph nodes has previously been reported. Peripheral blood and single-cell suspensions prepared from lymph nodes of patients with HIV-1 and control subjects were analysed using three-colour flow cytometry. Approximately 80% of the lymphocytes in control lymph nodes were CD3+ T lymphocytes, of which over 65% were CD4+. The majority of the CD4+ and CD8+ T lymphocytes obtained from both lymph nodes and blood of control subjects were immunologically naive (CD45RA+). By contrast, in HIV-1-infected patients there was a significant reduction in the proportion of CD4+ T lymphocytes and an expansion of the CD8+ T lymphocyte subset in both lymph nodes and peripheral blood. Furthermore, a high proportion of these T lymphocytes displayed a marker for immunological memory (CD45RO+). T lymphocytes derived from HIV-1-infected lymph nodes also showed altered expression of the adhesion molecules, L-selectin and very late antigen-4 (VLA-4), but not leucocyte function-associated antigen-1 (LFA-1). In an in vitro adhesion assay, lymphocytes from HIV-1-infected nodes were significantly more adhesive than control lymphocytes on fibronectin, as well as recombinant human intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) substrates. This combination of altered lymphocyte subpopulations in the HIV-1-infected lymph nodes, as well as enhanced adhesion phenotype and function, suggests that T lymphocyte traffic to lymph nodes in HIV disease may be an important determinant of pathogenesis.
Adult↗
Convergence of plant-rich and plant-only diets.
Discussants at the Third International Congress on Vegetarian Nutrition considered the nutritional adequacy, benefits, and health outcomes of plant-only (e.g., vegan and fruitarian), plant-based (e.g., macrobiotic, lactovegetarian, semivegetarian, and meatless), and omnivorous dietary patterns. The increased availability of a variety of plant foods, the advent of nutrient-fortified plant foods, the use of vitamin and mineral supplements, and the widespread dissemination of sound information on dietary patterns mean that convergence between the essential nutrient profiles of plant-only and plant-rich, plant-based diets is possible. Special attention should be paid to nutrition among vulnerable groups by age or physiologic status if they consume diets based solely on plants. Research has shown that both plant-only and plant-based eating patterns have health benefits, most notably in reducing the risk of chronic, degenerative diseases. The panel concluded that evidence for a convergence of scientific opinion on the safety and healthfulness of plant-only diets that are appropriately planned to meet all nutrient requirements compared with plant-based diets is considerable.
Diet, Macrobiotic↗
Too much versus too little: the implications of current iodine intake in the United States.
Iodine intake influences the health of Americans today, but in different ways than it has in the past. In the early 1900s, iodine deficiency was responsible for widespread endemic goiter in the United States. The incidence of goiter was markedly reduced by the introduction of iodine supplementation of salt and other foods in the 1920s. By the middle of this century iodine-related problems in the Unites States were more likely to be associated with too much rather than too little of this essential nutrient. Recent and disturbing new data suggest that there has been a sharp decline in iodine intake during the last 20 years, especially in women of reproductive age. A brief comparison of thyroid response to insufficient and excessive intakes in normal and diseased thyroid tissue is presented. The population affected and the implications for therapy are also reviewed.
Diet Surveys↗
Identifying elders at risk of malnutrition: a universal challenge.
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Adult↗
Taxonomic classification helps identify flavonoid-containing foods on a semiquantitative food frequency questionnaire.
We describe foods on the National Cancer Institute (NCI) semiquantitative food frequency questionnaire with respect to their botanical taxonomic classification and the likely presence of flavonoids. Foods listed in the NCI questionnaire were classified for potential flavonoid content using information from Linnaean taxonomic classification and processing techniques known to modify flavonoid content. The outcome measure was flavonoid presence in foods as evidenced in the food composition analytical literature. We then verified the presence of 6 classes of flavonoids in these foods by searching the chemical analytical literature (represented by Food Science and Technology Abstracts Service from January 1969 to June 1996). One hundred ninety foods were mentioned on the NCI questionnaire; after duplications were removed, 153 foods remained. Data obtained from literature searches indicated that 54 foods (35%) contained flavonoids. An additional 19 recipe foods (12%) had flavonoid-containing components or ingredients. Thirty-nine foods (25%) had flavonoids that had been reduced or removed during milling and other processing. Seven foods (5%) were stripped and judged to have no flavonoids. Thirty-four foods (22%), for example, dairy, meat, and sugar, were completely devoid of flavonoids. When food composition data are unavailable, botanical taxonomic classifications may be helpful in ascertaining the likely presence of flavonoids in foods. However, quantitative estimates are likely to be imprecise.
Databases, Factual↗
Potential benefits of resistance exercise training on nutritional status in renal failure.
Resistance or strength exercise training may help reverse the malnutrition common among patients in chronic renal failure and delay the progression of renal disease. Resistance training is characterized by resisting, lifting, and lowering weights. It results in muscle mass accretion, improved physical function, and slowed progression of muscle wasting. Resistance exercise training for a period of 8 to 12 weeks results in significant increases in muscle mass, muscle strength, and muscle function in frail "healthy" elderly individuals as well as in specific patient populations. States of malnutrition leading to muscle wasting directly affect lean tissue mass and functional capacity. Even at dietary protein intake below the Recommended Dietary Allowances, resistance training appears to exert an anabolic effect by improving energy intake and protein use allowing nitrogen retention. The potential benefits of resistance exercise extend beyond this direct impact on protein metabolism. They include improvements in functional capacity such as gait, balance, mobility, strength, exercise tolerance, improved glucose uptake, insulin sensitivity, and self-efficacy and self-esteem. Currently, the effects of resistance exercise in renal patients are unknown, although they are well shown in the case of other diseases. The potential benefits that resistance exercise training may have on muscle mass and function, nutritional status, hyperglycemia, disease progression, and the overall mental well-being of renal patients deserve further investigation. As an adjunct to current treatment modalities for chronic renal failure, resistance exercise may serve as a cost-effective, interdisciplinary, noninvasive approach to counteract malnutrition and improve the quality of life.
Exercise↗
Renal DETERMINE nutrition screening tools for the identification and treatment of malnutrition.
Nutrition screening is the first step in identifying and treating nutrition-related problems in renal patients. The Renal DETERMINE Nutrition Screening Tools help health care professionals recognize the risk factors for malnutrition in renal patients and suggest interventions to prevent, control, or ameliorate problems when they are present. The Renal DETERMINE Nutrition Awareness Checklist provides a series of questions for the health care professional to ask the renal patient to better identify nutrition problems. It can also be used with renal patients to help educate and increase awareness of nutrition issues. The Renal DETERMINE Nutrition Screening Reference Sheets are then used to help the health care professional identify appropriate interventions for the nutrition problem. The Reference Sheets list the most common nutrition-related concerns for chronic renal insufficiency, hemodialysis, peritoneal dialysis, and post kidney transplant patients. For each risk factor, rationales are presented and interventions to resolve the nutrition related problems are provided.
Humans↗
The ethics of tailoring the patient's chart.
Because psychiatrists cannot include everything they observe and everything the patient says in the medical chart, they must select and tailor what goes into the chart. They should tailor the chart to focus on what is significant for the diagnosis and treatment of the patient. However, sometimes they tailor the chart for other purposes: to ensure that managed care will cover continued hospitalization, to protect themselves against malpractice claims, to secure a civil commitment, or to obtain a long-term placement for the patient. The authors of this paper present and analyze four cases in which psychiatrists tailor charts for these purposes. They discuss whether each psychiatrist's actions are ethically justified and consider whether tailoring the chart is a deceptive practice. In each case, they present reasons for and against this practice and suggest truthful alternatives designed to improve patient care, preserve social trust in the profession of psychiatry, and challenge serious failings in the health care system.
Beneficence↗
Urinary urea nitrogen is imprecise as a predictor of protein balance in burned children.
OBJECTIVE: To compare estimates of protein balance using the urinary urea nitrogen method to predict total urinary nitrogen with isotopically derived estimates of metabolic protein balance as defined by the difference between rates of protein synthesis and breakdown. DESIGN: Prospective, descriptive, repeated measures analysis. Urinary urea nitrogen collections were obtained for 8 to 24 hours before infusion of L-[1-13C] leucine during fed and fasted states. SUBJECTS/SETTING: Eight acutely burned pediatric patients consecutively admitted to Shriners Burns Institute, Boston Unit, for medical and surgical care of their injuries. MAIN OUTCOME MEASURES: The difference between isotopically measured rates of protein synthesis and breakdown was used as an index of protein balance and compared with estimates of protein balance determined using the urinary urea nitrogen method. STATISTICAL ANALYSIS: Least squares regression analysis was used to assess the value of urinary urea nitrogen as a predictor of metabolic protein balance. Limits of agreements were used to determine bias and precision between the two methods. RESULTS: Urinary urea nitrogen was a significant predictor of metabolic protein balance (r2 = .77, P < .001). The direction of protein balance was the same in 14 of 16 measurements; however, there was significant lack of agreement between the two methods as demonstrated by large quantitative differences in protein balance. CONCLUSION: Although the urinary-urea-nitrogen-based estimates of protein balance correlate well with isotopically derived protein balance, they are not precise in determining protein balance in seriously burned children.
Adolescent↗
Intravenous immunoglobulin is ineffective in the treatment of patients with chronic fatigue syndrome.
PURPOSE: To determine whether the reported therapeutic benefit of intravenous immunoglobulin in patients with chronic fatigue syndrome (CFS) is dose dependent. PATIENTS AND METHODS: Ninety-nine adult patients, who fulfilled diagnostic criteria for CFS, participated in this double-blind, randomized, and placebo-controlled trial. Patients received intravenous infusions with either a placebo solution (1% albumin) or one of three doses of immunoglobulin (0.5, 1, or 2 g/kg) on a monthly basis for 3 months, followed by a treatment-free follow-up period of 3 months. Outcome was assessed by changes in a series of self-reported measures (quality-of-life visual analog scales, standardized diaries of daily activities, the profile of mood states questionnaire) and the Karnofsky performance scale. Cell-mediated immunity was evaluated by T-cell subset analysis and delayed-type hypersensitivity (DTH) skin testing. RESULTS: No dose of intravenous immunoglobulin was associated with a specific therapeutic benefit. Adverse reactions, typically constitutional symptoms, were reported by 70% to 80% of patients, with no relationship to immunoglobulin treatment. CONCLUSIONS: Intravenous immunoglobulin cannot be recommended as a therapy for the treatment of CFS. A better understanding of the pathophysiology of this disorder is needed before effective treatment can be developed.
Activities of Daily Living↗
An indirect means of assessing potential nutritional effects of dietary olestra in healthy subgroups of the general population.
The potential for olestra to affect the absorption of dietary components was measured in 18- to 44-y-old humans and the weanling pig. Results from the studies were assessed to determine if they were relevant to subgroups of the population not included in the studies. Hypothetrically, two factors that might cause the study results not to be relevant to certain subgroups are dietary pattern and metabolic need. A dietary pattern resulting in olestra-to-nutrient intake ratios greater than those tested in the studies might produce effects greater than those measured. Metabolic needs (i.e., nutrient requirements) among subgroups greater than those of the study population might mean that any effects on nutrient absorption seen in the studies would be larger among subgroups. If olestra-to-nutrient ratios and nutrient requirements of a subgroup were less than those covered in the studies, then the effects of olestra on the nutritional status of the subgroup should be no different than the effects measured in the studies. Subgroups with high olestra-to-nutrient intake ratios were identified by calculating the ratios for those nutrients assessed in the studies [i.e., macronutrients, vitamins A (including beta-carotene), D, E and K, folate, vitamin B12, calcium, iron and zinc]. Subgroups with the greatest olestra-to-nutrient intake ratios for one or more nutrients included children, teenagers and young adults, women from low income families and vegetarians. Subgroups with the greatest metabolic need for one or more nutrients included children, teenagers, and pregnant and lactating women. The olestra-to-nutrient ratios and nutrient requirements of the subgroups having the greatest ratios and requirements were compared with those of the test population. The olestra-to-nutrient intake ratios fed in the studies were greater than those for any subgroup for all nutrients except calcium, which is not affected by olestra. Metabolic needs of the test population were greater than those of all population subgroups for all nutrients. The effects of olestra on nutritional status should not be different or greater than those measured in the controlled clinical tests for subgroups not directly tested.
Adolescent↗
Safety and feasibility of harvesting cells for adoptive immunotherapy from patients with asymptomatic HIV infection.
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Adult↗
Is there a need to change the American diet?
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Diet↗